Psoriasis is a skin disease, but it can affect more than the skin. Not only are there complications that can arise during a flare, but the condition is also linked to several other health conditions, such as heart disease, inflammatory bowel disease, and psoriatic arthritis. The risks of developing these other conditions increase with the severity of your psoriasis, but everyone with psoriasis is at risk of developing comorbid conditions.
Emotional effects of psoriasis
The most common type of psoriasis is plaque psoriasis. Red, raised patches of skin appear most often on the scalp, knees, elbows, hands, and feet. The plaques can be extremely itchy and painful. They sometimes crack and bleed, which can lead to infection.
The fact that psoriasis is so visible can cause emotional distress; you might be self-conscious about your appearance or experience stigma to living with a skin condition. People might see your plaques and shy away, thinking that you are contagious. Some people might stare. The constant scrutiny and embarrassment can lead you to withdraw from social activities or isolate yourself from friends and family. Every day can be filled with anxiety and stress. Those with psoriasis have a 39 percent increased risk of being diagnosed with depression and a 31 percent higher risk of being diagnosed with anxiety than people without the condition, according to the National Psoriasis Foundation.
The risk of psoriatic arthritis
Between 10 and 30 percent of people with psoriasis will develop psoriatic arthritis (PsA) according to the National Psoriasis Foundation. Symptoms of PsA include inflammation and tenderness and stiffness of the joints and connective tissue. This can be very painful. Those with psoriatic arthritis may also experience swelling of the fingers and changes in the nails. It can occur in the fingers, toes, neck, lower back, knees, and ankles, although it is most common in the fingers and toes. It can be disabling and cause irreversible damage to joints. There is a better chance of preventing or slow joint damage when diagnosed early.
There is a high rate of metabolic syndrome in patients with psoriasis according to a study completed in 2016. The researchers speculate that chronic inflammation could be the cause of both. Metabolic syndrome includes obesity, elevated cholesterol, diabetes or insulin resistance, and hypertension. Those with psoriasis have a 40 percent chance of developing metabolic syndrome, as compared with 14 percent of the general population, according to the researchers. The severity of psoriasis symptoms is directly correlated with the higher risk of metabolic syndrome. Other findings from the research include:
Not only did those living with psoriasis have an increased prevalence of hypertension, but it is more difficult to control with medication. A previous study, published in PloS One in 2011, found that people with psoriasis needed more medications than those without psoriasis to control their blood pressure. High blood pressure increases your risk of heart attack or stroke.
Psoriasis puts you at an increased risk of cardiovascular disease, especially those who had severe psoriasis at an young age. The researchers believe it is possible that the inflammation that goes along with psoriasis contributes to the increased risk. If that is true, they indicate, then it would follow that decreasing inflammation would decrease the risk of heart disease. However, the FDA warns that the use of biologics for psoriasis can cause damage in those with severe heart failure, and this might outweigh any potential benefits
- Nonalcoholic steatohepatitis is the buildup of fatty tissue in the liver and is a consequence of obesity. It is associated with metabolic syndrome. The researchers found that 47 percent of people with psoriasis, when matched by gender, age, and BMI had signs of nonalcoholic steatohepatitis, as compared to 27 percent of those without the condition. It is more pronounced in those with severe psoriasis and those who were diagnosed at a young age. Per authors of the 2016 study: “We highlight the importance of the inflammatory burden on the clinical outcome of patients, not only on the activity of the disease, but also on comorbidities. In this sense, systemic treatments, either classical or immunobiological, may have a fundamental role to effectively control the inflammatory burden on psoriatic patients, decreasing the chance of comorbidities, more specifically of metabolic syndrome.”
What you can do
When you have psoriasis, it's important to have regular check-ups with your doctor. Discuss potential complications and ask about early warning signs of those conditions you are most at risk for, such as accumulated fat around the waist and elevated blood pressure or blood sugar levels. In addition, discuss regular screenings, such as blood tests to check glucose levels. Treating associated conditions early can help minimize the health risks.