If you have psoriasis, you’re at greater risk of developing other conditions, including:
- Psoriatic arthritis
- Eye conditions, such as conjunctivitis, blepharitis and uveitis
- Obesity
- Type 2 diabetes
- High blood pressure and cardiovascular disease
- Other autoimmune diseases, such as celiac disease, sclerosis and Crohn’s disease
- Mental health conditions, such as low self-esteem and depression
We provide a detailed overview of each condition and its link with psoriasis:
Psoriatic Arthritis
Psoriatic arthritis is a type of arthritis that affects some people with psoriasis. It typically causes affected joints to become swollen, stiff and painful.
Like psoriasis, psoriatic arthritis is a long-term condition that can get progressively worse. If it’s severe, there’s a risk of the joints becoming permanently damaged or deformed, and surgery may be needed. However, if psoriatic arthritis is diagnosed and treated early, its progression can be slowed down and permanent joint damage can be prevented or minimized.
Symptoms of Psoriatic Arthritis
The severity of the condition can vary considerably from person to person. Some people may have severe problems affecting many joints, whereas others may only notice mild symptoms in 1 or 2 joints. There may be times when symptoms improve (known as remission) and periods when they get worse (known as flare-ups or relapses).
Relapses can be very difficult to predict, but can often be managed with medicine when they do occur.
Causes of psoriatic arthritis
Almost 1 in 3 people with psoriasis also have psoriatic arthritis.
It tends to develop 5 to 10 years after psoriasis is diagnosed, although some people may have problems with their joints before they notice any skin-related symptoms.
Like psoriasis, psoriatic arthritis is thought to happen as a result of the immune system mistakenly attacking healthy tissue. But it’s not clear why some people with psoriasis develop psoriatic arthritis and others do not.
Diagnosing psoriatic arthritis
A regular annual check up with a general practitioner usually paves the way to an early diagnosis. If the GP thinks the patient may have psoriatic arthritis, they should refer the patient to a rheumatologist (a specialist in joint conditions) for an assessment.
A rheumatologist will usually be able to diagnose psoriatic arthritis while also will be able to rule out other types of arthritis, such as rheumatoid arthritis and osteoarthritis.
Treatment
No cure exists for psoriatic arthritis, so treatment focuses on controlling inflammation in affected joints to prevent joint pain and disability. Methotrexate is the most commonly prescribed non-biologic DMARD (Disease-modifying anti-rheumatic drugs) for psoriatic arthritis treatment.
In Special Hospital Naftalan in Croatia, Naftalan therapy is used for skin diseases (psoriasis, neurodermatitis), and for diseases of the musculoskeletal system (inflammatory rheumatic diseases: rheumatoid arthritis, psoriatic arthritis, degenerative diseases of hips and spine, non-articular rheumatism) which effectively help patients with diagnosed arthritis.
Learn more about the arthritis treatment programs in Naftalan hospital here.
Eye conditions
Did you know that psoriasis can cause pain in the eyes and blurred vision?
Eye problems may be directly related to psoriasis skin flare-ups around the eyes. But psoriasis can also lead to problems within the eye itself — problems that, when left untreated, can cause permanent damage and vision loss.
Cause and treatment:
Although they are relatively rare, psoriasis flare-ups near the eyes can be especially painful and hard to treat. Scales and dryness may cause the edges of the eyelids to curve up or down, which may produce drying of the cornea (the clear layer on the front of the eye) or allow the eyelashes to scrape the cornea.
- In such cases, the National Psoriasis Foundation recommends the following:
- Wash the affected lids and lashes with a mixture of water and baby shampoo.
- Use an over-the-counter eyelid cleaner to remove stubborn scales.
- Apply a topical medication around the eyes. These medications are only available by prescription and should be used with your doctor’s supervision.
- Have your intraocular eye pressure (IOP) tested by tonometry regularly by an ophthalmologist to ensure that these topical treatments aren’t harming your eyes.
