Skin Health Psoriasis Living With Comorbidities in Psoriasis Definition, Connection, and Conditions By Lana Barhum facebook linkedin Lana Barhum has been a freelance medical writer for over 10 years. She shares advice on living well with chronic disease. Learn about our editorial process Lana Barhum Medically reviewed by Medically reviewed by Leah Ansell, MD on September 24, 2020 linkedin Leah Ansell, MD, is a board-certified dermatologist and an assistant professor of dermatology at Columbia University. Learn about our Medical Review Board Leah Ansell, MD Updated on October 22, 2020 Print Living with psoriasis, you are very aware most people only see the external symptoms of psoriasis, which include raised, red patches of skin covered in silvery scales. New research is starting to shine a light on another important aspect of living with psoriasis—the increased risk for developing other conditions, classified as comorbidities or co-existing conditions. Comorbidities associated with psoriasis include psoriatic arthritis (PsA), depression, cardiovascular disease, and more. The presence of comorbid conditions can affect a person’s health and the type of treatment they receive. Anut21ng / Getty Images Comorbidity Defined The term “comorbidity” is used to refer to the presence of more than one health condition in the same person. For example, if you have both psoriasis and depression, you are said to have comorbid psoriasis and depression. Comorbid conditions are usually ones that are chronic or lifelong. Comorbidity tends to be associated with difficulty finding effective treatments, worse health outcomes, and increased medical costs. Having comorbid conditions challenges the way doctors treat psoriasis and researchers stress the importance of a personalized and comprehensive care approach in persons who live with more than one chronic disease. A study reported in 2012 by The Lancet shows 1 in 4 adults has at least two chronic conditions. Comorbidities and Psoriasis Psoriasis is a skin condition that causes skin cells to multiply at a much higher rate than what is considered normal. This causes a build-up of skin cells and an appearance of plaques—raised red patches covered in a white buildup of dead skin cells called scales. Psoriasis is not contagious, but it has been said to run in families. According to the National Psoriasis Foundation, psoriasis affects up to 125 million people worldwide. Additionally, up to 30% percent of people with psoriasis will go on to develop psoriatic arthritis (PsA), an autoimmune disease that causes joint pain and inflammation in addition to skin inflammation. Psoriasis has been recognized as a condition affecting multiple body systems (multi-systemic). This is because, like other autoimmune conditions, psoriasis starts in the immune system. Your immune system generally attacks infections and other foreign substances, but in the case of autoimmune diseases, it attacks healthy cells instead. One report from the Brazilian Annals of Dermatology (Anais Brasileiros de Dermatologia) reports up to 73% of people with psoriasis have at least one comorbidity. Psoriatic Disease and Your Immune System Psoriasis comorbidities may share the characteristic of systemic (whole body) inflammation, such as is the case with PsA. Other conditions are related to lifestyle choices and family history, as it is or metabolic syndrome. Common Psoriasis Comorbidities According to a 2018 report in the journal Seminars in Cutaneous Medicine and Surgery, the most common comorbidities of psoriasis are “psoriatic arthritis, cardiovascular disease, metabolic syndrome, overweight/obesity, inflammatory bowel disease, and depression." Being aware of known, potential comorbidities of psoriasis early on can help you and your doctor make better treatment decisions, including creating a plan to potentially slow down or prevent comorbidities, and improve your quality of life. To achieve this, your treating doctor may include screening for potential psoriasis comorbidities that he or she thinks may have an impact on you down the road. For example, research shows “depression and suicidal ideation are much more common in psoriasis.” In this case, a dermatologist would not be able to address the specific issues of depression and suicidal thoughts. However, he or she can inform you of your options and refer you to the appropriate specialist or doctor. Treating Psoriasis and Preventing Flares Psoriatic Arthritis Many people with psoriasis