What Lies Beneath the Surface: Psoriasis and Comorbidities

Psoriasis Is More Than Just a Skin Condition. Here Are 7 Health Conditions Linked to Psoriasis – and What You Can Do to Prevent Them

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Tracey Ruff

Psoriasis is a common, chronic skin condition that can have a severe impact on one’s quality of life. For a long time, psoriasis was regarded as a condition that only affected the skin and joints. In recent years, however, studies have shown that psoriasis, which affects 2-3% of the world’s Caucasian population, is a systemic inflammatory disease that is often associated with comorbidities. We’ve compiled a list of some of these (perhaps surprising) comorbidities below (but please note, this list is not exhaustive).

A Small Introduction

An incurable, chronic inflammatory skin condition, psoriasis speeds up the life cycle of skin cells, causing them to build up on the surface of the skin. These extra skin cells form scales and red patches that are itchy and sometimes painful. This excess production of skin cells is caused by inflammatory chemicals made by specialized white blood cells called T-lymphocytes.

There is a rapidly expanding body of literature in various populations and settings that supports associations between psoriasis and other chronic illnesses. This association between psoriasis and other illnesses is called comorbidity – a term that simply refers to the presence of more than one illness (either mental or physical) in an individual. In the following article, we list seven health issues that are linked to psoriasis.

1. Metabolic Syndrome

Metabolism is the process of converting the food we consume into energy for the body. Metabolic syndrome therefore refers to the name for a group of symptoms that relates to the disruption of normal metabolic processes. These symptoms include hypertension, high blood sugar, low blood levels of HDL cholesterol, high blood levels of triglycerides (a type of fat), and having a large waist with excess abdominal fat. Together, these symptoms increase one’s risk of developing coronary heart disease and other health problems, such as diabetes and stroke.

A study in the Archives of Dermatology, which used a sample of more than 6,500 participants, found that 40% of people with psoriasis had metabolic syndrome compared to 23% of the general population. This means that people with psoriasis have double the likelihood of developing metabolic syndrome.

The same study also found that the most common feature of metabolic syndrome in those with psoriasis was abdominal obesity, with more women with the condition developing metabolic syndrome than men.

Furthermore, a Danish study found that people with type 2 diabetes are 50% more likely to have psoriasis compared to those without diabetes, and obese people (with a BMI over 35) are 50% more likely to have psoriasis when compared to those of normal weight.

If you have psoriasis, there are certain things you can do to mitigate the risk of developing any of the symptoms associated with metabolic syndrome. For example, you can go for regular blood pressure and blood sugar screenings and adhere to a healthy lifestyle (such as eating heart-healthy foods and getting in enough exercise).

2. Osteoporosis and Osteopenia

Osteoporosis and osteopenia (low bone mass) cause the bones in the body to become thin, weak, and brittle. The term osteoporosis means ‘porous bone’. When viewed under a microscope, healthy bone looks like a honeycomb, but in osteoporosis, the holes and spaces in the honeycomb are much larger, resulting in decreased bone density. As bones become less dense, they are more likely to break. Symptoms of osteoporosis include chronic pain, loss of height, and limited mobility. Click here for a video and more information on osteoporosis.

Today’s research suggests that there is a definite link between psoriasis and osteoporosis. A recent study, conducted by researchers at the University of Rome, discovered that in a sample population of 43 people with psoriatic disease, 60% had osteopenia and 18% had full-blown osteoporosis. The study also found that for someone living with psoriasis, the risk of developing osteopenia or osteoporosis increased by 5% each year.

Therefore, if you have psoriasis, it is important that you get screened for bone loss regularly via a bone density test and find out what you can do to keep your bones as healthy as possible. Some medications used to treat psoriasis, like Cosentyx and Taltz, work by blocking cytokine IL-17A, which is an immune-system protein that inhibits bone-building activity. Therefore, these medications may help prevent bone loss, but more research is needed.

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3. Crohn’s Disease and Ulcerative Colitis

It is estimated that about 10% of women with psoriasis develop an inflammatory bowel disease (IBD). IBD is the umbrella term used to describe conditions that involve the chronic inflammation of the digestive tract. Types of IBD include ulcerative colitis and Crohn’s disease.

In ulcerative colitis, a person will experience long-lasting inflammation and ulcers in the inner linings of the colon and rectum. In Crohn’s disease, the inflammation affects the lining of the digestive tract and often spreads into affected tissues. Both conditions cause severe diarrhea, abdominal pain, weight-loss, and fatigue. IBD can be debilitating without treatment.

People with psoriasis have a slighter higher chance of developing an IBD and researchers believe that there may be a genetic link between the two conditions. Dr. Abrar A. Qureshi, a dermatologist in Boston, US, conducted a study on the possible link between psoriasis and Crohn’s disease when he noticed a number of patients had both psoriasis and Crohn’s.

As is the case with psoriasis, Crohn’s disease is an autoimmune disease in which the body mistakes its own healthy tissue for a foreign invader and attacks it. Qureshi’s study comprised 4,400 women who had psoriasis at the beginning of the study. During the follow-up study, Qureshi and his team found that about 187 participants developed Crohn’s disease and 236 ulcerative colitis. These results indicate that people with psoriasis have an increased risk of developing an IBD later in life.

If you notice any of the above symptoms and have psoriasis, then you need to consult a gastroenterologist as soon as possible to find effective treatment. IBD is not curable, but it can be managed effectively with medication and making a few lifestyle and dietary changes.

4. Cancer

Colloquially known as the dreaded C-word, cancer refers to a group of conditions that arise when certain cells in a person’s body grow uncontrollably, multiply in one area, and then spread to other areas of the body. In a healthy body, new cells grow in place of old, dead cells. Cancer disrupts this natural process, allowing damaged cells to survive and new cells (which are not needed) to form. This results in the formation of tumors.