Dermatologists will sometimes prescribe low-potency steroids for use on the eyelids. This can help, but, due to the risk of cataract and glaucoma development, you should not continue the use of these steroids beyond the time recommended by your doctor.
Uveitis and Iritis
Frequently, uveitis and iritis arise as a complication of a disease, such as psoriatic arthritis or lupus. Such diseases cause the body’s immune system to attack their healthy tissue.
Uveitis is an inflammation of the uvea, the middle layer of the eye’s surface. The uvea includes the iris, which makes up the colored area at the front of the eye. When uveitis is localized at the front of the eye, it’s called iritis (or anterior uveitis).
Uveitis can be localized to the ciliary body, too, which produces aqueous humor—the fluid that fills the eye. It can also be localized to the choroid, which are the small blood vessels behind the retina.
Symptoms of uveitis can include:
- Redness in the eye
- Sensitivity to light
- Blurred vision
- “Floaters” in the field of vision
- Pain in the eye
Because of the connection between psoriasis and uveitis, your ophthalmologist may want to consult your primary care physician, your rheumatologist, or any specialists you are seeing to determine a treatment plan.
Treatment of Uveitis:
In most cases, corticosteroid eye drops given at home will clear any inflammation. In recurring cases, a systemic drug that suppresses your immune system may be needed to fight the root cause of the inflammation. If other problems—such as glaucoma or cataracts—are diagnosed along with uveitis, surgery may be necessary.
People who have uveitis associated with psoriasis are more likely to have recurrent problems with uveitis than those who do not have psoriasis and other autoimmune disorders. If uveitis has become a recurring issue, you may find it helpful to reach out to others with the same problem.
Obesity
People with this skin condition are more likely than others to be obese. And if you have a lot of extra pounds, the condition may become worse and harder to treat.
Doctors don’t know which comes first. But long-lasting inflammation throughout the body is something they have in common.
Staying at a healthy weight is a good idea for everyone. But it’s especially important if you have psoriasis. Research shows being overweight or obese raises your chances of getting psoriasis. It can also make symptoms worse if you have it. Weight alone, though, doesn’t cause psoriasis. Fat cells may be able to turn on inflammation. There is also good evidence that the more you weigh, the more severe your psoriasis is.
Solving the link between obesity and psoriasis:
The link between psoriasis and excess weight isn’t clear. But experts know psoriasis is an inflammatory disease. Extra fat cells release inflammatory chemicals called cytokines that may play a role in psoriasis symptoms.
Losing even a little weight can help with itchy, flaky, and sore patches on your skin and scalp. One study found that people with psoriasis who lost weight by exercising and following a low-calorie diet saw their symptoms get better by almost 50% in 20 weeks. And that was without changing anything in their medication or treatment plan.
Losing even 5 or 10 pounds can lighten the load on your joints. That’s key, because up to a third of people with psoriasis get psoriatic arthritis. Losing weight may also make your psoriasis medications work better.
Best way to start taking care of excessive body weight is first cutting out foods that are know to trigger psoriasis: https://psoriasistreatments.net/weekly-psoriasis-focus-16-what-foods-to-avoid/
Type 2 diabetes
People who have psoriasis are more likely to get type 2 diabetes. That’s a condition that makes it hard for your body to make and use the hormone insulin. And the worse your skin problem is, the greater your chances of getting diabetes are.
More research is needed to explain why this happens, but your immune system may have something to do with it. Psoriasis, which causes raised, red, flaky, and itchy patches on your skin, is an autoimmune disease. That means your immune system attacks part of your own body by mistake. In this case, it’s your skin.
One theory is that psoriasis could change your immune system enough that over time, it starts going after and killing cells that make insulin.
Diabetes affect on psoriasis
It’s important for the doctor you see for your psoriasis to know you have diabetes so she can recommend the right treatments.
In some cases, she may be able to give you medicine that helps keep both health issues in check. For instance, some people who take a type 2 diabetes drug called a glucagon-like peptide-1 (GLP-1) notice that their skin gets better. This may be because it slows down your immune system. That helps ease inflammation throughout your body.
