How Psoriasis May Affect Your Entire Body: More Than Skin-Deep

Medically reviewed by Noah Levit, M.D., Ph.D., FAAD

Written by Alison Channon and Emily Wagner, M.S.

Posted on February 5, 2024

Your body’s immune system responds to bacteria and viruses with inflammation to prevent you from getting sick. If you have psoriasis, part of your immune system is overactive, causing chronic inflammation inside your body that may have negative effects on your overall health over time. Much more than flaky skin or scaly plaques, psoriasis can affect your joints, heart, mental health and more, if left untreated.¹

“Taking care of their psoriasis is a good step in taking care of the rest of their body,” Dr. Adel Haque, a board-certified dermatologist in Pennsylvania, told MyPsoriasisTeam. “Controlling [inflammation from psoriasis] is going to be really important for [the health of] all patients.”

It’s important to remember that although psoriasis may increase your risk of developing other health conditions, it’s not a guarantee that you will. Nor does it mean you have no control over your health. Together with your dermatologist, you can understand your personal set of risk factors and take steps to better manage your health. “We not only treat the psoriasis for the patient,” Dr. Haque said. “We say what else is going on internally, and we help coordinate [health] care.”

Your Mental Health and Psoriasis

Many people with psoriasis experience depression and anxiety. A 2023 British study found that 35 percent of participants with psoriasis had symptoms of depression and 29 percent had symptoms of anxiety.²

People with psoriasis may experience mental health difficulties for several reasons, including³:

Chronic inflammation — Ongoing inflammation, like that which occurs in psoriasis, can contribute to depression and other mental health disorders. It’s also possible that depression itself may trigger skin problems like psoriasis.
Managing several health issues — People with psoriasis may be managing multiple health conditions that could contribute to depression.
Social isolation — Sometimes people avoid social activities because of shame related to their skin. “It’s a huge social issue for a lot of people,” Dr. Haque commented. “A lot of people will isolate themselves into a severe depression.”

Tell your dermatologist or another health care provider if you’re experiencing symptoms of depression or anxiety. Symptoms of depression include ongoing sadness, feelings of worthlessness, or disinterest in activities you used to enjoy. Symptoms of anxiety include feelings of intense worry or fear that interfere with daily life.⁴ Your health care provider can help you get the treatment you need.

“Taking care of their psoriasis is a good step in taking care of the rest of their body.”
— Dr. Adel Haque

Your Lungs and Psoriasis

Several lung diseases occur more frequently in people with psoriasis than those without. The ongoing inflammation and the immune system dysfunction associated with psoriasis could be factors that lead to the development of lung diseases. Smoking is another factor that could explain why people with psoriasis develop lung diseases more often than those without the skin condition. Research shows a correlation between smoking and psoriasis and smoking is linked to the development of several lung diseases.⁵ Challenges related to psoriasis, such as uncomfortable skin symptoms, social isolation, or stress, may cause people with psoriasis to smoke.⁶

Lung diseases associated with psoriasis include:

Asthma — This inflammatory lung disease causes airways to narrow when they come in contact with an irritating substance. Studies show that people with psoriasis are 32 percent more likely to develop asthma than those without psoriasis. People ages 50 and older are at greater risk than younger individuals.⁷
Chronic obstructive pulmonary disease (COPD) — This disease blocks airflow through the lungs. Research shows that people with psoriasis, particularly severe psoriasis, are more likely to develop COPD than the general population.⁸
Interstitial lung disease (ILD) — ILD is a group of diseases that cause scarring in the lungs.⁹ Researchers have identified a possible relationship between psoriasis and psoriatic arthritis and ILD, though more studies are needed to better understand the connection.¹⁰

Your Heart and Psoriasis

People with psoriasis may be at increased risk of cardiovascular disease (heart disease). Some research has shown that people with severe psoriasis have a 57 percent increased risk of heart disease compared with those who don’t have psoriasis.¹¹

One reason for this increased risk is metabolic syndrome, which is common in people with psoriasis. Between 20 percent and 50 percent of individuals with psoriasis also have metabolic syndrome.¹¹

An individual has metabolic syndrome if they have three of the following five conditions¹²:

High blood sugar
High blood pressure
Low levels of good cholesterol
High triglycerides (fats) in the blood
Large waist circumference

Having metabolic syndrome puts a person at greater risk of heart disease and other complications such as stroke or diabetes. The conditions that together make up metabolic syndrome can also increase heart disease risk on their own.¹²

Psoriasis is also associated with atherosclerosis. This condition occurs when fatty deposits called plaque build up in the arteries. Researchers believe that certain immune cells involved in psoriasis also play a role in the formation of plaques. Atherosclerosis is linked to heart problems such as coronary artery disease and heart attack.^13,14

