More Than Skin Deep: 5 Psoriasis-Related Conditions

The outside of a house often has clues that suggest what’s going on inside. If you see a window-mounted air conditioning unit, the home likely doesn’t have central AC. If smoke is coming from the chimney, there’s a wood-burning fireplace inside.

It can be the same with the human body. Swollen ankles can be a sign of fluid retention. Yellowing skin suggests a liver problem. Psoriasis — a skin condition characterized by red, scaly plaques — indicates that you have widespread inflammation. But that inflammation can affect more than just your skin.

“The skin is a window into the body, and it tells us what’s going on,” says Dr. Kara Braudis, an MU Health Care dermatologist. People living with psoriasis are in a proinflammatory state. Their immune system is hyperactive and easily triggered to release inflammatory signals. “That excess inflammation can affect every system in the body, and there are several chronic diseases that are more likely to develop if you have psoriasis.”

Connection Between Psoriasis and Other Chronic Conditions

Inflammation is part of your body’s natural immune response. But if your body maintains a high level of inflammation for a long time, it can cause damage and lead to the development of inflammatory diseases.

Psoriasis is an inflammatory disease. It does not necessarily cause other chronic diseases, but it does suggest an excess of inflammation.

“It’s not exactly a ‘chicken-or-the-egg’ scenario,” Dr. Braudis says. “Psoriasis tells us that there’s inflammation happening in the body. While that circulating inflammation may or may not lead to a chronic disease, it can increase your risk.”

Experts are still trying to fully understand the link between psoriasis and other inflammatory diseases. But Dr. Braudis says there are established connections with certain chronic diseases, including:

Psoriatic Arthritis

Arthritis is typically categorized as degenerative (normal wear-and-tear breaks down joint cartilage) or inflammatory (inflammation causes joint pain and destruction). Psoriatic arthritis is an inflammatory arthritis.

Joint disease occurs in up to 30% of patients with psoriasis and is considered a common comorbidity. However, psoriasis and psoriatic arthritis do not have a one-to-one association.

“We see patients with severe psoriasis who have no joint disease,” Dr. Braudis says. “Other people may have very little psoriasis, but their psoriatic arthritis is so bad that we treat their psoriasis to help reduce the inflammation.”

It’s also possible that your joints may ache due to circulating inflammation, even if you don’t have visible inflammation in the joint. Dr. Braudis says there are a couple of very specific symptoms that signal that your joint pain may be psoriatic arthritis:

• Dactylitis, which is having one or more red, fully swollen digits (finger or toe)
• Enthesitis, which is painful inflammation where your tendons attach, commonly on the bottom of the foot or at the Achilles tendon

“You may have one of these tell-tale symptoms of psoriatic arthritis and not realize what it is,” Dr. Braudis says. “But knowing that you have psoriatic arthritis may be a reason to treat your psoriasis, even if your psoriasis isn’t bothersome.”

Heart Disease

According to the National Psoriasis Foundation, psoriasis can double your risk of cardiovascular disease. The risk is greatest in patients with severe psoriasis and psoriatic arthritis. Over time, systemic inflammation affects the heart and blood vessels.

“There is literature suggesting that patients with psoriasis who have heart disease should be treated aggressively,” Dr. Braudis says. “The goal is to break that cycle of inflammation that is causing cardiovascular symptoms and disease.”

Metabolic Syndrome

Metabolic syndrome is a group of conditions in combination that increase your risk of heart disease, stroke and Type 2 diabetes. A diagnosis of metabolic syndrome means you have three or more of the following:

• High blood pressure
• High blood sugar levels
• High blood triglycerides
• Large waistline
• Low HDL (good) cholesterol

Approximately 20% to 50% of people with psoriasis also have metabolic syndrome — the risk may increase with the severity of psoriasis. Researchers believe that metabolic syndrome and psoriasis may share overlapping genetic predispositions and the same type of inflammatory pathway.

Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is an umbrella term for a group of chronic conditions that involve inflammation in the gastrointestinal (GI) tract. Psoriasis is known to co-cluster with IBD and specifically increases the risk of Crohn’s disease and ulcerative colitis.

“We know that the microbiome of the skin and the gut are intimately connected — they are lined by the same protective layer of tissue,” Dr. Braudis says. “While there is still a lot of ongoing research in this area, we have drugs approved for both indications. That means you can take one drug and treat both conditions.”

Depression

It may not seem like it, but psoriasis and depression have a lot in common. They are both typically associated with:

• Inflammation
• Genetic connection
• Low melatonin
• Low vitamin D3

“The association between psoriasis and depression is well-known,” Dr. Braudis says. “And it’s more complicated than simply feeling self-conscious and depressed because of the way your skin looks or feels. We think the inflammatory mediators present in your blood may alter the chemical makeup and activities of your nervous system.”

The good news is that research shows that treating psoriasis can improve the symptoms of depression and your overall mental health.

Identifying Risk When You Have Psoriasis

Approximately 600,000 adults in the United States have undiagnosed psoriasis. Many who are diagnosed don’t seek medical treatment. Taking time to understand how psoriasis can impact your risk for other chronic diseases may affect your treatment decisions.

For example, having a personal or family history of an associated condition like psoriatic arthritis may change the way you manage psoriasis. It could be a reason to opt for systemic treatment — which can reduce circulating inflammation — instead of topical treatment.

“Sometimes the comorbidity drives the need for aggressive treatment of psoriasis,” Dr. Braudis says. “The inflammation that’s happening can cause irreversible damage.”

To get a better understanding of the risks associated with psoriasis, speak with your doctor. They can provide the best assessment of your condition and the implications for your health risks.

“You never really know something is relevant or meaningful until it’s part of the conversation,” Dr. Braudis says. “Having a clear picture of your health is always worth a discussion.”

Next Steps and Useful Resources

• Want to discuss more with a dermatologist? Find one today.