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Conditions Related to Psoriasis

Posted on November 15, 2021
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Emily Wagner, M.S.

Certain underlying health conditions are more common in people with psoriasis than in the general population. Some people may have these conditions before their psoriasis diagnosis, while other people may develop them as a result of the skin condition or its treatment.

Psoriasis is a chronic condition that causes inflammation and the accelerated production of skin cells. Skin builds up more quickly than it can shed, causing patches of thickened, scaly skin that can crack, bleed, and itch — as well as other symptoms.

Comorbidities and Complications

When a person has more than one health condition at the same time, they are known as comorbidities. On the other hand, complications refer to other problems that make treating an existing disease more difficult.

Age is an important factor in whether a person develops any comorbid conditions. Generally, the longer a person lives, the more likely they are to have illnesses. The National Psoriasis Foundation suggests visiting your primary care provider regularly to make sure you are healthy and to screen for any underlying conditions. It is also important to manage your psoriasis with proper treatment, because this can lower your risk of developing comorbidities.

Psoriatic Arthritis

Psoriatic arthritis (PsA) affects around 30 percent of people with psoriasis, making it the most common comorbidity for the condition. PsA is a chronic, autoimmune disease that affects the joints — specifically where the tendons and ligaments attach to the bone.

Common psoriatic arthritis symptoms:

  • Swollen fingers and toes
  • Pain and swelling around tendons
  • Morning stiffness
  • Fatigue
  • Limited range of motion
  • Pain and redness of the eyes — known as uveitis

PsA tends to develop in people between the ages of 30 and 50. In many cases, it starts around 10 years after psoriasis develops. However, some people can develop PsA before noticing psoriasis. There is little connection between the severity of psoriasis and the severity of PsA.

Cardiovascular Disease

People with psoriasis are more likely to develop cardiovascular disease. This is because the immune system is not regulated properly in psoriasis, which can result in inflammation throughout the entire body, including the heart and vascular system (blood vessels — arteries and veins). You are more likely to have comorbid cardiovascular disease if your psoriasis developed at a young age and is more severe.

The inflammation from psoriasis can lead to the development of atherosclerosis — fatty buildup in the arteries — which can further lead to heart attack or other cardiovascular complications, such as:

  • Ischemic heart disease
  • Stroke
  • Peripheral vascular disease
  • Irregular heartbeat (arrhythmia)
  • High blood pressure in the lungs (pulmonary hypertension)

Read more about the connection between psoriasis and heart disease.

Metabolic Syndrome

Metabolic syndrome refers to a set of conditions that increase the risk of stroke, heart disease, and type 2 diabetes mellitus. The set of conditions includes:

  • High blood pressure (hypertension)
  • Abnormal cholesterol levels (dyslipidemia)
  • Insulin resistance
  • Obesity (characterized by high body mass index, or BMI)

One study found that people with psoriasis have a 14 percent to 40 percent chance of developing a metabolic syndrome. By comparison, another study found that around 25 percent of the general population has metabolic syndrome. The severity of psoriasis also correlates with metabolic syndrome, with metabolic issues more prevalent in those with more severe psoriasis.

Obesity has been shown to increase levels of inflammation in the body, and it can also affect how well therapies work in treating psoriasis. A study found that weight loss coupled with biologic treatment — specifically, tumor necrosis factor-alpha (TNF-alpha) inhibitors such as Remicade (infliximab), Enbrel (etanercept), and Humira (adalimumab) — helps control psoriasis better than treatment in those who are overweight or obese.

Read more about the connection between psoriasis and obesity.

Other Autoimmune Diseases

Inflammation caused by psoriasis can also cause other autoimmune diseases to develop. These include inflammatory bowel disease (IBD), celiac disease, and systemic sclerosis.

Inflammatory Bowel Disease

Inflammatory bowel disease is caused by chronic inflammation in the stomach, intestines, and colon. The two main types of IBD are ulcerative colitis (UC) and Crohn’s disease (CD), which can cause:

  • Vomiting
  • Diarrhea
  • Loss of appetite
  • Weight loss
  • Abdominal pain

Many studies have found similarities between psoriasis and IBD, such as shared common genes and the same signs of inflammation. In fact, one study found that over time, people with psoriasis were 153 percent more likely to develop CD and 71 percent more likely to develop UC when compared to healthy individuals.

Celiac Disease

Celiac disease is another autoimmune disease that occurs in people with psoriasis. When a person with celiac disease eats gluten, their immune system recognizes the gluten as foreign and attacks it. This causes damage to the small intestine, and they cannot absorb nutrients from food as well. Research shows that people with psoriasis are three times as likely to develop celiac disease compared to people without psoriasis.

Systemic Sclerosis

Systemic sclerosis is a rare autoimmune disease that is similar to rheumatoid arthritis. It can cause swelling of the fingers and joints because the body produces too much collagen (a substance found in muscles, tendons, and joints). Systemic sclerosis can also cause damage to the lungs, kidneys, heart, and gastrointestinal tract due to increased inflammation.

Research shows that people with psoriasis are more than twice as likely to have systemic sclerosis when compared to healthy individuals.

Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) is a term used for a number of liver conditions that are not caused by drinking alcohol. It can develop in people with psoriasis, especially in those who also have metabolic syndrome. Many studies suggest that those with psoriasis are 1.5 to 3 times more likely to have NAFLD.

Another study found that those with psoriasis and NAFLD had more severe skin disease and had been living with psoriasis for longer. This group was also more likely to have other complications, such as diabetes, hypertension, and chronic obstructive pulmonary disease (COPD).

Read more about the connection between psoriasis and nonalcoholic fatty liver disease.

Certain Types of Cancer

People with psoriasis are also at an increased risk for developing certain types of cancer, due to the systemic inflammation from the skin condition. In addition, certain treatments for psoriasis that affect the immune system have also been found to increase the risk of developing cancer — specifically lymphoma.

Research shows that people with psoriasis are 18 percent more likely to develop cancer compared to healthy individuals; this risk is increased to 22 percent for people with severe psoriasis.

Types of cancer more common in those with psoriasis include:

  • Skin cancers — Specifically squamous cell carcinomas and basal cell carcinomas
  • Lymphomas (types of blood cancers)
  • Esophagus cancer
  • Bladder cancer
  • Liver cancer
  • Pancreatic cancer

Depression and Anxiety

Depression has long been linked to psoriasis, due to the impact that psoriasis has on the personal and social lives of those living with it. The two conditions also share several risk factors, including genetic aspects, low melatonin and vitamin D3 levels, and inflammation. Many people with psoriasis also have reported low self-esteem and anxiety in social situations, which can make depression worse.

Symptoms of depression can include:

  • Tiredness
  • Irritability
  • Changes in sleeping and eating patterns
  • Reduced interest in things you once liked
  • Feelings of sadness, hopelessness, or emptiness
  • Trouble focusing or sitting still
  • Difficulty making decisions
  • Feels of worthlessness or guilt
  • Suicidal thoughts

If you are experiencing any of these symptoms, talk to your doctor about treatment options. It is important to take care of yourself both mentally and physically. Options can include:

  • Therapy or counseling
  • Medication, such as antidepressants
  • Support groups or group therapy
  • Exercising regularly

The Impact of Comorbidities

Some comorbidities can affect your health and quality of life with psoriasis more than others. If you do have any of these underlying health conditions, it is important to speak with your doctor about how to manage and treat them. Addressing these conditions can help you lead a healthier, more comfortable life.

Condition Guide

All updates must be accompanied by text or a picture.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here.

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