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Cristina Fortes, PhD; Simona Mastroeni, MSc; Karen Leffondré, PhD; Francesca Sampogna, MSc; Franco Melchi, MD; Eva Mazzotti, MSc; Paolo Pasquini, MD, MPH; Damiano Abeni, MD, MPH; for the IDI Multipurpose Psoriasis Research on Vital Experiences (IMPROVE) Study Group

Arch Dermatol. 2005;141:1580-1584.

Objective  To evaluate the association between different components of smoking history and the clinical severity of psoriasis.

Design  A hospital-based cross-sectional study.

Setting  Inpatient wards of a hospital for skin diseases in Rome, Italy.

Patients  A total of 818 adults with psoriasis.

Main Outcome Measure  The Psoriasis Area and Severity Index was used to assess the clinical severity of psoriasis between February 21, 2000, and February 19, 2002.

Results  After adjustment for potential confounders (sex, age, body mass index, psychological distress, family history of psoriasis, duration of psoriasis disease, and alcohol consumption), high intensity of smoking (>20 cigarettes daily) vs a lower level of consumption (10 cigarettes daily) was associated with a more than 2-fold increased risk of clinically more severe psoriasis (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.2-4.1). Cigarette-years, measured as the product of the intensity and duration (years) of smoking, significantly increased the risk of clinically more severe psoriasis after adjustment for confounding factors (OR,1.3; 95% CI, 1.0-1.6, for a 600-U increase in cigarette-years). Separate analyses for men and women showed that the effect of cigarette-years was stronger for women (OR, 1.8; 95% CI, 1.2-2.6, for a 400-U increase in cigarette-years) than for men (OR, 1.2; 95% CI, 0.9-1.6, for a 700-U increase in cigarette-years).

Conclusion  Smoking is associated with the clinical severity of psoriasis and highlights the importance of smoking cessation in patients with psoriasis.

Author Affiliations: Clinical Epidemiology Unit (Drs Fortes and Pasquini and Mss Mastroeni and Mazzotti), Health Service Unit (Ms Sampogna and Dr Abeni), and Dermatology Unit (Dr Melchi), Istituto Dermopatico dell'Immacolata, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy; and Département de Médecine Sociale et Préventive and Axe Santé des Populations, Centre de Recherche du Centre Hospitalier, Université de Montréal, Montréal, Québec (Dr Leffondré).

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