Le comorbilità nel paziente psoriasico: analisi di 203 pazienti

Psoriasis is a chronical dermatosis with a prevalence among 0.5 and 4.6%. The interest for its comorbidities is a current matter, especially because of the negative impact on some of the most important therapeutical options. The most common comorbidities are: psoriatic arthritis, depression, alcohol and tobacco abuse, obesity, hypertension, dyslipidemia, type 2 diabetes mellitus and cardiovascular pathologies (metabolic syndrome). The aim of this study is comparing different sub-populations of patients affected by psoriasis to point out different profiles of comorbidities among them and then determine those at higher risk by sex, age and severity of psoriasis. The study involves 203 patients affected by psoriasis (71 women and 132 men). Data about Psoriasis Area Severity Index (PASI), Body Mass Index (BMI), comorbidities, alcohol, tobacco and drugs consumption were collected from each patient. The results point out that patients affected by hypertension, hypertrigliceridemia, type 2 diabetes mellitus and psoriatic arthritis such as drinkers and obeses show higher PASIs, namely a more severe psoriasis. The influence of sex and age on comorbidities has also been evaluated. These results could support the hypothesis about a connection between psoriasis and comorbidities based on the pro-inflammatory cytokine network, which has a role on lipidic a glucidic metabolism, too. The most important cytokine in this network is TNFα. High levels of Angiotensin Converting Enzyme (ACE) in patients affected by psoriasis could explain, moreover, the link between psoriasis and hypertension. Finally the core of the interest about comorbidities is the question of therapeutical troubles that emerge when most severe patients are found to be the most affected by comorbidites. Comorbidites can prevent the use of systemic agents (which could be otherwise suitable in case of moderate-severe psoriasis) and the therapies for the comorbidities can also interact with the ones for psoriasis.