More than the visible

Understanding the bigger picture is key to managing psoriasis well and protecting overall health. For most people, it is often mild, but there lurks some other, often missed associated conditions.

Joint problems are perhaps more widely known and more common among people with psoriasis than is perhaps thought. Up to one-third develop psoriatic arthritis, which causes swollen, stiff, and painful joints. Early diagnosis and treatment are crucial to prevent permanent joint damage and improve quality of life.

Heart health is another crucial concern. Research indicates that chronic inflammation in psoriasis extends beyond the skin and impacts blood vessels, raising the risk of cardiovascular diseases such as heart attacks and strokes. Biomarkers of systemic inflammation, like C-reactive protein and others, are frequently elevated in psoriasis patients, contributing to atherosclerosis (hardening of the arteries) even in the absence of traditional risk factors. Clinical studies suggest that systemic anti-inflammatory treatments may lower this cardiovascular risk by enhancing vascular function and reducing inflammation.

Psoriasis is also linked with metabolic issues including insulin resistance, type 2 diabetes, obesity, high blood pressure, and abnormal cholesterol levels. These conditions form part of the metabolic syndrome, which further raises cardiovascular risk. The inflammatory environment in psoriasis may worsen insulin resistance and contribute to an unhealthy metabolic state. Managing weight and metabolic health alongside psoriasis treatments is important for overall wellbeing.

The mental health impact of psoriasis should not be overlooked. Anxiety and depression rates are significantly higher in people with psoriasis due to the visible, chronic, and sometimes painful nature of the disease. Addressing emotional wellbeing and seeking support can greatly improve quality of life.

Additionally, psoriasis is associated with other systemic conditions such as inflammatory bowel diseases (Crohn’s disease and ulcerative colitis) and liver problems. These links further highlight the need for comprehensive health monitoring beyond the skin.

Modern biologic therapies targeting specific immune pathways not only clear the skin but also show promise in improving systemic inflammation and metabolic markers. This holistic approach may help reduce the burden of comorbidities in psoriasis.

In summary, psoriasis affects more than just the skin. It is a systemic disease with wide-ranging impacts on joints, heart health, metabolism, mental health, and more. Recognising and managing these comorbidities alongside psoriasis treatment can lead to better outcomes and healthier lives.

References:

Gelfand et al., Systemic inflammation and cardiovascular comorbidity in psoriasis, Frontiers in Immunology, 2018.

Becker et al., Cutaneous and systemic improvements in psoriasis patients after biologic treatment, Scientific Reports, 2025.

Baumer et al., Viewing psoriasis as a systemic disease for better health outcomes, PMC, 2021.

Gisondi et al., Psoriasis and systemic inflammatory disorders, MDPI International Journal of Molecular Sciences, 2022.