Studies indicate that people with psoriasis have a higher risk of developing certain types of cancers, like lung cancer, lymphoma, and non-melanoma skin cancers. For example, a recent study by Dr. Zelma C. Chiesa Fuxench, a dermatologist at the University of Pennsylvania, echoed the results from previous research that identified theses cancers as a comorbidity of psoriatic disease.

In the study conducted by Chiesa Fuxench and her colleagues, participants with psoriasis had a 34% increased risk of developing lymphoma. The same participants also had a 15% increased risk of developing lung cancer. For these three cancers, the risk was higher for participants who had a moderate to severe form of psoriasis. However, this doesn’t mean that the more severe the condition, the greater the risk of developing cancer.

Experts are still trying to identify whether the risk of developing cancer comes from psoriasis itself or from psoriasis treatments that have an effect on the immune system. However, no matter what the cause is, if you have psoriasis, there are numerous steps you can take to reduce your risk. For example, to protect yourself from developing skin cancer, you can be proactive in using sun protection. You can also quit smoking and speak to your doctor about treatment options and what works best for you.

5. Uveitis (you‑vee‑eye‑tis)

If you’re reading this, it is more than likely that you haven’t heard of uveitis before. But there’s a hint in the phonetic spelling of the name: yes, the eye. In simpler terms, uveitis is the general term for a group of inflammatory diseases that creates swelling and destroys the eye tissue. Uveitis often affects a part of the eye called the uvea (the middle layer of the eye containing blood vessels), hence its name.

However, these diseases also affect the lens, optic nerve, retina, and vitreous; causing reduced vision or blindness, pain, light sensitivity, and increased floaters (dark floating spots in the vision). Uveitis is typically classified by where it occurs in the eye. You can get more information on these classifications here.

Research indicates that people with psoriatic arthritis have a greater chance of developing uveitis compared to those with psoriasis. Recent studies indicate that approximately 7% of people with psoriatic arthritis will develop uveitis. Uveitis typically requires specific treatment, so if you notice any changes in your sight, you should see an ophthalmologist or an ocular immunologist.

6. Depression

It goes without saying that having psoriasis can cause emotional and psychological distress, including low self-esteem, social inhibition, and other mood disorders, like depression. Findings from a study published in the Journal of Rheumatology indicate that people with psoriatic arthritis in particular are more likely to develop depression and anxiety than those with psoriasis alone.

This study, conducted by researchers from Toronto, assessed 306 people with psoriatic arthritis and 135 people with psoriasis alone. The patients were asked to assess their symptoms of depression and anxiety via a questionnaire. The surveys revealed that about 37% of participants with psoriatic arthritis had anxiety, while about 22% had depression. In participants with psoriasis alone, the results showed that about 24% had anxiety and around 10% had depression. Although the statistics are lower for those with psoriasis, the figures are still notable.

Another study conducted by NYU in 2015 indicated that almost 17% of people living with psoriasis meet the criteria for a diagnosis of major depression. The cause of depression in people with psoriasis isn’t exactly clear, but researchers think it has to do with a variety of factors, including psoriasis medication, negative feelings associated with the condition, and the fact that the same inflammation in psoriasis causes depression.

If you happen to display any symptoms of depression, then you need to consult a doctor as soon as possible. You will probably be referred to either a psychiatrist or psychologist or both. Treatment for depression and psoriasis should therefore take a holistic approach, where you look after your physical, mental, and emotional well-being. Furthermore, you should always adhere to your psoriasis medication strictly as this will prevent the condition from worsening, thereby reducing your feelings of anxiety around your psoriasis.

7. Cardiovascular Disease

Several studies in recent years suggest that those living with psoriasis are at an increased risk of developing cardiovascular disease. One study reported that people with psoriasis are three times as likely to have a heart attack than people without the condition.

Cardiovascular disease, which is also known as heart disease, refers to several conditions that relate to the body’s cardiovascular system (heart and all blood vessels). People with psoriasis are at a greater risk of developing coronary artery disease, peripheral arterial disease, stroke, hypertension, and an irregular heartbeat (arrhythmia).

Researchers are still trying to understand why people with psoriasis are at greater risk of developing heart disease (and what this exact link is), but it is believed that the type of inflammation associated with psoriasis is also related to the process of atherosclerosis (the narrowing of the arteries). Furthermore, some psoriasis medications (like acitretin) can cause cardiovascular symptoms, like hypertension or high cholesterol levels.

However, this is no cause for alarm, as the effective treatment of psoriasis can greatly reduce your risk of having a heart attack or stroke and your healthcare provider will help you select the best treatment based on your needs. You can also reduce your risks by leading a heart-healthy lifestyle: stay at a healthy weight, exercise, limit unhealthy food, and go for regular blood pressure and blood sugar check-ups.

Comprehensive Care

As the body of literature on the links between psoriasis and other health conditions continues to grow, experts in the field are trying to push for more comprehensive care to be given to people living with psoriasis. Dr. Gary Goldenberg, assistant professor at the Icahn School of Medicine at Mount Sinai in New York, says,

“It’s time to stop looking at psoriasis as just a skin disease. It’s a systemic disease as much as anything else.”

If you have psoriasis, then you need to ensure that you go for regular check-ups and see a doctor if you notice any unusual symptoms. Don’t be afraid to be as open and as honest as possible with your doctor about your concerns and worries. There are always steps you can take to mitigate your risks of developing comorbidities, and your doctor can help you come up with a tailored treatment plan that will benefit you and your overall health most.

Take a look at some of the other posts on the MyTherapy blog:

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