Can Psoriasis Predispose You to Other Illnesses Like Covid-19?

With Coronavirus 2019 (Covid-19) still spreading around the world, many people with psoriasis may be worried about the risks an infection would pose to them particularly because psoriasis is considered an autoimmune disease. According to research presented by the Keck School of Medicine at the 2021 virtual meeting of the American Academy of Dermatology, people suffering from psoriasis were more likely to contract Covid-19 compared to the general population.

However, study authors noted that the patients with psoriasis were also more likely than the general population to have other Covid-19 risk factors, such as congestive heart failure, type-2 diabetes mellitus, obesity, or chronic obstructive pulmonary disease. People living with psoriasis may want to continue taking precautions against Covid-19 infections, like avoiding crowded places, masking up, and regularly washing hands, due to these findings.

Since Covid-19 is still a relatively new illness, there have been limited studies so far on how it affects people with psoriasis. There are, however, other illnesses with well-documented links to psoriasis. "Psoriasis is an auto-immune disease, and…we say that if you have one auto-immune disease, it increases the risk of having other auto-immune diseases, such as alopecia, celiac disease, or Crohn's disease,” Dr. Saakshi Khattri, a Dermatologist/Rheumatologist at Mount Sinai Health System, tells SurvivorNet.

"There are some auto-immune diseases that sort of cluster with psoriasis. Psoriatic arthritis is one of them; it is seen in about a third of patients that have psoriasis,” she adds.

Separately, Dr. George Han, a Dermatologist at Northwell Health/Lenox Hill Hospital, tells SurvivorNet that psoriasis is also connected with many internal comorbidities.

"The most obvious of which is psoriatic arthritis, which is an inflammatory arthritis that if left untreated is quite debilitating…as well as a number of other comorbidities that we are learning more and more about, such as inflammatory bowel disease and metabolic syndrome,” he says. “So, there are a lot of different connections, also with psychiatric comorbidities."

What is Psoriatic Arthritis?

Psoriatic arthritis can cause swollen, painful joints and other symptoms that are typical of arthritis. Sometimes, the joint pain is the first and only symptom to appear, while other people suffering from this disorder may see nail changes, such as pitting and discoloration. Psoriatic arthritis can affect any joint, causing stiffness and eventually leading to unwanted joint damage.

Dr. Khattri notes that any patient who is experiencing symptoms associated with psoriasis and notices painful or swollen joints should report these symptoms to a doctor as soon as possible. Early intervention is preferred before symptoms become bothersome and affect movement or gait (walking). "If you have psoriasis on the skin or what looks like psoriasis on the skin, along with the onset of joint pain, whether it is sort of stiffness in the lower back or a swelling of the finger or a toe that is inexplicable, do think of psoriatic arthritis and then certainly reach out to your healthcare providers sooner rather than later," she says.

What Other Issues Can Psoriasis Lead To?

Psoriasis can also increase a person's risk of developing several other diseases. Those include, but are not limited to, the following:

• Inflammatory bowel disease, such as Crohn's disease or ulcerative colitis
• Non-alcoholic steatohepatitis (NASH), which is an advanced form of non-alcoholic fatty liver disease
• Metabolic syndrome, which is a cluster of conditions (like high blood pressure and excess body fat) that increase the risk of heart disease, stroke, and type II diabetes

Dr. Khattri stresses, however, that people who have psoriasis should not assume they are definitely going to develop one of these additional conditions mentioned above. They are just at an increased risk of developing certain illnesses. "The risk is not linear in the sense that, if you develop psoriasis, you will develop inflammatory bowel disease and then progress to developing something else," she explains. "It is not a linear association like that, but it is an increased risk … compared to somebody that does not suffer from psoriasis."

Because of these risks, after a psoriasis diagnosis, your healthcare team may send you to get checked out to make sure you have not also developed one of these associated conditions.

Diagnosing Psoriasis

How psoriasis is diagnosed will depend on what type of the condition a person has and how the disease is presenting on their body. After a diagnosis, your doctor will be able to make determinations about risk factors for the conditions above, that have been linked to your psoriasis. In some cases, diagnosis is simple because the skin lesions associated with the disease are very clear, Dr. Khattri says. In other more challenging cases, a biopsy may be necessary.

"[Diagnosing patients] can be easy when it is obvious, the skin lesions, circumscribed meters, scaly plaques … so it is a clinical diagnosis. It can be a little challenging if you have involvement of just psoriasis on the scalp without any other part of the body, or if you just have genital psoriasis without any other part of the body, or just palms and souls." With those situations where psoriasis is only presenting in one area, or if it is erythrodermic psoriasis (which can cover the entire body), a biopsy will be needed to make the necessary diagnosis.

Final Thoughts

It is important to remember that your psoriasis can predispose you to other illnesses, like Covid-19 or irritable bowel syndrome (IBS). However, that does not necessarily mean you will develop such diseases. Because your immune system is mistakenly attacking normal cells at the molecular level of your psoriasis, this causes your immune system to be susceptible to viral infections (like Covid-19) or other auto-immune disorders (like Crohn's disease). Be sure to stay vigilant in recognizing when you feel ill and seek the appropriate medical attention. You do not want your psoriasis to exacerbate or aid in the development of other ailments. Be sure to talk with your clinical care team to identify ways to live a healthier lifestyle and how to navigate novel diseases (like Covid-19) while living with psoriasis.

Moving Forward – Questions to Ask Your Doctor

• What other conditions am I at risk for?
• How will I be monitored for these other illnesses?
• Are there any lifestyle adjustments I can make?
• What would treatment look like should I develop another condition?
• How can I reduce my risk of developing other illnesses, like Covid-19?

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