On the other hand, some drugs that treat psoriasis can raise your blood sugar and make your diabetes harder to control. That means your doctor probably won’t give you corticosteroids (steroids) or cyclosporine, which are both used to calm inflammation.
You’ll need to use other psoriasis drugs with some care. For example, a medicine called etanercept can trigger hypoglycemia (very low blood sugar). If your doctor thinks it’s the best option to treat your psoriasis, you may need to change your diabetes medication.
Another common psoriasis drug called methotrexate can cause serious liver damage in people with diabetes. If your doctor prescribes it, you’ll need to have a blood test in a few months to make sure your liver’s working the way it should.
Controlling both your psoriasis and diabetes.
Reduce stress. Worry and anxiety not only cause your skin to flare, but they also can raise your blood sugar. Try deep-breathing exercises, meditation, or regular exercise to keep your stress in check.
Eat healthy. Certain foods like fruits, veggies, and whole grains can help control your diabetes and psoriasis. Others (like sugary treats and alcohol) will make them worse. Ask a dietitian or nutritionist to help you plan healthy meals.
Watch your weight. Being a healthy weight helps your body respond better to psoriasis treatments. It also makes your blood sugar levels easier to manage.
Work as a team. In addition to your primary care doctor, you’ll probably see a dermatologist to care for your skin and an endocrinologist to help you control your diabetes. If you have psoriatic arthritis, you’ll also see a rheumatologist. And you may want to see a counselor to talk about your feelings. Find health care providers you trust and make sure they talk to one another to give you the care you need.
High blood pressure and cardiovascular diseases:
People with more severe cases of psoriasis may be at increased risk of uncontrolled high blood pressure.
Studies show that patients with severe psoriasis were 48 percent more likely to have poorly controlled blood pressure.
It is believed that the problem arises from an abnormal immune system attack on healthy skin cells – a reaction that causes chronic inflammation. Chronic inflammation in the blood vessels is thought to contribute to high blood pressure (“hypertension”), heart disease and stroke. Hypertension is a major risk factor for the development of cardiovascular disease.
Reducing psoriasis inflammation reduces risk of cardiovascular diseases
Research shows an link between psoriasis and an increase in several proteins and enzymes that indirectly raise blood pressure or increase inflammation. For example, angiotensin-converting enzyme (ACE) converts the hormone angiotensin I into angiotensin II, which indirectly raises blood pressure by causing blood vessels to constrict. Patients with psoriasis may have increased levels of angiotensins and angiotensin–converting ACE, leading to high blood pressure.
How to Lower Blood Pressure
In addition to eating a healthy diet, losing weight, and getting regular exercise, you can help lower your blood pressure by reducing your salt intake. Here are a few salt-reduction tips from the National Psoriasis Foundation:
- Choose fresh or frozen vegetables, which are generally salt-free or low-salt.
- Choose low- or salt-free options in canned or prepared foods, or rinse foods (such as canned beans).
- Limit salted or cured meats.
- Go light on condiments, which are often hidden sources of salt.
- Use herbs and spices, instead of salt, to flavor food.
Other autoimmune diseases, such as celiac disease, sclerosis and Crohn’s disease
Based on research developments in the past few years, psoriasis has generally been classified as an autoimmune disease. This means that your immune system cells, called T cells, mistakenly attack your own skin cells as foreign invaders. This causes your skin cells to rapidly multiply, leading to the characteristic psoriasis skin lesions.
Apart from genetic predisposition, the evidence for considering psoriasis as an autoimmune disease also includes overlap of several biochemical pathways with those altered in other autoimmune diseases such as Crohn’s disease, type-I diabetes, and rheumatoid arthritis.
In addition, psoriasis is found frequently associated with some major autoimmune disorders including systemic lupus erythematosus, autoimmune thyroid disease, celiac disease, inflammatory bowel disease (IBD), especially Crohn’s disease, multiple sclerosis, Sjögren’s syndrome, vitiligo, and alopecia areata.
