Monday, August 28, 2017

Psoriasis: More Than Skin Deep

Contributing Author: Alice Krueger

Visibly, psoriasis is an itchy skin condition with sore red patches of thickened dry skin, called plaques. These plaques occur most often on the scalp, face, elbows, palms, back, knees and feet. Psoriasis is an autoimmune disease in which the patient’s body attacks healthy skin cells, causing inflammation that leads to changes in skin structure and function.

Psoriasis is an unpredictable condition. Some people have remissions lasting several months without symptoms. Flares of increased symptoms seem to happen without warning and can be any severity level. Flares can be caused by stress, cold weather, dry skin, colds and respiratory infections, and smoking.

There is no known cure for psoriasis; treatment is symptomatic, striving to slow down the growth of skin cells. Topical treatments are the first intervention to be prescribed. These can be over-the-counter items (lotions containing salicylic acid or coal tar to cause skin shedding, or lotions containing aloe vera or jojoba to moisturize the skin) or by prescription. Nonsteroidal topical prescriptions containing synthetic vitamin A or D3 slow the production of skin cells. Corticosteroid prescriptions can thin the skin.

Biologic drugs for psoriasis are derived from live cell cultures and are administered by injection or IV. They block the action of the immune system that is overactive and misdirected in psoriasis. Phototherapy focuses UV or laser light on affected skin areas. Systemic medications, usually reserved for people with moderate or severe psoriasis, are taken in pill form or by injection. They work throughout the body, not just at the site of the psoriasis.

Psoriasis is associated with common symptoms of emotional distress, including sleep disorders and general anxiety 1. This indicates a lowered quality of life. The National Psoriasis Foundation states that 24% of people with psoriasis also have depression 2, which can lead to numerous other health and wellness issues. Young adults with psoriasis are at increased risk for suicide 3, especially if it causes them significant emotional distress, impairs their daily activities, causes them to have a negative body image or creates difficulty in establishing or maintaining close relationships.

Other serious health issues may be related to psoriasis. Although it is not clear which is cause and which is effect, metabolic syndrome is found in 40% of persons with psoriasis 4 while only 21% of the general population has this set of health problems. Metabolic syndrome is indicated by high blood pressure, high triglycerides, low HDL (“good”) cholesterol, high blood sugar, and too much fat around the waist. The increased risk of persons with psoriasis having metabolic syndrome may explain their increased risk for cardiovascular disease, obesity, and cancer.

The link between psoriasis and cardiovascular disease seems to lie in the inflammatory response 5. Inflammation can damage blood vessels, resulting in the formation of plaques (not the same kind as psoriasis plaques) in arteries leading to the heart. This can result in heart attacks or strokes.

People with psoriasis whose treatment included biological agents or methotrexate had lower rates of cardiovascular disease than did those with other treatment regimens 6. This might be due to systemic treatments reducing proteins that signal inflammation.

The direction of the relationship between obesity and psoriasis is unclear, and there is little evidence that diet affects psoriasis. However, a study showed that obesity increases both the risk of getting cardiovascular disease and of having psoriasis 7. Therefore it is doubly important to eat a healthy diet if you have psoriasis.

A study in the UK found an increased risk for psoriasis patients to get lymphoma, non-melanoma skin cancer and other cancers 8. The cancer risk seemed highest for those who received systemic treatments (e.g., phototherapy or methotrexate). It is important for persons with psoriasis to avoid risk behaviors that can lead to cancers, including smoking, excessive sun exposure, and alcohol abuse.

If you have psoriasis, it is wise to keep up with regular screenings for other health conditions, including depression. Ask your dermatologist to help you create a preventive program based on your medical history and additional risk factors.

To learn more about psoriasis during the month of August, visit the exhibit on Healthinfo Island in Second Life (SLURL: ).


  1. Pärna, E., Aluoja, A. & Kingo, K. (2015). Quality of life and emotional state in chronic skin disease. Acta Dermato-Venereologica, 95(3), 312-316.
  2. Kimball, A. B., Gladman, D., Gelfand, J. M., Gordon, K., Horn, E. J., Korman, N. J., et al. (2008). National Psoriasis Foundation clinical consensus on psoriasis co-morbidities and recommendations for screening. Journal of the American Academy of Dermatology, 58(6), 1031-1042.
  3. Picardi, A., Lega, I. & Tarolla, E. (2013). Suicide risk in skin disorders. Clinics in Dermatology, 31(1), 47-56.
  4. Love, T. J., Qureshi, A. A., Karlson, E. W., et al. (2011). Prevalence of the metabolic syndrome in psoriasis: Results from the National Health and Nutrition Examination Survey, 2003-2006. JAMA Dermatology, 147(4), 419-424.
  5. Gu, W.-J., Weng, C.-L., Zhao, Y.-T., Liu, Q.-H. & Yin, R.-X. (2013). Psoriasis and risk of cardiovascular disease: A meta-analysis of cohort studies. International Journal of Cardiology, 168(5), 4992–4996.
  6. Aheloff, O., Skov, L., Gislason, G., Lindhardsen, J., Kristensen, S. L., Iversen, L., et al. (2012). Cardiovascular disease event rates in patients with severe psoriasis treated with systemic anti-inflammatory drugs: A Danish real-world cohort study. Journal of Internal Medicine, 273(2), 197-204.
  7. Carrascosa, J. M., Rocamora, V., Fernandez-Torres, R. M., Jimenez-Puya, R., Moreno, J. C., Coll-Puigserver, N., et al. (2014). Obesity and psoriasis: Inflammatory nature of obesity, relationship between psoriasis and obesity, and therapeutic implications (in Spanish). Actas Dermo-Sifiliográficas, 105(1), 31-44.
  8. Fuxench, Z. C. C., Shin, D. B., Beatty, A. O. & Gelfand, J. M. (2016). The risk of cancer in patients with psoriasis: A population-based cohort study in the Health Improvement Network. JAMA Dermatology, 152(3), 282-290.

Image Credit: Wikimedia Commons

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