As we learn more about psoriasis, we begin to recognize the different ways it can cause and worsen other conditions. Although some psoriasis comorbidities can be attributed to poor diet and obesity, a 2021 study from The Journal of Dermatology suggests there are comorbidities that are not necessarily linked to these factors. Health care professionals need to make their patients aware of these comorbidities to help them manage their condition and better maintain their quality of life.
The researchers examined a wide range of studies to try and find common correlations between psoriasis and other health conditions. What are some comorbidities associated with psoriasis, and how at risk are these patients?
- Cardiovascular Disease
One of the more frequently observed and significant associations was cardiovascular disease. This was in large part due to patients with psoriasis being seen as more likely to have a number of cardiovascular disease risk factors (particularly hypertension and obesity) at increased and aggravated incidence.
While managing a patient’s diet and exercise regimen can be helpful for preventing cardiovascular events, the researchers proposed that the inflammation in patients with psoriasis can potentially induce pro-inflammatory cytokines. These cytokines can lead to a number of dysfunctional elements in the body that can cause cardiovascular disease.
- Type 2 Diabetes
One particular problem these cytokines can create for patients is insulin resistance. This can be very troubling for some patients, as type 2 diabetes has been seen as a potential comorbidity in more severe psoriasis cases. The researchers concluded from their data that type 2 diabetes management is especially important in treating psoriasis.
- Blood Lipid Levels
Blood lipid levels in patients with psoriasis were also seen as a potential comorbidity in many of the studies the researchers examined. In particular, it was often found that these patients had decreased HDL levels and increased LDL levels. HDL’s anti-inflammatory properties are not as effective in the midst of psoriasis and its chronic inflammation, but anti-psoriatic therapy has shown to be effective in restoring HDL function. Monitoring a patient’s cholesterol levels when they have psoriasis, particularly severe psoriasis, is necessary to prevent severe cardiovascular disease.
- Non-Alcoholic Fatty Liver Disease
Non-alcoholic fatty liver disease (NAFLD) can lead to many problems later in life, most notably cardiovascular disease. Per the researchers, patients with psoriasis may have a higher rate of NAFLD. Both conditions are linked to inflammation and insulin resistance, as well as the cytokine Interleukin-17 (IL-17). This could put patients at risk of severe steatohepatitis.
- Cerebrovascular Disease
The manner in which psoriasis inflammation can cause cardiovascular risk may also increase cerebrovascular risk. The researchers determined that cerebrovascular accidents were among the more common risks in patients with psoriasis. This could put patients at risk of ischemia or infarction in the brain.
The researchers believe that, as a result of all of these comorbidities, dermatologists should consider working more with cardiologists to help manage the effects of psoriasis in patients.
Yamazaki F. Psoriasis: comorbidities. J Dermatol. 2021;48(6):732-740. doi:10.1111/1346-8138.15840