Managing moderate to severe psoriasis with biologics and immunosuppressive medications may help reduce the risk of heart disease and complications. According to the American Academy of Dermatology, treating moderate to severe psoriasis and reducing inflammation can also lead to fewer strokes, heart attacks, and heart disease-related deaths.¹⁵

One study found that people who used biologic therapy to treat their psoriasis had a reduction in plaque buildup compared with those who didn’t use a biologic.¹⁶

Your Liver and Psoriasis

Psoriasis is associated with a condition called nonalcoholic fatty liver disease (NAFLD), a chronic liver condition affecting about a quarter of the United States population.^17,18 One of the risk factors for NAFLD is metabolic syndrome, which occurs frequently in people with psoriasis.^11,18

A large study of U.S. adults found that NAFLD was more prevalent in those with psoriasis than those without: 32.7 percent versus 26.6 percent.¹⁷ Other studies have reported higher prevalence, ranging from approximately 44 percent to 66 percent.¹⁷

Your Gastrointestinal System and Psoriasis

People with psoriasis are at greater risk of developing inflammatory bowel diseases like Crohn’s disease and ulcerative colitis. These conditions affect the gastrointestinal (GI) system, causing symptoms like diarrhea and abdominal pain. Researchers have found that genes related to psoriasis are also involved in ulcerative colitis and Crohn’s disease.¹⁹

Compared with the general population, those with psoriasis are up to 71 percent and 153 percent more likely to develop ulcerative colitis and Crohn’s disease, respectively.¹⁹

“Do you also have upset stomach or GI issues?” Dr. Haque will often ask during an appointment. He noted that often people will say yes or mention that a family member has an inflammatory bowel disease. In those cases, Dr. Haque can help “get you plugged in with a GI doctor,” he said.

Your Joints and Psoriasis

Approximately 30 percent of people with psoriasis will develop psoriatic arthritis.²⁰ Psoriatic arthritis is an inflammatory arthritis that causes symptoms like painful and stiff joints.²¹ Telltale symptoms of psoriatic arthritis include swollen fingers or toes (sometimes called sausage fingers) and nail symptoms like pitting.²⁰

Researchers are working to understand why some people with psoriasis develop psoriatic arthritis while others don’t. Psoriasis on your nails, scalp, or genitals may be associated with greater likelihood of developing psoriatic arthritis.²²

Dr. Haque explained that he regularly asks about symptoms related to psoriatic arthritis: “Do you ever feel like you wake up stiff in the morning? The first signs that we’re seeing may not be that your joints are getting swollen. It might just be that they’re a little stiff.”

It’s also possible for people with psoriasis to develop rheumatoid arthritis, another form of inflammatory arthritis.^21,23 Both psoriatic and rheumatoid arthritis cause joint pain and swelling, but there are some key differences. Your dermatologist may refer you to a rheumatologist who can examine your joints and run tests to determine the cause of your symptoms. It’s important to treat both conditions early so that you don’t develop permanent joint damage.²⁰ A treatment delay of just six months for people with psoriatic arthritis can result in joint erosion (destruction of the joint) and function limitations.²⁴

Your Skin and Psoriasis

Sometimes people with psoriasis develop other inflammatory skin conditions, such as hidradenitis suppurativa (HS). This chronic condition causes painful lesions, leaking wounds, and sometimes scarring, typically in the armpits, under the breasts, and around the groin and inner thighs. HS and psoriasis are both inflammatory conditions with overlapping risk factors, including smoking and metabolic syndrome.²⁵

In one large study, the researchers found that people with psoriasis were 80 percent more likely to have HS than those without psoriasis. However, HS rates were small in both groups in this particular study: 0.3 percent compared with 0.2 percent.²⁶ Overall, HS is estimated to affect about 1 percent of the overall population.²⁵

Talk to Your Doctor

It can be scary to learn how having psoriasis may affect your chances of developing additional health conditions, but you’re not alone when navigating these concerns. Your dermatologist, Dr. Haque explained, can be the “champion” of your care. They can help you best manage your psoriasis, understand your risks of other health conditions, and connect you with other health care providers, such as a rheumatologist or a gastroenterologist. Dr. Haque offered encouragement: “You can work towards getting better, not just with [psoriasis], but with your entire health.”

