It's more than just skin deep

For the past 30 years, the only reason I've gone to the dermatologist for my psoriasis is when I've run out of refills for the prescription creams and foams I use as needed. He usually gives me a prescription that can be filled many times, so I don't go very often. He's always acted as if psoriasis is just a pesky rash on my elbows and scalp, and I've always thought of it as just that. In reality, psoriasis is a chronic disease and is associated with nearly double the rate of metabolic syndrome that people without psoriasis will have! People with psoriasis need to take care of their total health and be screened for the individual components of metabolic syndrome like high blood sugar, obesity, high triglycerides, and low HDL levels, and take steps to correct any problems that are found before they progress on to diabetes or cardiovascular disease.

I never heard of such a thing until I started searching the research literature lately, when I realized I'd gained 10 pounds over the last year. I've gained the weight through drinking more sugary sodas and getting a lot less exercise. I also had developed psoriasis on my ears now, and on the back of one shoulder blade. I wanted to drop at least some of the weight pronto, so for two weeks I cut back on the sodas and I walked a mile nearly every day. I lost a couple of pounds, but much more strikingly I noticed that I had almost no psoriasis on my ears, and my "bad" elbow looked a lot less red. Did dropping two pounds lead to this improvement in my psoriasis? I wondered if my psoriasis was like the "canary in the coal mine" alerting me that my overall health was suffering!

I decided to look at the literature from psoriasis research. As we know, psoriasis is not just "skin deep." It's a chronic, autoimmune illness. Although I hadn't been aware of it, it's been known for years that there is an association between psoriasis and obesity and the other individual components of metabolic syndrome such as hypertension. Apparently the link is complex, but there is a link between the chronic inflammation status of psoriasis with metabolic disturbances.1

A study recently published online2 looked at two populations of people - one with and one without psoriasis. A lot of factors were considered and statistics evaluated, but the result was that the prevalence of metabolic syndrome was 40% in the group of people with psoriasis vs. 23% for the people without psoriasis. Also, whether it's to do with the size of the study sample of people is unknown, but the prevalance of metabolic syndrome among women with psoriasis was higher than that among men with psoriasis. 

The most common metabolic symptom among psoriasis patients was abdominal obesity, which was present in 63% of the patients! That was followed by high triglyerides and low LDL levels. 
Since the prevalence of metabolic syndrome in people with psoriasis was nearly double that of people who did not have psoriasis, doctors and psoriasis patients need to be alert for other health problems which seem to go hand-in-hand with psoriasis.

If you have psoriasis, get a checkup to make sure you don't have metabolic syndrome, and try to get or keep your weight in the normal range. I still don't understand which way a cause-and-effect works between psoriasis and obesity and blood sugar, but I do know that having psoriasis means we're more likely to have those other problems, whatever the reason, so we should try to cultivate healthy habits as part of our psoriasis treatment.  We can't go wrong by eating healthy diets and getting some good exercise, no matter what that complicated link between psoriasis and metabolic symptoms turns out to be. 

1 Psoriasis Independently Associated With Hyperleptinemia Contributing to Metabolic SyndromeYi-Ju Chen, MD; Chun-Ying Wu, MD, PhD, MPH; Jui-Lung Shen, MD; Szu-Ying Chu, MD; Chih-Kang Chen, MD; Yun-Ting Chang, MD, PhD; Chuan-Mu Chen, PhD Arch Dermatol. 2008;144[12]:1571-1575 

2 Prevalence of the Metabolic Syndrome in PsoriasisThorvardur Jon Love, MD, MMSc; Abrar A. Qureshi, MD, MPH; Elizabeth Wood Karlson, MD; Joel M. Gelfand, MD, MSCE; Hyon K. Choi, MD, DrPHArch Dermatol. Published online December 20, 2010. doi:10.1001/archdermatol.2010.370