Understanding Systemic Inflammation

Abby Van Voorhees, MD, discusses the relationship between systemic inflammation and psoriasis and why dermatologists need to think of psoriasis as a whole body disease.

Dr Van Voorhees is professor and chair of dermatology at Eastern Virginia Medical School in Norfolk, VA. She is chair emeritus and a member of the National Psoriasis Foundation Medical Board.

Transcript
Dr Van Voorhees: We used to think of psoriasis as a disease that was limited to the skin. Certainly, that's what patients see—that's why they come to our attention, but of course in the last decade or maybe it's slightly longer, we've come to understand that that's not true. Psoriasis is associated with systemic inflammation, and that it's really a whole-body disease. 

We knew patients who have psoriasis pretty frequently had issues with psoriatic arthritis. Now we've come to understand that that same inflammation that is causing difficulty in people's joints is also causing difficulty in their cardiovascular system and in their liver. I think we've come to understand that this is a very much a disease that impacts our patients very profoundly everywhere, and there are sometimes involvement of areas that are very sensitive for patients, be it palms or soles, where a small amount of psoriasis can cause a huge amount of disability. I find the solution to that is just to be very matter of fact about that psoriasis goes there. 

The other thing is there are variances rises that are very, very severe and can potentially be life-threatening. The erythrodermic psoriasis and generalized pustular psoriasis are what come to mind. These are kinds of psoriasis that have so much inflammation, that they can cause what's called high-output failure. That can cause patients, especially if they have any kind of underlying heart disease that has been sometimes fatal for patients. 

Understanding that this degree of inflammation can be really problematic, I think, is very, very important so that these patients are treated with the appropriate care and get the therapeutic intervention that they need right away so that we don't put them at risk. 

Understanding these areas and the outcomes of our patients who have psoriasis may become more and more complicated as we understand the impact of these various metabolic conditions and other systemic associations have our patients with psoriasis. We still have a lot to learn. 

I think that the more we learned, the more we'll be able to judge potentially how to treat people and how to get our patients to that goal that we all need to be striving towards, which is clear or almost clear.