Psoriasis and Its Comorbidities: 5 Things to Know

Psoriasis affects millions of people worldwide, with prevalence varying substantially by region, but the clinical challenge extends far beyond the skin. Recent comorbidity network analyses and a population-based study of 31,178 patients have further characterized the health conditions associated with psoriasis. Metabolic dysfunction-associated steatotic liver disease (MASLD) is an important associated metabolic condition, while a range of ocular conditions and sleep disturbances also contribute to the comorbidity burden. These conditions can impair quality of life, influence treatment selection, and contribute to adverse long-term outcomes. Here are five key things clinicians should know about psoriasis comorbidities. 1. Psoriatic Arthritis Drives Much of the Comorbidity Burden in PsoriasisPsoriatic arthritis (PsA) is a chronic inflammatory condition that develops in about 30% of patients with psoriasis. PsA can lead to progressive joint destruction, functional disability, and a substantially reduced quality of life when undiagnosed or inadequately treated. However, the systemic inflammatory burden of PsA extends beyond joints and includes inflammatory bowel disease, metabolic syndrome, uveitis, depression, and cardiovascular disease (CVD).A single-center retrospective cross-sectional study of 506 hospitalized patients with plaque psoriasis, predominantly representing moderate-to-severe disease, found that 79.64% had at least one assessed comorbidity, while 20.36% had none. The results section reported significantly higher overall comorbidity prevalence in patients with late-onset psoriasis (at age ≥ 40 years) than in those with early-onset psoriasis (before age 40 years), at 85.48% vs 74.81%. Significant between-group differences were reported for hypertension, diabetes, nonalcoholic fatty liver disease (now referred to as MASLD), cardiovascular and cerebrovascular disease, hepatic dysfunction, impaired renal function, and metabolic syndrome. These findings underscore the importance of comorbidity assessment in patients with psoriasis, particularly those with late-onset psoriasis, although they do not establish an independent effect of age at psoriasis onset or a specific screening schedule.Another cross-sectional study comprising 120 patients found that comorbidities were prevalent regardless of psoriasis subtype or severity, with no statistically significant differences in comorbidity rates observed across chronic plaque, palmoplantar, erythrodermic, or pustular forms. This finding supports the idea that screening for related health conditions should be performed for all patients with psoriasis, regardless of disease severity or psoriasis type.2. Cardiovascular Risk Rises With Psoriasis SeverityPsoriasis is recognized as an independent cardiovascular risk factor and is associated with increased risk for myocardial infarction, coronary artery disease, and stroke, particularly in patients with severe disease. Proposed mechanisms include shared inflammatory pathways involving Th1/Th17 responses and cytokines such as TNF-alpha, IFN-gamma, IL-6, and IL-17, which may contribute to systemic inflammation, endothelial dysfunction, and atherosclerosis. A national register-based cross-sectional study included 11,560 adults with psoriasis in China. Among the 9019 patients with available CVD data, comorbid CVD prevalence was 2.62%; prevalence among patients aged 65 years or older was 10.69%. In multivariable logistic regression, hypertension showed the strongest adjusted association with comorbid CVD among the assessed cardiometabolic and lifestyle factors, followed by diabetes, smoking, and obesity. Increasing psoriasis severity was associated with higher odds of comorbid CVD, with patients with moderate or severe disease more likely to have CVD than those with mild disease (P for trend < .001). A database-driven bioinformatic analysis identified 470 genes associated with both psoriasis and CVD. The top enriched biological processes were positive regulation of cytokine production, leukocyte migration, and regulation of inflammatory response; cytokine receptor binding was among the top enriched molecular functions. Protein-protein interaction analysis identified core proteins including IL-6, TNF-alpha, MAPK3, AKT1, and TLR4, suggesting potential shared mechanisms involving PI3K/AKT, MAPK, and TLR4/NF-κB signaling. These findings are hypothesis-generating rather than proof of a causal mechanistic link.3. MASLD Emerges as an Important Metabolic Comorbidity in PsoriasisMetabolic comorbidities of psoriasis — including obesity, dyslipidemia, hypertension, diabetes, and metabolic syndrome — have been recognized for more than a decade. With the 2023 transition from nonalcoholic fatty liver disease to MASLD nomenclature, attention has increasingly focused on steatotic liver disease as an important psoriasis-associated metabolic comorbidity. A 2025 systematic review and meta-analysis found that moderate-to-severe