Psoriasis severity linked to dramatic rise in type 2 diabetes

Though it is not widely known outside of the medical community, people with psoriasis are at a higher risk of developing type 2 diabetes. Now, new research from the University of Pennsylvania’s Perelman School of Medicine in Philadelphia shows that the risk rises dramatically based on the severity of the psoriasis.

Dr. Patrick Ottuso, M.D., a Vero Beach dermatologist and Fellow of the American Academy of Dermatology, is familiar with the Penn study and has observed the link between psoriasis and type 2 diabetes in his own practice. He says that psoriasis is also associated with “metabolic syndrome,” a cluster of conditions (high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels) that increase the risk of heart disease, stroke, and diabetes.

Although psoriasis most typically evidences itself in the skin, it is actually a disease of the immune system, in which T cells – a form of white blood cell – are overactive, producing too many skin cells. These skin cells move to the outermost layer of skin too quickly, building up in thick, scaly patches. What causes the T cells to malfunction isn’t fully known, but researchers believe that genetics and environmental factors both play a role.

The chronic inflammation caused by psoriasis is the most significant factor increasing the risk of type 2 diabetes. Psoriasis can also affect the immune system in ways that have been associated with insulin resistance and type 2 diabetes.

The Penn team was led by Joel M. Gelfand, a professor of dermatology and epidemiology, who says “we know psoriasis is linked to higher rates of diabetes, but this is the first study to specifically examine how the severity of the disease affects a patient’s risk.”

For their study, the researchers used data on two groups of adults – 8,124 with psoriasis and 76,599 without. The data came from a survey of general practitioners in the United Kingdom and included a measure of psoriasis severity called body surface area (BSA), which, as its name implies, gives the percentage of the body that is affected by the disease.

The results, published in Journal of the American Academy of Dermatology, were dramatic. The team found that people with psoriasis who had a BSA of up to 2 percent had a 21 percent higher risk of developing diabetes (compared to those without psoriasis), and people with a psoriasis BSA of 10 had a 64 percent higher risk of developing the disease.

Those with a BSA of 20 had an 84 percent increased risk, and those with a 30 percent BSA were at a 104 percent higher risk – more than double the risk of those without psoriasis.

The researchers drew their conclusions after making adjustments in their data to account for other diabetes risk factors, such as age, gender, and weight.

In the United States, approximately 7.5 million people have psoriasis. While most cases are mild to moderate, about 10 percent of sufferers – 1.5 million people – have a psoriasis BSA of 5 percent or more.

Penn’s Gelfand says “psoriasis and diabetes share similar genetic mutations, suggesting a biological basis for the connection between the two conditions we found in our study.” He also says that healthcare professionals should help people with psoriasis understand their risk of developing type 2 diabetes, and educate them about diabetes prevention, especially if their psoriasis BSA is 10 percent or higher.

Vero’s Dr. Ottuso says that an earlier study, conducted by the same Penn researchers, resulted in an even more alarming conclusion: the higher the BSA, the greater the risk of death. Over the course of four years, Gelfand and his team found that – after adjusting for demographics and risk factors such as smoking, obesity and major medical conditions – people with a BSA of over 10 had almost double the risk of death than those who did not have psoriasis.

While psoriasis cannot be cured, flare-ups can be controlled.  Some tips on reducing the frequency and severity of flare-ups:

  • Reduce stress. Stress is particularly problematic for people with psoriasis, as stress tends to cause an inflammatory reaction in the body. While psychotherapy can help, there are other everyday activities that can be effective stress-reducers, including yoga, meditation, and relaxation techniques.
  • Avoid certain medications. Dr. Ottuso says beta blockers (a type of blood pressure medication) and steroids can trigger a psoriasis flare-up. He says “people should talk to their doctor about any prescription or over-the-counter medications they’re taking. If it’s suspected that a medication is causing flare-ups, alternative are likely available, whether it’s a lower dose or a different medication altogether.”
  • Prevent skin injuries. In some people, injuries to the skin – such as sunburn and scratches – can trigger flare-ups. While spending time outdoors, psoriasis suffers should use sunscreen, wear a hat, and apply bug spray. Long sleeves and gloves should be worn when gardening.
  • Avoid infections. Infections can trigger psoriasis because they put stress on the immune system, causing an inflammatory reaction. It’s important to seek treatment right away if you think you have any sort of infection.
  • Eat foods that reduce inflammation. Foods that may reduce inflammation include fatty fish such as salmon and tuna, flaxseeds, pumpkin seeds, walnuts, almonds, and green leafy vegetables such as spinach and kale. Foods to avoid include red meat, dairy, high-fat foods, processed foods, refined sugars and citrus fruits.

Dr. Ottuso’s practice is part of Vero Beach Dermatology, located at 1955 22nd Ave; the phone number is 772-299-0085.

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