Women with psoriasis at increased risk for diabetes, hypertension

Researchers suggested psoriasis be considered a systemic disorder rather than a skin disease.

Women with psoriasis were 63% more likely to develop diabetes and 17% more likely to develop hypertension than women without the skin disease, according to the results of a prospective study.

“These data illustrate the importance of considering psoriasis a systemic disorder rather than simply a skin disease,” researchers wrote in Archives of Dermatology.

Researchers recorded data on self-reported diabetes and hypertension using pooled data on 78,061 women in the ongoing Nurses’ Health Study II who were aged 27 to 44 years at baseline. More than 1,800 women (2.3%) reported a diagnosis of psoriasis.

During 14 years of follow-up, the researchers reported 1,560 incident cases of diabetes and 15,724 incident cases of hypertension; all women were free of diabetes and hypertension at the start of the study.

Sixty incident cases of diabetes occurred among women with psoriasis (age-adjusted RR=2.08); none had type 1 diabetes. When compared with women without psoriasis, women with the skin disease had higher mean BMI, drank more alcohol and were more likely to be current or past smokers. This association remained significantly elevated even after adjusting for smoking status, BMI, alcohol intake and physical activity.

There were 386 cases of incident hypertension among women with psoriasis (age-adjusted RR=1.32); the increased risk for hypertension was attenuated and remained significant after multivariate adjustment (RR=1.17).

Inflammation could be one possible explanation of the association between psoriasis and diabetes and hypertension, according to the researchers. However, systemic steroid therapy or other treatments for psoriasis may promote development of diabetes or hypertension.

This is the first study to prospectively document a link between psoriasis and diabetes and hypertension, “although a link between diabetes and psoriasis was suggested as early as 1908,” according to an accompanying editorial by William H. Eaglstein, MD, Emeritus chair of the department of dermatology and cutaneous surgery at Miller School of Medicine, University of Miami, and Jeffrey P. Callen, MD, chief of the division of dermatology at University of Louisville School of Medicine.

“What is not evident is what impact therapy for psoriasis might have on the potential for development of diabetes at a later date or whether treatment of diabetes will have an impact on the likelihood of developing psoriasis or on the management strategies used for our patients with psoriasis,” they wrote.

Qureshi AA. Arch Dermatol. 2009;145:379-382.

Eaglstein WH. Arch Dermatol. 2009;145:467-469.