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9 Psoriasis Complications to Watch for After a Diagnosis

Self logo Self 10/22/2021 Sara Gaynes Levy

Being diagnosed with a chronic condition like psoriasis may feel overwhelming. There’s no cure for psoriasis—which causes inflammation as well as itchy, scaly patches known as plaques1 to develop on various parts of the body—but there are treatments that can help you keep your symptoms under control. Sometimes that can be challenging and finding the best medication for you may take a bit of trial and error.

With that, people with psoriasis also have to contend with the fact that they have a higher risk for a whole host of other health conditions. While people might think of these conditions as psoriasis complications, they are actually considered related conditions in the medical community. “We’ve done lots of studies2 now to show that a person with moderate to severe psoriasis—meaning more than 10% of their body surface area is affected with psoriasis—does have a higher risk of comorbidities,” Alan Menter3, M.D., chairman of the division of dermatology program at Baylor University Medical Center in Dallas, tells SELF.

Understanding the specific conditions that you may be at most risk for developing can help both you and your care team stay on top of monitoring your overall health. Here are some of the most common conditions you may want to watch for.

Autoimmune diseases | Psoriatic arthritis | Cardiovascular disease | Depression | Anxiety | Parkinson’s disease | Metabolic syndrome | Eye diseases | Type 2 diabetes | Untreated psoriasis| Psoriasis treatment 

Autoimmune diseases

When you have an autoimmune disease, like psoriasis, your immune system goes a bit haywire and mistakenly attacks healthy cells4, often setting off mysterious symptoms before you get to the bottom of it. There are more than 80 autoimmune conditions that impact different parts of the body, including everything from multiple sclerosis to arthritis to celiac disease to type 1 diabetes4.

And some of these diseases are more likely to affect people who already have psoriasis. For example, Crohn’s disease and ulcerative colitis, both autoimmune conditions that affect the gastrointestinal tract, are more common in people with psoriasis compared to those without it. However, researchers don’t know why this happens, and with many of these conditions, it is impossible to say which came first or if one caused another.

“There’s no specific answer to the ‘chicken-and-egg’ question,” Shivani Kaushik5, M.D., an assistant professor at the Rutgers Center for Dermatology, tells SELF. One possible theory, according to Dr. Kaushik, is that many autoimmune conditions, including psoriasis, Crohn’s disease, and ulcerative colitis, may be linked because they all cause inflammation in the body. “For many patients who have extensive psoriasis, there is no doubt that they have inflammation going on inside as well,” she says, as opposed to the inflammation you only see on the outside of the skin.

There is no surefire way to avoid developing multiple autoimmune disorders, but keeping your psoriasis in check by regularly taking your medications, such as biologics to target the immune system directly, and getting in touch with your doctor if you have new or worsening flare-ups can help you create a plan to keep inflammation under control.

Psoriatic arthritis

Psoriatic arthritis (PsA), while technically also an autoimmune condition6, has a more specific connection to psoriasis than other autoimmune diseases. Psoriatic arthritis most commonly shows up 7 to 10 years after the onset of psoriasis symptoms7, and happens when the immune system starts to attack healthy joints and/or tendons causing inflammation, pain, swelling and stiffness in the hands, knees, wrists, ankles and feet.

The two conditions are inextricably linked, but the connection isn’t totally clear to experts yet. Having psoriasis doesn’t necessarily cause psoriatic arthritis. Only about 20 to 30% of people with psoriasis are eventually diagnosed with psoriatic arthritis8 and a small number of people with psoriatic arthritis have no preexisting psoriasis symptoms9.

“We do know certain kinds of psoriasis patients tend to have higher chances of developing psoriatic arthritis,” including scalp psoriasis and inverse psoriasis, according to Samar Gupta11, M.D., an associate professor at the University of Michigan Medical School and the chief of VA clinical rheumatology and medical education.

So, it’s crucial to communicate any joint pain to your doctor if you have psoriasis, since early detection can help you start treatment sooner, which can help prevent psoriatic arthritis-related joint damage.

Cardiovascular disease

There’s a lot of research showing that chronic inflammation may cause fat and cholesterol buildup, called plaques, in your arteries12. Over time, and if you have a lot of buildup, plaques can burst and eventually lead to a stroke or heart attack. Reducing overall inflammation is really important when it comes to reducing your heart disease risk, Dr. Menter says, and one way you can do that is by controlling your psoriasis with medication.

It’s important to know that certain psoriasis treatments, including steroid hormones, retinoids, and some immunosuppressive drugs2, can create an imbalance in certain lipid levels, such as low-density lipoprotein cholesterol (LDL), high-density lipoprotein (HDL), and triglycerides13. Research shows that having more LDL cholesterol and triglycerides in your body makes it hard for your blood to get the oxygen it needs, which can ultimately raise your risk of cardiovascular disease.

