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Alcohol consumption: Is it really a risk factor for psoriasis?: Reply to Emilie Brenaut's letter

Dear Editor, With great interest, we have read the comments of Brenaut et al. The authors are absolutely right to conclude that alcohol consumption as a risk factor requires more data on alcohol consumption before the onset of psoriasis. In our article, we only obtained data about present alcohol consumption from case–control studies, even the study of Jankovic et al. mentioned by Brenaut et al. However, we also agree that many of the case–control studies included in our study describe the alcohol consumption as a risk factor in their papers. In our discussion, we have explained the limitation that we focused on case–control studies of prevalence only, but not incidence. However, despite the limitations, the results of this metaanalysis suggest that alcohol consumption may have involvement in the pathogenesis of psoriasis, regardless of subtype of alcohol consumption and subtype of psoriasis. We have excluded the two studies by Tey et al. and Naldi et al. There was also a strong evidence of significant association between psoriasis and alcohol consumption in drinking versus non-drinking subjects (odds ratio [OR] = 1.620, 95% confidence interval [CI] = 1.206–2.176, P = 0.001) (Tables S1 and S2). In the subgroup analysis, the pooled OR is 1.459 (95% CI; 1.092–1.950; P = 0.011) for European descent and 2.532 (95% CI; 0.854–7.511, P = 0.094) for Asian descent, showing that racial characteristics seem to influence the results. Heterogeneity is one of the limitations of our study. We used the random effects model (the DerSimonian and Laird method). We should highlight this in our discussion and carefully interpret the result.