Beyond the Skin: Understanding Psoriasis and Its Associated Comorbidities

January 24, 2024

plaques on the arm of a patient with psoriasis comorbidities

While the effects of psoriasis are seen most clearly on the surface of the skin, this condition is more than skin-deep. According to Dr. Sam Awan of U.S. Dermatology Partners in McKinney, Texas, “When people talk about psoriasis, they typically focus on the thickened skin plaques, the flakiness, dryness, itching, pain, and irritation associated with flare-ups of this condition. It’s important to address these painful symptoms as they arise, but managing psoriasis requires a treatment plan to prevent and address the effects of this condition, as well as the comorbidities that are common for those who struggle with psoriasis. Unless psoriasis and its comorbidities are treated simultaneously, people are likely to continue struggling with flare-ups and severe symptoms.” In this blog, Dr. Awan talks through common comorbidities associated with psoriasis and the ways to manage all comorbidities effectively.

Depression: A Common Comorbidity

According to the National Psoriasis Foundation, depression is one of the leading comorbidities associated with psoriasis. The pain and discomfort of the condition, worry about appearance, and feelings of isolation can all lead to an increase in depression symptoms and a more pronounced link between psoriasis and mental health. According to Dr. Awan, “When trying to manage the physical effects of psoriasis, many people assume their emotional and mental health struggles will improve if these external symptoms improve. In some cases, that’s true, but seeking support for mental health struggles can make it easier to navigate all aspects of psoriasis treatment while leading a healthy and satisfying life each day.”

Triggers for Psoriasis Flares

One of the first steps most dermatologists recommend for people who are diagnosed with psoriasis is to keep a journal of their symptoms that notes things like foods eaten, weather, any changes in skin care, and other factors. Dr. Awan says, “Every person’s triggers are different, so they’re not always clear to your dermatologist right away. Taking a few notes about your skin health and potential psoriasis triggers each day is the easiest way to notice patterns and pinpoint individual triggers, so you can work with your dermatologist to address them.” While everyone has different triggers, some of the most common include:

  • Infections
  • Medications, including beta-blockers and anti-malarial drugs
  • Skin injuries
  • Other chronic or inflammatory skin conditions
  • High levels of stress, especially prolonged stress
  • Cold, dry weather
  • Hormonal shifts
  • Smoking
  • Excessive alcohol consumption

Psoriasis and Autoimmune Disorders

Psoriasis itself is considered an immune-mediated disorder. According to Dr. Awan, “Psoriasis is a condition of system-wide inflammation. We don’t fully understand why each individual develops psoriasis – it’s likely a mix of many internal and external factors coming together – but the end result is an immune system that’s overactive. These immune pathways working in overdrive lead to inflammation throughout the body, which most commonly shows up as redness, scaling, and thickened skin. It’s important to keep in mind that the inflammation may show up in other places, with the most common being the joints.” It’s estimated that about 1 in 3 psoriasis patients will develop psoriatic arthritis. Make sure to talk to your dermatologist if you have symptoms of joint pain, swelling, or lower back stiffness, especially when waking in the morning. Your dermatologist may often involve a joint specialist (rheumatologist) to co-manage psoriatic arthritis.

Inflammatory Conditions Linked to Psoriasis

Like rheumatoid and psoriatic arthritis, psoriasis is both an immune and inflammatory disease, and it’s closely linked to other inflammatory conditions, including:

  • Inflammatory bowel disease (IBD) – this condition includes both Crohn’s disease and ulcerative colitis (UC). This relationship is considered bidirectional; patients with psoriasis may be at higher risk of IBD and vice-versa. Symptoms include abdominal cramping, changes in bowel movements, and blood in the stool.
  • Multiple sclerosis (MS) –People with MS, especially those who receive disease-modifying therapies, are significantly more likely to develop psoriasis, according to research presented at the 2021 Consortium of Multiple Sclerosis Centers.
  • Cardiovascular disease – multiple studies have indicated psoriasis patients are at an elevated risk for cardiovascular diseases such as heart attack and stroke. Managing precursors such as diabetes or high cholesterol is of paramount importance. Focusing on nutrition and maintaining a healthy weight can help psoriasis and decrease the likelihood of developing cardiovascular disease.

Managing Psoriasis Comorbidities

When it comes to managing psoriasis comorbidities, Dr. Awan says, “We take a global approach to psoriasis treatment with our patients. That starts with a complete medical and health history followed by a discussion of all current and past psoriasis symptoms and the development of a care plan. Our goal is to address all symptoms and treat psoriasis and comorbidities. In many cases, that means referring patients to rheumatologists, dieticians, and other specialists to ensure overall health and wellness.”

Diverse Treatments for Psoriasis

“We’re currently in a golden era for psoriasis treatments,” says Dr. Awan. “Thirty years ago, treatments were limited to crude methods such as tar, topical steroids, and medications with significant risks. Today, we have a vast number of treatment options that can help us customize treatment plans for our patients. We have several non-steroid topical creams, two oral medications, phototherapy, and for our most severe patients, injections with excellent safety profiles and high success rates.”

Talk to a Professional Today

Dealing with psoriasis and its comorbidities? Reach out to healthcare professionals at U.S. Dermatology Partners for tailored advice and effective management strategies. We make getting started with our team quick and easy. Simply take a few moments to complete our online scheduling request form. Once we hear from you, our team will be in touch to finalize the details of your upcoming visit.

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