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    Beyond the plaque

    Psoriasis patients may suffer metabolic problems


    Other comorbidities

    In addition to being at higher risk for cardio-metabolic disease and psoriatic arthritis, people with psoriasis are more likely to suffer from mood disorders, inflammatory bowel disease, and, rarely, T cell lymphoma of the skin.

    “People with psoriasis are more prone to anxiety and depression, social isolation and even having suicidal ideation,” Dr. Gelfand says. “Generally speaking, in my own interactions with patients, I try to understand if they’re having mental health issues, and, if so, how do they relate to psoriasis? So, if a patient feels their psoriasis is a contributing factor to their anxiety and depression, that’s another reason to treat the disease aggressively and try and control it.”

    The link between inflammatory bowel syndrome and psoriasis has long been established.

    “More recently, what we’ve learned that there’s probably some shared genetic susceptibility between psoriasis and inflammatory bowel disease,” Dr. Gelfand says.

    There is evidence of a cancer-psoriasis link, but isn’t as clear as the other comorbidities, according to Dr. Gelfand.

    “These patients seem to have a mildly increased risk of lymphoma and much of that is driven by T cell lymphoma of the skin,” Dr. Gelfand says. “It’s hard to know how much of that is driven by misdiagnosis, because, early on, T cell lymphoma of the skin can look a lot like psoriasis. Or maybe, if you’re living with chronic T cell proliferation on your skin, it could eventually transform into lymphoma of the skin.”

    It’s important that make the right diagnosis because some psoriasis treatments could aggravate and even result in progression of T cell lymphoma of the skin. As a result, skin biopsies are key in evaluating patients who have atypical features of psoriasis and for patients who  are not responding appropriately to treatment, Dr. Gelfand says.

    Make note

    It has been known for many years that strep infections can results in psoriasis flairs—particularly the guttate version of psoriasis.

    “When a patient comes with a psoriasis flair, we should ask have you had symptoms of sore throat or fever and look in the oral pharynx,” Dr. Gelfand says. “If we are going to be using immunologically modifying therapies that may predispose people to infection, one strategy to lower the risk of infection is to use vaccinations. Doctors should know that they should not use a live vaccine when someone is on one of these treatments. For example, the common live vaccines are the Zoster vaccine, as well as the inhaled flu vaccine. You wouldn’t want to use the inhaled version; you’d want to use the shot.”

    While dermatologists are generally aware of the high risk of psoriatic arthritis among psoriasis patients, recent evidence suggests that even dermatologists frequently miss the diagnosis, according to Dr. Gelfand.

    “Studies have been done where rheumatologists evaluate patients who have been seen by dermatologists for their psoriasis, and the rheumatologists have found a fair number of patients with psoriatic arthritis not identified by their dermatologists. So, this can be a very tricky disease to identify and diagnose,” he says.

    NEXT: Emerging evidence


    Lisette Hilton
    Lisette Hilton is president of Words Come Alive, based in Boca Raton, Florida.


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