A recent study found in the journal of JAMA Dermatology identified a link between psoriasis, a chronic skin disease to diabetes type 2 and obesity. People with diabetes type 2 had a 50% increased risk of developing psoriasis compared to those without diabetes according to researchers in Denmark. In that study, it was noted that the more obese the diabetic patient, the higher the risk became. Those with a BMI over 35% had the highest risk of the skin disorder. The exact correlation is still unclear but certain factors were presented as the connection. Factors included smoking, alcohol intake, genetics/family history and systemic inflammation. If psoriasis is discovered in a patient with diabetes then it is even more critical to prevent heart disease and its complications as both of these chronic conditions have extremely high incidences of heart problems. Over 34,000 twins were studied to formulate this information. Let’s examine what psoriasis is to help you stay informed:
What is psoriasis?
It is a skin disease that can vary in symptoms for different individuals and involves the immune system. It is chronic and causes skin cells to grow too fast. Instead of taking weeks to form new skin cells, it can take only days. The body does not remove these excess cells and they begin to increase on the skins’ surface. Thickened patches begin to form which is one type of psoriasis. These patches are usually found on the knees, elbows, lower back and scalp but can be found anywhere on the body. It is common in families due to heredity and genetics and over 7.5 million Americans are affected. It often presents during the ages from 15-30 and again from 50-60 years old. Psoriasis is more prevalent in Caucasians.
What are the symptoms?
Symptoms may include red raised itchy patches, silver-white scaly areas, dry cracked bleeding skin, thickened nails with areas of pitting and ridges or stiff, painful, swollen joints.
Is there more than one kind of psoriasis?
Yes, there are several kinds which may change to another kind over time. The most common type is plaque psoriasis which accounts for 80% of all cases. The specific presentation is red thick patches of skin which are often itchy. A second type called guttate psoriasis is mostly seen in children and young adults and can be triggered by a bacterial infection such as Strept throat. Inverse psoriasis may be triggered by fungal infection and is located in the armpits, groin and under the breasts. Pustular psoriasis is very uncommon but presents with multiple pus filled blisters all over the body accompanied by a fever and chills. Erythrodermic psoriasis is also rarely seen but presents as a large red peeling rash and can be extremely dangerous.
Does the condition always remain the same?
Psoriasis generally goes through various cycles, flaring, regressing and flaring again over weeks and months. It is also possible to enter a remission stage followed by a re-occurrence.
What are triggers?
Hereditary is involved and triggered by certain common denominators such as a highly stressful event, people who suffer with HIV, those who have had Strept throat, taking medications for malaria, taking Lithium for mental health disorders, using beta blockers for high blood pressure, getting a severe peeling sunburn, being in very cold dry weather, receiving bug bites, drinking alcohol heavily, being obese and smoking.
How is it diagnosed?
Usually, you would be seen by a dermatologist/rheumatologist and given a physical exam and a complete medical history. A skin biopsy would be checked under a microscope for confirmation.
Is it contagious?
No, it is not transmitted person to person and you should not be afraid to touch someone with psoriasis.
What other problems can occur with psoriasis?
People with psoriasis are more likely to have or develop Celiac disease (gluten intolerance), Crohn’s disease, Parkinson’s disease, diabetes type 2, Metabolic syndrome, eye inflammation including conjunctivitis, cardiovascular disease, hypertension and Psoriatic Arthritis. Psoriatic Arthritis occurs in 30% of people with this skin disease. It involves joints which can be severely damaged and must be medically treated.
What changes help this condition?
As with diabetes, positive lifestyle changes are paramount in caring for psoriasis. These include quitting smoking if you smoke or not starting, eating a healthy fresh diet with little or no processed foods, doing daily exercise, reducing or eliminating alcohol, getting proper nightly sleep, losing weight if you are overweight and reducing your stress.
How should I handle this emotionally?
Psoriasis can be overwhelming to some people since it is so visible. As with other chronic diseases such as diabetes, learn about your condition, join a support group, educate your family, friends and coworkers. Find a therapist if anxiety, depression or suicidal thoughts occur. If psoriasis is not treated then social isolation, rejection and decreased self esteem can occur.
Can it be treated?
Yes, there are several medical treatments to help control psoriasis but it is not curable. Simple treatments for mild cases can begin with OTC cortisone creams in various strengths. According to the Mayo Clinic staff “you may require prescription strength steroid creams which slow cell turnover by suppressing the immune system and lowers inflammation and itching”. Many of the medication treatments can become quite expensive and if you can’t afford your treatment contact “Financial assistance available for psoriasis medication”. Retinoid for the skin may be suggested. Tazorac and Arage which are vitamin A compounds, help the DNA activity in skin cells normalize and reduce inflammation. Anthralin is a medication that also helps DNA skin activity become more normal because it can remove scales and make the skin appear more smooth. Vitamin D analogues such as Dovonex are creams or solutions requiring a prescription. They slow down the growth of new cells and treat psoriasis in conjunction with light or phototherapy. Salicylic acid can be purchased over-the-counter or by prescription in higher concentrations. It encourages dead skin cells to slough off. It can be added to medicated shampoos and scalp solutions. Coal tar which is a by product of petroleum, can be purchased OTC and in higher strength by prescription. Coal tar reduces scaling, itching and inflammation.
There are many ointments, moisturizers and salves that may be recommended but they are mostly palliative and do little to change the cell formation. Methotrexate, a powerful medication sometimes used for certain cancers, may be recommended when other options fail. When taken orally, it may slow skin cell production and reduce inflammation. Cyclosporine, which is another immune suppressor, may be used. These drugs are powerful and may cause multiple side effects. Working with a rheumatologist and or a dermatologist is important since they generally deal with this disease. The newest treatments include biologics. Medications such as Enbrel, Remicade, Sterala and Humira are offered for more severe cases but do carry strong side effects including lowering the overall immune system. You will need to review all options with your health care provider before making a final decision.
Another form of therapy for treatment is light therapy. Some physicians suggest natural sunlight without sunscreen in small amounts which can slow skin cell turnover by having an affect on the T-cells. There are artificial lights available called UVB broadband or narrow band therapies which may improve symptoms without oral medication. Another therapy called Excimer Laser Therapy only affects the involved skin and may be able to reduce symptoms. Again, these are important decisions and you will need to consult with your health care provider to see which therapy or therapies will be most helpful for you.
There is evidence that there is a diabetes and psoriasis connection and the best way to control both disease entities are to keep blood sugars down, find a healthy eating plan, lose 5-10% of your body weight and exercise. Sound familiar? This plan helps everything!
Always feel free to email me your questions at RKleinman@adwdiabetes.com if you would like to share them with ADW diabetes.
NOTE: Consult your Doctor first to make sure my recommendations fit your special health needs.
She is a member of the American Diabetes Association as well as the South Florida Association of Diabetes Educators. She worked with the education department of NBMC to help educate the hospital's in-patient nurses about diabetes. She practices a healthy lifestyle and has worked as a personal fitness trainer in the past.
She was one of the initiators of the North Broward Diabetes Center (NBMC) which started in 1990 and was one of the first American Diabetes Association (ADA) certified programs in Broward County, Florida for nearly two decades. Robbie has educated patients to care for themselves and has counseled them on healthy eating, heart disease, high lipids, use of glucometers, insulin and many other aspects of diabetes care. The NBMC Diabetes Center received the Valor Award from the American Diabetes Center for excellent care to their patients. Robbie has volunteered over the years as leader of many diabetes support groups.