Highlights From the 2024 Psoriasis Health Indicator Report
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Psoriasis is a chronic, immune-mediated inflammatory disease that affects over 7.5 million adults in the United States. In 2024, the National Psoriasis Foundation (NPF) released its first-ever Psoriasis Health Indicator Report that reveals the far-reaching impacts of this disease. Currently, no national goals exist to guide improvements in psoriatic disease care and alleviating disease burden; however, the NPF report connects psoriasis to existing national goals for related diseases and conditions. This article highlights key information from the report, including health outcomes data, prevention of comorbidities associated with psoriasis, health disparities, and treatment and management of individuals with psoriasis.
The Scope of Psoriasis
In addition to being a skin disease, psoriasis is a systemic inflammatory condition that increases the risk of developing life-threatening comorbidities, such as psoriatic arthritis, cardiovascular disease (CVD), obesity, and diabetes/metabolic disorder.
Individuals with psoriasis are at an increased risk for developing psoriatic arthritis, a form of inflammatory arthritis that commonly involves enthesitis. Psoriatic arthritis affects up to 33% of patients with psoriasis and often goes undiagnosed for years due to the lack of a definitive diagnostic test. Among individuals with psoriasis, 10% to 15% currently live with undiagnosed psoriatic arthritis. Depression and obesity have been identified as risk factors for developing psoriatic arthritis. Depression increases the risk by 68%, and obesity increases the risk by 64%. Age is also a risk factor, with individuals aged 40 to 49 years having a 54% increased likelihood of developing psoriatic arthritis. Delayed diagnosis can have devastating consequences. Studies reveal that even a 6-month delay in psoriatic arthritis treatment can result in permanent joint damage, functional impairment, and disability. Early detection is critical to preserving quality of life and reducing the risk of irreversible damage. Despite this, access to rheumatology care remains limited, particularly for individuals relying on public insurance who report far lower rates of specialist consultations than privately insured patients.
CVD remains one of the most significant concerns. Compared with the general population, individuals with psoriasis face a 46% increased risk of cardiovascular mortality, a 17% higher likelihood of experiencing a heart attack, and a 19% elevated risk of stroke. The risk escalates further with disease severity: individuals with mild psoriasis experience a 29% increased risk of heart attack and a 12% increased risk of stroke, whereas those with severe psoriasis experience up to a 39% increased risk of CVD mortality, 200% increased risk of heart attack, and 59% increased risk of stroke.
Obesity also intersects strongly with psoriasis, both as a contributing factor and as a complicating condition. Individuals with psoriasis are up to 66% more likely to be obese compared with the general population. For those with severe disease, the likelihood of obesity increases dramatically, reaching as high as 123%. Individuals with psoriasis report significant barriers to physical activity, including skin sensitivity, embarrassment, and stigmatization, which further perpetuate the cycle of inflammation and weight gain.
Diabetes is another major concern, with psoriasis severity directly correlating with diabetes risk. For every 10% increase in body surface area affected by psoriasis, the risk of type 2 diabetes rises by 20%.
Impact on Quality of Life and Mental Health
Living with psoriasis greatly affects physical, emotional, and social well-being. The report highlights that up to 43% of patients report moderate-to-severe impacts on their quality of life, with symptoms like itching, flaking, and pain interfering with daily activities, social roles, and emotional health. For many, psoriasis-related stigma compounds this burden. Over half of individuals without psoriasis expressed discomfort in dating someone with the condition or even shaking hands with them.
Mental health issues are particularly prevalent among patients with psoriasis, with 20% to 28% experiencing depression and suicidal ideation rates more than doubling those of the general population. Alarmingly, only 7% of dermatologists screen for depression despite its strong association with psoriasis severity. Less than half of patients with psoriasis with a history of depression use an antidepressant to treat their depression.
Work Productivity and Economic Burden
Psoriasis also affects patients’ ability to work and maintain financial stability. Nearly 65% of individuals with psoriasis report work-related impairment, with productivity losses rising significantly among those with severe disease. Psoriatic arthritis further compounds this issue, with 81% of patients reporting that their condition has forced them to switch jobs, take extended sick leave, or leave the workforce entirely.
The economic burden extends beyond individuals, as psoriasis leads to higher rates of short-term disability and increased health care utilization, which strains health care systems and employers. Patients with severe psoriasis miss more workdays and incur higher medical costs compared with their peers without the disease. Patients with psoriasis show an average of 7.71 nonrecreational workdays missed, compared with 5.67 in individuals without psoriasis. Additionally, individuals with psoriasis miss an average of 4.38 days of work due to sick leave compared with 3.17 in individuals without psoriasis. Furthermore, individuals with psoriasis report 3.15 short-term disability days vs 2.60 in individuals without psoriasis.
Future Directions: Opportunities for Change
The Psoriasis Health Indicator Report serves as a wake-up call and a roadmap for action. To improve outcomes, the report emphasizes the need for coordinated care models that address the systemic nature of psoriasis and its comorbidities. Screening for conditions like hypertension, diabetes, and hyperlipidemia must become standard practice in dermatology and primary care settings. Among office visits across all health care providers engaged in the direct care of individuals with psoriasis, currently up to 36.4% involved blood pressure screening, 5.9% included blood glucose screening, 9% included cholesterol screening, and up to 42.8% evaluated body mass index.
Addressing health disparities also remains a priority. Increasing cultural competency among providers, improving diagnostic tools for skin of color, and diversifying clinical trials will help ensure equitable care for all patients.
Research into dietary interventions and lifestyle modifications offers another promising avenue. While evidence linking diet to psoriasis management is still limited, interventions targeting inflammation could provide additional tools for improving patient outcomes and reducing comorbidity risks.
Conclusion
Psoriasis is a complex, chronic inflammatory disease that extends far beyond the skin, affecting millions of individuals in the United States and bringing with it significant physical, emotional, and socioeconomic burdens. The NPF’s first-ever Psoriasis Health Indicator Report emphasizes the urgency of addressing the systemic nature of the disease, its associated comorbidities, and pervasive health disparities. It highlights the critical need for comprehensive care models that integrate routine screening for comorbid conditions, prioritize early diagnosis, and enhance access to equitable treatment. Targeted efforts to improve provider training, patient support, and public awareness, combined with innovative research on lifestyle interventions, hold promise for alleviating the profound impact of psoriasis and improving overall patient outcomes.
Reference
Gondo GC, Eakin G, Van Voorhees A, et al. Psoriasis Health Indicator Report. National Psoriasis Foundation. January 2024. Accessed December 17, 2024. https://npf-website.cdn.prismic.io/npf-website/Zkt5kSol0Zci9SlA_Health_Indicator_Report.pdf
