Invisible Inflammation Is a Stealthy Psoriasis Threat

Even when medication clears skin symptoms, people with psoriasis can still have inflammation throughout their bodies that increases the risk of obesity, heart disease, and liver issues.

Even when people with psoriasis take medication that clears up their skin, they can still have inflammation throughout their body that’s associated with an increased risk of other health problems, a new study suggests.

Researchers examined data on about 200 psoriasis patients in the United States, Spain, and Sweden who had mild symptoms or none at all after taking biologics for one year. Overall, 36 percent of participants still had what’s known as residual inflammation, a type that can contribute to a wide variety of health problems, according to findings published in the Journal of Investigative Dermatology.

Compared with people without residual inflammation, those with this condition were significantly more likely to have obesity, excess fat around their midsection, and a chronic liver disorder known as metabolic dysfunction–associated steatotic liver disease (MASLD) that’s caused by a buildup of fat in the liver due to an abnormal metabolism.

“When someone takes medication that clears up their visible skin symptoms, we might assume everything is fixed,” says Faranak Kamangar, MD, a dermatologist and chair of dermatology at the Palo Alto Medical Foundation in California.

“However, this study found that there was still invisible inflammation that continues to circulate in their bloodstream even when the skin looks better,” says Dr. Kamangar, who wasn’t involved in the new study.

Psoriasis Affects the Entire Body

Psoriasis is a chronic autoimmune disease that causes a rash with itchy, scaly patches, most commonly on the knees, elbows, trunk, and scalp. People with psoriasis are at greater risk for developing other chronic health issues like obesity, type 2 diabetes, and heart disease.

While psoriasis looks like a skin disease, symptoms are caused by inflammation throughout the body. Healthcare providers often treat moderate-to-severe psoriasis with powerful biologic drugs that are designed to reduce this inflammation, which in turn can clear up the skin.

As effective as biologics can be at improving symptoms and quality of life for people with psoriasis, the drugs still can’t completely eliminate inflammation from the body, says Danilo Del Campo, MD, a dermatologist at the Chicago Skin Clinic in Illinois, who wasn’t involved in the new study.

“I see this in practice with patients who maintain good skin control but still struggle with metabolic issues, which can be driven by this ongoing, nonvisible inflammation,” Dr. Del Campo says. “It highlights that psoriasis is not just a skin condition, but a systemic disease that can impact multiple organs and systems.”

Positive Lifestyle Changes Can Go a Long Way in Keeping Inflammation at Bay

The study has some limitations: It’s small and only followed patients for one year. There’s a possibility that the impact of biologics on patients’ skin and on inflammation might change over time.

Even so, the findings underscore the importance of a healthy lifestyle even when biologics work well to manage visible psoriasis symptoms, Del Campo says.

“This includes regular exercise, a balanced diet rich in anti-inflammatory foods, maintaining a healthy weight, and avoiding smoking and excessive alcohol,” Del Campo says.

A Mediterranean-style diet filled with foods like olive oil, fatty fish, colorful vegetables, and nuts can also help reduce the risk of underlying inflammation in people with psoriasis, Kamangar says.

So can stress management, whether it’s meditation, yoga, or something else that works for you, Kamangar adds.

“It is also important for patients to regularly follow up with their primary care provider to monitor overall health, as early detection and management of related conditions can significantly improve long-term outcomes,” Del Campo says. “In some cases, I might adjust a patient's biologic regimen or consider additional therapies if residual inflammation is still a concern.”

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