Treating Psoriasis Patients Who Vape: Barriers and Interventions

Announcer:
This is Clinician’s Roundtable on ReachMD. On this episode, we’ll hear from Dr. Joe Tung, a board-certified dermatologist who currently serves as the Medical Director of UPMC Falk Dermatology, Director of the Clinical Trials Unit, and Associate Director of the Dermatology Residency Program. He’ll be discussing strategies for supporting psoriasis patients who use e-cigarettes.

Here’s Dr. Tung now.

Dr. Tung:
One of the biggest challenges clinicians face is the perception that e-cigarettes are safe or at least safer than traditional smoking. Many patients, even those with chronic inflammatory conditions like psoriasis, don’t realize that vaping still exposes them to high levels of nicotine and other potentially pro-inflammatory chemicals, so they may not mention it unless specifically asked, and even then they often don’t see it as relevant to their skin disease.

There’s also a psychosocial component. Many psoriasis patients face anxiety, depression or social stigma, which can make nicotine use harder to break, and when someone is under that kind of emotional burden, they may be more resistant to lifestyle changes, even if they know it could improve their health.

Finally, there’s some evidence that ongoing nicotine use may blunt the effectiveness of treatments like our biologic agents, so if a patient continues vaping during treatment, they may not get the full benefit, and both the patient and provider might not understand why.

I think the solution starts with education. Dermatologists and primary care providers alike should communicate clearly that while e-cigarettes may reduce some risks compared to traditional smoking, they’re not risk free, especially for people with inflammatory conditions. Clinicians should also take more detailed histories around nicotine use, not just asking, you know, “Do you vape?” but digging into the frequency, type of device and nicotine concentration.

For patients who are open to quitting, we can offer resources like nicotine replacement therapy, behavioral counseling, and medications. Even if nicotine itself still carries some inflammatory risk, reducing or eliminating exposure is always better for managing chronic inflammation. It’s also important for us to address the whole person, offering support for stress, anxiety and mental health, which often underline nicotine dependence.

Finally, I think we need more prospective studies that follow patients over time to see how vaping impacts not just the psoriasis onset, but disease severity and treatment outcomes as well. In the meantime, what we know is enough to act. We should be counseling our psoriasis patients that vaping could be an underrecognized environmental trigger and supporting them in quitting may improve their skin and overall health.

Announcer:
That was Dr. Joe Tung talking about how to best care for psoriasis patients that smoke e-cigarettes. To access this and other episodes in our series, visit Clinician’s Roundtable on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!