What Health Risks Are Linked to Psoriasis?

If you have psoriasis, it’s important you’re aware of the comorbidities people with psoriatic disease are most often at risk of developing, how to lower your risks, and what to do if you have at least one of them.

Common Psoriasis Comorbidities

“When we’re treating psoriasis, we can’t look at it as a stand-alone issue, since it’s a systemic disease,” says Ife Rodney, M.D., a board-certified dermatologist and dermatopathologist at Eternal Dermatology in Fulton, Maryland.

A systemic disease is one that can impact the whole body, as opposed to a single organ or system. So while psoriasis can cause itchy, red scaling on the skin’s surface, it’s often accompanied by inflammation elsewhere, too.

“Psoriasis is an autoimmune, chronic inflammatory condition that affects mainly the skin, but also causes systemic inflammation that can affect other areas of the body,” Scott Paviol, M.D., a board-certified dermatologist at Paviol Dermatology in Charlotte, North Carolina, explains.

A good example of how the inflammation can affect the rest of the body is psoriatic arthritis, a type of inflammatory arthritis, which impacts about one in three people with psoriasis.

Other common psoriasis comorbidities include:

• Metabolic syndrome (obesity, hypertension, insulin resistance, and dyslipidemia)
• Obesity
• Diabetes
• High blood pressure
• High cholesterol/Dyslipidemia
• Cardiovascular disease (heart disease and peripheral vascular disease)
• Peptic ulcer disease
• Nonalcoholic fatty liver disease
• Sleep apnea
• Chronic obstructive pulmonary disease
• Chronic kidney disease
• Infections (such as streptococcal pharyngitis)
• Inflammatory bowel disease (Crohn’s disease or ulcerative colitis)
• Celiac disease
• Erectile dysfunction
• Uveitis (a type of eye inflammation)
• Psychological and psychiatric disorders (depression, anxiety, suicidal ideations)
• Osteoporosis
• Parkinson’s disease
• Lymphoma

Understanding the Connection

While at first glance it might be difficult to understand how these comorbidities might be related to psoriasis, when we look closer at the potential causes of each, there are some connections.

“The root of psoriasis could be traced to an inflammatory response in the body,” says Rodney. “Inflammation is also one of the root causes of hypertension and cardiovascular disease.”

Inflammation can also contribute to insulin resistance, which can lead to metabolic syndrome and diabetes, says Rodney.

And then there are the diseases like Crohn’s, which Paviol says can be genetically linked to patients with psoriasis.

“That is to say, a person’s genetics predisposes them to an increased inflammatory state and they are at a higher risk to develop one or more inflammatory conditions,” he explains.

What Are the Risks?

While these are all commonly recognized comorbidities of psoriasis, how common are they?

• Psoriatic arthritis affects up to one-third of people with psoriasis.
• People with severe psoriasis are almost twice as likely to develop metabolic syndrome (related to diabetes and heart disease) than those with mild psoriasis are. Severe psoriasis is defined as affecting more than 10 percent of body surface area.
• Similarly, younger people with psoriasis are twice as likely to develop cardiovascular disease than people twice their age are.

According to Paviol, people with psoriasis are:

• Twice as likely to suffer from depression
• Seven times more likely to develop celiac disease
• Twice as likely to develop inflammatory bowel disease (IBD), which includes Crohn’s and ulcerative colitis

“In addition, people with psoriasis are more likely to suffer from smoking and drinking habits, which raises their cardiovascular risk status,” he says. Psoriasis also raises one’s risk of chronic obstructive pulmonary disease (COPD) if they smoke, and liver disease if they drink excess alcohol.

Limiting the Risk

Dealing with just one chronic condition can be tough, so you may want to know what you can do to avoid developing additional chronic illnesses.

“If you have psoriasis, it is important that you make lifestyle changes as soon as possible to reduce the chances of these comorbidities from occurring,” says Rodney. “For starters, look at removing behaviors like smoking and alcohol, known triggers of the diseases.”

If you’re overweight or obese, talk to your doctor to see if losing weight could help and the best way to do it. “Research shows that people with higher BMI (body mass index) have the highest risk of developing psoriasis and its linked comorbidities,” says Rodney.

“Reducing BMI by just 5 points from obese (30 and above) or overweight (25 to 29.9) reduces the chances of comorbidities and reduces psoriasis flares. That means a change of diet, exercise, or both.”

While lifestyle change can be difficult to make at first, they can make a huge difference in not only the management of your psoriasis, but also your risk of developing additional comorbidities.

Managing Comorbidities

Unfortunately, our bodies don’t always respond to our best efforts. For some people, comorbidities will develop even if they’ve done everything right. When that happens, it’s important to focus on treating your conditions to the best of your ability—which can sometimes mean having to coordinate healthcare with multiple specialists.

In fact, working with your doctors may help you reverse some of your comorbidities. For example, someone with diabetes can get their sugars in better control by starting a healthy diet and exercise program along with taking their medications regularly. It’s never too late to get your health back on track, even if you develop comorbidities.

“To address both psoriasis and its comorbidities requires a multidisciplinary approach,” says Rodney. “This means that a variety of your doctors—your dermatologist, primary care doctor, and rheumatologist (joint disease specialist)—will all work together, with you, to get different aspects of your disease under control.”

She adds, “Because we still do not know for sure if it is psoriasis that triggers other diseases or vice versa, it is important that we address and treat all of these conditions, using both prescription medications as well as lifestyle changes like diet and exercise.”

Keeping track of all the information from different specialists may seem overwhelming, which is why it’s important to see a primary care doctor who can help you to manage it all. That doctor can recommend specialists depending your individual comorbidities and needs and can communicate information between them. Sometimes, insurance requires referrals through your primary care doctor (PCP), and having a good PCP will help you get your health back on track.

Still, it’s a good idea for you keep records, too, and have open communication with all your physicians about your diagnoses, symptoms, treatment plans, and medications.

“Many patients underestimate the effect that they can have in their care,” says Paviol. Doctors are busy taking care of many patients, so if you are organized and know the details of your health conditions, you can help them come up with the best plan for you and your life.

It may seem like a lot of effort, but it can make a huge difference in the quality of care you receive and the overall management of all your conditions.

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