In recent years more attention has been paid to the association between moderate to severe psoriasis and seemingly unrelated conditions like heart disease and cancer. What we are learning is that if you have moderate to severe psoriasis, you may in fact be at a somewhat higher risk of developing other medical problems too. If you have psoriasis, you may want to check out screening guidelines through the American Heart Association and American Cancer Society. Psoriasis itself may be an independent risk factor for many other conditions. Make sure your primary care physician is aware of this increased risk so that appropriate monitoring can be scheduled.
Psoriasis and Cardiovascular DiseasePsoriasis patients are at increased risk for cardiovascular disease and heart attack, independent of other risk factors such as obesity and smoking. In addition, many psoriatics are overweight and smoke, compounding the risk. Here are the American Heart Association recommendations for cardiovascular disease risk factor screening:
- blood pressure; body mass index (BMI); waist circumference and pulse:: monitored at least every two years. BP should be below 120/80 mm HG; BMI <25 and waist circumference less than 35 in. for women and < 40 in. for men.
- fasting cholesterol panel and blood glucose: monitored at least every 5 years, or every 2 years if other risk factors are present such as family history, diabetes, or smoking. Total cholesterol should be less than 200, HDL great than or equal to 50, LDL <L100 and blood glucose <100.
- moderate to intense physical activity at least 30 minutes most days of the week and healthy eating.
Psoriasis and MalignancyCancers noted with increased frequency in psoriasis include Hodgkin's lymphoma, cutaneous T-cell lymphoma (CTCL), and cutaneous squamous cell carcinoma (SCC). Various other cancers of internal organs may be noted with increased frequency in patients with psoriasis, however the other causes of cancer such as smoking, alcohol and the use of cancer-causing psoriasis treatments make measuring the risk of these cancers difficult. Here are the American Cancer Society screening recommendations:
- General Clinical Exam: Recommended for those 20 years and older,looking for cancer of the thyroid, oral cavity, skin, lymph nodes, testes, and or ovaries
- Breast Cancer: Ages 20-39: breast exam every three years; Ages 40 and older: annual breast exam and annual mammogram.
- Colon and Rectal cancer: For age 50 and over: fecal occult blood test or immunochemical test annually, flexible sigmoidoscopy every 5 years, double-contrast barium enema every 5 years, colonoscopy every 10 years
- Prostate cancer: Over age 50, PSA blood test and digital rectal exam annually.
Other RecommendationsReducing other known risk factors for cancer and heart disease are probably more important for those with psoriasis than without. Smoking cessation, reducing alcohol intake and monitoring for depression are all useful adjuncts to the above screening guidelines.
source: Kimball a, et. al. National Psoriasis Foundation clinical consensus on psoriasis comorbidities and recommendations for screening. J Am Acad Dermatol. 2008;58:1031-42