Vol 9, No 3 (2023)
Review paper
Published online: 2023-06-12

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Forum Dermatologicum

2023, Vol. 9, No. 3, 90–98

DOI: 10.5603/FD.a2023.0011

Copyright © 2023 Via Medica

ISSN 2451–1501, e-ISSN 2451–151X

Psoriasis in the pediatric population: comorbidities with psoriasis

Magdalena SzczegielniakAleksandra LesiakJoanna Narbutt
Department of Dermatology, Pediatric Dermatology and Oncology Clinic, Medical University of Lodz, Poland

Address for correspondence:

Magdalena Szczegielniak, MD, Department of Dermatology,
Pediatric Dermatology and Oncology Clinic, Medical University
of Lodz, Kniaziewicza 1/5, 91347 Lodz, Poland,
e-mail: magda.szczegielniak@gmail.com

Received: 30.12.2022 Accepted: 18.04.2023 Early publication date: 12.06.2023

The clinical picture, management and quality of life assessment in psoriasis in the paediatric population are discussed in another article: Szczegielniak M, Lesiak A, Narbutt J. Psoriasis in the pediatric population: clinical presentation, management and quality of life assessment. Forum Derm 2023; 9(2): 7174; DOI: 10.5603/FD.a2023.0009

Psoriasis is a chronic, non-infectious, immune-mediated inflammatory skin disease with periods of exacerbation and remission. Adult patients with psoriasis are predisposed to developing cardiovascular diseases, metabolic syndrome and its components, type 2 diabetes, and inflammatory bowel disease. In almost one-third of patients, the first symptoms of psoriasis occur in childhood. Early identification
of risk factors for comorbidities or their detection at an early stage of progression can reduce the likelihood of their development in adulthood. Psoriasis can adversely affect mental health, quality of life as well as functioning in the school community and peer environment. This paper reviews the current state of knowledge on comorbidities of psoriasis in the pediatric population.
Forum Derm. 2023; 9: 3, 9098
Keywords: psoriasis, children, comorbidities


Psoriasis is a chronic, non-infectious, immune-mediated disease. In recent years, there has been an increase in the incidence of moderate to severe psoriasis in children. As a systemic inflammatory disease, psoriasis predisposes to the development of comorbidities such as metabolic syndrome, cardiovascular diseases, psoriatic arthritis, inflammatory bowel disease, non-alcoholic fatty liver disease, and coeliac disease, which was confirmed in the adult population. In children and adolescents, studies are still underway to confirm comorbidities or the presence of risk factors for comorbidities of psoriasis in adulthood. Comorbidities of psoriasis are presented in Table 1. Laboratory tests performed on patients with psoriasis are listed in Table 2.

Table 1. Comorbidities of psoriasis

Classical diseases comorbid with psoriasis

Psoriatic arthritis

Inflammatory bowel diseases

Mental disorders


Cardiovascular diseases


Metabolic syndrome

Non-alcoholic fatty liver disease


Sleep disorders

Chronic obstructive pulmonary disease


Coeliac disease

Parkinson’s disease

Sexual disorders

Treatment-related diseases

Hypertension (cyclosporine)

Neurotoxicity (cyclosporine)

Hepatotoxicity (methotrexate)

Skin cancers (PUVA)

Dyslipidemia (acitretin)

Table 2. Laboratory tests performed in patients with psoriasis

Laboratory tests and measurements performed in patients with psoriasis

Complete blood count

C-reactive protein

Lipid profile

Liver tests

Fasting blood glucose test

Uric acid

Arterial blood pressure

Waist circumference


Psoriatic arthritis (PsA) is included in the spectrum of juvenile idiopathic arthritis (JIA). It represents 68% of all JIA. There are two peaks of incidence: in the second and third years of life and in the tenth and twelfth years of life. In 80% of children with PsA, inflammatory changes in the joints precede the appearance of skin lesions by 23 years [1–3]. The disease process may involve peripheral joints (asymmetric inflammation of both large and small joints is typical), spinal and sacroiliac joints, and tendon attachments. Isolated inflammation of the fingers is also possible. The most common symptoms reported by patients include morning stiffness, pain, and joint swelling. In younger children, especially girls, the lesions mainly affect single joints, while in older children, especially boys, enthesitis and spinal involvement are more commonly observed [4, 5]. Uveitis may coexist with psoriatic arthritis. It is recommended that the patient be asked about joint pain and mobility problems at every dermatological visit, which may facilitate earlier diagnosis of the disease and the implementation of appropriate systemic treatment as well as improve patients’ quality of life and prevent permanent complications [6–8].


Metabolic syndrome is the co-occurrence of obesity, hypertension, carbohydrate, and lipid disorders. The risk of metabolic syndrome in the adult population is at least twice as high in patients with psoriasis [9–11]. Psoriasis and metabolic syndrome share many pathogenic pathways. Both diseases are associated with chronic inflammation, vascular endothelial dysfunction, and oxidative stress [12–16]. The components of the metabolic syndrome represent a group of risk factors for atherosclerosis, cardiovascular diseases, and type 2 diabetes (T2D). The severity of psoriasis in both adults and children is related to the co-occurrence of metabolic syndrome [17]. Therefore, early diagnosis of the disease and effective treatment of psoriatic lesions can prevent the development of dangerous long-term sequelae and complications in adulthood [18–27].

In a 2017 meta-analysis by Pietrzak et al. [28] involving a total of 965 children with psoriasis, the majority of subjects had reduced HDL cholesterol levels and abnormal fasting blood glucose compared to controls. However, there were no abnormalities in triglyceride levels, waist circumference, or blood pressure values. The occurrence of the above abnormalities does not meet the criteria for the diagnosis of metabolic syndrome but may be an early stage of it or a risk factor for its development in adulthood [29, 30].

In the pediatric population, overweight and obesity are among the most commonly observed metabolic disorders that lead to metabolic syndrome. In recent years, there has been an increase in the prevalence of excess body weight in both adults as well as children, and adolescents. The link between psoriasis and obesity is explained by the presence of chronic inflammation typical of the diseases mentioned. In psoriasis, there are high levels of pro-inflammatory cytokines such as TNF-α, IL-6, IL-1, which leads to stimulation of the hypothalamic-pituitary-adrenal axis and, through this pathway, contributes to the development of central obesity [31–34]. Adipose tissue is hormonally active, which leads to increased production of pro-inflammatory mediators and may contribute to the exacerbation of psoriatic lesions and, according to some authors, be a risk factor for the development of skin lesions [35–39]. The above association was confirmed in a multicentre study among Turkish children with psoriasis and in a study conducted at a center in Padua involving 107 pediatric patients with psoriasis. It was found that the prevalence of overweight or obesity was higher than in the control group and increased with the duration of skin lesions. A multicentre study by Paller et al. also observed an increased prevalence of central obesity in children with psoriasis compared to controls [40–42].

A population-based study by Koebnick et al. [43] and a multicentre study among French children found that obesity often precedes the appearance of the first skin lesions, indicating an increased predisposition of obese children to develop psoriasis. There is also a more severe course of the disease in obese individuals and a poorer response to treatment. Children with psoriasis with comorbid obesity are more likely to have lipid disorders [44]. Weight reduction may improve skin conditions in psoriasis patients [45–48].


The clinical manifestations of atherosclerosis become apparent in adulthood, although it is a process progressing from childhood [49, 50]. Inflammatory cells and the mediators they produce both contribute to the development of psoriatic lesions and play a role in vascular endothelial damage and atherosclerotic plaque formation [51–65]. In multicentre studies of psoriasis patients in the adult population, cardiovascular disease was found to be an important source of mortality. This was also confirmed by a UK population-based epidemiological study using the General Practice Research Database [66–76]. A Danish population-based study revealed that patients with severe psoriasis have an increased risk of myocardial infarction [77]. An Iraqi study screening for cardiovascular risk factors in children with moderate to severe psoriasis reported an increased prevalence of overweight, obesity, atherogenic lipid profile, and hypertension [78]. A US-based analysis of patients hospitalized in the years 20022012, which included 4,884,448 children aged 017 years, confirmed that childhood psoriasis is associated with an increased risk of cardiovascular disease and its risk factors such as hypertension, obesity, and abnormal glucose tolerance [79]. One study assessed carotid artery intima-media complex (cIMT) thickness in children with psoriasis using ultrasound (US) Doppler. It was found that the cIMT value was significantly higher in the psoriasis group compared to the control group and positively correlated with disease duration and other metabolic disorders, indicating a higher risk of developing early cardiovascular disease [80–84].


