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Pigmentation Change, Heart Disease, and Other Effects of Psoriasis

Medically reviewed by Noah Levit, M.D., Ph.D., FAAD
Written by Alison Channon
Posted on February 5, 2024

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“Take that step. See your dermatologist. We can work together to help you get better,” board-certified dermatologist Dr. Adel Haque encouraged anyone living with psoriasis. Not treating psoriasis — or not treating it adequately — can have negative effects on your overall health and quality of life in both the short and long term.1

Transcript

00:00:00:00 - 00:00:23:11
Dr. Haque
Here's some key things that you need to know about the long-term and immediate effects that psoriasis can have on your body when uncontrolled. Psoriasis is a condition of marked inflammation. Commonly on the skin, patients will experience pigmentary changes that can be disfiguring and distressing. Patients may experience hypopigmentation, where patches of skin can become paler than the surrounding areas of skin, or the opposite experience,

00:00:23:17 - 00:00:52:24
Dr. Haque
hyperpigmentation, where patches of skin can become darker than the surrounding areas of skin. Many times, if not treated early and aggressively, these changes can be permanent. Because psoriasis is an inflammatory condition, the earlier you treat the inflammation, the less likely you will have scarring or skin pigment changes. For moderate to severe plaque psoriasis, the use of biologics early on to reduce the inflammation and treat the plaques may help prevent the development of post-inflammatory hyperpigmentation.

00:00:53:01 - 00:01:18:05
Dr. Haque
Early treatment, along with preventative measures such as wearing sunscreen, are also key. Psoriatic inflammation also affects the body internally. We don't know 100% all the downstream long-term effects of untreated psoriasis, but we do know that patients with psoriasis have a higher risk of joint disease, a higher risk of heart disease, high blood pressure, cholesterol, metabolic syndrome, liver and kidney disease.

00:01:18:07 - 00:01:49:01
Dr. Haque
So, controlling that inflammatory cascade may really be important. One study analyzing health insurance claims suggested that early treatment with systemic therapies reduce the onset of arthritis from psoriasis. There's great treatments out there that can help with hyperpigmentation and internal inflammation in the long-term. It's possible to get your psoriasis under control with the help of your dermatologist.

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Below are three reasons to take a proactive approach to your psoriasis management.

1. Reduce Pigmentation Changes

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Sometimes people with psoriasis notice pigmentation changes in their skin after psoriasis lesions heal. This can come in the form of hyperpigmentation (dark areas) or hypopigmentation (light areas). When skin color becomes affected, it’s very difficult to treat.2 “Prevention’s always going to be key,” Dr. Haque explained.

“Once we get patients on a biologic for psoriasis, a lot of times they clear up so well that we’re preventing further hyperpigmentation,” Dr. Haque noted.2,3

Skin color changes can occur in anyone. However, they’re more common and more noticeable in people with darker skin tones.4 “[For] patients that are in the darker skin tone range, that hyperpigmentation … can be very long-lasting and can be very disfiguring, almost as bad as their original disease,” Dr. Haque commented. “If you don’t get [psoriasis] under control early, [pigmentation changes] may be there for many years.”

If you do have skin color changes, all hope is not lost. You can take steps to prevent it worsening — by taking a biologic for psoriasis and, notably, by using sunscreen regularly.5 “Tinted sunscreens, especially on patients with skin of color, are always going to be the best way to prevent hyperpigmentation from getting any worse or lasting longer,” Dr. Haque said.5,6

There are also potential treatments for reversing hyperpigmentation that include topical or laser treatments, which you can discuss with a dermatologist, Dr. Haque explained.5

2. Support Your Mental Health

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Psoriasis can lead to “huge social issues for a lot of people,” Dr. Haque said. “A lot of people will isolate themselves, which can lead to depression” due to embarrassment or shame about their skin.7 A 2023 British study found that 35 percent of participants with psoriasis had symptoms of depression and 29 percent had symptoms of anxiety. The vast majority — 84 percent — reported that psoriasis affected their quality of life.8

Dr. Haque explained that he sees a big change in attitude when people see results from their treatments. He noted that particularly with biologics, “people can often achieve a lot more [skin] clearance than they do on topicals.”3

As a result, “I see my patients develop confidence, and I see them achieve a positive attitude toward their skin, which they maybe never had since their symptoms started,” Dr. Haque said. This newfound confidence can open up doors in their professional or social life that may have been closed because of psoriasis. That might mean having the self-assurance to seek a new job or ask someone out on a date.

3. Be Aware of Long-Term Health Consequences

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Over time, increased inflammation may lead to other health problems, such as heart disease. It’s believed that inflammation from psoriasis contributes to an increased risk of cardiovascular events like heart attack and stroke. People with psoriasis often also have other risk factors that contribute to heart disease, such as hypertension (high blood pressure).1

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Treating psoriasis with systemic treatments like biologics may reduce the likelihood of heart attack and stroke.9 “Targeting [psoriasis] from an internal systemic perspective is going to be the only thing that gets rid of that systemic inflammation,” Dr. Haque explained. “Topicals don’t achieve that.”3

Like psoriasis, psoriatic arthritis is an inflammatory condition that can also be treated with biologics. Approximately a third of people with psoriasis will develop psoriatic arthritis.1

There’s evidence that people with psoriasis who are treated with biologics may be at a decreased risk of developing psoriatic arthritis.10 Dr. Haque noted that he expects future research to clarify the relationship between treatment with biologics and the development of psoriatic arthritis, as well as other conditions associated with psoriasis.

If you do have psoriatic arthritis, proactive treatment is crucial to avoid serious and possibly irreversible joint damage.1 Irreversible joint damage can occur in as little as 6 months with psoriatic arthritis.11 “Getting ahead of their arthritis is going to be really important,” Dr. Haque shared. “I’ve seen plenty of my patients lose control of their hands [or have] multiple replacements of joints.”


Take control of your skin and your health. Watch the video to hear Dr. Haque’s tips for talking with your doctor about your psoriasis treatment.

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ABBV-US-01467-MC v1.0 January 2024

References
  1. Delzell E. Psoriatic disease affects more than skin and joints. National Psoriasis Foundation. February 3, 2021. Accessed October 30, 2023.
  2. Bilyj B. Treating skin of color. National Psoriasis Foundation. April 9, 2018. Updated June 17, 2020. Accessed October 30, 2023.
  3. Stringer T. Ease psoriasis symptoms with new biologic and topical treatments. MedStar Health. August 16, 2023. Accessed October 30, 2023.
  4. Markiewicz E, Karaman-Jurukovska N, Mammone T, Idowu OC. Post-inflammatory hyperpigmentation in dark skin: molecular mechanism and skincare implications. Clin Cosmet Investig Dermatol. 2022;15:2555-2565. doi:10.2147/CCID.S385162
  5. Kaus J. Seeing spots? treating hyperpigmentation. July 19, 2021. Accessed October 30, 2023.
  6. Nathan N, Manstein D. Tinted sunscreens: benefits beyond an attractive glow. Harvard Health Publishing. July 13, 2020. Accessed October 31, 2023.
  7. 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
  8. 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
  9. Does treating psoriasis reduce the risk of heart disease and stroke? American Academy of Dermatology. Accessed October 4, 2023.
  10. Rosenthal YS, Schwartz N, Sagy I, Pavlovsky L. Incidence of psoriatic arthritis among patients receiving biologic treatments for psoriasis: a nested case-control study. Arthritis Rheumatol. 2022;74(2):237-243. doi:10.1002/art.41946
  11. 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
    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.
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