Psoriasis beyond skin: What patients need to know about associated health risks

From news9live.com

By Sangeeta Das

Psoriasis affects more than the skin, increasing the risk of joint problems, heart disease and other health concerns. Find out the associated risks and treatment options

New Delhi: Psoriasis is often mistaken for a skin condition characterised by red, scaly patches, but its impact extends far beyond the skin. It is a chronic, immune-mediated inflammatory disease that can affect multiple organ systems. Recognising these associations is essential for protecting a patient’s long-term health.

Psoriatic arthritis: Recognising early signs

One of the most important conditions associated with psoriasis is psoriatic arthritis. Patients may experience joint pain, stiffness, swelling of the fingers or toes, and morning stiffness that improves with movement. In my clinical experience, one important point patients often overlook is that psoriatic arthritis can sometimes develop before the characteristic skin lesions appear. Persistent joint pain, swelling or changes in the joints and bones warrant medical assessment. Even a seemingly minor rash, scalp scaling or nail changes may offer valuable diagnostic clues. Consulting a dermatologist can help identify subtle signs of psoriasis, while early collaboration with a rheumatologist can prevent irreversible joint damage.

Cardiometabolic and cardiovascular risks

Psoriasis is also associated with an increased risk of cardiometabolic disorders, including obesity, type 2 diabetes, hypertension and abnormal cholesterol levels. Chronic systemic inflammation is thought to contribute to these associations. Patients, particularly those with moderate-to-severe disease, should undergo appropriate screening for blood pressure, blood glucose, lipid levels and excess body weight.

Cardiovascular health deserves particular attention. People with psoriasis, especially severe disease, may have a higher risk of heart attacks and strokes. Dermatologists must therefore look beyond visible plaques and encourage patients to address smoking, physical inactivity, excess weight and unhealthy dietary habits.

Impact on mental health

Mental health is equally important. Persistent itching, visible lesions and unpredictable flare-ups can affect self-esteem, relationships and social interactions. Anxiety and depression are not uncommon. Patients should feel comfortable discussing these concerns, as effective treatment can improve both symptoms and quality of life.

Psoriasis and liver health

Psoriasis has also been linked to metabolic dysfunction-associated steatotic liver disease (MASLD), previously called non-alcoholic fatty liver disease. Certain systemic treatments may require liver monitoring, making individualised assessment essential.

Managing psoriasis beyond skin

The encouraging news is that psoriasis can be managed with topical treatments, phototherapy, conventional systemic medicines and biologic therapies, depending on disease severity and associated conditions.

Regular follow-up, screening for relevant comorbidities and collaboration between dermatologists, rheumatologists and physicians can make a meaningful difference.

The central message is simple: treating psoriasis means treating the patient, not just the patches. A comprehensive approach can help control inflammation, identify associated health risks early and improve long-term well-being.

(By Dr Deepali Bhardwaj, Senior Consultant, Dermatology, Max Hospital, Saket)

Disclaimer: This article is written by the doctor mentioned above. The findings should not be considered medical advice or used for self-diagnosis or treatment. Consult a qualified healthcare professional for personalised guidance.

https://www.news9live.com/health/psoriasis-associated-health-risks-early-signs-3017093

When the Cold Takes a Toll on Your Skin

From tovima.com

Cold, dry air and indoor heating can trigger flare-ups of eczema, psoriasis and other skin conditions, while persistent cold-related lesions may sometimes point to an underlying autoimmune or vascular disorder

Cold weather, dry air outdoors and indoor heating create a particularly harsh environment for the skin. For most people, this may simply mean increased dryness. For people with atopic dermatitis, eczema, psoriasis or other skin conditions, however, winter can bring genuine flare-ups.

“Winter and cold weather significantly affect the skin, mainly because cold, dry air, combined with low humidity and increased indoor heating, disrupts the skin barrier and increases dryness and irritation,” Sotirios Theocharis, president of the Hellenic Society of Dermatology and Venereology, tells TO BHMA.

From Eczema and Psoriasis to Rosacea

At the top of the list of those most vulnerable are patients with atopic dermatitis and eczema in general. Flare-ups are also more common with seborrheic dermatitis.

“Psoriasis can flare up in a significant proportion of patients during the cold and dry months. However, there is no single rule that applies to all patients, as the disease’s seasonal pattern varies considerably from person to person,” Theocharis notes.

Rosacea can also be aggravated. The inflammatory skin condition affects the face and can cause visible small blood vessels, inflammatory lesions and a burning sensation.

There are also conditions that are much more directly linked to exposure to cold, such as cold urticaria and the familiar chilblains, also known as pernio. Here, too, a seemingly simple skin lesion can sometimes be a sign that further investigation is needed.

