Psoriasis-associated lung disease: A comprehensive review and case series

Psoriasis is a chronic systemic autoimmune disease primarily affecting the skin and joints. Growing evidence suggests an association with pulmonary comorbidities, though lung involvement remains under characterized. We reviewed the literature and conducted a retrospective analysis to define pulmonary manifestations in psoriasis patients, termed Psoriasis-Associated Lung Disease (Psoriasis-LD).

We identified 251 adult psoriasis patients at our academic center (2012-2022) who had chest CT scans and/or pulmonary function tests (PFTs). Data included demographics, psoriasis phenotype/treatment, respiratory symptoms, PFTs, radiographic features, and outcomes. Psoriasis-LD was defined by symptoms and/or CT abnormalities and/or abnormal PFTs. CT findings were categorized as: fibrotic (traction bronchiectasis/honeycombing), airway disease (bronchial wall thickening/bronchiectasis), or ground-glass opacities (GGO)/consolidation. Statistical analyses included descriptive statistics, group comparisons, Kaplan-Meier, and Cox proportional hazards models.

The mean patient age was 64.6 ± 14.7 years, with an equal gender distribution (50 % female). Common comorbidities included obesity, gastroesophageal reflux disease (GERD), and sleep apnea. CT abnormalities included pulmonary ground-glass opacification or consolidation (25.1 %), airway disease (8-9 %), and interstitial fibrosis (3-7 %), with over half of the patients displaying any one of these features. Airway disease and GGO were strongly linked to death or transplant (HR 2.07, 2.50, respectively). Follow-up showed that 39 % of patients died or received lung transplants. Interstitial lung disease (ILD) was confirmed in 8.8 %, mainly NSIP and UIP patterns and most patients with ILD had additional risk factors.

Pulmonary abnormalities frequently occur in psoriasis patients and correlate with poorer outcomes, suggesting that psoriasis may be a significant risk factor for pulmonary complications. Earlier detection and multidisciplinary management are essential to improving patient outcomes.