Patients with psoriasis are at increased risk of developing hypertension. Moreover, patients with moderate to severe forms of psoriasis tend to have hypertension resistant to hypotensive treatment. Hypertension may be a risk factor for the development of psoriasis, mainly due to patients’ use of blood pressure-lowering drugs such as β-blockers [85]. Abnormal activation of inflammatory cells with overexpression of pro-inflammatory cytokines in psoriasis set in motion an immune cascade, leading to vascular endothelial damage, collagen deposition in arteries, vascular stiffening, and the appearance of elevated blood pressure [86–92]. Children with psoriasis also have an increased incidence of hypertension. A study in Italy recruited children with mild to severe psoriasis without concomitant overweight, obesity, or other metabolic diseases. It was found that children with psoriasis had elevated blood pressure values compared to the control group. Patients with psoriasis should be routinely screened for the presence of hypertension [93].


There is an increased prevalence of T2D among adult patients with psoriasis [94–98]. Several meta-analyses revealed that the risk of diabetes is particularly increased in moderate to severe psoriasis [99–101]. Patients with psoriasis were also found to have a higher risk of insulin resistance compared to controls, implying that psoriasis may be a pre-diabetic condition. This justifies the need for screening in children and adolescents with psoriasis, especially with comorbid obesity and overweight [102–105]. The increased risk of glycemic disorders is associated with the systemic inflammatory process present in psoriasis and many common pathogenetic pathways of both diseases [106–109]. Psoriasis can also coexist with T1D [110–113]. The co-occurrence of diabetes and psoriasis was found to accelerate the development of complications in the form of micro- and macroangiopathies. At the same time, blood glucose normalization contributes to the resolution of psoriatic lesions [114, 115].


Inflammatory bowel diseases (IBDs) such as Crohn’s disease and ulcerative colitis often coexist with psoriasis [116–120]. It was found that there was a common pathogenetic link (basis) for the mentioned diseases at the genetic and immunological level and in relation to disturbances in the skin and gut microbiome. In terms of immunology, a particularly important role is played by the elevated levels of IL-17, which largely accounts for intestinal and skin manifestations. The common genetic basis is supported by the locus on chromosome 6p21, where psoriasis and inflammatory bowel disease susceptibility genes are located. In recent years, there has been an increase in the incidence of IBD. Crohn’s disease and ulcerative colitis are 34 times more common in children with psoriasis compared to controls. Follow-up for these diseases in psoriasis patients is recommended, particularly in the case of gastrointestinal complaints, impaired growth, and unintentional weight loss [121–124].


Patients with psoriasis are more likely to suffer from coeliac disease. This is due to common pathogenetic mechanisms including an inflammatory background and the presence of shared loci for genes [125, 126]. A UK study found that patients with psoriasis have a higher prevalence of the disease. Studies in Italy, the Czech Republic, and India confirmed an increased prevalence of coeliac disease in psoriasis [127–141]. There are also isolated reports that do not confirm the association of psoriasis with coeliac disease or the presence of elevated celiac-specific antibodies, suggesting the need for further follow-up of patients [142, 143]. In light of the evidence presented, it is important to bear in mind the possibility of co-occurrence of psoriasis and coeliac disease and ask patients diagnosed with psoriasis, both adults and children, about the presence of symptoms of the coeliac disease such as the presence of gastric symptoms, as well as iron deficiency anemia and hair loss. Moreover, the level of anti-endomysium antibodies, anti-gliadin antibodies, and anti-tissue transglutaminase IgA antibodies should be checked in these patients, and a gastroenterology consultation should be performed.


Non-alcoholic fatty liver disease (NAFLD) is described by lipid accumulation in hepatocytes in the absence of a history of excessive alcohol consumption. Over the past two decades, NAFLD has become one of the most common chronic liver diseases [144]. Compared to the general population, patients with psoriasis are at increased risk of NAFLD and of developing non-alcoholic steatohepatitis (NASH), as well as cirrhosis and liver fibrosis. In psoriasis, there are increased blood levels of pro-inflammatory cytokines such as TNF-α, IL-6, IL-17 and of pro-hyperglycemic adipokines, resulting in inflammation, insulin resistance, and thereby an increased risk of NAFLD and, later, NASH [145–150]. Also, comorbidities of psoriasis such as metabolic syndrome, being overweight and obesity can contribute to the development of NAFLD. This disease may exacerbate psoriatic lesions due to secreted pro-inflammatory cytokines. On the other hand, NAFLD is more common in patients with moderate to severe psoriasis and its course is then more severe [151–153]. Several studies revealed that psoriasis is an independent risk factor for liver diseases [154–169]. All patients with psoriasis, including children and adolescents, should have NAFLD screening and be appropriately consulted by a hepatologist to detect the first symptoms early and prevent further liver damage. This relationship should also be borne in mind when selecting systemic therapy in psoriasis.


Chronic and recurrent skin diseases, especially psoriasis, may increase the risk of mental disorders. The co-occurrence of psoriasis with depressive disorders, anxiety disorders, bipolar affective disorder, and schizophrenia was reported. There are numerous reports indicating a higher risk of these disorders in psoriasis than in other skin diseases [170–173]. One center in the USA conducted a long-term follow-up of several thousand children and adolescents under 18 years of age with psoriasis and observed that patients with psoriasis were at significantly higher risk of developing mental disorders compared to controls [174]. A study in a Danish center highlighted that children with psoriasis were at increased risk of developing eating disorders, alcohol abuse, and drug abuse. There was a significant increase in the use of psychopharmacology compared with children without skin lesions [175].

Early onset of the diseases and the associated negative self-perception has a significant impact on personality formation and on increasing the risk of mental disorders in adulthood. The onset of the disease in childhood may have a greater negative impact on mental health than the disease duration. Longer duration of the disease also positively correlates with an increased risk of depressive disorders and reduced quality of life. Early intervention and consultation with a psychologist are important [176–179]. Mental disorders and increased emotional stress play an important role in the development of the first symptoms and the initiation of the onset of the disease, as well as in the occurrence of exacerbations in the course of an already existing disease.

Emotional disorders in the form of increased anxiety, depression, and reduced quality of life are also present in caregivers of sick children [180–184].


Psoriasis is a systemic process that affects the functioning of the entire body and is not limited to the skin. Many population-based studies proved the association of this disease with an abnormal metabolic profile and other diseases. In a population of children and adolescents with psoriasis, abnormalities in the lipid profile are found in laboratory tests, indicating that psoriasis is an independent risk factor for future atherosclerosis and cardiovascular diseases. The treatment of psoriasis does not only involve conventional medications, but it also requires modifications in the lifestyle and implementation of preventive measures for comorbidities associated with psoriasis. It is important to keep this in mind when taking care of young patients with psoriasis.

Conflict of interest

The authors declare no conflict of interest.