When the Cold Reveals Something More

“There is a particular category we need to keep in mind: chilblain lupus, a form of cutaneous lupus erythematosus in which lesions on the fingers and other areas of the extremities appear or worsen in the cold. Chilblains can also occur secondarily in patients with systemic autoimmune or other diseases. That is why persistent, recurring or atypical lesions require medical evaluation,” Theocharis stresses.

Raynaud’s phenomenon is also of particular interest. According to Theocharis, it affects 2% to 4% of the general population and is characterized by sudden changes in the colour of the skin on the extremities.

“It should be investigated for the possible presence of a systemic disease,” he says. The key, however, is not to assign the cold a causal role that it does not have.

“Cold is not, by itself, the cause of all these diseases. In many cases, it acts as a factor that disrupts the skin barrier, causes vasospasm or triggers a flare-up of an existing skin condition.”

No Single Treatment for “Winter Skin Conditions”

Precisely because these are different diseases, there is no single winter treatment.

For dry skin and eczema, the first goal is to restore the skin barrier through the regular use of appropriate moisturizing and emollient products, while avoiding very hot water and irritating cleansers. When inflammation is present, treatment should be determined by a dermatologist.

“For atopic dermatitis, there are now many effective treatments, ranging from topical therapies to phototherapy and modern targeted systemic treatments. In psoriasis, treatment is tailored according to the extent and severity of the disease and may include topical treatments, phototherapy or systemic therapy, including newer biologic and other targeted treatments,” he says.

For chilblains, by contrast, the first step is protection from the cold and gradual rewarming of the extremities. Persistent or recurring lesions require evaluation for a possible underlying disease. In cases of chilblain lupus, cooperation between a dermatologist and a rheumatologist may even be necessary.

The Mistakes We Make When It Gets Cold

Everyday prevention is much simpler. Warm clothing, gloves and socks, protection for the face and ears, and avoiding prolonged exposure to very low temperatures form the first line of defence.

“Proper skin moisturization is equally important. Gentle cleansers are recommended, along with applying a good moisturizer immediately after bathing and reapplying it during the day when there is dryness. Bath water should not be very hot, and baths should not be prolonged,” Theocharis says.

Another mistake is trying to warm up frozen hands or feet abruptly with very hot water or by placing them against a radiator.

“Rewarming should be gradual,” he warns.

As for diet, he dismisses the idea that there is a special diet that protects the skin during winter.

“There is no specific ‘winter diet’ that prevents skin diseases.”

A balanced diet is sufficient, while arbitrary food restrictions or supplements are not recommended without a specific indication. One exception is psoriasis, for which there is evidence that weight loss in overweight or obese patients may reduce the severity of the disease.

Have skin conditions increased?

Theocharis is cautious on this point as well. In everyday clinical practice, dry skin, eczema and worsening of chronic skin conditions are frequently observed during the colder months.

That, however, is not enough to conclude that dermatological diseases overall have increased in recent years, as comparable epidemiological data would be required.

“What is certain is that the winter months are a period when many patients with chronic skin conditions need greater care and adjustments to their daily skin-care routine.”

The message he says people should take away is simple:

“Cold does not cause most skin diseases by itself, but it can disrupt the skin barrier, trigger flare-ups and, in some cases, reveal an underlying vascular or autoimmune disorder.”

https://www.tovima.com/society/when-the-cold-takes-a-toll-on-your-skin/ 

Could Anaemia Be Contributing to Your Psoriatic Arthritis Fatigue?

From health.yahoo.com

By Carmen Chai-Oakley

Fatigue can be one of the most disruptive - yet common - symptoms of psoriatic arthritis (PsA). And it isn't just ordinary tiredness: PsA can cause a lingering physical and mental exhaustion that doesn't disappear after a good night's sleep and can make working, exercising, socializing, and even carrying out everyday tasks more difficult.

There are a few factors at play. Interrupted sleep, symptoms like anxiety, depression, and swollen joints, and certain medications may contribute to fatigue.

But another potential factor is anaemia, a condition in which your body doesn't have enough healthy red blood cells. It can cause symptoms such as tiredness, weakness, and shortness of breath.

Here's how to tell if your fatigue may be anaemia-related - along with how anaemia is diagnosed and treated alongside PsA.

Causes of Anaemia in Psoriatic Arthritis

Anaemia occurs when you don't have enough healthy red blood cells to adequately carry oxygen throughout your body. But there isn't one single reason someone with PsA may develop it, according to Alireza Meysami, MD, the head of rheumatology at Henry Ford Health in Detroit, where he specializes in diagnosing and treating inflammatory arthritis, including PsA.

"Persistent inflammation can increase hepcidin, a liver hormone that traps iron in storage and limits its availability for making red blood cells. This is called anaemia of inflammation," Dr. Meysami says.

