From self.com
It can impact a lot more than just your skin
Psoriasis is a chronic skin condition at its core—but there’s a lot more happening beneath the surface. Psoriasis —which affects an estimated 7.5 million people in the US—is the result of an overactive immune system, which causes chronic inflammation. While we most often see the effects of this inflammation in the skin, it can also travel to other areas of the body, potentially affecting the nails, eyes, joints, heart, and more.
Read on to understand exactly what happens when you have psoriasis, how it might affect your body beyond the skin, and some treatment options that can help.
What’s happening with your immune system?
When your body needs to respond to an infection, an injury, or a substance that threatens your health in some way (like an allergen), your immune system should kick in to release various cells that fight potentially harmful invaders and protect the body. These cells travel to the affected area and start the healing process, causing inflammation. Here’s the problem: When your immune system is in overdrive, as is the case with any autoimmune condition, including psoriasis, it continues to pump out a large number of inflammatory cells, even when there’s no true threat to the body happening.
In people with psoriasis, it’s thought that there’s a faulty immune response that mistakenly identifies healthy skin cells as threatening, which causes the repair system to malfunction. This kicks off an overgrowth of new skin cells, which is what causes the hallmark psoriasis rash. The majority of people with psoriasis have plaque psoriasis, in which the “rash” appears as scaly patches, or plaques, on the skin’s surface.
This rash is just one visible sign of inflammation, but a doctor can measure inflammatory markers in your blood, Benjamin Ungar, MD, an assistant professor in the department of dermatology of Icahn School of Medicine at Mount Sinai, tells SELF. People who have psoriasis are more likely to have other autoimmune conditions as well, including certain forms of arthritis and inflammatory bowel disease (IBD). In fact, 25% of people with autoimmune diseases have more than one type—often a skin condition among them, research shows.
And constantly having higher-than-normal levels of inflammation can wreak havoc on everything from your joints to your arteries, potentially leading to confusing body-wide symptoms.
Psoriasis and your cardiovascular health
Having moderate-to-severe psoriasis ups your risk for cardiovascular health issues and metabolic diseases, like high cholesterol and obesity, Dr. Ungar says. While there’s not a clear-cut reason why psoriasis may play a role, research suggests that systemic inflammation in the body is associated with a build-up of plaque and cholesterol in your arteries, which can eventually block healthy blood flow and put you at risk for heart disease.
Because of these potential health risks, it’s a good idea for people with psoriasis to have annual blood pressure and cholesterol readings, and talk with their physician about any family history of heart disease, Samar Gupta, MD rheumatologist and associate professor of medicine at the University of Michigan Medical School, tells SELF. Beyond these check-ups, focus on what’s in your control, such as working closely with your care team to find the best treatment for your psoriasis and adopting heart-healthy habits like eating a nutritious diet and exercising regularly in some way, he adds. Getting proper sleep and prioritizing stress-reducing habits are key too.
Psoriasis and your joints
About 30% of people with psoriasis develop psoriatic arthritis, an inflammatory condition of the joints, tendons, and ligaments, according to the National Psoriasis Foundation. Most people are diagnosed with psoriasis first, though it is possible to develop the symptoms of psoriatic arthritis—such as joint pain, lower back pain, and swelling in fingers, toes, and feet—before psoriasis, says Dr. Gupta.
While certain inflammatory markers associated with both conditions may show up on a lab test, it’s still not clear exactly why psoriasis and psoriatic arthritis are so strongly linked, says Dr. Gupta. What is known is that psoriatic arthritis can affect anyone of any age who has psoriasis.
That said, there are some specific risk factors that heighten your likelihood of developing psoriatic arthritis. You might be more prone if you have severe psoriasis, have psoriasis on the scalp, or have a family history of psoriatic disease, explains Dr. Gupta. Joint injuries and viral or bacterial infections may also be potential triggers in people who are genetically predisposed.
Psoriasis and your digestive system
If you have psoriasis, you can be up to five times more likely to have IBD, research suggests. On the flip side, people with IBD also seem to be more likely to develop psoriasis.
We can’t really say that psoriasis causes IBD or vice versa, but the association between the two is worth mentioning. The possible reason for the link once again circles back to chronic inflammation, since IBD—including Crohn's disease and ulcerative colitis —are also autoimmune conditions. Symptoms—like unexplained bloating, cramping, abdominal pain, blood in your stool, and diarrhoea—that happen frequently or last for more than just a few days are worth mentioning to your doctor so you can get a work-up.
