Comorbidities in Patients With Psoriasis Linked With More Severe Skin Lesions, Adverse Treatment Outcomes

Patients with psoriasis who had comorbidities were associated with worse health-related quality of life and impaired treatment outcomes with conventional therapy, whereas biologic treatments maintained high efficacy despite presence of co-occuring conditions.

Presence of comorbidities may exacerbate skin lesion severity and reduce the efficacy of conventional therapy in patients with psoriasis, according to study findings published in International Journal of Environmental Research and Public Health.

Associated with a higher prevalence of comorbidities than the general population, patients with psoriasis have been linked with cardiovascular diseases and metabolic disorders, including diabetes, overweight/obesity, and lipid disturbances. Moreover, the impact of psoriasis has been shown to have an extensive impact on the health-related quality of life (HRQOL) of patients.

“Apart from its debilitating effect on the patient’s physical health, psoriasis disturbs the patient’s mental well-being, interferes with their daily routines and work activities, as well as social and family relationships,” noted researchers. “Undoubtedly, smoking exacerbates the course of psoriasis, has a negative effect on the outcome of treatment, and it is conducive to serious complications.”

They investigated the impact of comorbidities (hypertension, diabetes, lipid disorders), overweight/obesity (body mass index [BMI] score), and smoking status on HRQOL, measured by the Dermatology Life Quality Index (DLQI), prior to (baseline visit) and after a 3-month treatment course (control visit).

The analysis of 184 adult patients with plaque psoriasis (mean [SD] age, 46 [12] years) also examined psoriasis severity, measured via Psoriasis Area Severity Index (PASI), in which various types of systemic treatment, both conventional (methotrexate, cyclosporine, retinoids) and biological (adalimumab, ustekinumab, and secukinumab), were examined regarding median DLQI or PASI reduction from baseline.

In their findings, patients with psoriasis who had comorbidities presented with worse HRQOL and more severe skin lesions. At baseline, presence of comorbidities, BMI greater than or equal to 25 kg/m2, and smoking was associated with significantly higher DLQI and PASI scores vs patients without comorbidities, those whose BMI was below 25 kg/m2, and non-smokers.

After 3-month treatment, significant differences were still observed in the median PASI and DLQI scores between the studied subjects with comorbidities, BMI greater than or equal to 25 kg/m2, and smokers vs those presenting with no comorbidities, BMI below 25 kg/m2, and non-smokers, but these scores were lower in comparison with scores observed before treatment.

Regarding the impact of comorbidities on treatment efficacy, presence of comorbidities had a negative effect on the outcome of treatment with the use of conventional therapy, whereas methotrexate was effective even if the patients had co-existing hypertension.

Use of biologic therapies conversely exhibited high effectiveness in improving psoriatic skin lesions regardless of the presence of comorbidities. Although, the outcome of therapy with biological agents was independent of each of the analyzed factors (smoking, overweight/obesity).

“In patients with psoriasis receiving systemic conventional treatment, but not biological treatment, comorbidities had a negative impact on HRQOL and psoriasis severity,” concluded researchers.


Karpinska-Mirecka A, Bartosinska J, Krasowska D. The impact of hypertension, diabetes, lipid disorders, opverweight/obesity and nicotine dependence on health-related quality of life and psoriasis severity in psoriatic patients receiving systemic conventional and biological treatment. Int J Environ Res Public Health. Published online December 14, 2021. doi:10.3390/ijerph182413167