Clinical Review

Managing comorbid disease in patients with psoriasis

BMJ 2010; 340 doi: 10.1136/bmj.b5666 (Published 15 January 2010)
Cite this as: BMJ 2010;340:b5666

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  1. Wolf-Henning Boehncke, professor of dermatology1,
  2. Sandra Boehncke, consultant internist2,
  3. Michael P Schön, professor of dermatology3
  1. 1Department of Dermatology, Clinic of the Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
  2. 2Department of Internal Medicine, Section of Endocrinology, Diabetes and Metabolism, Clinic of the Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
  3. 3Department of Dermatology, Venereology and Allergology, Georg August University, Göttingen, Germany
  1. Correspondence to: W-H Boehncke, Department of Dermatology, Theodor-Stern-Kai 7, D- 60590 Frankfurt, Germany Boehncke{at}em.uni-frankfurt.de
  • Accepted 28 December 2009

Summary points

  • Psoriasis is a common and severe disease, impairing patients’ quality of life to an extent similar to other major diseases such as cancer or diabetes mellitus

  • Psoriasis is a systemic disease: Th17 cells are important effector cells and biomarkers of systemic inflammation are raised

  • Several important diseases including psoriatic arthritis, metabolic syndrome, Crohn’s disease, cancer, and depression are associated with psoriasis

  • Life expectancy is reduced by about four years in patients with severe psoriasis, primarily owing to their increased cardiovascular risk

  • Physicians in primary and secondary care need to detect developing comorbidities early, using validated questionnaires (to detect psoriatic arthritis) and proper monitoring

  • Treatment decisions must take into account patients’ comorbidities (to identify contraindications) and comedication (to avoid drug interactions)

Psoriasis is a common, chronic inflammatory skin disease that typically presents with sharply demarcated, red scaly dermatological plaques that may be painful and stigmatising (fig 1⇓). It causes a high burden of disease, comparable to that of cancer or diabetes mellitus.1 In about a quarter of people with psoriasis the condition is severe enough for them to need ultraviolet light therapy, systemic drug treatment, or hospital admission.

Fig 1 Patient with severe psoriasis: red scaly plaques cover more than 10% of the body surface area; this patient also has a body mass index >25

Three recent developments have changed our understanding of psoriasis substantially. Firstly, researchers identified “Th17 cells” (a new type of lymphocyte) as important effector cells in autoimmune diseases.2 Indeed, the first drug that interferes with the functions of Th17 cells was approved in 2009, its first indication being psoriasis.3 Secondly, psoriasis is now confirmed as a systemic disease, as serum biomarkers for inflammation are raised in patients with psoriasis.4 Finally, psoriasis frequently occurs alongside other diseases.5 This review focuses on comorbid …

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