ABBV-US-01423-MC v1.0 January 2024

References

Delzell E. Psoriatic disease affects more than skin and joints. National Psoriasis Foundation. February 3, 2021. Accessed October 4, 2023.
Bechman K, Hayes JF, Mathewman J, et al. Electronic screening for mental illness in patients with psoriasis. Br J Dermatol. 2023;189(2):246-248. doi:10.1093/bjd/ljad141
Sahi FM, Masood A, Danawar NA, Mekaiel A, Malik BH. Association between psoriasis and depression: a traditional review. Cureus. 2020;12(8):e9708. doi:10.7759/cureus.9708
Mental Health Conditions: Depression and Anxiety. Centers for Disease Control and Prevention. Updated September 14, 2022. Accessed October 20, 2023.
Mleczko M, Gerkowicz A, Krasowska D. Chronic inflammation as the underlying mechanism of the development of lung diseases in psoriasis: a systematic review. Int J Mol Sci. 2022;23(3):1767. doi:10.3390/ijms23031767
Altunay I, Doner N, Mercan S, Demirci GT. Stress coping mechanisms in smoking psoriatics. Dermatologica Sinica. 2013;31(3):130-133. doi:10.1016/j.dsi.2013.02.001
Wang J, Ke R, Shi W, et al. Association between psoriasis and asthma risk: a meta-analysis. Allergy Asthma Proc. 2018;39(2):103-109. doi:10.2500/aap.2018.39.4109
Li X, Kong L, Li F, et al. Association between psoriasis and chronic obstructive pulmonary disease: a systematic review and meta-analysis. PLoS One. 2015;10(12):e0145221. doi:10.1371/journal.pone.0145221
Interstitial lung disease. Cleveland Clinic. Updated August 5, 2022. Accessed October 3, 2023.
Ishikawa G, Dua S, Mathur A, et al. Concomitant interstitial lung disease with psoriasis. Can Respir J. 2019;2019:5919304. doi:10.1155/2019/5919304
Wu JJ, Kavanaugh A, Lebwohl MG, Gniadecki R, Merola JF. Psoriasis and metabolic syndrome: implications for the management and treatment of psoriasis. J Eur Acad Dermatol Venereol. 2022;36(6):797-806. doi:10.1111/jdv.18044
What is metabolic syndrome? American Heart Association. Updated March 25, 2021. Accessed October 3, 2023.
Jindal S, Jindal N. Psoriasis and cardiovascular diseases: a literature review to determine the causal relationship. Cureus. 2018;10(2):e2195. doi:10.7759/cureus.2195
What is atherosclerosis? National Heart, Lung, and Blood Institute. Updated March 24, 2022. Accessed October 2, 2023.
Does treating psoriasis reduce the risk of heart disease and stroke? American Academy of Dermatology. Accessed October 4, 2023.
Choi H, Uceda DE, Dey AK, et al. Treatment of psoriasis with biologic therapy is associated with improvement of coronary artery plaque lipid-rich necrotic core: results from a prospective, observational study. Circ Cardiovasc Imaging. 2020;13(9):e011199. doi:10.1161/CIRCIMAGING.120.011199
Ruan Z, Lu T, Chen Y, et al. Association between psoriasis and nonalcoholic fatty liver disease among outpatient US adults. JAMA Dermatol. 2022;158(7):745-753. doi:10.1001/jamadermatol.2022.1609
Nonalcoholic fatty liver disease. Mayo Clinic. Updated October 6, 2023. Accessed October 5, 2023.
Fu Y, Lee CH, Chi CC. Association of psoriasis with inflammatory bowel disease: a systematic review and meta-analysis. JAMA Dermatol. 2018;154(12):1417-1423. doi:10.1001/jamadermatol.2018.3631
Psoriatic arthritis. Cleveland Clinic. Updated September 19, 2023. Accessed October 4, 2023.
Gisondi P, Bellinato F, Maurelli M, et al. Reducing the Risk of Developing Psoriatic Arthritis in Patients with Psoriasis. Psoriasis (Auckl). 2022;12:213-220. Published 2022 Aug 10. doi:10.2147/PTT.S323300
Berry D. Psoriatic arthritis or rheumatoid arthritis? April 27, 2022. Accessed October 4, 2023.
Ogdie A, Nowell WB, Applegate E, et al. Patient perspectives on the pathway to psoriatic arthritis diagnosis: results from a web-based survey of patients in the United States. BMC Rheumatol. 2020;4:2. Published 2020 Jan 10. doi:10.1186/s41927-019-0102-7
Martin A, Thatiparthi A, Liu J, Wu JJ. Association between psoriasis and rheumatoid arthritis in a nationally representative population in the United States. J Am Acad Dermatol. 2022;86(6):1426-1427. doi:10.1016/j.jaad.2021.06.841
Macca L, Li Pomi F, Ingrasciotta Y, Morrone P, Trifirò G, Guarneri C. Hidradenitis suppurativa and psoriasis: the odd couple. Front Med (Lausanne). 2023;10:1208817. doi:10.3389/fmed.2023.1208817
Kridin K, Shani M, Schonmann Y, et al. Psoriasis and hidradenitis suppurativa: a large-scale population-based study. J Am Acad Dermatol. 2023;88(5):e231-e236. doi:10.1016/j.jaad.2018.11.036

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Posted on February 5, 2024

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Noah Levit, M.D., Ph.D., FAAD is a board-certified dermatologist practicing in Connecticut. Learn more about him here.

Alison Channon has nearly a decade of experience writing about chronic health conditions, mental health, and women's health. Learn more about her 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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