New Guidelines Emphasize Comorbidities in Psoriasis Patients
Psoriasis is a common skin condition that affects around 3.2% of adults in the United States.1 It generally appears as red, raised, scaly, and often itchy patches on the skin. These symptoms are caused by an overactive immune system, which causes skin cells to grow abnormally quickly.2 The dysfunctional immune response is also responsible for the redness, inflammation, and itchy symptoms associated with psoriasis.
People with psoriasis are at risk for other diseases (called comorbidities)
Doctors, especially dermatologists, have known for more than 10 years that people with psoriasis on their skin are at higher risk for a particular kind of arthritis known as psoriatic arthritis.
But over the past 10 years, researchers have recognized that people with psoriasis are also at higher risk for other diseases, as well. These include heart disease, metabolic syndrome, type 2 diabetes, and mental health issues. The diseases that can occur with psoriasis are often referred to as “comorbidities.”
Some psoriasis comorbidities are related to inflammation in the body, some to lifestyle choices, and some to the medicines that are used to treat psoriasis.3
Doctors develop new guidelines for diagnosis and treatment
Recently a research group worked to identify other diseases people with psoriasis are prone to. The research was a joint effort conducted by doctors from the American Academy of Dermatology and the National Psoriasis Foundation.4
The goal was to develop recommendations to guide dermatologists in their treatment of psoriasis patients. It’s important for dermatologists to be aware of the additional diseases that psoriasis patients can get more commonly, so they can offer appropriate treatment and prevent additional disease.
About 30-33% of psoriasis patients develop psoriatic arthritis, which appears as soreness and swelling in the joints. It often starts in the feet and hands, but it can begin in the spine, as well. Psoriatic arthritis is more common with people who have a larger area of affected skin, and it generally starts within 10-11 years of the psoriasis.1
Dermatologists are advised to inform patients about the relationship between psoriasis and psoriatic arthritis and to watch and test early for signs of the disease. They should also refer patients to a rheumatologist, or arthritis doctor. This is especially important, because psoriatic arthritis can lead to permanent joint damage, so diagnosing and treating it early is critical for patients’ health and quality of life.
Cardiovascular (heart) problems
Patients with psoriasis are at higher risk for heart disease and associated problems like high blood pressure and hardening of the arteries than people without the disease. The relative risk (compared to people without psoriasis) is even greater for younger people with psoriasis than for older people. Doctors think this might be caused, in part, by inflammation throughout the body.1
The good news is that some of the anti-inflammatory medicines for psoriasis also reduce the risk of heart disease.
Dermatologists are advised to inform psoriasis patients of the connection and to be sure they are in touch with their primary care doctors about proper screening. This could include measuring height, weight, blood pressure, blood glucose, lipid levels, belly fat, and BMI. Doctors should refer patients to cardiologists, when necessary.1
Metabolic syndrome involves multiple symptoms that can lead to heart disease, diabetes, cancer, and other health issues. The symptoms of metabolic syndrome include obesity, high blood pressure, high cholesterol, and insulin resistance—which leads to high blood sugar. Metabolic syndrome is more common in women with psoriasis than with men, and it occurs more frequently in people who have more severe disease.1
The individual symptoms found with metabolic syndrome have varying connections with psoriasis. There are strong links between psoriasis and obesity, and weight loss can actually improve psoriasis. Studies aren’t as clear linking high blood pressure and psoriasis. The risk for diabetes is very clear with psoriasis, increasing with disease severity.1
Dermatologists are advised to inform patients about the links between psoriasis and metabolic syndrome and to be sure they are being screened properly by their regular doctors, or specialists to confirm diagnoses. It is especially important to track high blood pressure. It is also important to guide patients to make healthy lifestyle choices.1
Mental health issues
Several studies have shown that people with psoriasis can be at increased risk for anxiety and depression, both of which decrease peoples’ quality of life. Treatments that reduce the severity of psoriasis also reduce mental health symptoms.1
Dermatologists are advised to refer people with anxiety, depression, and suicidal thoughts to mental health counselors for assessment and treatment. It is also important for dermatologists to ask patients about their mental health and to inform patients about the links between mental health and psoriasis.1
Smoking is a key risk factor for lung disease and it is also linked with the development of psoriasis. Drinking alcohol also increases the risk of psoriasis, and patients with psoriasis tend to drink more alcohol.1
Dermatologists are advised to educate patients to reduce alcohol and cigarettes both to improve their psoriasis and for their overall health. It is important to refer people with addictions to seek treatment.1
Inflammatory bowel disease (IBD)
People with psoriasis have increased risk of inflammatory bowel disease, which includes ulcerative colitis and Crohn’s disease. IBD involves inflammation in the bowel or entire digestive tract. This leads to symptoms including diarrhea, abdominal pain, bloody stools, and weight loss.1
Dermatologists are advised to inform patients of these connections and be sure they are evaluated if they show signs of IBD. Some IBD medications, including TNFi, can actually cause more psoriasis outbreaks on the skin.1
Other related diseases
Other diseases affect people with psoriasis more than those without, but the advisory group did not provide specific guidelines except to tell patients of the connections and conduct appropriate screening tests. The other health concerns include certain types of cancer, sleep apnea, kidney disease, chronic obstructive pulmonary disease, and liver disease. Some psoriasis medicines can harm the liver, so doctors are advised to be especially aware of liver disease in these cases.1
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