Psoriasis and metabolic syndrome: implications for the management and treatment of psoriasis

Abstract

Psoriasis is a chronic systemic inflammatory disorder associated with several comorbidities in addition to the characteristic skin lesions. Metabolic syndrome (MetS) is the most frequent comorbidity in psoriasis and a risk factor for cardiovascular disease, a major cause of death among patients with psoriasis. Although the exact causal relationship between these two disorders is not fully established, the underlying pathophysiology linking psoriasis and MetS seems to involve overlapping genetic predispositions and inflammatory pathways. Dysregulation of the IL‐23/Th‐17 immune signalling pathway is central to both pathologies and may be key to promoting susceptibility to metabolic and cardiovascular diseases in individuals with and without psoriasis. Thus, biological treatments for psoriasis that interrupt these signals could both reduce the psoriatic inflammatory burden and also lessen the risk of developing atherosclerosis and cardiometabolic diseases. In support of this hypothesis, improvement of skin lesions was associated with improvement in vascular inflammation in recent imaging studies, demonstrating that the beneficial effect of biological agents goes beyond the skin and could help to prevent cardiovascular disease. This review will summarize current knowledge on underlying inflammatory mechanisms shared between psoriasis and MetS and discuss the most recent clinical evidence for the potential for psoriasis treatment to reduce cardiovascular risk.

Clinical Efficacy and Safety of Psoriasis Treatments in Patients with Concomitant Metabolic Syndrome: A Narrative Review

“…Additionally, patients diagnosed with psoriasis have increased risk of developing insulin resistance or diabetes mellitus [ 9 ]. There is evidence for a shared genetic basis for psoriasis and MetS, with psoriasis-associated genes also implicated in the development of MetS, type II diabetes, and cardiovascular disease (recently reviewed in detail [ 10 ]). The American Heart Association (AHA) and the American College of Cardiology (ACC) now classify psoriasis (among other inflammatory diseases) as a risk factor for CVD [ 11 ] because of accumulating evidence that adults diagnosed with chronic inflammatory disorders have increased rates of multiple cardiovascular conditions [ 11 , 12 ].…”

Brain structure and connectivity in psoriasis and associations with depression and inflammation; findings from the UK biobank

“…Third, temporal and thereby causal relations between MDD, psoriasis and brain IDPs cannot be ascertained within the present dataset. We note that the study was designed to elucidate effects of psoriasis and depression on the brain, independent of significant cardiometabolic morbidity; cardiometabolic disease shows genetic overlap with and predisposition to psoriasis ( Wu et al, 2022 ) and is expected to confound the investigated associations. However, we cannot exclude further synergistic effects among psoriasis, depression and cardiometabolic disorders in the context of chronic inflammatory states, which are beyond the scope of the current study.…”

Acceptance of a digital therapy recommender system for psoriasis

“…The prevalence of psoriasis in the German population is approximately 2% [6]. As psoriasis not only affects the skin but comes with several comorbidities, such as cardiovascular diseases, arthritis and depression [7][8][9], topical treatment of the skin lesions (plaques) for some patients is not enough. Therefore, existing guidelines in Germany and the UK suggest systemic treatments with focus on reducing the risk of chronic in ammatory conditions, such as cardiovascular events [10,11].…”