Psoriasis and its Association with Metabolic Syndrome

Psoriasis is a multifactorial, chronic, immune-mediated inflammatory condition. Psoriasis often goes beyond the skin, nails and scalp and involves the eyes (uveitis), joints (arthritis) and several metabolic derangements, as seen in various studies. It is strongly associated with features of the metabolic syndrome (MetS) like hypertension, obesity, dyslipidaemia, type 2 diabetes, insulin resistance and non-alcoholic fatty liver disease. Amongst various skin diseases, MetS has the strongest association with psoriasis. The risk of having MetS is almost doubled in patients with psoriasis as compared to healthy individuals. Both conditions share a common pathophysiological background in terms of genetics, inflammatory markers, lifestyle choices, etc. The association of psoriasis with MetS is clinically important as it influences the prognosis, quality of life and choice of treatment. Systemic conventional drugs should be used with caution in such patients, as their long-term use may contribute to metabolic impairment. The treating dermatologist should be aware of such associations and their implications, and a more holistic approach should be taken to manage psoriasis where equal importance is given to lifestyle and dietary modifications and comorbid conditions, in addition to the pharmacological therapy so as to decrease the burden of the disease for both the patient and the health system.