Comorbidities in Psoriasis

Psoriasis is an interesting disorder.  It affects about 2% of the US population.  As I often explain to patients, it is something that some people are genetically inclined to have, just like their hair color and eye color.  It is not something we can permanently cure, and for most, it is a lifelong disorder that comes and goes.  BUT…What we knew, or what we thought we knew about psoriasis has changed dramatically in just the past 15-20 years.  Each day it seems we learn more.  Some of the new findings are particularly startling.

Patients receiving treatments for severe psoriasis have a 41% increased risk of dying from malignancy than patients without psoriasis.

Many studies have shown that people who have psoriasis are statistically at a higher risk of having a number of other disorders and risks.  We label these statistical findings as comorbidities.  The official definition of comorbidity is “the simultaneous presence of two chronic diseases or conditions in a patient.” Why does this matter?

Studies have shown that patients with psoriasis have up to 10 years decreased life span due to comorbidities

Over the past few years, it has been increasingly emphasized that it is important for us as dermatologists to educate patients regarding these comorbidities and risk factors.  Because this field is changing a lot, this post serves as an update to my previous blog post on this topic.

A more recent article set forth guidelines for children with psoriasis as well to detect comorbidities early.  The increased risk calculations can vary from study to study, so I have tried to put an estimate of increased risk based on a compilation of scientific studies.

Comorbidities with psoriasis…

-Obesity – 2x the risk of obesity. Increases with the severity of psoriasis

-Type 2 diabetes -30% increased risk

-Coronary artery disease –2 x increased risk

-Arthritis- About 30% of patients who have psoriasis have psoriatic arthritis.  This is a destructive type of arthritis.

-High blood pressure  – up to 2x increased risk

-Inflammatory Bowel Disease –Crohn’s Disease and less commonly Ulcerative Çolitis – up to 3x increased risk.

-Non-Alcoholic Fatty Liver and other Liver Disease – up to 2x increased risk

-Lymphoma – up to 2x increased risk

-Malignancy other than psoriasis – 15% increased risk

-Metabolic syndrome (includes high blood pressure, elevated blood glucose, elevated lipids, and obesity) – 2x

-Increase risk of non-melanoma skin cancer  – 4x increased risk

-Psychological conditions- Depression and anxiety -30-50% increased risk

-Polycystic Ovarian Syndrome- 6x increased risk

-Peridontitis – 60% increased risk

-Chronic Kidney Disease  – 30% increased risk

A significant amount of current research is looking for substantial evidence for systemic treatment of psoriasis to reduce these comorbidities and increase life span.

 

Below are my recommendations for psoriasis patients to reduce the risk of illness and death from comorbid disease…

-Yearly physical by PCP

-Yearly Full skin examination

-Yearly set of lab work including Fasting blood glucose, Hemoglobin A1C, Cholesterol, triglycerides, Liver (AST, ALT, GGT) and kidney function tests (BUN and Creatinine)

-Keep up to date on age appropriate malignancy scans.

-Reducing weight by as little as 10% significantly improves cardiovascular risk

-Reducing and limiting alcohol intake

-Cardiovascular exercise at least 3-4 times per week.

-Daily Vitamin E 400IU, Fish Oil

-Coffee, black, in moderation

-At least yearly dental exams and cleanings.

In our office, we often treat psoriasis, partly using light therapy. Check out the video, and let us know if you think light therapy could benefit you.

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If you are interested in reviewing this topic in more scientific detail, below are two of the articles I used in updating this post.

Psoriasis and Comorbid Diseases Part I. Epidemiology

Psoriasis and Comorbid Diseases Part II. Implications for Management

While UV light therapy for psoriasis won’t impact many of the comorbidities discussed above, it will improve the symptoms and appearance of psoriasis.  Many psoriasis patients express anxiety and depression symptoms when considering spring and summer.  In office, UV light treatments have had a huge impact on quality of life for many of our patients.  One joyous patient went to the beach for the first time with her kids because she was finally confident and comfortable with her skin!  To learn more about the NBUVB light booth and Excimer laser treatments we offer for psoriasis, check out our website.

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