Comorbidities in Psoriasis

Psoriasis can cause obvious symptoms, which include raised, red patches of skin covered in silvery scales. When you're living with psoriasis, you are also at an increased risk of developing other conditions, classified as comorbidities or co-existing conditions.

Comorbidities associated with psoriasis include psoriatic arthritis (PsA), depression, cardiovascular disease, and more. Having comorbid conditions can affect your health and the type of treatment you need.

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.

Comorbidity tends to be associated with worse health outcomes and increased medical costs. Having comorbid conditions can add challenges to your treatment plan, and researchers emphasize the importance of a personalized and comprehensive care approach for people who are living with more than one chronic disease.

Comorbidities and Psoriasis

Psoriasis is a skin condition that causes a build-up of skin cells and an appearance of plaques—raised red patches covered in white scales. Psoriasis can be hereditary, and it is not contagious,

According to the National Psoriasis Foundation, psoriasis affects up to 125 million people worldwide. Additionally, up to 30% percent of people with psoriasis develop psoriatic arthritis (PsA), an autoimmune disease that causes joint pain and inflammation, in addition to skin inflammation.

Your immune system generally attacks infectious microorganisms, but in the case of autoimmune diseases, it attacks healthy cells instead. Psoriasis is an autoimmune condition. and it's considered multi-systemic (affects multiple body systems).

One report from the Brazilian Annals of Dermatology (Anais Brasileiros de Dermatologia) reports that up to 73% of people with psoriasis have at least one comorbidity.

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."

You and your healthcare provider can create a plan to potentially slow down or prevent comorbidities. This may include screening for potential psoriasis comorbidities, and treatment if you develop early signs.

For example, research shows “depression and suicidal ideation are much more common in psoriasis.” In this case, your dermatologist would not be able to treat depression and suicidal thoughts. But if you are having symptoms of depression, you could be referred to a provider who can treat this condition.

Psoriatic Arthritis

In general, the more severe your psoriasis, the higher the risk for developing PsA. Early diagnosis is vital in order to get control of PsA before it damages joints or causes permanent disability.

Unfortunately, early diagnosis is not always possible. In fact, one study published in 2015 in the Journal of European Academy of Dermatology and Venereology, finds that 1 in 10 people with psoriasis has undiagnosed PsA. Further, the impact on quality of life in people with undiagnosed PsA is substantial.

Cardiovascular Disease

Research shows a link between psoriasis and cardiovascular disease, especially if a person has severe psoriasis. The report’s authors express 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 because inflammation 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 can eventually restrict blood flow. These findings mean that biologic therapies not only treat inflammation, but also reduce the risk of cardiovascular disease.

Metabolic Syndrome

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 in comparison to others without psoriasis. The researchers further emphasize the need for early treatment and screening of metabolic syndrome in psoriasis patients.

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 of these problems doesn’t mean a person has metabolic syndrome, but having two or more of these increases the risk for complications, including type 2 diabetes and stroke.

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, potentially resulting in diabetes or worsening the effects of diabetes.

In addition to medication, management of type 2 diabetes includes weight control, exercise, and eating high-fiber foods. If you have psoriasis, you should have your 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.

Research shows that people with psoriasis are more likely to be obese, in comparison to others in the general population.

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 associated with IBD. Some of the same genes that increase the risk for psoriatic disease also increase the risk for IBD. Talk to your healthcare provider if you experience symptoms of IBD, including diarrhea, abdominal pain, and bloody stools.

Depression

According to the National Psoriasis Foundation, depression is the top comorbidity of psoriasis. Living with skin problems can contribute to depression.

Treatment with antidepressants can help reduce symptoms of depression. And for some people, treatment of psoriasis can help reduce symptoms of depression and improve quality of life.

Depression is defined as a feeling of persistent sadness or loss of interest. Symptoms may include changes in sleep, appetite, energy levels, daily behaviors, and self-esteem. Depression can also be associated with suicidal thoughts (thinking about or planning suicide).

Other Conditions

Psoriasis is associated with a number of other conditions, including osteoporosis, uveitis, and liver and kidney disease.

• Osteoporosis causes 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 with psoriasis is associated with 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.

Psoriasis has also been connected to an increased risk of infections, sleep disorders, chronic obstructive pulmonary disease (COPD), and sexual dysfunction.

A Word from Verywell

With psoriasis, you absolutely can have a good quality of life, but taking care of your health may involve some extra time and attention. If you have been diagnosed with psoriasis, it is important to be aware of the potential for comorbid diseases so that you will recognize the symptoms and get early and effective treatment.