Early treatment aids quality of life in psoriasis

Treating psoriasis patients earlier in life could help prevent late physical and psychological problems.

“We used to think that we should save our therapies until our patients really needed them, because we were afraid that toxicity might accumulate.”  However, that thinking has changed, thanks in part to the availability of safer treatment options.

But of equal importance, “treating patients early in their disease may have an impact that affects the rest of their lives,” including jobs, education, socioeconomic status, and curbing the development of health problems like obesity, cardiovascular disease, and psychiatric disorders.

The quality of life issues associated with psoriasis are well known, but recent data confirm that physical and mental comorbidities start in childhood.

According to recent data from the National Psoriasis Foundation, 38% of children with psoriasis reported being bullied because of their condition, noted Massachusetts General Hospital and Harvard Medical School, both in Boston.

Another study found that approximately one-third of children aged 4-17 years with psoriasis had a body mass index greater than the 95th percentile. Conditions such as childhood obesity are not easily managed, and have significant implications for future health.

In a retrospective study of 7,404 psoriasis patients younger than 18 years and 37,020 healthy controls, children with psoriasis were significantly more likely than controls to develop any psychiatric disorder (5% vs. 4%), depression (3% vs. 2%), and anxiety (2% vs. 1%), colleagues found.

And the likelihood of comorbidities in psoriasis patients continues as they grow up. “Chronic disease interacts with psychosocial and health events in a complex and ongoing manner throughout a person’s life.”

Comorbidities in psoriasis patients appear to accumulate over time. Cited data from the Nurses’ Health Study I, a cohort including more than 100,000 women who were aged 27-44 years in 1991. In a subset of 1,813 women  with psoriasis, the risk of diabetes was approximately 60% higher, and the risk of hypertension was almost 20% higher, compared with women without psoriasis.

In a case-control study conducted by colleagues, cardiovascular disease, diabetes, depression, hyperlipidemia, hypertension, and obesity all increased significantly in psoriasis patients, compared with healthy controls, over a 4-year follow-up period.

These findings suggest that comorbidities associated with psoriasis accumulate over time: therefore, aggressive treatment of psoriasis in younger patients could improve their psychological and physical quality of life. Although there are no recommendation for additional health screening for psoriasis patients health measures, “younger patients especially need to be monitored for psychiatric issues.” These patients should be kept up to date on vaccinations, particularly the annual flu vaccine and the human papillomavirus vaccine.