1. Home>
2. Specialties>
3. Dermatology>
4. Summary and Comment

Health Implications of Psoriasis: More Than Just Skin Deep

The inflammatory process might be involved in the association between psoriasis and myocardial infarction.

In two recent studies, investigators found associations between psoriasis and increased rates of myocardial infarction (MI) and certain lymphomas. They prospectively evaluated data from the U.K. General Practice Database on more than 130,000 patients with psoriasis aged 20 to 90, who were followed from 1987 to 2002.

In the first study, the researchers compared the risk for MI in patients with and without psoriasis. After controlling for known cardiac risk factors (e.g., smoking, diabetes, obesity, hypertension, and hyperlipidemia), the incidence of MI per 1000 person-years was significantly higher in psoriasis patients (5.13 with severe disease; 4.04 with mild disease; 3.58 in controls). Risk was unrelated to the use of systemic medications for psoriasis. The highest adjusted relative risks for an MI in psoriasis patients were in the youngest and in those with more severe disease (hazard ratio, 1.54 for mild disease; 7.08 for severe disease).

In the second study, investigators examined the relationship between psoriasis and lymphoma. Compared with controls, patients with psoriasis had modest increases in lymphoma incidence, most markedly in those who had not received systemic therapy for psoriasis. Among lymphoma subtypes, the association was greatest for cutaneous T-cell lymphoma (CTCL; HR, 5.42 with mild psoriasis and 17.18 with severe psoriasis). There were nonsignificant trends toward increased incidences of Hodgkin and non-Hodgkin lymphomas.

Comment: Further investigation employing large U.S. databases will probably follow. Particularly interesting is the identification of psoriasis as an independent risk factor for MI. Increased MI incidence has been observed in other T-cell–mediated diseases, such as rheumatoid arthritis, suggesting an association with the inflammatory response. Dermatologists should counsel psoriasis patients to reduce other MI risk factors. The increased lymphoma risk in these patients was lower than in other studies. Misdiagnosis and the use of such medications as cyclosporine and methotrexate might be involved in the increased incidence of CTCL but do not explain the association entirely.

At this point, to conclude that aggressive psoriasis treatment reduces the risk for MI or has any effect, positive or negative, on lymphoma development is impossible. We hope that these findings will prompt dermatologists and their professional organizations to work with cardiologists and other specialists to improve the health of patients with psoriasis.

— Craig A. Elmets, MD

Published in Journal Watch Dermatology October 27, 2006

Citation(s):

Gelfand JM et al. Risk of myocardial infarction in patients with psoriasis. JAMA 2006 Oct 11; 296:1735-41.

• Original article (Subscription may be required)
• Medline abstract (Free)

Gelfand JM et al. The risk of lymphoma in patients with psoriasis. J Invest Dermatol 2006 Oct; 126:2194-201.

• Medline abstract (Free)