  1. Espinosa M, Gottlieb BS. Juvenile idiopathic arthritis. Pediatr Rev. 2012; 33(7): 303313, doi: 10.1542/pir.33-7-303, indexed in Pubmed: 22753788.
  2. Lewkowicz D, Gottlieb AB. Pediatric psoriasis and psoriatic arthritis. Dermatol Ther. 2004; 17(5): 364375, doi: 10.1111/j.1396-0296.2004.04039.x, indexed in Pubmed: 15379771.
  3. Ogdie A, Weiss P. The epidemiology of psoriatic arthritis. Rheum Dis Clin North Am. 2015; 41(4): 545568, doi: 10.1016/j.rdc.2015.07.001, indexed in Pubmed: 26476218.
  4. Stoll ML, Punaro M. Psoriatic juvenile idiopathic arthritis: a tale
    of two subgroup
    s. Curr Opin Rheumatol. 2011; 23(5): 437443, doi: 10.1097/BOR.0b013e328348b278, indexed in Pubmed: 21709556.
  5. Veale DJ, Fearon U. The pathogenesis of psoriatic arthritis. Lancet. 2018; 391(10136): 22732284, doi: 10.1016/S0140-6736(18)30830-4, indexed in Pubmed: 29893226.
  6. Gottlieb AB, Merola JF. Axial psoriatic arthritis: an update for dermatologists. J Am Acad Dermatol. 2021; 84(1): 92101, doi: 10.1016/j.jaad.2020.05.089, indexed in Pubmed: 32747079.
  7. Gottlieb A, Merola JF. Psoriatic arthritis for dermatologists. J Dermatolog Treat. 2020; 31(7): 662679, doi: 10.1080/09546634.2019.1605142, indexed in Pubmed: 31014154.
  8. Van den Bosch F, Coates L. Clinical management of psoriatic arthritis. Lancet. 2018; 391(10136): 22852294, doi: 10.1016/S0140-6736(18)30949-8, indexed in Pubmed: 29893227.
  9. Gisondi P, Fostini AC, Fossà I, et al. Psoriasis and the metabolic syndrome. Clin Dermatol. 2018; 36(1): 2128, doi: 10.1016/j.clindermatol.2017.09.005, indexed in Pubmed: 29241748.
  10. Zimmet P, Alberti G, Kaufman F, et al. International Diabetes Federation Task Force on Epidemiology and Prevention of Diabetes. The metabolic syndrome in children and adolescents. Lancet. 2007; 369(9579): 20592061, doi: 10.1016/S0140-6736(07)60958-1, indexed in Pubmed: 17586288.
  11. Milčić D, Janković S, Vesić S, et al. Prevalence of metabolic syndrome in patients with psoriasis: a hospital-based cross-sectional study. An Bras Dermatol. 2017; 92(1): 4651, doi: 10.1590/abd1806-4841.20175178, indexed in Pubmed: 28225956.
  12. McCracken E, Monaghan M, Sreenivasan S. Pathophysiology of the metabolic syndrome. Clin Dermatol. 2018; 36(1): 1420, doi: 10.1016/j.clindermatol.2017.09.004, indexed in Pubmed: 29241747.
  13. Stefanadi EC, Dimitrakakis G, Antoniou CK, et al. Metabolic syndrome and the skin: a more than superficial association. Reviewing the association between skin diseases and metabolic syndrome and a clinical decision algorithm for high risk patients. Diabetol Metab Synd. 2018; 10(9), doi: 10.1186/s13098-018-0311-z.
  14. Fanning E, O’Shea D. Genetics and the metabolic syndrome. Clin Dermatol. 2018; 36(1): 913, doi: 10.1016/j.clindermatol.2017.09.003, indexed in Pubmed: 29241759.
  15. Steele CE, Morrell D, Evans M. Metabolic syndrome and inflammatory skin conditions. Curr Opin Pediatr. 2019; 31(4): 515522, doi: 10.1097/MOP.0000000000000790, indexed in Pubmed: 31169544.
  16. Furue M, Kadono T. “Inflammatory skin march” in atopic dermatitis and psoriasis. Inflamm Res. 2017; 66(10): 833842, doi: 10.1007/s00011-017-1065-z, indexed in Pubmed: 28620798.
  17. Langan SM, Seminara NM, Shin DB, et al. Prevalence of metabolic syndrome in patients with psoriasis: a population-based study in the United Kingdom. J Invest Dermatol. 2012; 132(3 Pt 1): 556562, doi: 10.1038/jid.2011.365, indexed in Pubmed: 22113483.
  18. Armstrong AW, Harskamp CT, Armstrong EJ. Psoriasis and metabolic syndrome: a systematic review and meta-analysis of observational studies. J Am Acad Dermatol. 2013; 68(4): 654662, doi: 10.1016/j.jaad.2012.08.015, indexed in Pubmed: 23360868.
  19. Osier E, Wang AS, Tollefson MM, et al. Pediatric psoriasis comorbidity screening guidelines. JAMA Dermatol. 2017; 153(7): 698704, doi: 10.1001/jamadermatol.2017.0499, indexed in Pubmed: 28514463.
  20. Gisondi P, Galvan A, Idolazzi L, et al. Management of moderate to severe psoriasis in patients with metabolic comorbidities. Front Med (Lausanne). 2015; 2: 1, doi: 10.3389/fmed.2015.00001, indexed
    in Pubmed: 25654080.
  21. Goldminz AM, Buzney CD, Kim N, et al. Prevalence of the metabolic syndrome in children with psoriatic disease. Pediatr Dermatol. 2013; 30(6): 700705, doi: 10.1111/pde.12218, indexed in Pubmed: 24016334.
  22. Rodríguez-Zúñiga MJ, García-Perdomo HA. Systematic review and meta-analysis of the association between psoriasis and metabolic syndrome. J Am Acad Dermatol. 2017; 77(4): 657666.e8, doi: 10.1016/j.jaad.2017.04.1133, indexed in Pubmed: 28917453.
  23. Au Sc, Goldminz AM, Loo DS, et al. Association between pediatric psoriasis and the metabolic syndrome. J Am Acad Dermatol. 2012; 66(6): 1012––1013, doi: 10.1016/j.jaad.2011.11.935, indexed in Pubmed: 22583717.
  24. Małecka-Tendera E, Zachurzok-Buczyńska A. Otyłość i zespół metaboliczny u dzieci i młodzieży epidemiologia, klasyfikacja i leczenie.
    In: Podolec P. ed. Podręcznik Polskiego Forum Profilaktyki. T. 2. Medycyna Praktyczna, Kraków 2010: 209221.
  25. Zimmet P, Alberti KG, Kaufman F, et al. IDF Consensus Group. The metabolic syndrome in children and adolescents - an IDF consensus report. Pediatr Diabetes. 2007; 8(5): 299306, doi: 10.1111/j.1399-5448.2007.00271.x, indexed in Pubmed: 17850473.
  26. Jańczyk W, Litwin M, Socha P. Co to jest zespół metaboliczny u dzieci? Stand Med/Pediatria. 2010; 7: 2325.
  27. Caroppo F, Galderisi A, Ventura L, et al. Metabolic syndrome and insulin resistance in pre-pubertal children with psoriasis. Eur J Pediatr. 2021; 180(6): 17391745, doi: 10.1007/s00431-020-03924-w, indexed
    in Pubmed: 33483797.
  28. Pietrzak A, Grywalska E, Walankiewicz M, et al. Psoriasis and metabolic syndrome in children: current data. Clin Exp Dermatol. 2017; 42(2): 131136, doi: 10.1111/ced.13014, indexed in Pubmed: 28044372.
  29. Mahé E, Maccari F, Beauchet A, et al. GEM Resopso. Childhood-onset psoriasis: association with future cardiovascular and metabolic comorbidities. Br J Dermatol. 2013; 169(4): 889895, doi: 10.1111/bjd.12441, indexed in Pubmed: 23937622.
  30. Aalemi AK, Hamdard AG, Chen H. Association of metabolic syndrome with pediatric psoriasis: a case-control study in Kabul, Afghanistan. Int J Dermatol. 2020; 59(4): 451456, doi: 10.1111/ijd.14805, indexed in Pubmed: 32043572.
  31. Daniels SR, Arnett DK, Eckel RH, et al. Overweight in children and adolescents: pathophysiology, consequences, prevention, and treatment. Circulation. 2005; 111(15): 19992012, doi: 10.1161/01.CIR.0000161369.
    , indexed in Pubmed: 15837955.
  32. Gutmark-Little I, Shah KN. Obesity and the metabolic syndrome
    in pediatric psoriasi
    s. Clin Dermatol. 2015; 33(3): 305315, doi: 10.1016/j.clindermatol.2014.12.006, indexed in Pubmed: 25889131.
  33. Gottlieb AB, Chao C, Dann F. Psoriasis comorbidities. J Dermatolog Treat. 2008; 19(1): 521, doi: 10.1080/09546630701364768, indexed in Pubmed: 18273720.
  34. Sterry W, Strober BE, Menter A, et al. International Psoriasis Council. Obesity in psoriasis: the metabolic, clinical and therapeutic implications. Report of an interdisciplinary conference and review. Br J Dermatol. 2007; 157(4): 649655, doi: 10.1111/j.1365-2133.2007.08068.x, indexed in Pubmed: 17627791.
