IPC Comorbidities Symposium Covers Depression, Obesity, and More

Comorbidities of psoriasis were the focus of the International Psoriasis Council’s meeting in advance of the 2025 American Academy of Dermatology (AAD) Annual Meeting in Orlando, Florida.

“Syposium: Preventing Comorbig Disease in Psoriasis” started with presentations on depression and cardiovascular disease before covering obesity and psoriatic arthritis.

April Armstrong, MD, MPH, and Mio Nakamura, MD, MS, FAAD, noted that depression is seen in approximately 20% of patients with psoriasis, with suicidal ideation/behavior seen in up to half of that subset. Specific risk factors include female gender, younger age, severe psoriasis, symptoms such as itching or pain, palmoplantar/genital/nail psoriasis, and psoriatic arthritis.

Inflammatory gene expression and markers elevated in depression, they said, include toll-like receptors, C-reactive protein, TNF-alpha, and IL-6. Treatment of psoriasis has been found to improve depression symptoms, and treating depression along with psoriasis can have additional benefits compared to treatment of psoriasis alone.

“There is definitely systemic inflammation that is shared between psoriasis and depression,” Dr. Nakamura said.

Dr. Nakamura’s clinical recommendations included screening psoriasis patients for depression; treating them adequately; multidisciplinary care with mental health professionals; and reassessing mental health status at subsequent visits.

“When we are thinking about psoriasis patients,” Dr. Armstrong told Practical Dermatology, “we, in a sense, intrinsically know that if they have severe disease, that they are depressed; however, as a field, we are moving forward to understand deeper into the issue, and what we see is that we are understanding more of this neuro-immune inflammation in patients with extensive psoriasis, especially, that is happening in their brain, where the elevated levels of cytokines can actually cross the brain barrier and have a direct toxic effect on certain cells in the brain, therefore predisposing our psoriasis patients to developing depression. So, it is important to know that there may be underlying mechanistic reasons for increased rates of depression.”

On the topic of obesity and psoriasis, panel moderator Bruce Strober, MD, PhD, noted that the value of weight-loss drugs as they pertain to psoriasis may go beyond simply treating a comorbidity.

“I think as the years go on,” Dr. Strober said, “we’re going to see the effects that weight-loss drugs have on inflammation.”