Beyond skin deep: addressing comorbidities in psoriasis

Abstract

Summary Psoriasis is a chronic inflammatory disease that is commonly encountered in primary care and is associated with significant morbidity that extends beyond the skin manifestations. Psoriasis is associated with an elevated risk of psoriatic arthritis, cardiovascular disease, obesity, insulin resistance, mental health disorders, certain types of malignancy, inflammatory bowel disease and other immune‐related disorders, and hepatic and renal disease. Enhanced recognition of these comorbidities may lead to earlier diagnosis and potentially better overall health outcomes. Psoriatic nail involvement, severe skin disease and obesity are associated with a greater risk of psoriatic arthritis. Individuals with psoriasis should be routinely screened for psoriatic arthritis to allow for early intervention to improve long term prognosis. Life expectancy is reduced in people with psoriasis due to a variety of causes, with cardiovascular disease and malignancy being the most common aetiologies. Psoriasis affects several factors that contribute to worsened quality of life and increased risk of depression and anxiety. Effective therapies are now available that have been shown to concurrently improve skin disease, quality of life and psychiatric symptoms. As the concordance between psychosocial impact and objective disease severity does not always correlate, it is essential to tailor management strategies specifically to the needs of each individual. Cigarette smoking and excess alcohol consumption are among the most important modifiable risk factors that increase the likelihood of psoriasis development and severity of skin disease. This provides a compelling rationale for smoking cessation and limiting alcohol intake in people with psoriasis beyond their traditional harmful health consequences.

Transcriptomic Analysis of the Mechanisms for Alleviating Psoriatic Dermatitis Using Taodan Granules in an Imiquimod-Induced Psoriasis-like Mouse Model

“…Psoriasis also has a serious negative impact on work productivity and health-related quality of life ( Lopes et al, 2019 ). Psoriasis is a systemic disease that not only involves the skin, but is also associated with comorbidities, including cardiovascular disease, chronic obstructive pulmonary disease, diabetes, obesity, and hyperuricemia ( Miele et al, 2009 ; Li et al, 2015 ; Yuan et al, 2019 ; Kovitwanichkanont et al, 2020 ). Systemic inflammation and oxidative stress in psoriasis are closely related to a variety of complications associated with a conspicuously high risk of death in patients with conditions such as kidney disease and liver disease ( Dhana et al, 2019 ).…”

The Association Between Psoriasis and Cardiovascular Diseases

“…[ 9 ] The disease also has a significant impact on physical and mental well-being, with a subsequent impact on heart disease as a result. [ 18 , 19 ] The majority of deaths for people with psoriasis are related to cardiovascular or cerebrovascular morbidities, such as MI or stroke, and not solely to renal diseases or infection as previously thought. [ 9 ] There is evidence of an increased risk of major cardiovascular events in patients with psoriasis and it has a direct and linear relationship with disease severity.…”

Managing Psoriatic Arthritis With Inflammatory Bowel Disease and/or Uveitis

“…PsA is associated with comorbidities such as obesity, metabolic syndrome, insulin resistance, and cardiovascular disease ( 4 ). The extra-articular manifestations of PsA include inflammatory bowel disease (IBD) and uveitis ( 5 ). In recent years, there are advancements in therapeutic options to treat musculoskeletal manifestations of PsA ( 6 ), but research to understand the pathogenesis of extra-articular manifestations and their treatment options is still in infancy.…”