Comorbidity Patterns in Moderate-to-Severe Psoriasis Highlight Need for Integrated Clinical Management

A retrospective cross-sectional study of hospitalized individuals with moderate-to-severe plaque psoriasis has demonstrated a high burden of systemic comorbidities, emphasizing the importance of comprehensive care strategies that extend beyond skin-directed therapy. The findings, published in Clinical, Cosmetic and Investigational Dermatology, were drawn from electronic medical records at the Shanghai Skin Disease Hospital between 2021 and 2023, providing insight into the demographic distribution and clustering of psoriatic comorbidities using phenotypic comorbidity network (PCN) analysis.

Among 506 patients with plaque psoriasis, 79.64% had at least one comorbid condition. The most prevalent comorbidities were non-alcoholic fatty liver disease, hypertension, hyperlipidemia, overweight or obesity, and hyperuricemia. Comorbidity rates peaked in adults aged 30 to 40 years and 50 to 70 years, with notable increases in hepatic dysfunction and metabolic syndrome during these age intervals.

The study revealed sex-based differences in comorbidity distribution, with male patients showing a slightly higher frequency of comorbid conditions than female patients. Additionally, individuals with early-onset psoriasis were more likely to present with certain comorbidities compared with those with late-onset psoriasis, indicating that disease duration and age at onset may influence systemic involvement.

“PCN analysis identified hepatic dysfunction, hypertension, metabolic syndrome, NAFLD, obesity, hyperlipidemia, and diabetes as strongly associated with psoriasis,” the authors noted, confirming the multifaceted burden of systemic inflammation in this patient population.

These findings reinforce the concept of psoriasis as a chronic systemic inflammatory disease rather than a solely cutaneous condition. For practicing dermatologists, the key clinical implication is the need for proactive screening and multidisciplinary coordination to address comorbidities that may influence treatment selection, disease course, and long-term outcomes.

This approach includes routine evaluation for cardiometabolic risk factors, liver function abnormalities, and metabolic syndrome components—particularly in male patients, individuals with early-onset disease, and those in the 30- to 70-year age range. Targeted screening and prevention strategies based on age and disease phenotype may optimize care delivery and reduce cumulative morbidity in patients with moderate-to-severe psoriasis.

By incorporating comorbidity surveillance into dermatologic care, clinicians can improve disease control, minimize therapeutic risks, and enhance overall patient quality of life.

Reference
Chen W, Zheng J, Wang X, et al. Comorbidity pattern in patients with moderate-to-severe plaque psoriasis: network analysis of a hospitalized database in China. Clin Cosmet Investig Dermatol. 2025;18:491-501. doi:10.2147/CCID.S509739