Correspondence

Hazards of Smoking during Therapy for Psoriasis

N Engl J Med 1994; 330:1541May 26, 1994

Article

To the Editor:

In addition to the well-established systemic, dermatologic, pulmonary, and vascular damage caused by cigarette smoking, smoking poses an additional hazard for patients with psoriasis who are treated with flammable tar preparations.

A 46-year-old man with chronic plaque psoriasis was admitted to the inpatient dermatology service at our hospital for therapy with topical steroids, ultraviolet light, and tar. He had been responding well to this treatment when, on the seventh hospital day, he was seen in the hospital courtyard bursting into flames. A small ring of fire began on the anterior chest several centimeters above the sternal notch and encircled his neck. The patient promptly put out the fire.

When questioned after the incident, the patient reluctantly reported that he had lit a cigarette moments before the fire started. On physical examination he was found to be a healthy-appearing middle-aged man. The skin of his neck and upper chest was erythematous but intact. The top of his pajamas had subtle stains of liquor carbonis detergens, a coal-tar solution, at the collar line and upper chest area, corresponding to the path of the flame. Fortunately, there were no sequelae.

Seventy years ago Goeckerman introduced a regimen of ultraviolet light and topical tar therapy for extensive plaque psoriasis1. With some modifications, this regimen is still widely used at dermatology centers, including ours2. Tar is notorious for its staining properties. Liquor carbonis detergens is an alcohol extract of coal tar, less messy than crude tar, that is used in many centers. Because of its alcohol content of 5 to 15 percent, liquor carbonis detergens is potentially flammable.

This incident illustrates the importance of obtaining a smoking history from patients with dermatologic conditions,3,4 particularly those who may be treated with flammable agents such as liquor carbonis detergens. Patients with psoriasis, like those with chronic obstructive pulmonary disease who are receiving supplemental oxygen, should be warned about the danger of smoking during treatment.

Darrell J. Fader, M.D.
Michael S. Metzman, M.D.
University of Michigan, Ann Arbor, MI 48109

4 References

1
Goeckerman WH. The treatment of psoriasis. Northwest Med 1925;24:229-231

2
Dodd WA. TARS: their role in the treatment of psoriasis. Dermatol Clin 1993;11:131-135
Web of Science | Medline

3
Frances C. Smoking and the skin. Int J Dermatol 1992;31:779-780
CrossRef | Web of Science | Medline

4
Goldminz D, Bennett RG. Cigarette smoking and flap and full-thickness graft necrosis. Arch Dermatol 1991;127:1012-1015
CrossRef | Web of Science | Medline

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