If you’re using one of these medications, talk to your doctor about any risks you should know. Together you can determine whether you might need regular blood tests to monitor your numbers or if there are other ways you can minimize any possible side effects.

Depression

Being diagnosed with a chronic illness affects more than just your physical health. Dealing with the lifelong, visible, and painful symptoms that come along with psoriasis can have a profound effect on your mental health. “Most of the people who get diagnosed with psoriasis are younger than 40, which means they’ve got another 40 years to live with it,” explains Dr. Menter. “That can be psychologically incapacitating.”

It’s hard to pin down exact numbers, but 16.5% of individuals with psoriasis reported having symptoms that could be diagnosed as major depression, according to a 2016 study of 12,382 people published in JAMA Dermatology14. (This was compared to 8.9% of people who had the same symptoms but didn’t have psoriasis.)

There are two main ways that chronic conditions can affect your mental well-being, according to Lauren Selfridge15, L.M.F.T., a therapist in private practice in California. “One is the whole experience of living with it—dealing with the symptoms, dealing with doctors appointments, self-advocacy, how it can affect certain things they love doing—it’s just a lot of energy to manage all of that. And the other side of it is the social stigma,” she tells SELF. Even when they don’t mean to, people may treat you differently for having a chronic condition or say things that make you feel bad about yourself or your health.

That’s why it’s extremely important to prioritize your mental health if you have psoriasis (or any chronic illness, for that matter). “We don’t always think about therapy as something that could help us with navigating a health condition, but that’s not correct,” says Selfridge. “There are many therapists, including myself, who specialize in working with people with health conditions. People can actually get specific care for this. One common thing I hear from people is that they wish that when they were newly diagnosed, they had reached out for therapy.”

You can find more affordable options through resources like Open Path, a collective of practitioners who offer reduced-fee sessions, or the Anxiety and Depression Association of America website, which includes a database of therapists and support group options. When reaching out to therapists, it can be helpful to ask them a few questions before you commit, like if they experience working with people who have chronic conditions or if they have a particular stance on prescribing medications.

Anxiety

Psoriasis flare-ups can be unpredictable, and never knowing how you’ll feel on a given day can cause anxiety. About 2 to 23% of people with psoriasis report having anxiety compared to 1 to 11% among those without the condition, according to the aforementioned review of studies published in Seminars in Cutaneous Medicine and Surgery2.

Allowing yourself to take a break from always being productive if you need to rather than constantly trying to get through your to-do list can help when you’re feeling anxious. “Maybe you spend some time journaling. Maybe you spend some time talking with a trusted friend or a family member,” Selfridge suggests. “Or maybe you zone out and watch a movie or go for a walk or play a video game—do something that gives you that mental and emotional rest of not having to be constantly processing.”

In addition to therapy-based techniques for managing anxiety and depression, treating the psoriasis itself so you have better control of your flares can help you feel better overall. Several studies have found that self-reported feelings of anxiety and depression improve when people with psoriasis are taking their medications and seeing corresponding improvements in their skin and other symptoms2.

Parkinson’s disease

Experts don’t know the exact causes of Parkinson’s disease, a neurological condition that causes tremors, stiff muscles, and problems walking, but they do know people with the condition commonly have inflammation in their brain16.

A 2016 meta-analysis of four studies including more than 66,000 people found that those with psoriasis are 38% more likely to develop Parkinson’s compared to people without it16.

There is a lot that experts still don’t understand about Parkinson’s disease, including its connection to psoriasis, so more research is needed to understand if there’s anything people can do to reduce their risk of developing the disease later on16. With that in mind, you can manage potential symptoms by catching the disease early and working with your doctor to start a treatment plan.

Metabolic syndrome

Metabolic syndrome is a collection of health issues that can raise your risk of experiencing heart attack, stroke, and diabetes. Those health issues include increased waist circumference, high blood pressure, hypertriglyceridemia (high levels of fat in your blood), reduced high-density lipoprotein (your “good” cholesterol), and/or insulin resistance (meaning your body has a harder time using the sugar in your blood for energy)2. To be diagnosed you must have at least three of these.

“Metabolic syndrome is a very, very important issue, because it is tied into cardiovascular concerns as well,” explains Dr. Menter. Having psoriasis, especially a severe form, is correlated with developing each individual condition in metabolic syndrome2.

Similarly to some of the other conditions we mentioned, experts suspect this happens because of the chronic inflammation associated with psoriasis. Not to mention, the stress caused by psoriasis—which can also trigger flare-ups—can be really overwhelming and make it more difficult to exercise or be mindful of eating nutritious foods, which help lower your risk of developing metabolic syndrome, according to the Mayo Clinic17.

Eye diseases

If you have psoriasis, then you have a higher risk of developing eye conditions such as conjunctivitis (pink eye), dry eye, uveitis (eye inflammation), and cataracts. There’s conflicting data on how often these diseases develop in people with psoriasis, though.