will go on to develop PsA. In general, the more severe your psoriasis, the higher the risk for developing PsA. Identifying PsA early in people with psoriasis can be a challenge. But early diagnosis is vital in order to get control of PsA before it damages a person’s joints or causes permanent disability. Unfortunately, early diagnosis is not always possible. In fact, one study reported in 2015 in the Journal of European Academy of Dermatology and Venereology, finds 1 in 10 people with psoriasis have undiagnosed PsA. Further, the impact of quality of life in people with undiagnosed PsA is substantial. What Exactly is Psoriatic Disease? Cardiovascular Disease Research shows a link between psoriasis and cardiovascular disease, especially if a person has severe psoriasis. The report’s authors stress the importance of detailed screening and management for cardiovascular disease in people with psoriasis. Chronic inflammation is likely to blame for the increased risk for cardiovascular disease and stroke, as inflammation is can cause damage to arteries over time. Treating psoriasis properly can reduce the risk of heart attack or stroke. Researchers have found biologic drug treatment targets immune system activity that causes both chronic skin inflammation and early plaque buildup that would eventually clog arteries and restrict blood flow. These findings mean biologic therapies can not only treat inflammation, but also reduce the risk for cardiovascular disease risk. If you have psoriasis, your doctor will want to monitor your heart health and suggest you take steps to manage your heart health, such as following a healthy diet and exercising. Heart Health Numbers You Need to Know Metabolic Syndrome Metabolic syndrome is a collection of conditions occurring together that increase the risk of heart disease, stroke, and type 2 diabetes. These conditions include elevated blood pressure, high blood sugar, excess body fat in the waist, and abnormal cholesterol or triglyceride levels. Having one condition doesn’t mean a person has metabolic syndrome but having two or more of these conditions increases the risk for complications, including type 2 diabetes and stroke. According to a study reported in 2017 in the Anais Brasileiros de Dermatologia, people with psoriasis are six times more likely to have metabolic syndrome, this in comparison to others without psoriasis. The researchers further note these higher incidences emphasize the need for early treatment and screening of metabolic syndrome in psoriasis patients. Type 2 Diabetes Inflammation affects the way the body’s cells absorb sugar from the food you eat. This causes extra sugar to build up in the blood, resulting in diabetes or worsening symptoms of the condition. You can manage type 2 diabetes with weight loss, exercise, and by eating high-fiber foods. If you have psoriasis, you should have blood sugar levels checked regularly. Obesity Obesity means having too much body fat. This is different than just being overweight, which means weighing too much, as weight tends to be associated with more than fat, and includes muscle and bone weight, and body water. Researchers know people with psoriasis are more likely to be obese, this in comparison to others in the general population. Further, weight loss can improve psoriasis and PsA and even prevent psoriasis development people are obese. Inflammatory Bowel Disease There is a connection between psoriasis and inflammatory bowel disease (IBD). Findings from a 2018 systematic review and meta-analysis in the journal JAMA Dermatology suggest psoriasis is significantly associated with IBD. This is because the same genes that increase the risk for psoriatic disease also increase the risk for IBD. Talk to your doctor if you experience symptoms of IBD, including diarrhea, abdominal pain, and bloody stools. Depression Depression is a common complication of psoriasis that generally comes about from quality of life issues relating to body image and living with skin pain and other skin problems. According to the National Psoriasis Foundation, depression is the top comorbidity of psoriasis. Further, people with psoriasis use anti-depressants at much higher rates than others in the general population. While treatment can help reduce the effect of depression, the best way to improve depression and quality of life is to better manage and treat psoriasis. Depression is defined as a feeling of persistent sadness or loss of interest. Symptoms may