The following are the most important diseases or complications that may be caused by psoriasis:
Eyes and eye appendages (H00-H59).
Endocrine, nutritional, and metabolic diseases (E00-E90).
- Diabetes mellitus type 2 (insulin resistance).
- Metabolic syndrome – clinical name for the symptom combination of obesity, hypertension (high blood pressure), elevated fasting glucose (fasting blood sugar) and fasting insulin serum levels (insulin resistance), and hyperlipoproteinemia (elevated VLDL triglycerides, decreased HDL cholesterol). Furthermore, a coagulation disorder, with an increased risk of thromboembolism can often be detected [highest prevalence (disease frequency) of all known comorbidities in psoriasis].
Skin and subcutaneous (L00-L99).
- Erythroderma (infiltrative redness of the skin with scaling; may affect up to 90% of the body surface) → inpatient treatment required.
- Nail changes (nail psoriasis: 10-55% of cases in adults; 30-40% of cases in children; lifetime incidence: 80-90% [10):
Cardiovascular system (I00-I99)
- Abdominal aortic aneurysm (AAA; formation of a wall bulge in the aorta that can rupture (burst)); Overall incidence rates were 3.72, 7.30, and 9.87 per 10 000 person-years for the reference population (23 696 cases), mild psoriasis (240 cases), and severe psoriasis (50 cases), respectively.
- Aortic valve stenosis (aortic valve narrowing; twice the risk in the reference population).
- Apoplexy (stroke)
- Atherosclerosis (arteriosclerosis, hardening of the arteries)
- Hypertension (high blood pressure) – prevalence (disease frequency) increases with the extent of dermatosis/skin disease:
- Mild psoriasis (< 3% of the skin): no hypertension.
- Moderate psoriasis (3-10 % of the skin): up to 20 % had hypertension
- Severe psoriasis (> 10 % of the skin): up to 48 % had hypertension
- Myocardial infarction (heart attack) – patients with severe psoriasis have a 1.5-fold increased mortality (death rate) compared to the control group.
- Venous thromboembolism (VTE) – entrainment of a thrombus (blood clot) or embolus (vascular plug) within the bloodstream, with subsequent displacement of a vessel part or occlusion of an entire vessel.
Infectious and parasitic diseases (A00-B99).
- Chronic inflammation – e.g., presence of elevated C-reactive protein (CRP) [inflammatory parameter].
Liver, gallbladder, and biliary tract – pancreas (pancreas) (K70-K77; K80-K87).
- Nonalcoholic fatty liver (NAFL; NAFLE; NAFLD, “nonalcoholic fatty liver disease”) (47% of patients).
- Non-alcoholic fatty liver hepatitis (NASH) (20% of patients).
- Liver cirrhosis (irreversible damage to the liver leading to gradual connective tissue remodeling of the liver with limitation of liver function; 14.1% of all patients with severe psoriasis) – was associated with central obesity, insulin resistance, and severity of psoriasis
Musculoskeletal system and connective tissue (M00-M99).
- Movement restrictions due to arthralgia (joint pain).
- Psoriatic arthritis (PsA; about 5-15% of all psoriasis patients suffer from it; sometimes it also precedes the skin disease); about 66% of psoriatic arthritis patients have nail changes (see above )In children, this is called juvenile psoriatic arthritis /JPsA); this often precedes the actual skin disease in children!
Neoplasms (C00-D48)
- Risk increase for tumor disease (RR: relative risk):
- Cancers in oral cavity (RR 2.80).
- Esophagus (food pipe) (RR 2.05)
- Liver (RR 1.83)
- Squamous cell carcinoma of the skin/spinalioma (RR 1.71)
- Colon carcinoma (cancer of the large intestine) (RR 1.34)
- Renal cell carcinoma (kidney cancer) (RR 1.58)
- Lymphoma (RR 1.40)
- Non-Hodgkin lymphomas (RR 1.28)
- Pancreatic carcinoma (cancer of the pancreas) (RR, 1.41).
Likewise, severe psoriasis also carries an increased risk of cancer death (RR, 1.22; 1.08-1.38); the risk is particularly pronounced for hepatocellular carcinoma (liver cancer) (1.43), esophageal (esophageal) (RR, 2.53), and pancreatic/pancreatic cancer (RR, 1.31).
- A systematic review with meta-analysis concluded that: relative risks (RR) were increased compared with controls in:
- Keratinocytic cancer, ie, basal cell or squamous cell carcinoma (RR 2.28).
- Hodgkin’s lymphoma (RR 1.87).
- Non-Hodgkin lymphomas (1.48)
- Bronchial carcinoma (lung cancer) (RR 1.26).
- Urinary bladder carcinoma (bladder cancer) (RR 1.12)
No increased risk of cancer was demonstrated when psoriasis patients were treated with biologics; the same was true for patients with psoriatic arthritis.
Psyche – Nervous System (F00-F99; G00-G99).
- Anxiety disorders
- Alcohol dependence
- Depression
- Drug addiction
- Erectile dysfunction (ED; erectile dysfunction)
- Resignation
- Social isolation
Pregnancy, childbirth and puerperium (O00-O99)
- Gestational diabetes mellitus (GDM) (gestational diabetes) (1.36-fold).
- Pregnancy-induced hypertension (synonyms: EPH-gestosis; eclampsia; premature gestosis; gestational hypertension; gestosis; gravidity-gestosis; gravidity toxicosis; HELLP syndrome; hypertension in pregnancy (HIS); hypertensive encephalopathy of pregnancy (HES); Graft gestosis; Praeeclampsia; Propfgestosis; Preeclampsia; Hypertension of pregnancy; Pregnancy-induced hypertension; Toxicosis of pregnancy; Late gestosis; Toxicosis; Hypertensive disease of pregnancy) (1,26-fold).
- Delivery by caesarean section (cesarean section) (1.17-fold).
Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99)
- Suicidality (suicidal tendencies).
Further
- Increased mortality (death rate) with a life expectancy shortened by about three to four years is assumed, especially for younger patients with severe psoriasis
- Increased risk of addiction (tobacco use; alcohol use; drugs).
- People with psoriasis have a 58% higher risk of alcohol-related death than comparable peers without psoriasis
Prognostic factors
- Overweight (obesity) increases the disease activity of psoriasis.
- Nail involvement is considered a negative prognostic factor for healing of skin lesions; after 24 weeks of treatment, 40% of patients with nail involvement were less likely to achieve the goal of healing. Conclusion: these patients require a longer duration of therapy.