Managing comorbidities in psoriasis

Psoriasis is a common inflammatory skin condition, often associated with other diseases. Around 25 % of patients develop joint involvement in the form of psoriatic arthritis as well. Recent epidemiologic studies demonstrated an increased cardiovascular morbidity among psoriasis patients, which contributes to their reduced life expectancy. High prevalence of the metabolic syndrome as well as adverse effects of systemic anti-psoriatic therapies may contribute to the observed association. The consequences for the management of psoriasis at this point are three-fold: As comorbidity goes along with comedication, potential drug interactions need to be kept in mind when choosing a systemic anti-psoriatic therapy. Moreover, as psoriasis itself is a risk factor for cardiovascular morbidity, patients must avoid other known risk factors such as obesity or smoking. Dermatologists need to communicate this additional risk to their patients and support them accordingly. Finally, dermatologists serve as sentinels when it comes to the early diagnosis of developing comorbidities in general and psoriatic arthritis in particular, thus opening the door to early intervention.