Treatments that target the immune system
Treatment for psoriasis depends on the type and severity of the condition, your general health, and other factors.
There are 2 main groups of treatments that target specific factors in the immune system that cause inflammation. These are generally used when your psoriasis symptoms are moderate to severe:
TNF antagonists
A more recent drug targets a substance that causes inflammation called tumor necrosis factor (TNF). TNF is a cytokine made by immune system components such as T cells. These new drugs are called TNF antagonists.
Anti-TNF drugs are effective, but less so than newer biologics. TNF antagonist drugs include:
- adalimumab (Humira)
- etanercept (Enbrel)
- infliximab (Remicade)
- certolizumab pegol (Cimzia)
Biologics
More recent biologics target and block particular T cell and interleukin pathways involved in psoriasis. Three biologics that target IL-17 have been approved since 2015:
- secukinumab (Cosentyx)
- ixekizumab (Taltz)
- brodalumab (Siliq)
Other drugs aim to block another interleukin pathway (I-23 and IL-12):
- ustekinuman (Stelara) (IL-23 and IL-12)
- guselkumab (Tremfya) (IL-23)
- tildrakizumab-asmn (Ilumya) (IL-23)
- risankizumab-rzaa (Skyrizi) (IL-23)
If you have moderate or severe psoriasis, it is suggested to discuss these options with your dermathologist.
Mental health conditions
Research shows that 62% of psoriasis patients show symptoms of depression.
Depression is a product of our mind. It does not come from the outside, it a part of us. Same as psoriasis, but the difference is that psoriasis is a physical manifestation and depression is a psychological one. There is a clear link between the two. Psoriasis can put us in a state of feeling depressed and in the same time depression can cause psoriasis flaring. We can see by controlling depression we will have a positive impact on our psoriasis. It goes like a positive domino effect.
Psoriasis is a skin disorder, but for some of us, it can go deeper and impact our emotional health
We live with psoriasis which is often very physically uncomfortable, limits physical activities and intimacy. Because of this we suffer from being stigmatized, bullied, and otherwise discriminated against.
This creates a high potential for anxiety and depression.
Depressions can manifest itself in several forms, most common being:
- Lack of energy
- Constant sadness or anxiousness
- Lack of interest in work or things you used to enjoy
- Problems with falling asleep, followed by a morning feeling like you can’t get out of bed
- Feelings of hopelessness and underachievement
Depression can be a serious issue and it is not something we can easily just snap out of. It takes time and effort, and most of all, it is a roller coaster ride: good days will be followed by a bad day, but that will not stop us in our attitude that we can beat depression!
Looking to beat depression without medication? Here are 3 ideas how to do it:
- Stay Engaged
Another way that you might be able to help improve depressive symptoms is by staying engaged socially. Many people who experience depression withdraw from friends and family and shut themselves out. Maintaining these relationships and even expanding them can improve your overall mood. Similarly, staying socially stimulated by volunteering may be one of the best ways to fight depression through social engagement, and it is mutually beneficial as well.
- Challenge negative thoughts.
In your fight against depression, a lot of the work is mental — changing how you think. When you’re depressed, you leap to the worst possible conclusions.
The next time you’re feeling terrible about yourself, use logic as a natural depression treatment. You might feel like no one likes you, but is there real evidence for that? You might feel like the most worthless person on the planet, but is that really likely? It takes practice, but in time you can beat back those negative thoughts before they get out of control.
- Take on responsibilities.
When you’re depressed, you may want to pull back from life and give up your responsibilities at home and at work. Don’t. Staying involved and having daily responsibilities can help you maintain a lifestyle that can help counter depression. They ground you and give you a sense of accomplishment.
If you’re not up to full-time school or work, that’s fine. Think about part-time. If that seems like too much, consider volunteer work.
Remember, psoriasis is part of us, but it does not define us. Each of us can become a beacon of happiness!
Looking for other solutions on beating depression? Have a look at our dedicated blog post on beating depression without medication: https://psoriasistreatments.net/weekly-psoriasis-focus-10-beating-depression-without-medication/