psoriasis was associated with a 4.01-fold higher risk for prevalent MASLD compared with no psoriasis. In a separate 2025 retrospective cross-sectional study of 506 hospitalized patients with moderate-to-severe plaque psoriasis, MASLD was the most prevalent recorded comorbidity, affecting 42.69% of patients, followed by hypertension (30.33%), hyperlipidemia (27.67%), overweight/obesity (24.31%), and hyperuricemia (15.81%). In that study’s phenotypic comorbidity network, liver dysfunction was the most central condition by network connectivity. These findings underscore the need to consider liver health — particularly in patients with cardiometabolic risk factors — alongside more routinely assessed risks such as hypertension and diabetes.A large-scale population-based study of 31,178 patients with psoriasis in Spain found that disorders of lipid metabolism were the most frequent chronic comorbidity (35.87%) and identified significant associations between psoriasis and other liver diseases, obesity, and diabetes. A 2025 cross-sectional study of 120 adult psoriasis outpatients in Dhaka, Bangladesh, reported obesity in 41.67% of participants, dyslipidemia in 33.33%, diabetes in 25%, and metabolic syndrome in 16.67%. In a separate retrospective study of hospitalized patients with moderate-to-severe plaque psoriasis in China, psoriasis preceded diabetes diagnosis in 66.15% of patients included in the temporal analysis. This finding is consistent with the hypothesis that psoriasis may contribute to subsequent metabolic disease but does not establish causality or identify chronic inflammation as the mechanism.4. Depression, Anxiety, and Sleep Disorders Add to Disease BurdenPeople with psoriasis generally have higher rates of depression and anxiety than those without psoriasis. Visible skin lesions, chronic pruritus, pain, and social stigmatization can contribute to a substantial psychological burden. A retrospective observational study of 31,178 patients with psoriasis found significant associations with anxiety disorders, depression and mood disorders, and alcohol-related disorders after adjustment for age and sex. Because the study relied on diagnoses recorded during routine clinical care rather than systematic psychiatric screening, the recorded prevalence may underestimate the true burden of mental health conditions. A study of a diverse national cohort, including racial and ethnic minority participants, found significant associations between psoriasis and restless legs syndrome, insomnia, and obstructive sleep apnea (OSA) after adjustment for sociodemographic variables and relevant comorbidities. Associations were generally stronger in non-White participants, particularly for insomnia and OSA. Shared inflammatory pathways involving cytokines such as IL-17 and TNF-alpha may help explain the association between psoriasis and OSA. Sleep disruption and systemic inflammation may reinforce one another, although the underlying mechanisms remain incompletely understood. Observational evidence supports a bidirectional association between psoriasis and OSA.5. Ocular Comorbidities in Psoriasis Extend Beyond UveitisUveitis is a recognized extra-articular manifestation of psoriatic arthritis, which belongs to the spondyloarthritis spectrum. Recent systematic evidence strengthens recognition of a broader range of ocular conditions associated with psoriasis, including dry eye disease, cataract, glaucoma, and retinal vein occlusion, that clinicians should consider when evaluating patients with ocular symptoms.A 2026 systematic review and meta-analysis showed statistically significant associations between psoriasis and cataract, uveitis, dry eye disease, glaucoma, retinal vein occlusion, conjunctivitis, meibomian gland dysfunction, and blepharitis. These findings support assessment for ocular symptoms and prompt ophthalmic consultation when symptoms are present.A separate population-based cohort study found an increased risk for incident uveitis in patients with severe psoriasis, with the highest risk observed in those with spondyloarthritis-related comorbidities. This pattern was consistent with a contribution from greater systemic inflammatory burden, although inflammation was not directly measured. Among all 1512 psoriasis patients with uveitis, inflammatory arthritis was recorded in 17.9% and inflammatory bowel disease in 5.2%. Uveitis was diagnosed before psoriasis in 44.8% and afterward in 55.2%, indicating that either condition may be diagnosed first rather than establishing a bidirectional causal relationship. These findings support attention to skin and joint history when evaluating uveitis, as well as heightened vigilance for ocular symptoms in patients with psoriasis, particularly those with severe disease or spondyloarthritis-related comorbidities.Editor's Note: This article was created using several editorial tools, including generative AI models, as part of the process. Human review and editing of this content were performed prior to publication.