For example, uveitis may affect between 7 and 20% of people with psoriasis. In general, about two-thirds of people with psoriasis18 will have some sort of eye condition too.

As with many of these other conditions, there’s no concrete explanation for why this happens, but it’s important to know that these numbers vary so much (and are so imprecise) because eye conditions can be really easy for physicians to miss if they aren’t specifically looking for them. A dermatologist, for example, won’t necessarily be focused on your eye health. That’s why it’s so important to talk to your ophthalmologist or optometrist about how often you should have routine exams to catch any potentially problematic symptoms.

Type 2 diabetes

Numerous studies show that some people with psoriasis also develop type 2 diabetes, which is another condition that, you guessed it, comes back to having more inflammation2. However, researchers still aren’t clear about the correlation and whether having one is a risk factor for developing the other. As with many of the other conditions on this list, this risk is especially pronounced if you have severe psoriasis2.

What’s more, either form of diabetes can cause skin symptoms19 such as increased thickness, blisters, itchiness, and dryness. Combined with psoriasis symptoms, type 2 diabetes can make you feel even more uncomfortable. This is yet another reason why treating psoriasis quickly and effectively is super important in reducing your risk of type 2 diabetes or any of the other conditions mentioned above. Being mindful of certain lifestyle factors, like getting enough exercise and eating high-fiber, nutritious foods like whole grains and vegetables, can also help keep your blood sugar levels in a healthy place.

What happens if psoriasis is left untreated?

 Managing your psoriasis can be an ongoing process for some people, but there are numerous medications that can help relieve your specific symptoms. Aside from plaques and itchy skin, you may also develop pitted nails, cracked and dry skin, and skin pain1. And if you don't treat these symptoms, your psoriasis could become more severe. For example, you might have more plaques on your body or you could even develop a more severe form of the condition. Talking to your doctor as soon as you experience symptoms can help you prevent this from happening and can help you find relief. 

Psoriasis treatment

There are many types of psoriasis treatments, and your doctor will recommend a plan for you depending on your particular symptoms. Generally, treatment is available as topicals, light therapy, and systemic medications. Here’s a little more about each20:

  • Topicals include corticosteroids, an anti-inflammatory drug that can reduce redness and itchiness. Corticosteroids are usually recommended for people with mild to moderate psoriasis and come in creams, lotions, sprays, gels, and shampoos. Other topicals include synthetic vitamin D creams to help with scales, scale softeners containing salicylic acid to exfoliate your skin and soften psoriasis scales, and retinoids to increase cell turnover and loosen psoriasis scales.
  • Light therapy can use either synthetic or natural light to help reduce the size of your psoriasis patches. This option is usually best for people with moderate to severe psoriasis.
  • Systemic medications are medications that you take either orally or by injections to suppress your immune system or to target the part of your immune system that causes psoriasis to happen.

Keep in mind that your treatment options may change over time based on new research and newly available therapies. Make sure you have ongoing conversations with your doctor about which treatment options may be best for you.

Bottom line: Psoriasis is associated with other health conditions, but it's important to reiterate that they are not psoriasis complications. Still, being aware of your symptoms, working closely with your doctor, and staying on top of your treatment can help you care for your overall health. 

Sources:

  1. Mayo Clinic, Psoriasis
  2. Seminars in Cutaneous Medicine and Surgery: Common and Not-So-Common Comorbidities of Psoriasis
  3. Baylor, Scott & White Health, Martin Alan Menter, M.D.
  4. Medline Plus, Autoimmune Conditions
  5. Rutgers Robert Wood Johnson Medical School, Shivani B. Kaushik, M.D
  6. Brigham & Women’s Hospital, Psoriatic Arthritis
  7. NIH, Psoriatic Arthritis
  8. Stat Pearls, Psoriatic Arthritis
  9. Medline Plus, Psoriatic Arthritis
  10. Johns Hopkins, Psoriatic Arthritis
  11. University of Michigan Health, Samardeep Gupta, MBBS
  12. Cardiovascular Research, Inflammation and Cardiovascular Diseases: Lessons From Seminal Clinical Trials
  13. NIH, Dyslipidemia
  14. JAMA Dermatology, Psoriasis and the Risk of Depression in the U.S. Population
  15. Lauren Selfridge Psychotherapy
  16. Indian Journal of Dermatology (via NIH): Risk of Parkinson's Disease Among Patients with Psoriasis: A Systematic Review and Meta-analysis
  17. Mayo Clinic, Metabolic Syndrome
  18. Journal of Family Medical Primary Care: Update on psoriasis: A review
  19. American Academy of Dermatology, Diabetes: 12 Warning Signs That Appear On Your Skin
  20. Mayo Clinic, Psoriasis

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