5 Things Your Doctor May Not Think to Tell You About Psoriasis

Psoriasis is more than an inflammatory skin condition. It’s a chronic, complex autoimmune disease that can affect your overall health in ways that may surprise you.

If you’re living with psoriasis, it’s important to learn as much as you can about it. That way, you’ll feel empowered to bring up any concerns you may have with your doctor and take a multidisciplinary approach to managing it.

To get started, it can help to understand these five facts about living with psoriasis and discuss with your doctor any that apply to you.

1. Psoriasis increases your risk of other health problems.

A number of medical conditions are associated with psoriasis. Chief among them are joint problems, such as psoriatic arthritis, gout, and osteoarthritis. According to the National Psoriasis Foundation (NPF), around a third of people with psoriasis, especially those with severe disease, develop psoriatic arthritis, typically 10 years or so after being diagnosed.

Psoriatic arthritis is debilitating. What’s more, the underlying inflammation can affect collagen, the main component of connective tissue, including the white of the eye (sclera) and the cornea, according to the Arthritis Foundation. This can lead to uveitis — inflammation that causes pain and redness — and even vision loss. Psoriatic arthritis also increases the risk for glaucoma and cataracts.

Hearing can be affected by psoriasis and psoriatic arthritis as well. A study in the American Journal of Clinical Dermatology found that people with psoriasis are about 1½ times more likely to be diagnosed with sensorineural hearing loss, a mild form of hearing impairment. Other research has shown hearing loss associated with psoriatic arthritis contributes to depression and other mental health issues.

Other common conditions related to psoriasis include inflammatory bowel disease, heart disease, and diabetes. Your doctor should screen for them and, if necessary, refer you to a specialist, says Jeffrey M. Weinberg, MD, an associate clinical professor of dermatology at Mount Sinai in New York City.

2. Psoriasis can have a profound impact on your mental health.

Because psoriasis is such a visible disease — scales, plaques, and flaking can be difficult to hide — it can cause intense self-consciousness in social and intimate situations and lead to feelings of isolation, hopelessness, and shame.

“It can negatively affect patients more so than other chronic illnesses such as asthma and diabetes. Part of this may relate to the stigma associated with skin disease,” says Lindsay C. Strowd, MD, an assistant professor of dermatology at Wake Forest School of Medicine in Winston-Salem, North Carolina.

Research also shows a strong link between psoriasis and depression, as well as anxiety and stress, which can trigger psoriasis flares.

To help break the psoriasis-stress cycle and relieve other mental and emotional side effects of living with psoriasis, Dr. Strowd advises asking your doctor for help dealing with any negative effects the disease has on your emotional well-being.

In addition, she says, “There are many resources to help cope with psoriasis, including social media platforms and support groups through the NPF and the American Academy of Dermatology.”

3. Your lifestyle can hurt — or help — your psoriasis.

As with other autoimmune conditions, psoriasis does not occur in a vacuum. Nearly everything you do, or don’t do, can potentially worsen or improve your symptoms.

Take diet, for example. There is no medical evidence to support a specific psoriasis diet, but many people have found that avoiding certain foods and eating others seems to help fend off flares and reduce inflammation.

The NPF recommends a Mediterranean diet, in particular, as it may also help lower the risk for related conditions such as heart disease. This healthy approach to eating emphasizes olive oil, plant-based foods, whole grains, and at least two servings of fish weekly, especially ones high in omega-3 fatty acids, such as salmon, herring, mackerel, and anchovies.

Other elements of daily life can impact psoriasis, too, including sleep quality, exercise habits, social connectedness, and stress. To address these, “Your doctor should discuss lifestyle changes with you,” says Zhanna Mikulik, MD, a rheumatologist at The Ohio State University Wexner Medical Center in Columbus, but be proactive. Speak up if you suspect there may be things you could do to manage your psoriasis better.

4. Weight can play a heavy role in psoriasis symptoms.

Obesity, which is defined as having a body mass index over 30, doubles the risk of developing psoriasis, research has shown. Experts don’t fully understand why but believe genetics, along with metabolic and environmental factors, may be involved. It’s also known that fat, especially visceral fat (the kind that surrounds organs), contributes to inflammation in general.

Obesity makes it harder to treat psoriasis, partly because it may prevent some medications, specifically those that work systemically (affect the entire body), from working effectively. Certain psoriasis drugs also may have negative effects on liver and kidney function in people who are obese.

According to Dr. Mikulik, losing weight can make the body more responsive to pharmacological treatments. It’s a good idea to speak up about the role your weight may play in the severity of your psoriasis and the effectiveness of your treatment. Your doctor can help you get your obesity and psoriasis under control.

5. You may be able to shrink your psoriasis treatment costs.

Managing psoriasis can be expensive, especially if you’re dealing with coexisting conditions. You may find yourself unable to afford the medications that work best for you and wind up undertreated — or untreated altogether.

According to data collected by the NPF, cost is the reason 21 percent of people with psoriasis say they go untreated. Expense as a barrier to treatment is particularly problematic with biologics, which are effective for treating psoriatic disease but very expensive.

If money is a factor and you have health insurance, talk to your doctor and your insurer: You may have benefits and options you aren’t aware of. You also may be eligible for a financial-aid program, whether you have health insurance or not. One source of such information is the NPF’s Financial Assistance page, which also offers access to financial aid resources.