People tend to think of psoriasis as a skin condition, and it’s easy to see why. The most visible symptom is red patches covered by silvery plaques that appear anywhere on the body. But those plaques are more than skin deep. They’re just one manifestation of an immune system malfunction that causes certain white blood cells to overproduce proteins called cytokines, leading to chronic inflammation. You can see the effects of inflammation on the skin, but the damage is happening internally, too.
Common complications
The low-grade, systemic inflammation that comes with psoriasis can contribute to a host of hidden complications, such as increased insulin resistance, oxidative stress, endothelial cell dysfunction, and atherosclerosis (plaque buildup in the arteries), increasing the risk for other diseases.
- Heart disease. Cardiovascular disease (CVD) is one of the most significant conditions that can occur with psoriasis. It’s one result of the dramatic snowball effect of systemic inflammation: First, the inflammation leads to insulin resistance. That’s when cells in your liver, muscles, and fat don’t use the hormone insulin to effectively tap the glucose, or sugar, in your blood for your energy needs. Your pancreas is then tasked with making more insulin to help the process along, but at some point, it may not be able to keep up, setting the stage for diabetes.
Inflammation-induced insulin resistance is thought to lead to endothelial dysfunction—when the endothelial cells that line your arteries don’t work as they should, causing blood vessels to narrow. This creates what’s called vascular stiffness and increases the risk for atherosclerosis, dangerous plaque buildup along the arteries. Treating psoriasis and monitoring its effects on your heart can help protect your heart health.
- Eye conditions. Many people with psoriatic disease also develop autoimmune eye diseases. Inflammation of the iris, uvea, or retina (uveitis) is the most common disorder, but any part of the eye can be affected, including the cornea (keratitis), the edges of the eyelids (blepharitis), the membrane that lines the eyes and eyelids, called the conjunctiva (conjunctivitis), the whites of the eyes, called the sclera (scleritis), and the tissue between the conjunctiva and the sclera (episcleritis).
- Psoriatic arthritis. In about one-third of people with psoriasis, the immune system will attack the joints in what’s called psoriatic arthritis (PsA). As with many other types of arthritis, inflammation leads to painful, stiff, and swollen joints. The arthritis can be severe and lead to permanent joint damage.
- Obesity. Being overweight can cause inflammation, but there’s also a link between obesity and psoriasis. Researchers reported in Frontiers in Immunology that obesity is an independent risk factor for the onset and severity of psoriasis. A study in the British Journal of Dermatology reported that people who lost weight saw a 50 percent reduction in psoriasis symptoms within about five months.
- High blood pressure. Hypertension is more common in patients with psoriatic disease. People with late-onset psoriasis or obesity have the highest risk, researchers reported in Clinical Rheumatology in 2019.
- Other autoimmune diseases. Having psoriasis makes having another autoimmune disease more likely. There’s genetic overlap between psoriasis, Crohn’s disease, ankylosing spondylitis, primary sclerosing cholangitis, and ulcerative colitis.
Researchers reported in the journal Immunology that two autoimmune disorders, vitiligo, which causes skin-pigmentation loss, and alopecia areata, which causes hair loss, are linked to psoriasis.
Guarding against complications
Just as many complications are interrelated, there’s overlap among prevention steps. For instance, sticking with your psoriasis treatment, losing weight, eating a healthier diet, and exercising more will all help you avoid obesity, diabetes, high blood pressure, and cardiovascular disease. Here are more specifics:
- Quit smoking. Smoking stimulates inflammation, and quitting is one of the strongest recommendations in the 2018 American College of Rheumatology/National Psoriasis Foundation guideline for PsA treatment. There is strong evidence that smoking makes the disease worse and even reduces the efficacy of biological medications.
- Control stress. Physical activity, deep breathing, meditation, and cognitive behavioral therapy can help you manage both your physical and mental health.
- Get a good night’s sleep. Deep sleep strengthens the immune system, while too little weakens it and may increase your pain perception.
Practice good sleep hygiene: Shut off screens at least an hour before bed, go to bed at the same time every night, and keep your bedroom dark and cool. Pain can make it hard to get good rest, so tell your doctor if your symptoms aren’t under control. Adjusting your medications may help you get the deep sleep you need.
- Aim for daily exercise. Regular physical activity can lessen joint pain and improve your mobility, energy level, endurance, and sleep quality. Go for low-impact activities like walking, bicycling, swimming, and water exercises to avoid stressing your joints.
Exercise will also help with weight loss. Gentle stretching for at least five minutes before and after activity can help you warm up, expand your range of motion, and avoid injury.
- Eat a quality diet. New research published in the Journal of Investigative Dermatology found that too much sugar and saturated fat can upset the gut microbiome and worsen inflammation, psoriasis, and PsA.
The Mediterranean diet is a great anti-inflammation approach to good health, incorporating fish, grains, fruits, vegetables, and extra virgin olive oil, which research shows has anti-inflammatory properties.
- Get regular health checks. In addition to working with a rheumatologist to control psoriasis, get regular blood pressure checks and blood tests that measure cholesterol and glucose levels. High levels of all of these can increase the risk for heart disease and diabetes.