include changes to sleep, appetite, energy levels, daily behaviors, and self-esteem. Depression can also be associated with suicidal thoughts (thinking about or planning suicide). Talk to your doctor if you think you might be depressed. Your doctor can refer you to mental health professional so that you can get the help you need to better manage the challenges associated with psoriasis. What Is the Connection Between Psoriasis and Depression? Other Conditions Psoriasis is associated with a number of other conditions, including osteoporosis, uveitis, and liver and kidney disease. Osteoporosis is known for causing bones to become weak and brittle and its connection to psoriasis is due to chronic inflammation that eventually leads to bone weakness. Uveitis is an inflammatory eye condition and the increased risk is due to the fact psoriasis and uveitis share similar genetic characteristics. Severe psoriasis is associated with liver disease, especially nonalcoholic fatty liver disease (NAFLD) and cirrhosis. Severe psoriasis also poses an increased risk for kidney disease. Inflammatory conditions are known for causing damage to the kidneys or liver, either directly or through whole-body inflammation that eventually leads to organ damage. Psoriasis has also been connected to increased risk for infections, sleep disorders, chronic obstructive pulmonary disease (COPD), and sexual dysfunction. A Word from Verywell It is important to be aware of diseases that may be associated with psoriasis. Being informed about these conditions can help you to be upfront with your doctor about new or worsening symptoms you experience. Even if you don’t think symptoms are linked to psoriasis or a comorbid condition, trust that your dermatologist or other treating doctor can identify these, address risk factors, request screening for comorbid conditions, and refer you to other doctors or specialists. Additionally, you can reduce your risk for psoriasis comorbid conditions by making healthy lifestyle choices, including eating healthy and exercising, and following your doctor-prescribed treatment plan. 6 Health Complications of Psoriasis Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Valderas JM, Starfield B, Sibbad B, et al. Defining comorbidity: Implications for understanding health and health services. Ann Fam Med. 2009 Jul; 7(4): 357–363. doi:10.1370/afm.983 Barnett K, Mercer SW, Norbury M, et al. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012 Jul 7;380(9836):37-43. doi:10.1016/S0140-6736(12)60240-2 National Psoriasis Foundation. Statistics. Machado-Pinto J, dos Santos Diniz M, Bavoso NC. Psoriasis: new comorbidities. An Bras Dermatol. 2016 Jan-Feb; 91(1): 8–14. doi:10.1590/abd1806-4841.20164169 Menter MA, Armstrong AW, Gordon KB, et al. Common and not-so-common comorbidities of psoriasis. Semin Cutan Med Surg. 2018 Feb;37(2S):S48-S51. doi: 10.12788/j.sder.2018.011 Kurd KK, Troxel AB, Crits-Christoph P, et al. The risk of depression, anxiety and suicidality in patients with psoriasis: A population-based cohort study. Arch Dermatol. 2010 Aug; 146(8): 891–895. doi:10.1001/archdermatol.2010.186 Spelman L, Su JC, Fernandez-Peñas P, et al. Frequency of undiagnosed psoriatic arthritis among psoriasis patients in Australian dermatology practice. J Eur Acad Dermatol Venereol. 2015 Nov;29(11):2184-91. doi:10.1111/jdv.13210 Gu WJ, Weng CL, Zhao YT, et al. Psoriasis and risk of cardiovascular disease: A meta-analysis of cohort studies. Int J Cardiol. 2013 Oct 12;168(5):4992-6. doi:10.1016/j.ijcard.2013.07.127 Milčić D, Janković S, Vesić S, et al. Prevalence of metabolic syndrome in patients with psoriasis: a hospital-based cross-sectional study. An Bras Dermatol. 2017 Jan-Feb; 92(1): 46–51. doi:10.1590/abd1806-4841.20175178 National Institute of Diabetes and Digestive and Kidney Diseases. Managing diabetes. Published December, 2016. Mahil SK, McSweeney SM, Kloczko E, et al. Does weight loss reduce the severity and incidence of psoriasis or psoriatic arthritis? A critically appraised topic. Br J Dermatol. 2019 Nov;181(5):946-953. doi:10.1111/bjd.17741 Fu Y, Lee CH, Chi CC. Association of psoriasis with inflammatory bowel disease: a systematic review and meta-analysis. JAMA Dermatol. 2018 Dec 1;154(12):1417-1423. doi: 10.1001/jamadermatol.2018.3631 National Psoriasis Foundation. Depression. National Institute of Mental Health. Depression. Updated February 2018. National Psoriasis Foundation. Comorbidities associated with psoriatic disease.