Our Blog

Psoriasis: It’s More Than Just Skin Deep

Posted on October 24, 2017

By Sarah Churton, MD, FAAD

Psoriasis is a chronic, immune-mediated, systemic inflammatory disorder. The immune system sends faulty signals that cause cell turnover to speed up, resulting in red, itchy, scaly, raised plaques on the skin. Psoriasis affects as many as 7.5 million Americans. The exact cause of psoriasis is unknown, but there are genetic and environmental influences that play a role. An environmental insult can trigger the immune system to release inflammatory cytokines resulting in psoriasis in those with a genetic predisposition. Triggers include stress, injury to the skin, weather, infections, certain medications, alcohol, smoking, and obesity. Psoriasis can appear on any part of the body, but common locations include the scalp, elbows, knees, buttocks, hands, feet, and nails. Psoriasis is not contagious. It can develop at any age but often starts between ages 15-35. Psoriasis can run in families, but many people do not have a family history of psoriasis when they are diagnosed.

Beyond the Skin
Nearly one third of people with psoriasis develop psoriatic arthritis which causes joint pain, stiffness, and swelling. Having psoriasis increases the risk for developing multiple other serious medical conditions, called comorbidities (1). Some of these conditions are listed below:

• Atherosclerosis (hardening of the arteries)
• Heart attack
• Stroke
• High blood pressure
• High cholesterol
• Diabetes and Metabolic syndrome
• Fatty liver disease
• Obesity
• Cancer
• Chronic pulmonary disease
• Depression and Anxiety
• Alcoholism

It has been proposed that overlapping mechanisms of systemic inflammation contribute to the link between psoriasis and cardiovascular disease. Those with severe psoriasis have a higher risk of comorbidities, such as cardiovascular disease-related conditions. Research shows that even pediatric patients with psoriasis have an increased risk of cardiovascular comorbidities including obesity, high blood pressure, and diabetes. Recent evidence suggests that some psoriasis treatments improve cardiovascular risk (2). Because of the possibility of developing comorbidities associated with psoriasis, I recommended that people with psoriasis see a dermatologist for skin exams as well as their primary care physician for regular physicals. Patients with psoriasis who have joint pain may be referred to a rheumatologist to evaluate for psoriatic arthritis.Psoriasis and

Quality of Life
Psoriasis can have a negative impact on personal and health-related quality of life. Physically, psoriasis can be itchy and uncomfortable, and mentally, psoriasis can impact people socially and psychologically. Psoriasis patients are over 1.5 times as likely to develop depression and have a higher risk of anxiety. Reaching out to a mental health professional is important for anyone who is feeling depressed or hopeless.

Dietary and Lifestyle Modifications
Some studies have shown that losing weight may help improve psoriasis symptoms. Excess abdominal fat causes inflammation that is similar to the inflammation in psoriasis and several studies have shown a correlation between body mass index and psoriasis severity. Losing weight may also increase the effectiveness of some psoriasis medications. Studies on elimination diets and dietary supplementation for the treatment of psoriasis have provided conflicting results. Psoriasis is an inflammatory disease, so following an anti-inflammatory diet could reduce symptoms of psoriasis. A gluten-free diet can help in patients with psoriasis who also have celiac disease. With the increased risk of cardiovascular disease and metabolic syndrome, patients with psoriasis should strive to follow a healthy diet.

Psoriasis Treatments
There is no cure for psoriasis, but there are many different treatment options. Treatments include topical medications, phototherapy, systemic medications, and biologics. New therapies have been approved in the past few years and there are more medications currently being studied for psoriasis and psoriatic arthritis. Biologic medications are derived from proteins and work by blocking immune cell interactions. Biologics can be infused or injected in the home or office, depending on which treatment is chosen. Treatment regimens are individualized for each patient depending on the severity of psoriasis and one’s other medications and medical conditions. When working closely with a dermatologist, it is possible to control the symptoms of psoriasis and psoriatic arthritis. Treating your psoriasis, living a healthy lifestyle, and being aware of the comorbidities associated with psoriasis can lead to a better quality of life.

You can learn more about psoriasis by scheduling an appointment at The Woodruff Institute.

Dr. Churton specializes in psoriasis and completed a 3-year Psoriasis Research Fellowship at Case Western Reserve University at University Hospitals Cleveland Medical Center. During her research fellowship, she studied the correlation between psoriasis and cardiovascular disease and was an investigator in multiple clinical trials for psoriasis.

References
1. Churton, Sarah E.; Doud, Kristen; Korman, Neil J. Comorbidities of psoriasis. Expert Review of Dermatology. 2013 Jun;8(3):277-290.
2. Churton, Sarah E.; Brown, Liza; Shin, Thuzar; Korman, Neil J. Does treatment of psoriasis reduce risk of cardiovascular disease? Drugs. 2014;74(2):169-182.