What are the possible complications of psoriasis?
Not only are there are different types of psoriasis, but it is also a complex condition.
As scientists learn more about inflammatory conditions and how they affect people, they are also establishing more links between conditions that have different diagnoses.
In addition, psoriasis poses lifestyle challenges that can be difficult to cope with. This can lead to additional symptoms, such as depression.
Read on to find out more about some of the problems that may occur alongside this condition.
Celiac disease appears to be more common in people with psoriasis, and a gluten-free diet may suit some people with the condition.
People with psoriasis are more likely to have antibodies for celiac disease, suggesting that there may be a link between the two.
Celiac disease affects around 1 percent of the general population, but it may be present in up to 4.3 percent of those with psoriasis.
People with celiac disease can experience a severe reaction when they consume gluten.
Both celiac disease and psoriasis appear to stem from dysfunction in the immune system. Some people find that avoiding gluten helps to reduce the symptoms of psoriasis.
Researchers who published a review of studies in the Archives of Dermatology in 2017 suggested a number of conditions that are common in people with psoriasis may indicate a link with the gastrointestinal system.
In 2014, authors of a meta-analysis published in the Journal of the American Academy of Dermatology concluded that a gluten-free diet may help some people with psoriasis. However, they called for more research to confirm a link.
People with psoriasis who are considering giving up gluten should speak to a doctor first, as whole grains can contain valuable nutrients, and a gluten-free diet may not be suitable for everyone.
Some studies have suggested that people with psoriasis are more likely to develop problems with mucous membranes in the oral cavity, such as fissures in the tongue and lesions in the gums and cheeks.
Scientists have not established a specific link between psoriasis and oral problems, but research suggests that tongue fissures, for example, appear to be more common in those with psoriasis. Why they occur together also remains unclear.
Psoriasis and mouth problems could stem from similar genetic factors, or they might result from exposure to similar triggers, such as stress and alcohol.
Inflammatory bowel disease
Scientists have looked at possible links between psoriasis and inflammatory bowel disease (IBD), Crohn's disease, and ulcerative colitis.
Studies have suggested that people with psoriasis and their family members may be more susceptible to these conditions.
Psoriasis and IBD have various genetic factors in common.
Vitamin D deficiency
People with psoriasis may benefit from vitamin D supplements, but studies have produced conflicting evidence.
Studies have found that vitamin D deficiency is often present at the onset of some autoimmune diseases.
Some experts recommend taking vitamin D supplements to improve the symptoms of psoriasis.
One observational study involving 561 people, of whom 170 had psoriasis, found that people with psoriasis had significantly lower levels of vitamin D than those without the condition. The researchers suggested that vitamin D levels could impact the length of time symptoms last.
However, they note that the association between vitamin D and psoriasis is "controversial."
Another study, also published in 2018, looked at 61 people with psoriasis and 61 people without. The researchers found no correlation between vitamin D levels and the severity of psoriasis symptoms in the two groups.
The results were published in the Indian Journal of Dermatology in 2018.
One reason may be the use of systemic medications in treatment. These drugs affect the whole body.
Other underlying reasons may include genetic factors and the impact of psoriasis on the individual's lifestyle. More research is necessary to confirm a link.
Experts do not know what might link these conditions with psoriasis. There may be common genetic factors, they may share similar environmental triggers, or there may be a combination of reasons.
People with moderate-to-severe psoriasis should undergo testing for these conditions, so that they can receive preventive treatment if necessary.
Body temperature regulation
Some types of psoriasis can affect body temperature regulation, and this can have an impact on internal organs, such as the heart and the kidneys, according to the National Psoriasis Foundation.
The skin is important for keeping the body temperature stable, and problems that affect the skin can also affect temperature, especially with more severe forms, such as erythrodermic and pustular psoriasis.
Pustular psoriasis is a severe form of psoriasis that can appear in people who already have psoriasis.
One type, known as Zumbusch psoriasis, can lead to severe erythroderma and skin scaling.
In a case study of a patient with pustular psoriasis, published in 2015, researchers noted that the condition can increase the risk of the following life-threatening complications:
The patient who was the focus of the study had the following symptoms:
- pustular skin lesions
- pitted nail beds
- fever and chills
- muscle weakness
- a rapid heartbeat
- difficulty breathing
- an over-accumulation of fluids, or edema
The person may need to spend time in the hospital until treatment normalizes their fluid, chemical balances, heart function, and skin condition.
It usually appears between the ages of 30 and 50 years.
While 85 percent of people with this condition first have skin symptoms, it can occur before or without dermatological symptoms.
- pain and swelling over the tendons
- swollen fingers and toes
- reduced mobility
- stiffness and pain in one or more joints
- pitted nails that may look as if they have a nail fungus
There are also different types of PsA, including:
- spondylitis, which affects the spine
- enthesitis, which occurs where the ligaments or tendons meet the bones
- dactylitis, which affects the fingers and toes
Anyone with psoriasis who has joint pain or stiffness should speak to their doctor. Early treatment can reduce the risk of permanent joint damage.
The researchers found that 60 percent of those with PsA had some degree of hearing loss, compared with only 8.3 percent of those without the condition. They concluded that PsA may lead to damage in the inner ear.
Kidney disease shares some risk factors with psoriasis. It appears to be more common among those with psoriasis.
Chronic kidney disease appears to be more common among people with psoriasis.
Scientists reporting in 2016 described this as "logical," because psoriasis has links with cardiovascular disease, and kidney disease shares the same risk factors.
In addition, the treatments people use for psoriasis are likely to have a toxic effect on the kidneys.
Psychological and emotional consequences
Living with psoriasis can be difficult, and it can have emotional and social consequences.
In a review published in Dermatology and Therapy in 2013, researchers describe psoriasis as a "common, long-term skin condition associated with high levels of psychological distress and considerable life impact."
People who have visible lesions may feel embarrassed by their appearance. This can lead to isolation, depression. and anxiety.
This can affect areas of life such as:
- leisure and social activities
However, there may also be physiological reasons for the psychological impact of psoriasis.
Scientists have found evidence of adrenal and pituitary involvement, which could lead to a hormonal imbalance. This imbalance could impact both the skin changes and the psychological well-being of a person with psoriasis.
Stress and worry, in turn, can make symptoms worse.
Anyone with psoriasis who is experiencing signs of depression or low mood should speak to a doctor about their concerns.
As doctors increasingly come to understand the mental health challenges that people with psoriasis face, more effective treatment will hopefully become available.
Psoriasis is a complex condition with a wide range of possible complications and comorbidities.
When a person is familiar with the possible problems that can arise, it will be easier for them to explain to their doctor how they feel and to seek help.
Treatment is available that can help to reduce many of the symptoms and complications of psoriasis and to improve a person's quality of life.