Antipsoriatic treatment extends beyond the skin: recovering of high-density lipoprotein function

Epidemiological and clinical studies have shown a consistent association of psoriasis with systemic metabolic disorders including an increased prevalence of diabetes, obesity and cardiovascular disease. Psoriasis is accompanied by systemic inflammation and low levels of high-density lipoprotein (HDL) cholesterol. Recent studies provided clear evidence that psoriasis affects HDL composition and function. HDL isolated from patients with psoriasis showed a significantly impaired capability to mobilize cholesterol from macrophages, a crucial step in reverse cholesterol transport and markedly lower paraoxonase activity, a protein that co-transports with HDL in serum with well-known anti-atherogenic properties. Of particular interest, successful antipsoriatic therapy significantly improved HDL composition and function independently of serum HDL cholesterol levels. These novel findings suggest that the conventional approaches of evaluating cardiovascular risk in psoriasis may be in need of refinement. As these data argue for a loss of beneficial activities of HDL in patients with psoriasis, altered HDL functionality should be considered when evaluating the lipid status of patients.