If left untreated, the inflammation can gradually spread and trigger changes in the nails, joints, eyes, brain, kidneys, heart, pancreas, and blood vessels. This is why the early and appropriate treatment of psoriasis is needed to control inflammation and prevent medical complications that are more than skin deep.
Nail Psoriasis
Nail psoriasis is the most common comorbidity (co-existing illness) in people with psoriasis. According to a 2017 review in the journal Psoriasis, no less than 50% of people with psoriasis have signs of nail damage at the time of diagnosis, while 90% experience significant nail changes at some point in their life.
Symptoms of nail psoriasis include:
Nail pitting Thickening of the nail plate (subungual hyperkeratosis) Horizontal ridges on the nail (Beau’s lines) Yellowish-red dots beneath the nail (“oil drops”) White nail patches (leukonychia) Tiny blacks lines beneath the nail caused by burst capillaries (splinter hemorrhages) Lifting of the nail plate (onycholysis) Brittle and crumbling nails Redness in the white arch at the base of the nail (spotted lunula)
Psoriatic Arthritis
Psoriatic arthritis can affect from anywhere from 6% to 41% of people with psoriasis, according to a 2015 study from the University of Pennsylvania. Moreover, around 85 % of people with psoriatic arthritis will also have psoriasis.
Symptoms can vary from person to person but may include:
Pain, swelling, or stiffness in one or more jointsJoint redness and warmthSausage-like swelling in the fingers or toes (dactylitis)
Psoriatic arthritis is most often asymmetric (only affecting a joint on one side of the body), but can become symmetric (affecting the same joint on both sides of the body) in more severe cases. Psoriatic arthritis may also affect the spine (spondyloarthritis) or cause severe damage to the distal joints (those nearest the nails) of the fingers and toes.
Eye Problems
Most of the eye problems associated with psoriasis are caused by blepharitis (inflammation of the eyelid). The condition is caused by the appearance of lesions on or near the eyelid. When this occurs, the eyelid can lift or shift abnormally, causing eye dryness, burning, and itching.
Blepharitis can lead to conjunctivitis (pink eye) and uveitis (inflammation of the pigmented portion of the eye). Without treatment, both conditions can significantly impair eyesight.
Mood Disorders
The very fact that you have psoriasis can cause depression, particularly if symptoms are severe and uncontrolled. But, there is increasing evidence that the disease can alter your brain chemistry in ways that incite significant changes in your mood and cognition.
According to a 2015 review from the University of Iowa, there is evidence that acute psoriasis flares can activate the hormonal complex known as the hypothalamic-pituitary-adrenal (HPA) axis. This can cause the excessive secretion of cortisol, a substance commonly referred to as the “stress hormone.”
We know from conditions like Cushing’s disease that the excessive secretion of cortisol translates to higher rates of depression, anxiety, irritability, and insomnia, as well as the loss of concentration and memory. The same may hold true for psoriasis.
There is even evidence, albeit uncertain, that psoriasis may increase the risk of the neuromuscular disorder Parkinson’s disease.
Cardiovascular Disease
There is evidence that severe psoriasis can more than double the risk of cardiovascular disease compared to the general population. Chronic inflammation is believed to be a major player in the development of heart disease, although other factors are known to contribute.
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The chronic inflammation associated with psoriasis can cause the thickening of tissues (hyperplasia) in the skin and other organs. When it affects blood vessels, it can trigger the development of atherosclerosis (so-called hardening of the arteries) and hypertension (high blood pressure), both of which are closely linked to heart attacks and stroke.
The inflammatory burden can also affect the pancreas, increasing the risk of diabetes and, in turn, heart disease. In their totality, these factors account for higher rates of cardiovascular disease in people with severe (rather than moderate or mild) psoriasis.
Cancer
Psoriasis, like rheumatoid arthritis, has long been associated with an increased risk of lymphoma (a type of cancer affecting white blood cells). Research now suggests that psoriatic inflammation may damage cellular DNA and spur the growth of different types of cancer.
A 2016 study in JAMA Dermatology concluded that psoriasis, as an independent risk factor, increased the risk of the following cancers compared to the general population:
Lymphoma (all types): 34%Lung cancer: 15%Non-melanoma skin cancer: 12%
One type of lymphoma, known as cutaneous T-cell lymphoma, occurs at a rate four times that of the general population.
Based on these findings, it is likely that the early and effective treatment of psoriasis can mitigate many of these risks and other comorbidities as well.
