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Psoriasis affects more than just skin and scalp: new research shows the condition has far-reaching effects and can lead to more serious medical diseases and conditions.

Psoriasis is an autoimmune disease of the skin that causes cells to multiply rapidly on the surface of the skin, appearing as itchy red, scaly plaques and thick silvery scales that the body is unable to slough off fast enough. Over 7.5 million Americans have psoriasis, which can appear in many forms, all over the body.

Previous studies have linked psoriasis to heart disease, stroke, diabetes and other health problems, but researchers at the Perelman School of Medicine, University of Pennsylvania (U.Penn), have now sought to determine if illness severity is related to how much of patients' skin surface area is affected by psoriasis.

THE STUDY. Led by Dr. Joel Gelfand, associate professor of dermatology at U.Penn, researchers studied 9,035 British patients who had psoriasis and matched each up against 10 similar people without psoriasis (control group). They found that the risk for any other type of serious illness was 11 percent higher for people with mild psoriasis, 15 percent higher for those with moderate psoriasis, and 35 percent higher for those with severe psoriasis than for those in the control group. Mild disease, which affected more than half the psoriatic group, affected less than three percent of their skin, while 36 percent with moderate disease had up to 10 percent of their skin area affected, and the 12 percent with severe disease, had more than 10 percent of their skin affected.

THE FINDINGS. Patients with moderate psoriasis were 22 percent more likely to have diabetes than people without psoriasis, while those with severe psoriasis had a 32 percent increased risk of diabetes. (The diseases share a common pathway--TH-1 cytokines, which are known to promote inflammation and insulin resistance.)

Having moderate psoriasis conferred a 36 percent increased risk of diabetes, with complications such as eye disease, while severe psoriasis conferred an 87 percent higher risk.

Moderate and severe psoriasis increased risk of cardiovascular disease by 39 percent and 81 percent, respectively. In addition, researchers found links to chronic obstructive pulmonary disease, kidney disease, liver disease, peptic ulcers, as well as rheumatologic diseases affecting the bones and joints. Identifying the co-occurring diseases will lead to more comprehensive health care for patients, the researchers say.

GENES COUNT. One in three people with psoriasis has a relative who suffers from the disease. If a parent has psoriasis, a child has a 10 percent chance of developing the disease, and if both parents have the disease, a child's odds of developing it are about 50 percent.

INFLAMMATION IS A CULPRIT. Dr. Gelfand noted that people who have psoriasis have more inflammation in their blood vessels, which probably is the cause of some of the increased risk for other diseases. He said also that genes related to heart disease are active in the skin cells of people with psoriasis, and those blood cells make substances, such as the blood-pressure-boosting enzyme renin, that circulate in the blood. Dr. Gelfand and colleagues are conducting a study to determine if psoriasis patients undergoing treatment for the condition will have less inflammation in their blood vessels.

TREATMENT. Treatment is aimed at interrupting the cycle that causes the increased production of skin cells, thereby reducing inflammation and plaque formation, and at removing the scales and smoothing the skin.

Treatments can be topical--creams and ointments such as corticosteroids, vitamin D analogues, anthralin, retinoids, calcineurin inhibitors, salicyclic acid, coal tar (the oldest treatment for psoriasis) and moisturizers which can help alleviate skin dryness.

Light therapy for the condition can be as simple as exposure to sunlight, and progress to UVB phototherapy, narrowband UVB therapy, a combination treatment of UVB and coal tar, photochemotherapy or psoralen plus ultraviolet A, Excimer laser, pulsed dye laser and combination light therapy.

In addition, oral or injected medications may be prescribed, including retinoids, methotrexate, cyclosporine, hydroxyurea and biologics (Enbrel, Remicade, among others) and Thioguanine. Typically, your doctor will start with the mildest treatment, progressing to stronger ones if necessary.

Even if a person has mild psoriasis, Dr. Gelfand says, "it's a warning sign" and a reminder to undergo preventive health examinations.


To help alleviate symptoms of psoriasis:

* Take daily baths

* Use moisturizer

* Cover affected areas over night

* Expose your skin to small amounts of sunlight

* Apply medicated cream or ointment

* Avoid drinking

* Eat a healthy

Avoid psoriasis triggers, such as:

* Infections: strep throat or thrush

* Skin injury: cut, scrape, bite, severe sunburn

* Stress

* Cold weather

* Smoking

* Heavy alcohol consumption

* Some medications: lithium, beta blockers, antimalarials iodides


Systemic Illness with Farreaching Health Implications

"Published research over the past several years has helped us understand that psoriasis is associated with the metabolic syndrome. The cited population-based study of nearly 10,000 people with psoriasis shows clearly that those with even mild psoriasis experience dramatically increased risk for cardiovascular and a host of other diseases, notably diabetes. Mild psoriasis, which is common, was defined as less than 3 percent of body surface area, essentially, just having psoriasis of the elbows and knees. The finding that even mild psoriasis is associated with an increased risk of a variety of chronic illnesses should remind patients and providers that psoriasis is not just a skin condition; it is a systemic illness with far-reaching personal and public health ramifications. Given the information we now have about health risks associated with psoriasis, it is reasonable for patients with psoriasis to employ positive lifestyle modifications (maintenance of ideal body weight and exercise), along with aggressive management of modifiable cardiovascular risk factors, in an effort to improve their risk for cardiovascular disease and diabetes."

LISA G. CRISCIONE-SCHREIBER, MD, Department of Medicine, Division of Rheumatology & Immunology, Duke
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Author:Criscione-Schreiber, Lisa G.
Publication:Duke Medicine Health News
Date:Dec 1, 2013
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