  35. Boccardi D, Menni S, La Vecchia C, et al. Overweight and childhood psoriasis. Br J Dermatol. 2009; 161(2): 484486, doi: 10.1111/j.1365-2133.2009.09276.x, indexed in Pubmed: 19519836.
  36. Becker L, Tom WL, Eshagh K, et al. Excess adiposity preceding pediatric psoriasis. JAMA Dermatol. 2014; 150(5): 573574, doi: 10.1001/jamadermatol.2014.324, indexed in Pubmed: 24695974.
  37. Duarte GV, Oliveira Md, Cardoso TM, et al. Association between obesity measured by different parameters and severity of psoriasis. Int J Dermatol. 2013; 52(2): 177181, doi: 10.1111/j.1365-4632.2011.05270.x, indexed in Pubmed: 22998685.
  38. Kong Yi, Zhang S, Wu R, et al. New insights into different adipokines in linking the pathophysiology of obesity and psoriasis. Lipids Health Dis. 2019; 18(1): 171, doi: 10.1186/s12944-019-1115-3, indexed
    in Pubmed: 31521168.
  39. Duarte GV, Oliveira Md, et al. Association between obesity measured by different parameters and severity of psoriasis. Int J Dermatol. 2013; 52(2): 177181, doi: 10.1111/j.1365-4632.2011.05270.x, indexed
    in Pubmed: 22998685.
  40. Ergun T, Seckin Gencosmanoglu D, Karakoc-Aydiner E, et al. Prevalence of obesity in paediatric psoriasis and its impact on disease severity and progression. Australas J Dermatol. 2017; 58(4): e182e187, doi: 10.1111/ajd.12491, indexed in Pubmed: 27242061.
  41. Guidolin L, Borin M, Fontana E, et al. Central obesity in children with psoriasis. Acta Derm Venereol. 2018; 98(2): 282283, doi: 10.2340/00015555-2816, indexed in Pubmed: 29048098.
  42. Paller AS, Mercy K, Kwasny MJ, et al. Association of pediatric psoriasis severity with excess and central adiposity: an international cross-sectional study. JAMA Dermatol. 2013; 149(2): 166176, doi: 10.1001/jamadermatol.2013.1078, indexed in Pubmed: 23560297.
  43. Koebnick C, Black MH, Smith N, et al. The association of psoriasis and elevated blood lipids in overweight and obese children. J Pediatr. 2011; 159(4): 577583, doi: 10.1016/j.jpeds.2011.03.006, indexed
    in Pubmed: 21524758.
  44. Mahé E, Beauchet A, Bodemer C, et al. Groupe de Recherche de la Société Française de Dermatologie Pédiatrique. Psoriasis and obesity in French children: a case-control, multicentre study. Br J Dermatol. 2015; 172(6): 15931600, doi: 10.1111/bjd.13507, indexed in Pubmed: 25363889.
  45. Jensen P, Skov L. Psoriasis and obesity. Dermatology. 2016; 232(6): 633639, doi: 10.1159/000455840, indexed in Pubmed: 28226326.
  46. Upala S, Sanguankeo A. Effect of lifestyle weight loss intervention on disease severity in patients with psoriasis: a systematic review and meta-analysis. Int J Obes (Lond). 2015; 39(8): 11971202, doi: 10.1038/ijo.2015.64, indexed in Pubmed: 25920774.
  47. Akhyani M, Ehsani AH, Robati RM, et al. The lipid profile in psoriasis: a controlled study. J Eur Acad Dermatol Venereol. 2007; 21(10): 13301332, doi: 10.1111/j.1468-3083.2007.02260.x, indexed in Pubmed: 17958837.
  48. Ma C, Harskamp CT, Armstrong EJ, et al. The association between psoriasis and dyslipidaemia: a systematic review. Br J Dermatol. 2013; 168(3): 486495, doi: 10.1111/bjd.12101, indexed in Pubmed: 23106411.
  49. Tom WL, Playford MP, Admani S, et al. Characterization of lipoprotein composition and function in pediatric psoriasis reveals a more atherogenic profile. J Invest Dermatol. 2016; 136(1): 6773, doi: 10.1038/JID.2015.385, indexed in Pubmed: 26763425.
  50. Moudgil S, Mahajan R, Narang T, et al. Central obesity and dyslipidemia in pediatric patients with psoriasis: An observational study from India. J Am Acad Dermatol. 2021; 85(6): 16551657, doi: 10.1016/j.jaad.2020.12.072, indexed in Pubmed: 33434596.
  51. Miller IM, Skaaby T, Ellervik C, et al. Quantifying cardiovascular disease risk factors in patients with psoriasis: a meta-analysis. Br J Dermatol. 2013; 169(6): 11801187, doi: 10.1111/bjd.12490, indexed in Pubmed: 23815240.
  52. Shahwan KT, Kimball AB. Psoriasis and cardiovascular disease. Med Clin North Am. 2015; 99(6): 12271242, doi: 10.1016/j.mcna.2015.08.001, indexed in Pubmed: 26476250.
  53. Ma L, Li Me, Wang H, et al. High prevalence of cardiovascular risk factors in patients with moderate or severe psoriasis in northern China. Arch Dermatol Res. 2014; 306(3): 247251, doi: 10.1007/s00403-013-1437-3, indexed in Pubmed: 24385235.
  54. Prodanovich S, Kirsner RS, Kravetz JD, et al. Association of psoriasis with coronary artery, cerebrovascular, and peripheral vascular diseases and mortality. Arch Dermatol. 2009; 145(6): 700703, doi: 10.1001/archdermatol.2009.94, indexed in Pubmed: 19528427.
  55. Mansouri B, Kivelevitch D, Natarajan B, et al. Comparison of coronary artery calcium scores between patients with psoriasis and type 2 diabetes. JAMA Dermatol. 2016; 152(11): 12441253, doi: 10.1001/jamadermatol.2016.2907, indexed in Pubmed: 27556410.
  56. Boehncke WH, Boehncke S, Tobin AM, et al. The ‘psoriatic march’: a concept of how severe psoriasis may drive cardiovascular comorbidity. Exp Dermatol. 2011; 20(4): 303307, doi: 10.1111/j.1600-0625.2011.01261.x, indexed in Pubmed: 21410760.
  57. McDonald CJ, Calabresi P. Psoriasis and occlusive vascular disease. Br J Dermatol. 1978; 99(5): 469475, doi: 10.1111/j.1365-2133.1978.tb02012.x, indexed in Pubmed: 708620.
  58. Armstrong EJ, Harskamp CT, Armstrong AW. Psoriasis and major adverse cardiovascular events: a systematic review and meta-analysis of observational studies. J Am Heart Assoc. 2013; 2(2): e000062, doi: 10.1161/JAHA.113.000062, indexed in Pubmed: 23557749.
  59. Tablazon ILD, Al-Dabagh A, Davis SA, et al. Risk of cardiovascular disorders in psoriasis patients: current and future. Am J Clin Dermatol. 2013; 14(1): 17, doi: 10.1007/s40257-012-0005-5, indexed in Pubmed: 23329076.
  60. Evensen K, Slevolden E, Skagen K, et al. Increased subclinical atherosclerosis in patients with chronic plaque psoriasis. Atherosclerosis. 2014; 237(2): 499503, doi: 10.1016/j.atherosclerosis.2014.10.008, indexed in Pubmed: 25463081.
  61. Mehta NN, Yu Y, Pinnelas R, et al. Attributable risk estimate of severe psoriasis on major cardiovascular events. Am J Med. 2011; 124(8): 775.e1775.e6, doi: 10.1016/j.amjmed.2011.03.028, indexed in Pubmed: 21787906.
  62. Mehta NN, Azfar RS, Shin DB, et al. Patients with severe psoriasis are at increased risk of cardiovascular mortality: cohort study using the General Practice Research Database. Eur Heart J. 2010; 31(8): 10001006, doi: 10.1093/eurheartj/ehp567, indexed in Pubmed: 20037179.
  63. Dey AK, Joshi AA, Chaturvedi A, et al. Association between skin and aortic vascular inflammation in patients with psoriasis: a case-cohort study using positron emission tomography/computed tomography. JAMA Cardiol. 2017; 2(9): 10131018, doi: 10.1001/jamacardio.2017.1213, indexed in Pubmed: 28564678.
  64. Gelfand JM, Dommasch ED, Shin DB, et al. The risk of stroke in patients with psoriasis. J Invest Dermatol. 2009; 129(10): 24112418, doi: 10.1038/jid.2009.112, indexed in Pubmed: 19458634.
