Editing Psoriasis (section)

==Prognosis==
Most people with psoriasis experience nothing more than mild skin lesions that can be treated effectively with topical therapies.<ref name="Samarasekera2013"/> Depending on the severity and location of outbreaks, people may experience significant physical discomfort and some disability, affecting the person's [[Quality of life (healthcare)|quality of life]].<ref name="Prieto2013" /> Itching and pain can interfere with basic functions, such as self-care and sleep.<ref name="Parrish2012" /> Participation in sporting activities, certain occupations, and caring for family members can become difficult activities for those with plaques located on their hands and feet.<ref name="Parrish2012" /> Plaques on the scalp can be particularly embarrassing, as flaky plaque in the hair can be mistaken for [[dandruff]].<ref name="Dessinioti2013">{{cite journal | vauthors = Dessinioti C, Katsambas A | title = Seborrheic dermatitis: etiology, risk factors, and treatments: facts and controversies | journal = Clinics in Dermatology | volume = 31 | issue = 4 | pages = 343–351 | year = 2013 | pmid = 23806151 | doi = 10.1016/j.clindermatol.2013.01.001 }}</ref>
[[ File:Women_with_vitiligo_Psoriasis2.jpg|thumb|100px|[[Women in the Philippines|Filipina]] with psoriasis]]
Individuals with psoriasis may feel self-conscious about their appearance and have a poor self-image that stems from fear of public rejection and [[Psychosexual disorder|psychosexual concerns]]. Psoriasis has been associated with low self-esteem and [[Depression (mood)|depression]] is more common among those with the condition.<ref name=Menter2008 /> People with psoriasis often feel prejudiced against due to the commonly held incorrect belief that psoriasis is contagious.<ref name="Parrish2012">{{cite journal | vauthors = Parrish L | title = Psoriasis: symptoms, treatments and its impact on quality of life | journal = British Journal of Community Nursing | volume = 17 | issue = 11 | pages = 524–528 | date = November 2012 | pmid = 23124421 | doi = 10.12968/bjcn.2012.17.11.524 }}</ref> Psychological distress can lead to significant [[clinical depression|depression]] and [[social isolation]]; a high rate of [[Suicidal ideation|thoughts about suicide]] has been associated with psoriasis.<ref name="Gelmetti2009"/> Many tools exist to measure the quality of life of people with psoriasis and other dermatological disorders. Clinical research has indicated individuals often experience a diminished quality of life.<ref name=Bhosle>{{cite journal | vauthors = Bhosle MJ, Kulkarni A, Feldman SR, Balkrishnan R | title = Quality of life in patients with psoriasis | journal = Health and Quality of Life Outcomes | volume = 4 | pages = 35 | date = June 2006 | pmid = 16756666 | pmc = 1501000 | doi = 10.1186/1477-7525-4-35 | doi-access = free }}</ref> Children with psoriasis may encounter [[bullying]].<ref>{{cite journal | vauthors = Magin P | title = Appearance-related bullying and skin disorders | journal = Clinics in Dermatology | volume = 31 | issue = 1 | pages = 66–71 | date = Jan–Feb 2013 | pmid = 23245976 | doi = 10.1016/j.clindermatol.2011.11.009 }}</ref>

Several conditions are associated with psoriasis including [[obesity]], [[Cardiovascular disease|cardiovascular]], and [[Metabolic disorder|metabolic disturbances]]. These occur more frequently in older people. Nearly half of individuals with psoriasis over the age of 65 have at least three [[Comorbidity|comorbidities]] (concurrent conditions), and two-thirds have at least two comorbidities.<ref name=Habif2010>{{cite book|vauthors=Habif TP|title=Clinical dermatology a color guide to diagnosis and therapy|year=2010|publisher=Mosby Elsevier|location=Edinburgh|isbn=978-0-323-08037-8|chapter-url=https://books.google.com/books?id=kDWlWR5UbqQC|edition=5th|chapter=8|access-date=8 May 2020|archive-date=14 January 2023|archive-url=https://web.archive.org/web/20230114005622/https://books.google.com/books?id=kDWlWR5UbqQC|url-status=live}}</ref>

===Cardiovascular disease===
Psoriasis has been associated with [[obesity]]<ref name=Menter2008 /> and several other cardiovascular and metabolic disturbances. The [[Incidence (epidemiology)|number of new cases per year]] of diabetes is 27% higher in people affected by psoriasis than in those without the condition.<ref name=Sh2014>{{cite journal | vauthors = Shlyankevich J, Mehta NN, Krueger JG, Strober B, Gudjonsson JE, Qureshi AA, Tebbey PW, Kimball AB | title = Accumulating evidence for the association and shared pathogenic mechanisms between psoriasis and cardiovascular-related comorbidities | journal = The American Journal of Medicine | volume = 127 | issue = 12 | pages = 1148–53 | date = December 2014 | pmid = 25149424 | pmc = 4259841 | doi = 10.1016/j.amjmed.2014.08.008 }}</ref> Severe psoriasis may be even more strongly associated with the development of diabetes than mild psoriasis.<ref name=Sh2014/> Younger people with psoriasis may also be at increased risk for developing diabetes.<ref name=Habif2010 /> Individuals with psoriasis or psoriatic arthritis have a slightly higher risk of heart disease and [[Myocardial infarction|heart attacks]] when compared to the general population. Cardiovascular disease risk appeared to be correlated with the severity of psoriasis and its duration. There is no strong evidence to suggest that psoriasis is associated with an increased risk of death from cardiovascular events. [[Methotrexate]] may provide a degree of protection for the heart.<ref name="Richard2013">{{cite journal | vauthors = Richard MA, Barnetche T, Horreau C, Brenaut E, Pouplard C, Aractingi S, Aubin F, Cribier B, Joly P, Jullien D, Le Maître M, Misery L, Ortonne JP, Paul C | title = Psoriasis, cardiovascular events, cancer risk and alcohol use: evidence-based recommendations based on systematic review and expert opinion | journal = Journal of the European Academy of Dermatology and Venereology | volume = 27 | issue = Supplement 3 | pages = 2–11 | date = August 2013 | pmid = 23845148 | doi = 10.1111/jdv.12162 | s2cid = 2766931 | doi-access = free }}</ref><ref name=Habif2010 />

