Advances in Psoriasis Research and Side-by-Side Treatment Review

New Insights, Treatment Updates and Comparisons

Naveed Saleh, MD, MS; Reviewed by Graeme Lipper, MD

Disclosures

May 31, 2017

New Insights: Psoriasis, Cardiovascular Risk, and Metabolic Syndrome

In regard to cardiovascular risk, on the basis of epidemiologic study, it appears that people with more severe psoriasis experience increased risk for stroke, myocardial infarction, and death secondary to cardiovascular causes independent of conventional risk factors. Such epidemiologic study as well as an improved understanding of the pathophysiology of psoriasis has helped elucidate that psoriasis is not only a skin disorder but also a more generalized and systemic inflammatory disorder.[10]

Overlapping inflammatory pathways as well as genetic predisposition may also link psoriasis with metabolic syndrome, a constellation of obesity, hypertension, dyslipidemia, and insulin resistance. This link is supported by an ever-expanding body of research and has several clinical implications. Specifically, researchers suggest the following[11]:

  • People with psoriasis should be screened for cardiovascular risk factors.

  • Steps should be taken to lower cardiovascular risk in those with psoriasis.

  • Safety and efficacy of treatments should be adjusted to take cardiovascular risk into mind.

Treatment of Psoriasis

Treatment of psoriasis depends on various factors, including the severity, type, and location of the disease. Localized plaque psoriasis can usually be treated with topical agents. More severe, widespread psoriasis can be treated with systemic (oral or parenteral) agents.[4] Systemic therapies for psoriasis include methotrexate, cyclosporine, acitretin, and biologic agents targeting proinflammatory cytokines such as tumor necrosis factor (TNF)-alpha, interleukin (IL)-12, IL-17, and IL-23.

Of note, ultraviolet light therapy can be used as adjunctive therapy with topical and systemic agents for widespread psoriasis.[4]

In some patients, combining topical, systemic, and light therapy is effective and reduces the dosages of each medication involved.[3] Patients should be told to avoid excess drying of their skin and be advised to administer moisturizers.[4]

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