Psoriasis is more than just skin deep. If you have it, you are more at risk of developing comorbidities. These are health conditions that happen because you have psoriasis.
“People with psoriasis are at higher risk of conditions such as type 2 diabetes, cardiovascular events such as a heart attack or stroke, and early death,” says Joel Gelfand, MD, medical director of the Psoriasis and Phototherapy Treatment Center at the University of Pennsylvania in Philadelphia. He recently spoke about this topic as part of a panel on psoriasis and comorbidities at the 2024 Fall Clinical Dermatology Conference.
The good news is that there are many ways to reduce your risk of developing these conditions. If you have them already, there’s also a lot you can do to get them under control.
Here’s a closer look at why there’s a link and what you can do about it.
The Link Between Psoriasis and Comorbidities
People with psoriasis are at risk of getting other conditions. These include:
- Psoriatic arthritis
- Heart attack and stroke
- Depression and anxiety
- Type 2 diabetes
- Inflammatory bowel disease
- Obesity
- Metabolic syndrome
There are a few reasons why people with psoriasis are more likely to develop comorbidities. “Psoriasis is a disease caused by an overactive immune system,” Gelfand explains. “People with psoriasis overproduce certain inflammatory chemicals in their body, like IL-23. This leads to the inflammation that causes skin disease. But it probably causes inflammation in other parts of the body, as well.”
But there are more indirect reasons why, too. “If you have psoriasis, you may avoid exercise because it’s uncomfortable,” says Gelfand. “You gain weight, which then raises your risk of developing heart disease or diabetes.” You may also feel self-conscious about your psoriasis, which then leads to depression, he adds.
Despite these risk factors, many doctors don’t check for these conditions like they should. A 2023 study co-authored by Gelfand and published in the Journal of Investigative Dermatology found that less than 3% of psoriasis patients had their cholesterol checked, and less than 2% had their blood glucose levels tested to check for type 2 diabetes. “A lot of people don’t see their primary care provider regularly, which is part of the problem,” says Gelfand. “They may see their dermatologist, who doesn’t think to do these screenings.”
It’s important for psoriasis patients to make sure that their primary care doctor keeps in touch with their dermatologist, says Steven Feldman, MD, PhD, a professor of dermatology at the Wake Forest University School of Medicine in Winston-Salem, North Carolina. They can both screen for conditions such as psoriatic arthritis and depression. People with psoriasis should also get their blood pressure, cholesterol and blood glucose levels checked at least once a year. “I tell my patients to keep it in perspective,” he says. “People in their 20s who have severe psoriasis have a threefold increased risk of having a heart attack. But what patients also need to remember is that the baseline risk of a healthy 20 or 30 year old to have a heart attack is very, very small.”
Finding the Best Treatment With Comorbidities
People with psoriasis are often treated with drugs known as biologics. They target specific cells or proteins in your immune system that trigger psoriasis. Since they also treat inflammation, they may help to reduce your risk to develop many of these comorbidities, says Gelfand.
A 2020 study published in the journal Circulation: Cardiovascular Imaging found that psoriasis patients who were treated with a biologic also showed a significant reduction in the amount of cholesterol plaque in their arteries. “After a year, we saw a reduction of about 8% – the equivalent of what you’d see after you took a statin,” says study author Nehal Mehta, MD, chief of the Section of Inflammation and Cardiometabolic Diseases at the National Heart, Lung, and Blood Institute.
If you already have a comorbidity, you do need to be careful which biologic you do take, Gelfand cautions. “A patient with inflammatory bowel disease needs to avoid biologics that inhibit the protein IL-17, while a patient with heart failure should avoid a type of biologic known as a TNF-inhibitor,” he explains.
Dermatologists should also consider working closely with a preventative cardiologist, Gelfand adds. “Many dermatologists already collaborate with rheumatologists to manage psoriatic arthritis, but cardiovascular disease isn’t on their radar,” he says. “It’s a good idea for psoriasis patients to see a preventative cardiologist at least once if they have other risk factors for heart disease, like high blood pressure or being overweight.”
Weight Loss Drugs for Psoriasis?
The panel also talked about the potential use of GLP-1 agonists in psoriasis patients. These drugs are a class of medications that help to manage high blood glucose levels in people with type 2 diabetes as well as treat obesity.
A 2024 review published in the Journal der Deutsche Dermatologische Gesellschaft found that GLP-1 agonists significantly improved symptoms of all psoriasis patients, even those who didn’t have type 2 diabetes. But there need to be larger, better studies to know for sure, says Gelfand. “There’s a little bit of research, but not enough to hang your hat on,” he stresses.
Mehta agrees. “For years, we’ve known that lifestyle measures like weight loss can help psoriasis,” he says. “But GLP-1 agonists are expensive, and we don’t know for sure yet if they work in all patients with psoriasis or just patients who are already obese or have type 2 diabetes.”
The better step, he advises, is for all patients with psoriasis to follow a heart-healthy diet that’s rich in fruits, vegetables, whole grains, and healthy proteins like legumes, nuts, fish, seafood, and low-fat dairy. Exercise for at least 150 minutes a week. If these two steps aren’t enough to keep your blood pressure, cholesterol, and blood glucose levels in check, then he recommends that you talk to your doctor about medications such as statins.
“There are three B's when it comes to patients with psoriasis: BMI, blood pressure, and bloodwork to check cholesterol and glucose levels,” he explains. “If you’re able to get all three under control, then you’ll have done a lot to reduce your risk of comorbidities such as heart disease.”
Show Sources
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SOURCES:
Fall Clinical Dermatology Conference, Las Vegas, Nevada, October 24-27, 2024: “CME Satellite Symposium: The Comorbidities of Psoriasis: What Clinicians Need to Know to Optimize Care.”
Joel Gelfand, MD, medical director, Psoriasis and Phototherapy Treatment Center, University of Pennsylvania, Philadelphia.
Steven Feldman, MD, PhD, professor of dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
Nehal Mehta, MD, chief, Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute.
National Psoriasis Foundation: “Related Conditions of Psoriasis.”
National Institute of Arthritis and Musculoskeletal Diseases: “Psoriasis Types, Symptoms and Causes.”
Journal of Investigative Dermatology: “Regional Variation in Cardiovascular Risk Factor Screening by Dermatologists for Psoriasis Patients in the United States.”
Journal of the American College of Cardiology: “Cardiovascular Risk in Patients with Psoriasis: JACC Review Topic of the Week.”
Circulation: Cardiovascular Imaging: “Treatment of Psoriasis With Biologic Therapy Is Associated With Improvement of Coronary Artery Plaque Lipid-Rich Necrotic Core.”
BioDrugs: “Biologic and Small-Molecule Therapies for Moderate-to-Severe Psoriasis: Focus on Psoriasis Comorbidities.”
Journal der Deutschen Dermatologischen Gesellschaft: “Efficacy of Glucagon-Like Peptide-1 Receptor Agonists for Psoriasis: An Updated Systematic Review and Meta-Analysis.”
American Heart Association: “The American Heart Association Diet and Lifestyle Recommendations.”
