Understanding Psoriasis and Metabolic Syndrome: A Guide for Patients

Psoriasis is a chronic skin disorder that can be very difficult to treat. It's also associated with a number of health conditions, including metabolic syndrome. In this article, we'll discuss the connection between psoriasis and metabolic syndrome and how you can manage both conditions. We hope this information will help you get the treatment you need and improve your overall health.

Psoriasis is a chronic inflammatory skin disease. Several cardiovascular diseases and potential health disorders are associated with psoriasis. To say in general, high blood pressure, heart failure, and diabetes go hand in hand with psoriasis more than with controls.

Psoriasis is a skin condition that is caused by autoimmune reactions. It affects any part of the body, and its symptoms are different for each. It has not been cured yet there are so many developed advancements in its treatments and diagnosis. It stays for a lifetime but is manageable with medication, exercise, and little lifestyle changes.

Plaque psoriasis prevails in India with 0.44 to 2.8 percent. It has a global prevalence of 1 to 8 percent.  With slightly more dispersion in males than in females, it accounts for the most common variant of psoriasis in our country. 

One of them is genital psoriasis. Which is quite prevalent, and common. But not often complained, about, or spoken about because half of the patients do not feel comfortable talking about it to the physicians. 

In our country plaque psoriasis is the most common with 93 percent of actual psoriasis patients living with it, while inverse psoriasis is the most uncommon kind of psoriasis. 

Plantar psoriasis affects the legs and palmar psoriasis affects the hands, which stands next to plaque psoriasis with about 20 percent battling them. 

Whereas genital psoriasis, the one we are talking about, is 11 percent.

What is Metabolic syndrome?

Metabolic syndrome is defined as a collection of multiple metabolic risk factors that tend to pile together, resulting in an increased risk of say, type two diabetes mellitus, cardiovascular disease, and various cancers. This clustering of a group of defined metabolic and physical abnormalities is referred to as a metabolic syndrome.

It is a huge health concern worldwide which is responsible for the growing number of premature deaths throughout the world. 

Metabolic syndrome is significant because it plays an important role in the etiology of coronary heart disease and non-insulin-dependent diabetes mellitus. Amongst these two, coronary heart disease is still the leading cause of death all over the world while diabetes mellitus is the most prevalent and serious metabolic disease in the world for the longest time known. In India, the incidence of metabolic syndrome was found to be 19% back in 2013 alone. There is a significantly higher prevalence of metabolic syndrome in psoriasis patients as compared to the general population. There is high mortality caused by comorbidities.

People who have metabolic syndrome can coexist with many diseases even in their youth. There is an increased risk of cardiovascular disease and are at an increased risk for all causes of mortality. It increases type two diabetes which in turn is an important trigger for an atherosclerotic disease which is equivalent to coronary heart disease. 

Patients with metabolic syndrome commonly have 

• abdominal obesity, 
• reduced levels of high-density lipoprotein, hyperinsulinemia, 
• glucose intolerance, 
• hypertension, 
• insulin resistance, 
• an increased plasma concentration of very low-density li protein triglyceride, polycystic ovarian syndrome, 
• nonalcoholic fatty liver disease, 
• gallstones, 
• sleep disturbances, 
• sexual impotence in men, 
• hypogonadism,
• psoriasis,  
• and various cancers such as breast cancer, pancreatic cancer, colon cancer, endometrial cancer, prostate cancer, urologic cancer, and liver cancer.

Insulin resistance is the primary metabolic defect that will be compensated by developing hyperinsulinemia. Also, abdominal obesity acts as a key contributor to the above changes. Hyperinsulinemia and hyperglycemia act as the common denominator that is responsible for this cluster of changes. 

Relationship between psoriasis and metabolic syndrome.

• Among all cutaneous diseases, psoriasis has shown a close-knit relationship with metabolic syndrome. The prevalence of metabolic syndrome in patients with psoriasis ranges from 20 to 50 percent. It affects almost 20 to 30 percent of the world’s population. 
• Metabolic syndrome is at least double in psoriatic patients compared with non-psoriatic control healthy individuals. 
• There’s enough evidence that on a severity scale of psoriasis, metabolic syndrome is more common in severe psoriasis than in mild skin conditions. 
• Metabolic syndrome is seen frequently in patients with psoriasis. 
• Females have a significant frequency of this syndrome and tend to have a higher BMI than males.

• Both psoriasis and metabolic syndrome share multiple metabolic risks, genetic backgrounds, and pathogenic pathways. 
• Psoriasis associated with comorbidities, especially metabolic syndrome, contributes substantially to premature mortality in patients with psoriasis.

Causative Mechanisms of Psoriasis and Metabolic Syndrome:

Certain mechanisms that mediate the association between psoriasis and metabolic syndrome include endoplasmic reticulum stress, pro-inflammatory cytokine releases, excess production of reactive oxygen species, alterations in adipocytokine levels, and gut microbiota symbiosis. 

• The gut microbiome has become a hot topic in psoriasis as it has been shown to affect both allergy and autoimmunity. Research on the fecal samples of psoriasis patients with that of healthy controls showed fascinating conclusions. Several bacteria were more abundant in psoriasis patients than in healthy people. The cytokines especially the interleukin 2 have shown a positive relationship with the bacterium. 
• The conclusion put forth was that microbiota dysbiosis might induce an abnormal immune response in psoriasis patients.
• As psoriasis causes sustained inflammation throughout the body, the immune system creates cytokines. Cytokines cause inflammation. 
• These adipocytokines provide support for both fat metabolism and body organ functions. In patients with psoriasis, these levels go low which contributes to the development of metabolic syndrome. 
• The oxidative stress involvement in the complexities of the pathophysiology of metabolic syndrome has been widely acceptance. It is the major underlying mechanism for mitochondrial dysfunction, ectopic lipid accumulation, and gut microbiota impairment. Studies have proven that oxidant-antioxidant imbalance is a key contributor to this condition. 
• This imbalance and excess of reactive oxygen species results from redox control, increased lipid peroxidation products, protein carbonylation, a decrease in antioxidants, and also a decrease in glutathione levels. Especially in an obese person, oxidative stress and chronic inflammation are the contributing factors to the development of comorbidities. 

• The dysregulation of some specific interleukin immune signaling pathways is central to both metabolic syndrome and psoriasis pathologies. 

Treatments for Psoriasis and Metabolic Syndrome:

Conventional systemic treatments should be used with caution in psoriatic patients who also have metabolic syndrome. Especially for long-term use, because they have potential adverse effects on coexisting metabolic disorders. Instead, biologics are usually well tolerated as they have a different safety profile than systemic treatments. 

Biological treatments for psoriasis that interrupt the interleukin immune signals can both reduce the psoriatic inflammatory burden, and lessen the risk of developing atherosclerosis, and cardiometabolic diseases. Studies showed that the improvement of skin lesions was also associated with improvement in vascular inflammation.

NOTE:
“This article does not provide medical advice. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on this website. If you think you may have a medical emergency, immediately call or visit your doctor.”
For more information about Ayurvedic Treatment for Psoriasis / Psoriasis and Metabolic Syndrome, and for consultation call +919945850945
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References

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5. https://ijdvl.com/prevalence-of-metabolic-syndrome-in-patients-with-psoriasis-2/
6. https://www.sciencedirect.com/science/article/abs/pii/S0738081X17301591
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3670770/
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