  65. Raaby L, Ahlehoff O, de Thurah A. Psoriasis and cardiovascular events: updating the evidence. Arch Dermatol Res. 2017; 309(3): 225228, doi: 10.1007/s00403-016-1712-1, indexed in Pubmed: 28213804.
  66. Kwa MC, Silverberg JI. Association between inflammatory skin disease and cardiovascular and cerebrovascular co-morbidities in US adults: analysis of nationwide inpatient sample data. Am J Clin Dermatol. 2017; 18(6): 813823, doi: 10.1007/s40257-017-0293-x, indexed
    in Pubmed:
  67. Hu SCS, Lan CCE. Psoriasis and cardiovascular comorbidities: focusing on severe vascular events, cardiovascular risk factors and implications for treatment. Int J Mol Sci. 2017; 18(10), doi: 10.3390/ijms18102211, indexed in Pubmed: 29065479.
  68. Furue M, Tsuji G, Chiba T, et al. Cardiovascular and metabolic diseases comorbid with psoriasis: beyond the skin. Intern Med. 2017; 56(13): 16131619, doi: 10.2169/internalmedicine.56.8209, indexed in Pubmed: 28674347.
  69. Lin HW, Wang KH, Lin HC, et al. Increased risk of acute myocardial infarction in patients with psoriasis: a 5-year population-based study in Taiwan. J Am Acad Dermatol. 2011; 64(3): 495501, doi: 10.1016/j.jaad.2010.01.050, indexed in Pubmed: 21216492.
  70. Li WQ, Han JL, Manson JE, et al. Psoriasis and risk of nonfatal cardiovascular disease in U.S. women: a cohort study. Br J Dermatol. 2012; 166(4): 811818, doi: 10.1111/j.1365-2133.2011.10774.x, indexed
    in Pubmed: 22175820.
  71. Ogdie A, Yu Y, Haynes K, et al. Risk of major cardiovascular events in patients with psoriatic arthritis, psoriasis and rheumatoid arthritis: a population-based cohort study. Ann Rheum Dis. 2015; 74(2): 326332, doi: 10.1136/annrheumdis-2014-205675, indexed in Pubmed:
  72. Wu JJ, Choi YM, Bebchuk JD. Risk of myocardial infarction in psoriasis patients: a retrospective cohort study. J Dermatolog Treat. 2015; 26(3): 230234, doi: 10.3109/09546634.2014.952609, indexed in Pubmed: 25102892.
  73. Levesque A, Lachaine J, Bissonnette R. Risk of myocardial infarction in canadian patients with psoriasis: a retrospective cohort study. J Cutan Med Surg. 2013; 17(6): 398403, doi: 10.2310/7750.2013.13052, indexed in Pubmed: 24138976.
  74. Shiba M, Kato T, Funasako M, et al. Association between psoriasis vulgaris and coronary heart disease in a hospital-based population in Japan. PLoS One. 2016; 11(2): e014931. Erratum in: PLoS One. 2016;11(6):e0158699, doi: 10.1371/journal.pone.0149316, indexed
    in Pubmed:
  75. Gelfand JM, Neimann AL, Shin DB, et al. Risk of myocardial infarction in patients with psoriasis. JAMA. 2006; 296(14): 17351741, doi: 10.1001/jama.296.14.1735, indexed in Pubmed: 17032986.
  76. Kaye JA, Li L, Jick SS. Incidence of risk factors for myocardial infarction and other vascular diseases in patients with psoriasis. Br J Dermatol. 2008; 159(4): 895902, doi: 10.1111/j.1365-2133.2008.08707.x, indexed in Pubmed: 18616778.
  77. Egeberg A, Thyssen JP, Jensen P, et al. Risk of myocardial infarction
    in patients with psoriasis and psoriatic arthritis:
    a nationwide cohort study. Acta Derm Venereol. 2017; 97(7): 819824, doi: 10.2340/00015555-2657, indexed in Pubmed: 28350413.
  78. Dhaher SA, Alyassiry F. Screening for comorbid cardiovascular risk factors in pediatric psoriasis among iraqi patients: a case-control study. Cureus. 2021; 13(9): e18397, doi: 10.7759/cureus.18397, indexed
    in Pubmed: 34729275.
  79. Kwa L, Kwa MC, Silverberg JI. Cardiovascular comorbidities of pediatric psoriasis among hospitalized children in the United States. J Am Acad Dermatol. 2017; 77(6): 10231029, doi: 10.1016/j.jaad.2017.08.034, indexed in Pubmed: 28964537.
  80. Fabi M, Chessa MA, Panizza D, et al. Psoriasis and cardiovascular risk in children: the usefulness of carotid intima-media thickness. Pediatr Cardiol. 2022; 43(7): 14621470, doi: 10.1007/s00246-022-02869-1, indexed in Pubmed: 35316356.
  81. Ryan C, Kirby B. Psoriasis is a systemic disease with multiple cardiovascular and metabolic comorbidities. Dermatol Clin. 2015; 33(1): 4155, doi: 10.1016/j.det.2014.09.004, indexed in Pubmed: 25412782.
  82. Lai YiC, Yew YW. Psoriasis as an independent risk factor for cardiovascular disease: an epidemiologic analysis using a national database. J Cutan Med Surg. 2016; 20(4): 327333, doi: 10.1177/1203475415602842, indexed in Pubmed: 26316538.
  83. Benson MM, Frishman WH. The heartbreak of psoriasis: a review
    of cardiovascular risk in patients with psoriasi
    s. Cardiol Rev. 2015; 23(6): 312316, doi: 10.1097/CRD.0000000000000048, indexed in Pubmed: 26440534.
  84. Abuabara K, Azfar RS, Shin DB, et al. Cause-specific mortality in pa-
    tients with severe psoriasis: a population-based cohort study in the U.K. Br J Dermatol. 2010; 163(3): 586592, doi: 10.1111/j.1365-2133.2010.09941.x, indexed in Pubmed: 20633008.
  85. Wu S, Han J, Li WQ, et al. Hypertension, antihypertensive medication use, and risk of psoriasis. JAMA Dermatol. 2014; 150(9): 957963, doi: 10.1001/jamadermatol.2013.9957, indexed in Pubmed: 24990147.
  86. Armesto S, Coto-Segura P, Osuna CG, et al. Psoriasis and hypertension: a case-control study. J Eur Acad Dermatol Venereol. 2012; 26(6): 785788, doi: 10.1111/j.1468-3083.2011.04108.x, indexed in Pubmed: 21569114.
  87. Cohen AD, Weitzman D, Dreiher J. Psoriasis and hypertension: a case-control study. Acta Derm Venereol. 2010; 90(1): 2326, doi: 10.2340/00015555-0741, indexed in Pubmed: 20107721.
  88. Armstrong AW, Harskamp CT, Armstrong EJ. The association between psoriasis and hypertension: a systematic review and meta-analysis
    of observational studie
    s. J Hypertens. 2013; 31(3): 433442; discussion 442, doi: 10.1097/HJH.0b013e32835bcce1, indexed in Pubmed: 23249828.
  89. Abedini R, Najafi MT, Azizpour A, et al. Hypertension in psoriasis patients: based on office and ambulatory blood pressure measurement. Blood Press Monit. 2020; 25(6): 351354, doi: 10.1097/MBP.0000000000000489, indexed in Pubmed: 33074930.
  90. Miller IM, Ellervik C, Yazdanyar S, et al. Meta-analysis of psoriasis, cardiovascular disease, and associated risk factors. J Am Acad Dermatol. 2013; 69(6): 10141024, doi: 10.1016/j.jaad.2013.06.053, indexed
    in Pubmed:
  91. Hu MY, Yang Q, Zheng J. The association of psoriasis and hypertension: focusing on anti-inflammatory therapies and immunological mechanisms. Clin Exp Dermatol. 2020; 45(7): 836840, doi: 10.1111/ced.14327, indexed in Pubmed: 32789979.
  92. Su YS, Yu HS, Li WC, et al. Psoriasis as initiator or amplifier of the systemic inflammatory march: impact on development of severe vascular events and implications for treatment strategy. J Eur Acad Dermatol Venereol. 2013; 27(7): 876883, doi: 10.1111/j.1468-3083.2012.04599.x, indexed in Pubmed: 22702656.
  93. Caroppo F, Ventura L, Belloni Fortina A. High blood pressure in normal-weight children with psoriasis. Acta Derm Venereol. 2019; 99(3): 329330, doi: 10.2340/00015555-3076, indexed in Pubmed: 30328469.
  94. Shah K, Mellars L, Changolkar A, et al. Real-world burden of comorbidities in US patients with psoriasis. J Am Acad Dermatol. 2017; 77(2): 287292.e4, doi: 10.1016/j.jaad.2017.03.037, indexed in Pubmed: 28623046.
