Skin disease shares common inflammatory pathway with metabolic disorder

University of Pennsylvania School of MedicineJun 19 2012

Psoriasis is an independent risk for Type 2 Diabetes, according to a new study by researchers with the Perelman School of Medicine at the University of Pennsylvania, with the greatest risk seen in patients with severe psoriasis. Researchers estimate that an additional 115,500 people will develop diabetes each year due to the risk posed by psoriasis above and beyond conventional risk factors. The research is published in the latest issue of the Archives of Dermatology, a JAMA Network publication.

"These data suggest that patients with psoriasis are at increased risk for developing diabetes even if they don't have common risk factors such as obesity," said senior author Joel M. Gelfand, MD, MSCE, associate professor of Dermatology in the Perelman School of Medicine. "Patients with psoriasis should eat a healthy diet, get regular exercise, and see their physician for routine preventative health screenings such as checks of blood pressure, cholesterol, and blood sugar."

Psoriasis is a common inflammatory skin disease affecting over 7.5 million Americans and causes thick, inflamed, scaly patches of skin. The disease has previously been associated with increased risk of myocardial infarction, stroke, metabolic syndrome and cardiovascular mortality.

"This research builds on previous work demonstrating a diverse set of increased health risks for people with psoriasis," said lead author Rahat S. Azfar, MD, MSCE, adjunct assistant professor of Dermatology in the Perelman School of Medicine. "In addition to having an increased risk of diabetes, people with psoriasis are more likely to have metabolic syndrome, high triglycerides, and raised glucose levels, even if they are not overweight or have other common risk factors for these conditions. Both patients with psoriasis, especially those with severe psoriasis, and their treating physicians should be aware of the potential for systemic metabolic complications associated with this skin disease."

Both psoriasis and diabetes are diseases caused by chronic inflammation. A shared pathway - TH-1 cytokines - can promote insulin resistance and metabolic syndrome, and promote inflammatory cytokines known to drive psoriasis.

The study compared 108,132 people with psoriasis to 430,716 matched patients without psoriasis, and determined patients with mild psoriasis had an 11% increased risk of diabetes and patients with severe psoriasis had a 46% higher risk compared to patients without psoriasis. The study also looked at treatments used by those diagnosed with diabetes, and found that the patients with both psoriasis and diabetes were more likely to require pharmacological treatment of diabetes, compared to diabetics without psoriasis.

Researchers noted that future studies should look into the extent to which psoriasis and its treatment play a role in the development of Type 2 Diabetes and its complications.

The research team includes Daniel B. Shin, BA, Andrea B. Troxel, ScD, David J. Margolis, MD, PhD, from Penn's Dermatology and Biostatistics and Epidemiology departments and the Center for Clinical Epidemiology and Biostatistics. The work was done in collaboration with co-lead author Nicole M. Seminara, MD, from the Department of Internal Medicine at the New York University Langone Medical Center.

The research was funded by grants from the National Institute for Arthritis and Musculoskeletal and Skin Diseases (F32-AR056799), the National Heart, Lung, and Blood Institute (3R01HL089744-01A2S1, R01HL089744-03)and a T32 University of Pennsylvania dermatology departmental training grant.