Psoriasis is a chronic immune-mediated disease that affects the skin. Metabolic syndrome is the term for a set of risk factors that increase the likelihood of cardiovascular issues. Psoriasis and metabolic syndrome share some common links and associations.

The two conditions often occur together. This may be because they share several underlying factors, including oxidative stress and inflammation. The presence of both conditions can influence treatment recommendations.

This article explores what researchers know about the links between psoriasis and metabolic syndrome.

Psoriasis is an immune-mediated disease that leads to inflammation in the body. The condition affects more than 7.5 million adults in the United States, which equates to about 3% of the adult population.

Although psoriasis can present in different ways, plaque psoriasis is the most common type, affecting nearly 80% of those with psoriasis. It causes raised, scaly skin lesions known as plaques. These can occur anywhere on the body, but they most often appear on the scalp, knees, and elbows, as well as in or around the bellybutton and lower back.

Researchers do not know the exact cause of psoriasis, but genetics and the immune system likely both play a role. It is not contagious, so it does not spread from person to person.

Metabolic syndrome refers to a group of risk factors that raise a person’s risk of developing heart disease, diabetes, stroke, or other health issues.

A doctor will diagnose metabolic syndrome if a person has at least three of the following metabolic risk factors or is receiving treatment for them:

  • High blood pressure, or hypertension: Doctors define blood pressure as high when the reading is 130/80 millimeters of mercury or above.
  • High fasting blood sugar: Values of 100 milligrams per deciliter (mg/dl) and above are high.
  • High levels of triglycerides: The definition for high levels is 150 mg/dl or higher.
  • Low levels of high-density lipoprotein (HDL), or “good,” cholesterol: A reading of 40 mg/dl or lower puts a person at increased risk.
  • Large waistline: Doctors consider waist measurements of more than 40 inches for males and 35 inches for females to be large.

Research has shown that psoriasis and metabolic syndrome share some common links. Below, we look at what researchers currently know about the connection.

Metabolic syndrome is the most common comorbidity of psoriasis

A comorbidity refers to a medical condition that occurs alongside another condition. Numerous studies over the years have shown that metabolic syndrome is one of the most common comorbidities of psoriasis.

The authors of a 2019 review article propose that the high rate of metabolic syndrome in people with psoriasis should shape treatment recommendations. Their suggestions include involving preventive medicine specialists and nutritionists early in the psoriasis treatment process to help reduce the risk of cardiovascular disease and other health issues.

Psoriatic inflammation may be the direct link

According to a 2021 study, psoriasis causes sustained inflammation throughout the body. As a result, the immune system creates a substance called cytokines. Cytokines are responsible for several functions, including inflammation.

According to the same study, proinflammatory cytokines are related to the development of several other health conditions, including type 2 diabetes, high blood pressure, obesity, non-alcohol-related fatty liver disease, and hyperlipidemia, which is fat in the blood. Tissue inflammation can also cause insulin resistance.

In other words, the same inflammation responsible for psoriasis can lead to several of the risk factors that make up metabolic syndrome.

Oxidative stress and endoplasmic reticulum stress may play a role

In a 2021 study, researchers found that oxidative stress and endoplasmic reticulum stress occur in both psoriasis and metabolic syndrome.

Oxidative stress can lead to the breakdown of DNA and eventually cause cell death. Endoplasmic reticulum stress affects several functions in the body, including protein synthesis, carbohydrate processing, and fat creation.

This may help explain the link or association between psoriasis and metabolic syndrome.

Adipocytokines levels may link psoriasis and metabolic syndrome

Adipocytokines provide support for both fat metabolism and organ functioning. According to a 2021 study, low levels of adipocytokines in people living with psoriasis are linked to the development of metabolic syndrome.

The study authors conclude that future research may be necessary to determine the risk of developing metabolic syndrome alongside psoriasis.

Severity of psoriasis may influence risk of metabolic syndrome

According to that same 2021 study, psoriasis severity can influence the risk of developing metabolic syndrome. This backs up claims in earlier studies from 2018 and 2012, which also note that the severity of psoriasis influences a person’s risk of metabolic syndrome.

People living with more severe psoriasis should talk with a doctor about their risk of metabolic syndrome. The doctor may recommend additional treatment to help reduce the risk of cardiovascular disease.

How the gut microbiome relates to both conditions

Again, the same 2021 study found that the gut microbiome might affect both psoriasis and metabolic syndrome. The gut microbiome is a collection of billions of bacteria, viruses, and other microorganisms that play a role in metabolic functions and several overall bodily functions.

The authors note that changes in the microbiome occur in both obesity and psoriasis. As a result, they hypothesize that gut microbiome changes may influence the development of metabolic syndrome in people living with psoriasis.

A person’s risk factors should influence treatment

In a 2015 review article, the authors highlight a potential issue involving treatments for psoriasis and some of the risk factors that make up metabolic syndrome. They note that doctors should be cautious when prescribing systemic medications that treat psoriasis, such as methotrexate, for people with obesity or diabetes.

They also note that cyclosporine may not be suitable for everyone due to its potential to increase high blood pressure, reduce the body’s ability to process fats, and increase insulin resistance.

The authors state that overall, biologics do not have as much of an effect on the factors that make up metabolic syndrome. However, certain types of biologics may affect a person’s weight or contribute to dyslipidemia.

Finally, they note that the use of ACE inhibitors or beta-blockers to treat or prevent cardiovascular disease could worsen psoriasis symptoms.

Therefore, they recommend that doctors work closely with each of their psoriasis patients to develop a treatment plan tailored to their needs.

A newer study from 2019 noted similar concerns and suggestions. These researchers also found that obesity can impair the effectiveness of some psoriasis treatments.

Lifestyle changes may help treat both conditions

In the 2015 review article, the authors note that lifestyle changes may be effective in treating both psoriasis and metabolic syndrome. They recommend that people who have both psoriasis and metabolic syndrome risk factors try:

  • making changes to their diet
  • increasing their activity levels
  • stopping smoking, if applicable

Other researchers have noted similar findings, pointing out that Western lifestyle habits may contribute to the prevalence and rise in cases of psoriasis.

They express particular concern about the high intake of simple and total carbohydrates and fat, along with the lower consumption of complex carbohydrates and lean protein.

They recommend altering dietary habits and taking steps to reach a moderate weight to help with metabolic syndrome risk, as well as psoriasis.

Psoriasis and metabolic syndrome are linked in many ways. The more severe the psoriasis, the higher the risk of metabolic syndrome.

A person living with psoriasis should talk with a doctor about their risk of developing metabolic syndrome. The presence of metabolic syndrome may influence psoriasis treatment recommendations.