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Psoriasis is a benign, chronic, inflammatory disease that usually involves outbreaks, periods of flare‑ups, and remission.
The prognosis of this disease is the same as for the general population, except in cases where there are associated cardiovascular risk factors or other diseases independent of psoriasis. However, the quality of life of patients with extensive lesions, or during flare‑ups, can be significantly affected.
Although acute complications are very rare, the following are considered variants of psoriasis:
Generalized pustular psoriasis or Von Zumbusch‑type. This can be related to certain trigger factors (drugs, hypocalcaemia, stressors, and infections) and presents as small sterile pustules that appear rapidly, anywhere on the body, even the nails. It is accompanied by systemic symptoms (fever, leukocytosis, elevated acute phase reactants, etc.) and requires intensive treatment to avoid dehydration and severe infections. After treatment, the patient usually presents the clinical form of psoriasis they were suffering previously.
Erythrodermic psoriasis. This involves the appearance of generalised erythema that affects more than 90% of the body’s surface area and which may be accompanied by severe systemic symptoms (fever, leukocytosis, elevated acute phase reactants, protein deficit, etc.). It may appear after the withdrawal of oral corticosteroids, as a response to serious sunburn, or due to the use of certain drugs that worsen psoriasis.
Cardiovascular risk factors. Psoriasis sufferers have higher percentages of diseases such as diabetes, obesity, and hypertension. It is not yet known whether there is a genetic link between these diseases. This association implies increased mortality in patients with psoriasis. In fact, they are said to be more likely to have what is known as metabolic syndrome, an association of several metabolic disorders such as increased blood sugar, triglycerides, blood pressure levels, and abdominal fat, with decreased HDL cholesterol. The presence of three or more of these metabolic alterations carries an increased risk of cardiovascular disease.
Autoimmune diseases. In addition, psoriasis is associated with other immunological diseases, particularly rheumatoid arthritis, but also alopecia areata, coeliac disease, and lupus erythematosus.
Depression. Depression is twice as common in people with psoriasis as in the general population. The factors contributing to the development of depression in patients with psoriasis include those relating to difficulties with social relationships and factors deriving from the frustration with treatments.
Complications from topical and systemic treatments. Prolonged use of topical corticosteroids can cause atrophy, stretch marks, or telangiectasia (spider veins). Immunosuppressive drugs may be related to increased infections, although this potential complication can be reduced through better selection.
Psoriatic arthritis affects 15-30% of people with psoriasis
One of the illnesses that can significantly affect psoriasis is arthritis, which develops into a rheumatic condition; psoriatic arthritis. It affects 15-30% of patients with psoriasis. It can manifest in various ways, from exclusively affecting the spine, with lumbar or cervical pain, to arthritis or inflammation of the joints, similar to other types of chronic arthritis such as rheumatoid arthritis. Furthermore, there are other types in which the only manifestation is inflammation in one finger (dactylitis or sausage digit) or tendonitis in the lower limbs (Achilles tendon, the sole of the foot, knee, etc.).
There is no direct relationship between the spread of psoriasis on the skin and which joints are affected. Therefore, some patients whose skin is greatly affected never have trouble with their joints throughout their lives. In fact, the majority of patients who develop arthritis have a mild skin condition. Likewise, skin outbreaks in patients who have been diagnosed with psoriatic arthritis can progress differently to their joint condition.
Furthermore, not all joint trouble found in patients with psoriasis is related to psoriatic arthritis, as psoriasis can occur with joint or muscle pain without arthritis. This is why it is always important to consult a medical professional if you have any doubts.
In general, the treatment for psoriatic arthritis is quite similar to that for other types of arthritis. Using treatments that slow the progression of the illness is recommended and in many cases are those used for psoriasis.
Early treatment improves the prognosis for these patients. There are various questionnaires, both in dermatology and in primary care, for detecting those patients who are at higher risk of developing psoriatic arthritis. It is hoped, therefore, that the impact of this disease will decrease over time, as early diagnosis can prevent negative consequences in the long term.
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Substantiated information by:
Felipe Julio Ramirez GarciaRheumatologistRheumatology Department
Mercè Alsina GibertDermatologistDermatology Department
Paula Aguilera PeiroDermatologistDermatologist Department
Sara Gómez ArmayonesDermatologistDermatologist Department
Published: 22 February 2019
Updated: 22 February 2019
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