Health Problems in Psoriasis (Comorbidities)

-In the US comorbidities in Psoriasis cost 4920 USD per patient per year. For the whole US psoriasis population, this amounts to 36.4 billion USD
-This represents up to a third of psoriasis health cost (27-33%)

Health problems associated with Psoriasis.
-It is known that psoriasis is associated with metabolic syndrome (cardiometabolic disease).

Below are the associated conditions (in CAPITAL LETTERS with a few associated facts):

-CARDIOVASCULAR DISEASE/INCREASED MORTALITY link to Psoriasis and Cardiovascular Problems: HERE.

• In addition to this let’s add that dermatologists need to do the screening as Primary Care Physicians (PCP, GP) and Cardiologists don’t do the screening in psoriasis patients

-OBESITY/METABOLIC SYNDROME . (Diabetes…)

• Is reaching epidemic proportions in the United States.
• Indeed a third of the population has a Body Mass Index over 30 (30 and higher fits the definition of Obesity)
• The National average is 27.5 (a BMI between 25 and 30 fits the definition of “overweight”)
• Reminder BMI is calculated by dividing the weight (in Kg) / height x height (in meters)

-PSORIATRIC ARTHRITIS (PsA)

• 40 to 60% of psoriasis patients develop erosive arthropathy
• early diagnosis is critical and because of delayed diagnosis, 50% develop irreversible joint damage

-OTHER AUTOIMMUNE DISEASES

-SKIN CANCER/LYMPHOMA

• There is a 4 fold increased risk ok keratinocyte carcinoma (KC, previously called NMSC). KC=Squamous Cell Carcinoma (SCC) and Basal Cell Carcinoma (BCC)
• There is a 3 fold increased risk of lymphoma in mild psoriasis. The relative risk increases to 8 if psoriasis is severe.

-NONALCOHOLIC FATTY LIVER DISEASE (NAFLLD)

• NAFLDS affects 30% of the US population. In 3-10% of cases this develops into non-alcoholic steatohepatitis (NASH): this leads to cirrhosis and liver failure, inflammation, scarring
• Psoriasis patients are more at risk for NASH and have a higher incidence of NAFLD than controls (47% vs 28%)

-PSYCHIATRIC DISEASES

• Depression
  • Compared to Controls Psoriasis patients have a 1.39 fold relative risk
  • In severe psoriasis, this rises to 1.72
  • When severe depression is present in psoriasis there is a 2-fold increased odds of Cardiovascular events. 16.5% of depressed psoriasis patients have Cardiovascular problems (prevalence)
  • 3 theories explaining depression:
    • Cytokines activate the H-­‐P-­‐A system ((Hypothalamic–pituitary–adrenal axis)). This leads to excess cortisol levels
    • Cytokines stimulate serotonin uptake by activating neuronal serotonin transporters, leads to decreased serotonin
    • Cytokines stimulate indoleamine2,3-­‐dioxygenase, leads to tryptophan depletion
• For anxiety and Suicide the relative risk is 1.31 and 1.44 respectively

-COPD

-SLEEP APNEA

-VITAMIN D DEFICIENCY

-PREGNANCY COMPLICATIONS

U003 – Comorbidities in Psoriasis: What a Dermatologist Needs to Know. AAD 2016 – Washington DC, United States USA