It has long been known that psoriasis, a chronic skin condition characterized by thick, red, scaly plaques that itch and bleed, can have a significant negative impact on a patient’s overall quality of life. Now, dermatologists are finding that psoriasis, especially severe psoriasis, is linked with a number of serious medical conditions – including cardiovascular disease, depression and cancer.
In the report entitled, “National Psoriasis Foundation clinical consensus on psoriasis comorbidities and recommendations for screening,” published online in the Journal of the American Academy of Dermatology, dermatologist Alexa B. Kimball, MD, MPH, FAAD, associate professor of dermatology at Harvard Medical School in Boston, Mass., led a task force of the National Psoriasis Foundation Medical Board that explored psoriasis co-morbidities. The group presented a summary of recently published research on the association between psoriasis and other medical conditions and recommendations on how dermatologists can help at-risk patients find appropriate preventative care or treatment.
“Our review found that people with more severe cases of psoriasis appear to have an increased incidence of psoriatic arthritis, cardiovascular disease, hypertension, diabetes, cancer, depression, obesity and even other immune-related conditions such as Crohn’s disease,” said Dr. Kimball. “I advise patients at minimum to follow the nationally recognized recommendations that are appropriate for their age and gender. These include getting regular, comprehensive exams from their doctors and working to make lifestyle changes such as losing weight, exercising more, quitting smoking, reducing high blood pressure, controlling cholesterol, maintaining emotional health, and managing diabetes as needed.”
Dr. Kimball noted that psoriasis has been associated with increased cardiovascular disease for decades. Initially, this was attributed to the increased prevalence of behavioral risk factors – such as obesity and smoking, which are thought to be linked to the psychosocial burden of psoriasis. However, two recent studies have enhanced dermatologists’ understanding of cardiovascular risk in psoriasis patients. “One large population-based study demonstrated an increased risk of myocardial infarction in patients with psoriasis – particularly those with severe cases of the disease – even when accounting for major cardiovascular risk factors, such as obesity, smoking, diabetes and hypertension,” explained Dr. Kimball. “Similarly, a small study of a well-defined population of patients with very severe psoriasis demonstrated that these patients had a higher frequency of coronary artery disease compared to a control group of patients, even when controlling for known risk factors for atherosclerosis. Taken together, these studies suggest that psoriasis itself may be a risk factor for developing atherosclerosis and myocardial infarction.”
Dr. Kimball advised psoriasis patients to follow the American Heart Association’s established recommendations for cardiovascular risk factor screening, which includes an evaluation of a patient’s blood pressure, body mass index, waist circumference, pulse, fasting serum lipoprotein (or total and HDL cholesterol), and fasting blood glucose.
Other factors that may increase the risk of cardiovascular disease include behavioral-driven risk factors such as obesity, smoking and depression. These risk factors can be modified by changes in lifestyle, including maintaining a healthy weight (often measured by Body Mass Index (BMI) < 25), physical activity for 30 minutes of moderate intensity several times a week and healthy eating habits. Dr. Kimball also recommended that psoriasis patients who smoke stop smoking.
Psoriasis has long been known to cause considerable emotional stress for patients, including a lack of self-esteem and an increased incidence of mood disorders, such as depression. One study estimates that approximately one-fourth (24 percent) of psoriasis patients suffer from depression.
“Depression in patients with psoriasis is a serious concern that should be addressed, as it may significantly impact a patient’s overall emotional and physical well being,” said Dr. Kimball. “Another concern is that depression may be a contributing factor to an increased risk of cardiovascular disease, which as we know is already an increased risk in psoriasis patients.”
A number of studies have found an increased risk of certain types of cancer in psoriasis patients, such as a form of skin cancer known as squamous cell carcinoma and lymphoma. In some instances, these cancers have been associated with specific psoriasis treatments which suppress the immune system. “Following the recommended routine health screenings for cancers and avoiding high-risk behaviors that increase the risk of developing some cancers, such as smoking, alcohol abuse, and intentional sun exposure, must be a high priority for psoriasis patients who may be at an increased risk for these potentially life-threatening diseases,” said Dr. Kimball.
Dr. Kimball and the task force urged psoriasis patients to work together with their dermatologists and other appropriate physicians to outline an appropriate preventative program based on the patient’s individual medical history and known risk factors to ensure they are continually monitoring for the potential onset of any health issues related to psoriasis. The authors hope that this review begins a dialogue on how to best diagnose, monitor, and treat the co-morbidities associated with psoriasis.
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