Psoriasis: Secondary Diseases

The following are the most important diseases or complications that may be caused by psoriasis:

Eyes and eye appendages (H00-H59).

  • Uveitis (inflammation of the middle skin of the eye).

Endocrine, nutritional, and metabolic diseases (E00-E90).

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):
    • Spotted nails – multiple retractions on the nail.
    • Onycholyses – yellow-brownish dirty changes under the surface of the nail.
    • Crumb nails – thickened, dystrophic nails.

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):

    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:

    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.