Psoriasis: most due to smoking

Smoking and alcohol may be major causes of the skin complaint psoriasis. Smoking seems more likely to trigger it in women, whereas alcohol is more likely to be the cause in men.

Recent research adds weight to a study in 1985, which first linked smoking to the skin condition.

Hywel Williams, a research fellow at St Thomas's Hospital in London, estimates that smoking may have triggered up to half the cases of palmoplantar pustular psoriasis characterized by thickened plaques on the palms and soles of the feet, which can become cracked and painful.

He said that smoking and drinking should now be added to the growing list of likely causes, alongside trauma, drugs and emotional stress.

"Any progress in identifying modifiable risk factors for this common and socially disabling disease is to be welcomed and it is more useful than reports of temporary remission with expensive and potentially toxic drugs," he says (BMJ, 12 February 1994).

No research for smear tests

While the British press has been highlighting the blunders of health authorities in failing to recall women for follow up smear tests, they have missed a more fundamental problem.

Britain's chief medical officer Dr Ken Calman has admitted the cervical smear programme has been implemented ad hoc since the 1960s with no research evidence, leading to variations at the local level. He said the screening programme for hearing loss in children also needed reviewing.

In the UK, over 25,000 cases have so far been reported of women who have failed to receive a follow up request, usually because of an administrative error. The latest case was in South London.