  95. Dregan A, Charlton J, Chowienczyk P, et al. Chronic inflammatory disorders and risk of type 2 diabetes mellitus, coronary heart disease, and stroke: a population-based cohort study. Circulation. 2014; 130(10): 837844, doi: 10.1161/CIRCULATIONAHA.114.009990, indexed in Pubmed: 24970784.
  96. Papagrigoraki A, Del Giglio M, Cosma C, et al. Advanced glycation end products are increased in the skin and blood of patients with severe psoriasis. Acta Derm Venereol. 2017; 97(7): 782787, doi: 10.2340/00015555-2661, indexed in Pubmed: 28358411.
  97. Dubreuil M, Rho YH, Man A, et al. Diabetes incidence in psoriatic arthritis, psoriasis and rheumatoid arthritis: a UK population-based cohort study. Rheumatology (Oxford). 2014; 53(2): 346352, doi: 10.1093/rheumatology/ket343, indexed in Pubmed: 24185762.
  98. Brazzelli V, Maffioli P, Bolcato V, et al. Psoriasis and diabetes, a dangerous association: evaluation of insulin resistance, lipid abnormalities, and cardiovascular risk biomarkers. Front Med (Lausanne). 2021; 8: 605691, doi: 10.3389/fmed.2021.605691, indexed in Pubmed: 33834030.
  99. Holm JG, Thomsen SF. Type 2 diabetes and psoriasis: links and risks. Psoriasis (Auckl). 2019; 9: 16, doi: 10.2147/PTT.S159163, indexed in Pubmed: 30697518.
  100. Armstrong AW, Harskamp CT, Armstrong EJ. Psoriasis and the risk of diabetes mellitus: a systematic review and meta-analysis. JAMA Dermatol. 2013; 149(1): 8491, doi: 10.1001/2013.jamadermatol.406, indexed in Pubmed: 23407990.
  101. Lee MS, Lin RY, Lai MS. Increased risk of diabetes mellitus in relation to the severity of psoriasis, concomitant medication, and comorbidity: a nationwide population-based cohort study. J Am Acad Dermatol. 2014; 70(4): 691698, doi: 10.1016/j.jaad.2013.11.023, indexed in Pubmed: 24411084.
  102. Wan MT, Shin DB, Hubbard RA, et al. Psoriasis and the risk of diabetes: a prospective population-based cohort study. J Am Acad Dermatol. 2018; 78(2): 315322.e1, doi: 10.1016/j.jaad.2017.10.050, indexed in Pubmed: 29128465.
  103. Gyldenløve M, Storgaard H, Holst JJ, et al. Patients with psoriasis are insulin resistant. J Am Acad Dermatol. 2015; 72(4): 599605, doi: 10.1016/j.jaad.2015.01.004, indexed in Pubmed: 25653028.
  104. Bajaj S, Mandal S, Singh KG, et al. Metabolic diseases and associated complications in patients with psoriasis. J Assoc Physicians India. 2020; 68(10): 4446, indexed in Pubmed: 32978925.
  105. Augustin M, Radtke MA, Glaeske G, et al. Epidemiology and comorbidity in children with psoriasis and atopic eczema. Dermatology. 2015; 231(1): 3540, doi: 10.1159/000381913, indexed in Pubmed: 25966818.
  106. Dhara S, Dasgupta A, Rout JK, et al. Clinico-biochemical correlation between psoriasis and insulin resistance. Indian J Clin Biochem. 2015; 30(1): 99103, doi: 10.1007/s12291-013-0413-1, indexed in Pubmed: 25646049.
  107. Boehncke WH. Systemic inflammation and cardiovascular comorbidity in psoriasis patients: causes and consequences. Front Immunol. 2018; 9: 579, doi: 10.3389/fimmu.2018.00579, indexed in Pubmed: 29675020.
  108. Wang H, Wang Z, Rani PL, et al. Identification of PTPN22, ST6GAL1 and JAZF1 as psoriasis risk genes demonstrates shared pathogenesis between psoriasis and diabetes. Exp Dermatol. 2017; 26(11): 11121117, doi: 10.1111/exd.13393, indexed in Pubmed: 28603863.
  109. Gisondi P, Bellinato F, Girolomoni G, et al. Pathogenesis of chronic plaque psoriasis and its intersection with cardio-metabolic comorbidities. Front Pharmacol. 2020; 11: 117, doi: 10.3389/fphar.2020.00117, indexed in Pubmed: 32161545.
  110. Granata M, Skarmoutsou E, Trovato C, et al. Obesity, type 1 diabetes, and psoriasis: an autoimmune triple flip. Pathobiology. 2017; 84(2): 7179, doi: 10.1159/000447777, indexed in Pubmed: 27639922.
  111. Vashist S, Mahajan VK, Mehta KS, et al. Association of psoriasis with autoimmune disorders: results of a pilot study. Indian Dermatol Online J. 2020; 11(5): 753759, doi: 10.4103/idoj.IDOJ_648_19, indexed in Pubmed: 33235841.
  112. Krawczyk A, Miśkiewicz J, Strzelec K, et al. Apoptosis in autoimmunological diseases, with particular consideration of molecular aspects of psoriasis. Med Sci Monit. 2020; 26: e922035, doi: 10.12659/MSM.922035, indexed in Pubmed: 32567582.
  113. Caroppo F, Galderisi A, Moretti C, et al. Prevalence of psoriasis in a cohort of children and adolescents with type 1 diabetes. J Eur Acad Dermatol Venereol. 2021; 35(9): e589e591, doi: 10.1111/jdv.17318, indexed in Pubmed: 33914987.
  114. Armstrong AW, Guérin A, Sundaram M, et al. Psoriasis and risk of diabetes-associated microvascular and macrovascular complications. J Am Acad Dermatol. 2015; 72(6): 96877.e2, doi: 10.1016/j.jaad.2015.02.1095, indexed in Pubmed: 25791800.
  115. Ip W, Kirchhof MG. Glycemic control in the treatment of psoriasis. Dermatology. 2017; 233(1): 2329, doi: 10.1159/000472149, indexed in Pubmed: 28538228.
  116. Binus AM, Han J, Qamar AA, et al. Associated comorbidities in psoriasis and inflammatory bowel disease. J Eur Acad Dermatol Venereol. 2012; 26(5): 644650, doi: 10.1111/j.1468-3083.2011.04153.x, indexed in Pubmed: 21689167.
  117. Fu Y, Lee CH, Chi CC. Association of psoriasis with inflammatory bowel disease: a systematic review and meta-analysis. JAMA Dermatol. 2018; 154(12): 14171423, doi: 10.1001/jamadermatol.2018.3631, indexed in Pubmed: 30422277.
  118. Egeberg A, Mallbris L, Warren RB, et al. Association between psoriasis and inflammatory bowel disease: a Danish nationwide cohort study. Br J Dermatol. 2016; 175(3): 487492, doi: 10.1111/bjd.14528, indexed in Pubmed: 26959083.
  119. Bar Yehuda S, Axlerod R, Toker O, et al. The association of inflammatory bowel diseases with autoimmune disorders: a report from the epi-IIRN. J Crohns Colitis. 2019; 13(3): 324329, doi: 10.1093/ecco-jcc/jjy166, indexed in Pubmed: 30304371.
  120. Burisch J, Jess T, Egeberg A. Incidence of immune-mediated inflammatory diseases among patients with inflammatory bowel diseases in denmark. Clin Gastroenterol Hepatol. 2019; 17(13): 27042712.e3, doi: 10.1016/j.cgh.2019.03.040, indexed in Pubmed: 30936024.
  121. Cho JH. The genetics and immunopathogenesis of inflammatory bowel disease. Nat Rev Immunol. 2008; 8(6): 458466, doi: 10.1038/nri2340, indexed in Pubmed: 18500230.
  122. Pietrzak D, Pietrzak A, Krasowska D, et al. Digestive system in psoriasis: an update. Arch Dermatol Res. 2017; 309(9): 679693, doi: 10.1007/s00403-017-1775-7, indexed in Pubmed: 28905102.
  123. Bezzio C, Della Corte C, Vernero M, et al. Inflammatory bowel disease and immune-mediated inflammatory diseases: looking at the less frequent associations. Therap Adv Gastroenterol. 2022; 15: 17562848221115312, doi: 10.1177/17562848221115312, indexed in Pubmed: 35924080.
  124. Skroza N, Proietti I, Pampena R, et al. Correlations between psoriasis and inflammatory bowel diseases. Biomed Res Int. 2013: 983902, doi: 10.1155/2013/983902, indexed in Pubmed: 23971052.
  125. Hsu LN, Armstrong AW. Psoriasis and autoimmune disorders: a review of the literature. J Am Acad Dermatol. 2012; 67(5): 10761079, doi: 10.1016/j.jaad.2012.01.029, indexed in Pubmed: 23062896.