This process is also known as anaemia of chronic disease because it can affect people with conditions that cause inflammation, including autoimmune diseases like PsA. With chronic inflammation, your body struggles to use stored iron for red blood cell production.

But PsA-related inflammation isn't the only possibility. Anaemia may be triggered by:

• Regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) for joint pain. "NSAIDs may cause gastritis, ulcers, or slow gastrointestinal bleeding," Meysami says. This may lead to iron deficiency anaemia.

• Iron deficiency from menstrual or gastrointestinal blood loss

• Iron deficiency from poor absorption or nutritional deficiencies

• Methotrexate. While methotrexate is commonly prescribed to treat PsA, anaemia is a potential side effect. "Methotrexate interferes with folate metabolism and, rarely, may suppress the bone marrow, which is why we prescribe folic acid and monitor blood counts," Meysami says.

Methotrexate itself can also cause fatigue in some people, even when it hasn't caused anaemia, says Neal Birnbaum, MD, a rheumatologist and past president of the American College of Rheumatology who's been practicing for 48 years in San Francisco.

Ultimately, anaemia can be "multifactorial," Dr. Birnbaum says. It shouldn't automatically be attributed to arthritis, he says. Comorbidities can contribute to anaemia, too, including kidney or thyroid disease.

Signs and Symptoms of Anaemia-Related Fatigue

It's not always straightforward to figure out whether fatigue is coming from PsA or anaemia, because there can be overlap.

"[PsA] patients often describe feeling completely drained, physically heavy, or mentally foggy, even after sleeping. Some have to choose between working, exercising, caring for their family, or participating in social activities because they do not have enough energy for everything," Meysami says.

Anaemia can cause fatigue and weakness, too. But some additional symptoms may make anaemia worth investigating, including:

• Shortness of breath

• Pallor (skin that's paler than usual)

• Dizziness, lightheadedness

• Headaches

• Heart palpitations

• Chest pain

• Cold hands and feet

Still, symptoms alone can't determine whether you're anaemic. Blood tests are needed for a diagnosis.

If your fatigue appears as your haemoglobin level falls and improves after the anaemia is corrected, that's a clue that anaemia was contributing to the exhaustion, Birnbaum says.

But even then, it may just be one factor among several. Sometimes, factors like chronic pain, poor sleep, anxiety and depression, thyroid disease, or fibromyalgia may be causing fatigue, Meysami says. "Steroids may cause insomnia while antihistamines and some pain or anxiety medications may cause daytime sleepiness," he says.

How Anaemia Is Diagnosed

Maria Kray/iStock

If persistent fatigue is interfering with your everyday life, talk to your rheumatologist or primary care doctor about whether testing for anaemia makes sense, Birnbaum says.

Your doctor may conduct a complete blood count test to start, which focuses on red blood cells, including their size and shape, Birnbaum says.

If anaemia is present, additional testing may include further blood testing for reactive proteins, ferritin, iron, transferrin saturation, reticulocyte count, vitamin B12, folate, and kidney and thyroid function, Meysami says.

"Depending on the patient, evaluation for menstrual or gastrointestinal blood loss may also be necessary," Meysami says.

Treating Anaemia When You Have Psoriatic Arthritis

Treatment depends on why you're anaemic.

If anaemia is related to inflammation from PsA, getting the disease under better control may help with both the anaemia and the fatigue. "If you have effective treatment, if the skin and joints are under control, then the anaemia is going to improve," Birnbaum says.

But controlling PsA won't resolve every form of anaemia. Blood loss, iron deficiency, vitamin deficiencies, kidney disease, or medication-related problems need their own treatment, Meysami says.

If testing confirms iron deficiency, treatment may include oral or intravenous iron, while folate or vitamin B12 can be replaced if a deficiency is found.

Your rheumatologist will also review your medical history, prescribed medications, and other factors, such as NSAID use, potential gastrointestinal bleeding, sleep problems, and chronic pain, Meysami says.

"Do not accept severe fatigue as something you simply have to live with because you have PsA. Fatigue is real, can be disabling, and deserves a proper evaluation," Meysami says.

The Takeaway

• Fatigue is a common symptom for people with psoriatic arthritis (PsA) and several potential factors can be at play, including inflammation, chronic pain, disrupted sleep, certain medications, or anaemia.

• Anaemia in PsA can stem from chronic inflammation, which causes the body to struggle to use stored iron for red blood cell production, or from factors like iron loss from bleeding, nutrient deficiencies, or medication side effects.

• Blood tests are needed to confirm whether anaemia is contributing to fatigue, and treatment ultimately depends on the cause, ranging from better management of PsA inflammation to iron and vitamin replacement.

https://health.yahoo.com/conditions/anemia/articles/could-anemia-contributing-psoriatic-arthritis-050000943.html