Information presented at American Academy of Dermatology’s 70th Annual Meeting by Joel M. Gelfand, MD, MSCE, FAAD, assistant professor of dermatology and epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia.
Psoriasis is a chronic skin condition characterized by raised, red, scaly, plaques that can itch, crack and bleed. Psoriasis can be localized and affect only limited areas of the skin, such as the scalp or elbows, or it can involve the skin on the entire body. The condition can be painful, disfiguring and disabling. It is believed to occur due to an interaction of multiple genes, the immune system and the environment.
Research has shown that excessive inflammation is a critical feature of psoriasis. Because chronic inflammation also is a characteristic of insulin resistance, obesity, abnormal cholesterol levels and cardiovascular disease, emerging studies have linked these serious medical conditions with psoriasis. As a result, it is important for psoriasis patients--particularly those with severe cases--to monitor their health very closely for signs of these diseases.
Studies establish link to serious medical conditions
Cholesterol concerns. Studies using innovative techniques to evaluate cholesterol composition and function have shown that psoriasis patients have LDL (or “bad”) cholesterol that consists of smaller and denser cholesterol particles, a pattern observed in patients with diabetes. These smaller and denser particles are more likely to promote hardening of the arteries and cause heart attacks. Gelfand added that for the first time it has been demonstrated that psoriasis patients also have impaired function of HDL (or “good”) cholesterol, which may not allow HDL to remove cholesterol from the cells in the arteries.
Metabolic syndrome concerns. Studies involving more than 4,000 patients with psoriasis have shown that the more body surface area of skin that is affected by psoriasis, the higher the likelihood that the patient will have metabolic syndrome--a group of cardiovascular risk factors of obesity, hypertension, insulin resistance and increased triglycerides. Gelfand explained that this study suggested a “dose-response” effect of psoriasis, whereby increasing skin disease severity was more strongly associated with these potentially serious metabolic disorders.
Cardiovascular disease concerns. One study found patients with severe psoriasis may die about five years younger than patients who do not have the disease, and 50% of this excess mortality is due to cardiovascular disease. More studies have linked more severe cases of psoriasis to higher rates of major cardiovascular events, such as heart attacks.
Tips for clients with psoriasis
- Eat a healthy balanced diet.
- Lead an active lifestyle.
- Avoid smoking.
- Limit alcohol consumption.
- Maintain an ideal body weight.
- Reduce stress.
- Get routine screenings for cardiovascular risk factors, including blood pressure, blood sugar and cholesterol.
Academy expert advice
“Future research is necessary to better determine how skin disease severity affects the risk of developing insulin resistance, obesity, abnormal cholesterol levels and cardiovascular disease, and whether successful treatment of psoriasis alters these risks,” says Gelfand.
A rigorous multicenter clinical trial, funded by the National Heart, Lung and Blood Institute, is planned to determine if treatment of psoriasis improves arterial inflammation, cholesterol function and metabolic disease – a critical step necessary to evaluate whether successfully controlling psoriasis will lead to a lower risk of cardiovascular disease and mortality.
According to published research on psoriasis:
- Psoriasis is a common disease that affects more than 7 million Americans, yet as many as 3 million of these have active psoriasis but have never been diagnosed with the condition by a health care professional.
- Although psoriasis can begin at any age, it typically starts in the 20s and 30s.
- Approximately 20% of patients have such severe psoriasis that topical creams and ointments alone are not enough to control the disease.
- Approximately 40% of patients with psoriasis have a family history of the disease.
- Psoriatic arthritis occurs in about 10% of psoriasis patients and in as many as 30-40% of patients with extensive, severe skin disease.