Can psoriasis kill you? Long-term impact

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Psoriasis is linked to some conditions that may be serious or life-threatening.

Experts believe the connection between these conditions and psoriasis is likely due to inflammation. The skin is most obviously affected by the condition.

However, psoriasis is considered a multisystem inflammatory disorder and may result in a higher risk of comorbidities. These include inflammatory arthritis, cardiovascular disease and stroke, and depression.

Inflammatory arthritis

Psoriasis is associated with psoriatic arthritis (PsA). It’s also associated with dactylitis, which causes inflammation of the small joints in the hands and feet, and enthesitis, which causes inflammation where tendons and ligaments meet bone.

Cardiovascular disease and stroke

Psoriasis can cause long-lasting inflammation inside the body that may affect the heart and blood vessels. I can also result in a greater risk of developing heart disease or having a stroke.

Psoriasis is also associated with factors connected to cardiovascular disease and stroke, including:

• metabolic syndrome
• hypertension
• obesity
• type 2 diabetes
• dyslipidemia, where lipid levels are too high or low

Recent guidelines on the management of blood cholesterol by the American Heart Association and American College of Cardiology identify chronic inflammatory diseases, including psoriasis, as risk-inducing for some cardiovascular diseases.

Depression

Depression is a comorbidity of psoriasis. According to the World Health Organization (WHO), depression is a leading cause of disability and can lead to suicide.

Psoriasis is a chronic autoimmune condition that happens when a person’s immune system does not function correctly. This causes white blood cells to attack skin cells as if they were bacteria or viruses.

The body reacts by growing skin cells more rapidly than normal, which causes skin cells to build up on top of each other, rather than being shed as normal. The built-up skin cells may become itchy, painful scaly plaques.

Psoriasis can cause rashes and scales anywhere on the body, but they most commonly occur on the elbows, knees, and scalp as a red rash on white skin, and gray, violet, or darker brown rashes on skin of color.

Psoriasis may be linked with other conditions, including:

• psoriatic arthritis
• inflammatory bowel disease such as Crohn’s disease
• uveitis, an inflammation of the eye
• celiac disease
• pustulosis
• metabolic syndrome

Erythrodermic psoriasis is rare, affecting around 2% of people who have psoriasis. This type of psoriasis can be life-threatening and includes symptoms such as shedding skin in sheets, dehydration, severe pain and itching, and intense redness.

Learn more about erythrodermic psoriasis here.

Other types of psoriasis include:

Plaque psoriasis

This is the most common type of psoriasis. It affects up to 80% of people with psoriasis.

Plaque psoriasis causes silvery, scaly plaques and rashes to develop on the skin. The rash can appear red, brown, gray or violet, depending on a person’s skin color. The plaques are often painful or itchy.

Inverse psoriasis

Inverse psoriasis affects about 25% of people with psoriasis. It may cause severe reddening of the skin in areas where the skin folds, such as under the arms and breasts, and the genital area. It does not cause scaly plaques, and can be painful and itchy.

Guttate psoriasis

Guttate psoriasis affects about 8% of people with psoriasis. It appears as small, round, red spots.

Pustular psoriasis

Pustular psoriasis is rare, and affects around 3% of people with psoriasis. It appears as puss-filled, white bumps on reddened, inflamed skin. It may occur across the entire body, or in a certain area, such as the feet or hands.

Inflammation causes the symptoms of psoriasis. Symptoms may flare up badly, and then calm down and disappear. Symptoms can differ from one person to another, and may include:

• Skin that is itchy, cracked, or bleeding.
• Skin that is gray, violet, dark brown, or red, depending on a person’s skin color.
• Ridged, thickened nails.
• Silvery scales that burn and itch.

Experts do not completely understand what causes psoriasis, although factors may include family history, certain triggers, and a malfunction in a person’s immune system:

Family history

If a person has a close family member such as a sibling, parent, or grandparent with psoriasis, they are at a higher risk of developing the condition.

Triggers

Certain things may trigger psoriasis, either for the first time or as a flare-up in someone who has previously experienced the condition. Common triggers may include:

• stress
• dry, cold weather
• skin injury, such as severe sunburn
• excessive alcohol use
• tobacco
• certain medication, including lithium and hydroxychloroquine
• some infections, such as strep throat

Immune system

A person’s immune system can malfunction, resulting in psoriasis. Blood cells normally attack bacteria and viruses in the body. If they malfunction, however, it is possible that they may attack the skin and other cells.

This can cause the body to rapidly produce new skin cells, which build on top of each other on the skin’s surface. This causes the change in skin color, rashes, and scales associated with psoriasis.

A doctor can diagnose psoriasis by examining the skin, scalp, and nails for signs of the condition.

They may also ask questions to determine if a person has experienced any symptoms of psoriasis, or has a family history of the disorder. It’s possible that they may also take a biopsy of the skin to examine it more closely.

There are various treatments that may improve symptoms of psoriasis. A dermatologist can advise you on the best options for a person, depending on where the rashes are on the body and the severity of the condition.

Treatments may include both prescription and over-the-counter (OTC) medications, phototherapy, and diet.

Prescription medications

A doctor or dermatologist may prescribe certain medications for psoriasis, including methotrexate, which may suppress the overactive immune system.

Apremilast may help reduce scales and redness, and oral retinoids can help reduce swelling and redness and stop the overproduction of skin cells.

Biologics

These medications target the overactive part of the immune system. A doctor can administer biologics through a drip, or via injection.

OTC medications

These products can be beneficial to people with mild psoriasis.

Various options include:

• hydrocortisone, which is a mild corticosteroid that can help reduce inflammation and itching
• coal tar, which may be in some prescription and OTC medications. It can help reduce flaking, itching, overproduction of skin cells, and scaling
• scale softeners, which include products that contain urea, lactic acid, and salicylic acid
• anti-itch products that help stop the itching caused by psoriasis

Anti-itch products may contain ingredients such as camphor, calamine, and menthol.

Other topical treatments

A doctor or dermatologist may prescribe topical treatments, such as:

• retinoid for the skin to reduce swelling and redness
• prescription steroids
• synthetic vitamin D to slow the growth of overproducing skin cells

Phototherapy

This therapy involves a dermatologist aiming a certain type of UV light at the affected areas of the skin. It can help slow the growth of skin cells, suppress the overactive immune system, and reduce itching and inflammation.

Diet

A person can eat a diet containing anti-inflammatory foods to help with psoriasis. This may include:

• beans
• oily fish
• fruits and vegetables
• nuts and seeds

Psoriasis is a chronic autoimmune condition that can be lifelong, and erythrodermic psoriasis may be life-threatening. The condition may also be linked to cardiovascular disease and stroke, depression, and certain types of arthritis.

Symptoms include inflamed, dry skin, rash, and silvery scales. The condition may be caused by several factors. A doctor or dermatologist may treat psoriasis with prescription medication, topical medication, biologics, or phototherapy.