Psoriasis and your eyes
Psoriasis can affect the skin around your eyes in an obvious way, since you may experience flaking and itchy rashes, but the underlying inflammation from psoriasis or psoriatic arthritis can also cause eye inflammation, Dr. Hejazi says. Again, it’s unclear why, exactly, this happens, but psoriasis-specific inflammation can also potentially affect the cells in the eyes. In fact, about 65% of people with psoriasis will have eye inflammation at some point in their lives, per research published in the Journal of Family Medicine and Primary Care.
This means you could end up with uveitis, inflammation inside the eye that might involve redness, pain, and blurred vision. If you have these symptoms, it’s important to see your doctor, who can refer you to an ophthalmologist. “Uveitis can lead to permanent eye damage” when left untreated, Dr. Hejazi says.
You’ll also want to look out for pink eye (medically known as conjunctivitis), a common and uncomfortable eye condition that causes redness, tearing, and even discharge from the eyes. It’s important to note that viral or bacterial pink eye is very contagious, so the possibility of getting it from another person—rather than from inflammation due to psoriasis—is probably more likely.
Psoriasis and your nails
You may not think of your nails that often, but psoriasis and psoriatic arthritis can affect your nail health and the skin around it. Basically, the immune system tells new skin cells to grow too fast under and around the nails, which can lead to a bunch of uncomfortable symptoms. “The nails can begin to lift up,” Dr. Hejazi explains. “When the nail health is compromised in conditions like psoriasis, there is increased risk of fungal nail infections,” which often leads to thickening of the nail and white or yellow discoloration, he adds.
With nail psoriasis, you might also see nail pits, a series of dents and divots in the nail itself, or have brittle nails that crumble. The best way to figure out what’s going on if you have these symptoms is to make an appointment with your derm, who can take a small sample of the nail to either confirm or rule out an infection, which will guide proper treatment, Dr. Hejazi says.
Psoriasis and your mental health
Psoriasis is a highly stigmatized condition, which can have a big impact on the self-esteem and mental health of the people living with it. According to the American Academy of Dermatology (AAD), 86% of people with psoriasis say they’re embarrassed by their skin’s appearance, 81% have depression or other emotional issues stemming from their condition, and 66% feel isolated or alone. “Many patients with psoriasis are extremely self-conscious about their skin, because psoriasis often affects very visible areas of the body such as the scalp, face, hands, elbows, and legs,” Dr. Hejazi points out. “I have several patients who refuse to wear short sleeves or shorts as it may expose their rash.” All of that can heighten feelings of anxiety and depression when it comes to psoriasis, she says.
On top of that, there may be a reaction happening in the body that potentially predisposes people with psoriasis to have mood disorders. An important pathway, called the gut-brain-skin axis, connects the microbiome of bacteria in your gut, the inflammation (or lack thereof) in your skin, and your mental state, Dr. Gupta says. The ways they impact each other are complex and not super straightforward, but the gut microbiome has been found to play an important role in facilitating communication between the immune system and the brain. Normally, good bacteria in your microbiome help produce neurotransmitters, like serotonin and dopamine, which are necessary to regulate mood. In people with psoriasis, there sometimes seems to be a miscommunication that results in an unsuccessful transmission of those “happy hormones” from the gut to the brain, which can possibly set the stage for higher levels of anxiety and depression.
How to minimise the effects of psoriasis
When it comes to treating psoriasis, the sooner you get a diagnosis and begin your treatment journey, the better. There are a number of medications that can help reduce inflammation throughout your body—so you can start feeling better quickly. If one doesn’t work for you, there will be plenty of others to consider.
Treatment options that target the entire body include oral immunosuppressant medications, which work by tamping down an overactive immune system, and injectable or infusion medications called biologics, which target specific parts of the immune system to block the faulty reaction that causes psoriasis, according to the AAD. Both biologics and oral immunosuppressants essentially reduce chronic inflammation, which also can reduce the effects of psoriasis beyond the skin. On top of that, topical medications and managing your psoriasis triggers—stress is a big one—can help keep your flare-ups in check.
https://www.self.com/story/how-psoriasis-affects-your-body
