Severe Psoriasis Linked to Increased Risk of Death

Psoriasis severity has been linked to increased risk of death in a new study published in the Journal of Investigative Dermatology. Researchers found that the risk of death increased for patients who had more surface area covered by psoriasis.

The study used the Body Surface Area (BSA) measure of disease severity instead of the type of treatment a patient was receiving, such as oral, injectable, or phototherapy. The BSA literally measures the percentage of the body covered by psoriasis. Patients who had psoriasis on 10% or more of their body had nearly double the risk of death.

“It’s well established that psoriasis is associated with an increased risk for other comorbidities like chronic kidney disease, diabetes, and cardiovascular disease, but we don’t yet understand how the severity of psoriasis impacts future risk of major health problems,” the study’s senior author Joel M. Gelfand, MD MSCE, a professor of Dermatology and Epidemiology at the University of Pennsylvania, said in a statement.

Gelfand and his colleagues used a database in the United Kingdom to look at 8760 patients with psoriasis and 87,600 patients without it. They surveyed the patients' general practitioners to determine the body surface area affected and looked at the number of deaths in each group by person-years.

During the average follow-up time of 4 years, there was an average of 6.39 deaths per 1000 person-years in patients with psoriasis on more than 10% of their bodies. In patients without psoriasis, there were 3.24 deaths per 1000 person-years. After adjusting for other demographic factors, patients with psoriasis on more than 10% of their bodies were still 1.79 times more likely to have died.

The researchers said a better understanding of the specific causes of death is needed, and further research can help determine whether and how treatment impacts the risk for patients with extensive psoriasis.

“Other studies that have examined this question, including our own prior research, have looked at patients who were receiving treatment for psoriasis, which is not an objective measurement of severity, making it unclear to whom the prior studies apply,” said the study’s lead author Megan H. Noe, MD, MPH, a dermatologist and post-doctoral research fellow in Gelfand’s laboratory. “By using BSA, which we can evaluate in a patient’s clinical visit, we can better understand which patients are at highest risk for future medical problems and need preventative care.”