  126. Wu JJ, Nguyen TU, Poon KYT, et al. The association of psoriasis with autoimmune diseases. J Am Acad Dermatol. 2012; 67(5): 924930, doi: 10.1016/j.jaad.2012.04.039, indexed in Pubmed: 22664308.
  127. Ojetti V, Aguilar Sanchez J, Guerriero C, et al. High prevalence of celiac disease in psoriasis. Am J Gastroenterol. 2003; 98(11): 25742575, doi: 10.1111/j.1572-0241.2003.08684.x, indexed in Pubmed: 14638373.
  128. Ludvigsson JF, Lindelöf B, Zingone F, et al. Psoriasis in a nationwide cohort study of patients with celiac disease. J Invest Dermatol. 2011; 131(10): 20102016, doi: 10.1038/jid.2011.162, indexed in Pubmed: 21654830.
  129. Birkenfeld S, Dreiher J, Weitzman D, et al. Coeliac disease associated with psoriasis. Br J Dermatol. 2009; 161(6): 13311334, doi: 10.1111/j.1365-2133.2009.09398.x, indexed in Pubmed: 19785615.
  130. De Bastiani R, Gabrielli M, Lora L, et al. Association between coeliac disease and psoriasis: Italian primary care multicentre study. Dermatology. 2015; 230(2): 156160, doi: 10.1159/000369615, indexed in Pubmed: 25662711.
  131. Ungprasert P, Wijarnpreecha K, Kittanamongkolchai W. Psoriasis and risk of celiac disease: a systematic review and meta-analysis. Indian J Dermatol. 2017; 62(1): 4146, doi: 10.4103/0019-5154.198031, indexed in Pubmed: 28216724.
  132. Juzlova K, Votrubova J, Dzambova M, et al. Gastrointestinal comorbidities in patients with psoriasis in the Czech Republic: the results of 189 patients with psoriasis and 378 controls. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2016; 160(1): 100105, doi: 10.5507/bp.2015.048, indexed in Pubmed: 26498213.
  133. Acharya P, Mathur M. Association between psoriasis and celiac disease: A systematic review and meta-analysis. J Am Acad Dermatol. 2020; 82(6): 13761385, doi: 10.1016/j.jaad.2019.11.039, indexed
    in Pubmed:
  134. Bhatia BK, Millsop JW, Debbaneh M, et al. Diet and psoriasis, part II: celiac disease and role of a gluten-free diet. J Am Acad Dermatol. 2014; 71(2): 350358, doi: 10.1016/j.jaad.2014.03.017, indexed
    in Pubmed:
  135. Akbulut S, Gür G, Topal F, et al. Coeliac disease-associated antibodies in psoriasis. Ann Dermatol. 2013; 25(3): 298303, doi: 10.5021/ad.2013.25.3.298, indexed in Pubmed: 24003271.
  136. Kolchak NA, Tetarnikova MK, Theodoropoulou MS, et al. Prevalence of antigliadin IgA antibodies in psoriasis vulgaris and response
    of seropositive patients to
    a gluten-free diet. J Multidiscip Healthc. 2018; 11: 1319, doi: 10.2147/JMDH.S122256, indexed in Pubmed: 29343966.
  137. Dhattarwal N, Mahajan VK, Mehta KS, et al. The association
    of anti
    -gliadin and anti-transglutaminase antibodies and chronic plaque psoriasis in Indian patients: Preliminary results of a descriptive cross-sectional study. Australas J Dermatol. 2020; 61(4): e378e382, doi: 10.1111/ajd.13308, indexed in Pubmed: 32397002.
  138. Michaëlsson G, Gerdén B, Ottosson M, et al. Patients with psoriasis often have increased serum levels of IgA antibodies to gliadin. Br J Dermatol. 1993; 129(6): 667673, doi: 10.1111/j.1365-2133.1993.tb03329.x, indexed in Pubmed: 8286249.
  139. Kalayciyan A, Kotogyan A. Psoriasis, enteropathy and antigliadin antibodies. Br J Dermatol. 2006; 154(4): 778779, doi: 10.1111/j.1365-2133.2006.07132.x, indexed in Pubmed: 16536832.
  140. Nagui N, El Nabarawy E, Mahgoub D, et al. Estimation of (IgA) anti-gliadin, anti-endomysium and tissue transglutaminase in the serum
    of patients with psoriasi
    s. Clin Exp Dermatol. 2011; 36(3): 302304, doi: 10.1111/j.1365-2230.2010.03980.x, indexed in Pubmed: 21418272.
  141. Damasiewicz-Bodzek A, Wielkoszyński T. Serologic markers of celiac disease in psoriatic patients. J Eur Acad Dermatol Venereol. 2008; 22(9): 10551061, doi: 10.1111/j.1468-3083.2008.02713.x, indexed
    in Pubmed:
  142. Egeberg A, Griffiths CEM, Mallbris L, et al. The association between psoriasis and coeliac disease. Br J Dermatol. 2017; 177(6): e329e330, doi: 10.1111/bjd.15684, indexed in Pubmed: 28555725.
  143. Kia KF, Nair RP, Ike RW, et al. Prevalence of antigliadin antibodies in patients with psoriasis is not elevated compared with controls. Am J Clin Dermatol. 2007; 8(5): 301305, doi: 10.2165/00128071-200708050-00005, indexed in Pubmed: 17902732.
  144. Heitmann J, Frings VG, Geier A, et al. Non-alcoholic fatty liver disease and psoriasis - is there a shared proinflammatory network? J Dtsch Dermatol Ges. 2021; 19(4): 517528, doi: 10.1111/ddg.14425, indexed in Pubmed: 33768700.
  145. Prussick RB, Miele L. Nonalcoholic fatty liver disease in patients with psoriasis: a consequence of systemic inflammatory burden?
    Br J Dermatol. 2018; 179(1): 1629, doi: 10.1111/bjd.16239, indexed in Pubmed: 29235656.
  146. Balak DMW, Piaserico S, Kasujee I. Non-alcoholic fatty liver disease (NAFLD) in patients with psoriasis: a review of the hepatic effects of systemic therapies. Psoriasis (Auckl). 2021; 11: 151168, doi: 10.2147/PTT.S342911, indexed in Pubmed: 34909410.
  147. Ramos AN, de Oliveira Rocha B, de Almeida Rêgo VR, et al. The linkage between psoriasis and non-alcoholic fatty liver disease: a literature review. Acta Dermatovenerol Croat. 2014; 22(2): 132136, indexed
    in Pubmed: 25102800.
  148. Wenk KS, Arrington KC, Ehrlich A. Psoriasis and non-alcoholic fatty liver disease. J Eur Acad Dermatol Venereol. 2011; 25(4): 383391, doi: 10.1111/j.1468-3083.2010.03841.x, indexed in Pubmed: 20840346.
  149. Ganzetti G, Campanati A, Molinelli E, et al. Psoriasis, non-alcoholic fatty liver disease, and cardiovascular disease: three different diseases on a unique background. World J Cardiol. 2016; 8(2): 120131, doi: 10.4330/wjc.v8.i2.120, indexed in Pubmed: 26981209.
  150. Ganzetti G, Campanati A, Offidani A. Non-alcoholic fatty liver disease and psoriasis: so far, so near. World J Hepatol. 2015; 7(3): 315326, doi: 10.4254/wjh.v7.i3.315, indexed in Pubmed: 25848461.
  151. Gisondi P, Targher G, Zoppini G, et al. Non-alcoholic fatty liver disease in patients with chronic plaque psoriasis. J Hepatol. 2009; 51(4): 758764, doi: 10.1016/j.jhep.2009.04.020, indexed in Pubmed: 19560226.
  152. Madanagobalane S, Anandan S. The increased prevalence of non-alcoholic fatty liver disease in psoriatic patients: a study from South India. Australas J Dermatol. 2012; 53(3): 190197, doi: 10.1111/j.1440-0960.2012.00905.x, indexed in Pubmed: 22672067.
  153. Klujszo EH, Parcheta P, Witkowska AB, et al. Non-alcoholic fatty liver disease in patients with psoriasis: therapeutic implications. Postepy Dermatol Alergol. 2020; 37(4): 468474, doi: 10.5114/ada.2019.83983, indexed in Pubmed: 32994765.
  154. Gisondi P, Barba E, Girolomoni G. Non-alcoholic fatty liver disease fibrosis score in patients with psoriasis. J Eur Acad Dermatol Venereol. 2016; 30(2): 282287, doi: 10.1111/jdv.13456, indexed in Pubmed: 26537011.
  155. Candia R, Ruiz A, Torres-Robles R, et al. Risk of non-alcoholic fatty liver disease in patients with psoriasis: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2015; 29(4): 656662, doi: 10.1111/jdv.12847, indexed in Pubmed: 25418531.
