PSORIASIS AND COMORBIDITIES

WHAT IS COMORBIDITY?

Comorbidity is a concurrence of multiple diseases or disorders in association with a given disease, in this case, psoriasis.

INCREASED RISK

The patient with psoriasis has an increased risk of developing one or more of a number of other diseases/conditions that share many immunological features with psoriasis.

CHART 1: Comorbidities Associated with Psoriasis

Occular Inflammation –

Iritis

Uveitis

Episcleritis

Psychological and Psychiatric Disorders – Depression

anxiety

Suicide

Addiction

Inflammatory Bowel Disease –

Crohn’s Disease

Ulcerative Colitis

Celiac Disease

Irritable Bowel Syndrome

Metabolic Syndrome –

Cardiovascular Disease – Arterial hypertension/ Atherosclerosis Nonalcoholic fatty liver disease Lymphoma

Chronic obstructive pulmonary disease

Sleep apnea

Celiac disease

Parkinson’s disease

Lymphomas

Insulin Resistant Diabetes

Obesity

Dyslipidemia (Raised cholesterol)

Psoriatic Arthritis

Spondyloarthropathies

Periodontitis

Desquamative gingivitis 

Fissured and geographical tongue 

Renal Disease

Chronic Kidney Disease

Sudden sensorineural hearing loss (SSNHL) 

1, 2, 3

Overall, ophthalmological (eye) problems occur in about 10% of the cases of psoriasis and include blepharitis, conjunctivitis, keratitis, xerophthalmia, corneal abscess, cataract, orbital myositis, symblepharon, chorioretinopathy, uveitis and ectropion with trichiasis and madarosis secondary to eyelid involvement.

The association between obesity and psoriasis has been the subject of several reviews and studies confirm that a positive correlation exists between body weight and the prevalence and severity of psoriasis. It has been proposed that psoriasis might lead to obesity through progressive social isolation, poor eating habits, depression, increased alcohol consumption, and decreased physical  activity (more pronounced in patients with psoriatic arthritis). But another hypothesis is that obesity predisposes patients to psoriasis.

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It is considered, however, that the low-grade chronic proinflammatory state present in both these conditions increases the risk of comorbidity, including a higher likelihood of developing diabetes or metabolic syndrome, and an increase in cardiovascular disease. 6

It is very important for newly diagnosed psoriasis patients to be screened for diabetes, liver disease, renal disease, and dyslipidaemia (high cholesterol) at the time of diagnosis, due to the fact that treatment for psoriasis may complicate treatment for the comorbid condition, or the comorbid condition may complicate the treatment for psoriasis.

SSNHL is defined as hearing loss of at least 30 dB (decibels) in 3 sequential frequencies in the standard pure tone audiogram for 3 days or less. The condition has an estimated incidence of between 5 and 30 cases per 100,000 per year. According to background information provided by the study authors, the average age at which SSNHL occurs is 50 to 60 years, and it equally affects men and women. Most cases are unilateral (one ear), with only 5% being bilateral (two ear involvement). The condition can be mild, moderate, or severe to profound and can affect high, low, or all frequencies. Tinnitus occurs in about 80% of patients and vertigo in about 30%. Up to 80% of patients report a feeling of ear fullness.7 Auto-immunity is described as an etiology of Sudden or Progressive Sensory neural Hearing Loss; similarly autoimmunity is described as an etiology for many skin diseases like Psoriasis etc. In one study researchers found that Psoriasis patients have, after 6 years of follow up; a 1.51 times higher risk incidence of developing SSNHL than those in the control group.8

For psoriasis patients who have had their psoriasis for several years, it is important that they have a yearly medical check up to ensure that they have not developed any comorbid conditions.

Changing one’s lifestyle may also be of benefit in either delaying comorbidity, or in controlling both their psoriasis and their comorbid condition. Such changes would include cessation of smoking, reducing or ceasing intake of alcohol, reducing sugar intake, changing ones diet to include more green vegetables, less red meat and if obese, losing weight.

 Read our BLOGS – Psoriasis and Diet – Part 1 and 2, Psoriasis and Alcohol, Psoriasis and Smoking

REFERENCES

  • Arzu K?l?ç, Seray Cakmak; PSORIASIS AND COMORBIDITIES; EMJ Dermatol. 2013;1:78-85.
  • Howa Yeung et al.;Psoriasis Severity and the Prevalence of Major Medical Comorbidity – A Population-Based Study; JAMA Dermatol. 2013;149(10):1173-1179. doi:10.1001/jamadermatol.2013.5015
  • Aurangabadkar SJ. Comorbidities in psoriasis. Indian J Dermatol Venereol Leprol 2013;79, Suppl S1:10-7
  • Agnieszka B. Owczarczyk-Saczonek , Roman Nowicki; The association between smoking and the prevalence of metabolic syndrome and its components in patients with psoriasis aged 30 to 49 years; Postep Derm Alergol 2015; XXXII (5): 331–336 DOI: 10.5114/pdia.2015.54743
  • Dediol I. et al.; ASSOCIATION OF PSORIASIS AND ALCOHOLISM: PSYCHODERMATOLOGICAL ISSUE; Psychiatria Danubina, 2009; Vol. 21, No. 1, pp 9–13
  • Carrascosa J.M. et al.; Obesity and Psoriasis: Inflammatory Nature of Obesity, Relationship Between Psoriasis and Obesity, and Therapeutic Implications; Actas Dermosifiliogr.2014;105:31-44 – Vol. 105 Num.1 DOI: 10.1016/j.adengl.2012.08.024
  • Schreiber BE. et al.; Sudden sensorineural hearing loss.; Lancet.2010 Apr 3;375(9721):1203-11. doi: 10.1016/S0140-6736(09)62071-7.
  • Sesha Prasad, M. Sreedhar Rao, A. V. S. Hanumantha Rao, D. Satyanarayana, S. Muneeruddin Ahmed, M. Mahendra Kumar. “Audiological Evaluation in Auto: Immune Skin Diseases- A Clinical Study of 124 Patients”. Journal of Evolution of Medical and Dental Sciences 2015; Vol. 4, Issue 30, April 13; Page: 5128-5137, DOI: 10.14260/jemds/2015/749