  156. Ruan Z, Lu T, Chen Y, et al. Association between psoriasis and nonalcoholic fatty liver disease among outpatient US adults. JAMA Dermatol. 2022; 158(7): 745753, doi: 10.1001/jamadermatol.2022.1609, indexed in Pubmed: 35612851.
  157. Bellinato F, Gisondi P, Mantovani A, et al. Risk of non-alcoholic fatty liver disease in patients with chronic plaque psoriasis: an updated systematic review and meta-analysis of observational studies. J Endocrinol Invest. 2022; 45(7): 12771288, doi: 10.1007/s40618-022-01755-0, indexed
    in Pubmed: 35147926.
  158. Valenzuela F, De La Cruz C, Lecaros C, et al. Comorbidities in Chilean patients with psoriasis: a global healthcare study on psoriasis. Clin Exp Dermatol. 2022; 47(12): 22342241, doi: 10.1111/ced.15384, indexed in Pubmed: 35988043.
  159. van der Voort EAM, Koehler EM, Dowlatshahi EA, et al. Psoriasis is independently associated with nonalcoholic fatty liver disease in patients 55 years old or older: results from a population-based study. J Am Acad Dermatol. 2014; 70(3): 517524, doi: 10.1016/j.jaad.2013.10.044, indexed in Pubmed: 24373781.
  160. Abedini R, Salehi M, Lajevardi V, et al. Patients with psoriasis are at a higher risk of developing nonalcoholic fatty liver disease. Clin Exp Dermatol. 2015; 40(7): 722727, doi: 10.1111/ced.12672, indexed in Pubmed: 25958919.
  161. Yang JJ, Nguyen KA, Fleischman MW, et al. Psoriasis in liver disease: associations beyond nonalcoholic fatty liver disease. J Am Acad Dermatol. 2022; 86(4): 883885, doi: 10.1016/j.jaad.2021.03.023, indexed in Pubmed: 33722548.
  162. Gau SY, Huang KH, Lee CH, et al. Bidirectional association between psoriasis and nonalcoholic fatty liver disease: real-world evidence from two longitudinal cohort studies. Front Immunol. 2022; 13: 840106, doi: 10.3389/fimmu.2022.840106, indexed in Pubmed: 35251036.
  163. Torbator K, Poo S, Al-Rubaye T, et al. Whether screening for non-alcoholic fatty liver disease in patients with psoriasis is necessary: a pilot quality improvement project. Cureus. 2022; 14(5): e24714, doi: 10.7759/cureus.24714, indexed in Pubmed: 35518363.
  164. Ortolan A, Lorenzin M, Tadiotto G, et al. Metabolic syndrome, non-alcoholic fatty liver disease and liver stiffness in psoriatic arthritis and psoriasis patients. Clin Rheumatol. 2019; 38(10): 28432850, doi: 10.1007/s10067-019-04646-7, indexed in Pubmed: 31254236.
  165. Magdaleno-Tapial J, Valenzuela-Oñate C, Ortiz-Salvador JM, et al. Prevalence of non-alcoholic fatty liver and liver fibrosis in patients with moderate-severe psoriasis: a cross-sectional cohort study. Australas J Dermatol. 2020; 61(2): 105109, doi: 10.1111/ajd.13175, indexed
    in Pubmed: 31731325.
  166. Phan K, Onggo J, Charlton O, et al. Relationship between psoriasis and non-alcoholic fatty liver disease updated systematic review and adjusted meta-analysis. Australas J Dermatol. 2019; 60(4): e352e355, doi: 10.1111/ajd.13015, indexed in Pubmed: 30906989.
  167. van der Voort EAM, Koehler EM, Nijsten T, et al. Increased prevalence of advanced liver fibrosis in patients with psoriasis: a cross-sectional analysis from the rotterdam study. Acta Derm Venereol. 2016; 96(2): 213217, doi: 10.2340/00015555-2161, indexed in Pubmed: 26062958.
  168. Prussick R, Prussick L, Nussbaum D. Nonalcoholic Fatty liver disease and psoriasis: what a dermatologist needs to know. J Clin Aesthet Dermatol. 2015; 8(3): 4345, indexed in Pubmed: 25852814.
  169. Miele L, Vallone S, Cefalo C, et al. Prevalence, characteristics and severity of non-alcoholic fatty liver disease in patients with chronic plaque psoriasis. J Hepatol. 2009; 51(4): 778786, doi: 10.1016/j.jhep.2009.06.008, indexed in Pubmed: 19664838.
  170. Kurd SK, Troxel AB, Crits-Christoph P, et al. The risk of depression, anxiety, and suicidality in patients with psoriasis: a population-based cohort study. Arch Dermatol. 2010; 146(8): 891895, doi: 10.1001/archdermatol.2010.186, indexed in Pubmed: 20713823.
  171. Leisner MZ, Riis JL, Schwartz S, et al. Psoriasis and risk of mental disorders in denmark. JAMA Dermatol. 2019; 155(6): 745747, doi: 10.1001/jamadermatol.2019.0039, indexed in Pubmed: 31066861.
  172. Cohen BE, Martires KJ, Ho RS. Psoriasis and the risk of depression
    in the US population: national health and nutrition examination survey 2009
    -2012. JAMA Dermatol. 2016; 152(1): 7379, doi: 10.1001/jamadermatol.2015.3605, indexed in Pubmed: 26421371.
  173. Rabin F, Bhuiyan SI, Islam T, et al. Psychiatric and psychological comorbidities in patients with psoriasis a review. Mymensingh Med J. 2012; 21(4): 780786, indexed in Pubmed: 23134936.
  174. Kimball AB, Wu EQ, Guérin A, et al. Risks of developing psychiatric disorders in pediatric patients with psoriasis. J Am Acad Dermatol. 2012; 67(4): 651657.e1, doi: 10.1016/j.jaad.2011.11.948, indexed
    in Pubmed:
  175. Todberg T, Egeberg A, Jensen P, et al. Psychiatric comorbidities
    in children and adolescents with psoriasis:
    a population-based cohort study. Br J Dermatol. 2017; 177(2): 551553, doi: 10.1111/bjd.15095, indexed in Pubmed: 27681652.
  176. Remröd C, Sjöström K, Svensson A. Psychological differences between early- and late-onset psoriasis: a study of personality traits, anxiety and depression in psoriasis. Br J Dermatol. 2013; 169(2): 344350, doi: 10.1111/bjd.12371, indexed in Pubmed: 23565588.
  177. Simonić E, Kaštelan M, Peternel S, et al. Childhood and adulthood traumatic experiences in patients with psoriasis. J Dermatol. 2010; 37(9): 793800, doi: 10.1111/j.1346-8138.2010.00870.x, indexed in Pubmed: 20883363.
  178. Mitchell AE. Bidirectional relationships between psychological health and dermatological conditions in children. Psychol Res Behav Manag. 2018; 11: 289298, doi: 10.2147/PRBM.S117583, indexed in Pubmed: 30104911.
  179. Bilgic A, Bilgic Ö, Akış HK, et al. Psychiatric symptoms and health-related quality of life in children and adolescents with psoriasis. Pediatr Dermatol. 2010; 27(6): 614617, doi: 10.1111/j.1525-1470.2010.01195.x, indexed in Pubmed: 21078106.
  180. Snast I, Reiter O, Atzmony L, et al. Psychological stress and psoriasis: a systematic review and meta-analysis. Br J Dermatol. 2018; 178(5): 10441055, doi: 10.1111/bjd.16116, indexed in Pubmed: 29124739.
  181. Kara T, Topkarcı Z, Yılmaz S, et al. Pediatric patients with psoriasis and psychiatric disorders: premorbidity and comorbidity in a case-control study. J Dermatolog Treat. 2019; 30(2): 129134, doi: 10.1080/09546634.2018.1476653, indexed in Pubmed: 29757035.
  182. Koo JY, Do JH, Lee CS. Psychodermatology. J Am Acad Dermatol. 2000; 43(5 Pt 1): 848853, doi: 10.1067/mjd.2000.109274, indexed
    in Pubmed:
  183. Patel KR, Lee HH, Rastogi S, et al. Association of psoriasis with psychiatric hospitalization in united states children and adults. Dermatology. 2019; 235(4): 276286, doi: 10.1159/000499564, indexed in Pubmed: 31163441.
  184. Manzoni AP, Weber MB, Nagatomi AR, et al. Assessing depression and anxiety in the caregivers of pediatric patients with chronic skin disorders. An Bras Dermatol. 2013; 88(6): 894899, doi: 10.1590/abd1806-4841.20131915, indexed in Pubmed: 24474096.