The odds of having [[hypertension]] are 1.58 times {{nowrap|( ''i.e.'' 58%)}} higher in people with psoriasis than those without the condition; these odds are even higher with severe cases of psoriasis. A similar association was noted in people who have psoriatic arthritis—the odds of having hypertension were found to be 2.07 times {{nowrap|( ''i.e.'' 107%)}} greater when compared to odds of the general population. The link between psoriasis and hypertension is not currently{{when|date=October 2019}} understood. Mechanisms hypothesized to be involved in this relationship include the following: dysregulation of the [[renin–angiotensin system]], elevated levels of [[endothelin 1]] in the blood, and increased [[oxidative stress]]. The number of new cases of the heart rhythm abnormality [[atrial fibrillation]] is 1.31 times {{nowrap|( ''i.e.'' 31%)}} higher in people with mild psoriasis and 1.63 times {{nowrap|( ''i.e.'' 63%)}} higher in people with severe psoriasis.<ref name="Tablazon2013"/> There may be a slightly increased risk of [[stroke]] associated with psoriasis, especially in severe cases.<ref name="Richard2013"/><ref>{{cite news|title=Psoriasis Linked to Stroke Risk|publisher=BBC|url=https://www.bbc.co.uk/news/health-14559523|date=August 2011|url-status=live|archive-url=https://web.archive.org/web/20110828171242/http://www.bbc.co.uk/news/health-14559523|archive-date=28 August 2011}}</ref> Treating [[hypercholesterolemia|high levels of cholesterol]] with [[statin]]s has been associated with decreased psoriasis severity, as measured by PASI score, and has also been associated with improvements in other cardiovascular disease risk factors such as markers of [[inflammation]].<ref name="Ghazizadeh2011">{{cite journal | vauthors = Ghazizadeh R, Tosa M, Ghazizadeh M | title = Clinical improvement in psoriasis with treatment of associated hyperlipidemia | journal = The American Journal of the Medical Sciences | volume = 341 | issue = 5 | pages = 394–8 | date = May 2011 | pmid = 21233693 | doi = 10.1097/MAJ.0b013e3181ff8eeb | s2cid = 12519829 }}</ref> These [[Cardioprotection|cardioprotective]] effects are attributed to ability of statins to improve blood [[lipid]] profile and because of their anti-inflammatory effects. Statin use in those with psoriasis and [[hyperlipidemia]] was associated with decreased levels of [[high-sensitivity C-reactive protein]] and [[TNFα]] as well as decreased activity of the immune protein [[Lymphocyte function-associated antigen 1|LFA-1]].<ref name="Ghazizadeh2011"/> Compared to individuals without psoriasis, those affected by psoriasis are more likely to satisfy the criteria for [[metabolic syndrome]].<ref name="Raychaudhuri2014">{{cite journal | vauthors = Raychaudhuri SK, Maverakis E, Raychaudhuri SP | title = Diagnosis and classification of psoriasis | journal = Autoimmunity Reviews | volume = 13 | issue = 4–5 | pages = 490–5 | date = January 2014 | pmid = 24434359 | doi = 10.1016/j.autrev.2014.01.008 }}</ref><ref name="Tablazon2013">{{cite journal | vauthors = Tablazon IL, Al-Dabagh A, Davis SA, Feldman SR | title = Risk of cardiovascular disorders in psoriasis patients: current and future | journal = American Journal of Clinical Dermatology | volume = 14 | issue = 1 | pages = 1–7 | date = February 2013 | pmid = 23329076 | doi = 10.1007/s40257-012-0005-5 | s2cid = 207482092 }}</ref>

===Other diseases===
The rates of [[Crohn's disease]] and [[ulcerative colitis]] are increased when compared with the general population, by a factor of 3.8 and 7.5 respectively.<ref name=Menter2008 /> People with psoriasis also have a higher risk of [[celiac disease]].<ref name=BarreaNappi2016 /><ref name=BhatiaMillsop2014 /> Few studies have evaluated the association of [[multiple sclerosis]] with psoriasis, and the relationship has been questioned.<ref name=Menter2008 /> Psoriasis has been associated with a 16% increase in overall relative risk for non-skin cancer, thought to be attributed to systemic therapy, particularly methotrexate.<ref name="Richard2013"/> People treated with long-term systemic therapy for psoriasis have a 52% increased risk [[lung cancer|cancers of the lung and bronchus]], a 205% increase in the risk of developing [[esophageal cancer|cancers of the upper gastrointestinal tract]], a 31% increase in the risk of developing [[Urologic disease|cancers of the urinary tract]], a 90% increase in the risk of developing [[liver cancer]], and a 46% increase in the risk of developing [[pancreatic cancer]].<ref name="Richard2013"/> The risk for development of non-melanoma skin cancers is also increased. Psoriasis increases the risk of developing [[Squamous cell skin cancer|squamous cell carcinoma of the skin]] by 431% and increases the risk of [[basal cell carcinoma]] by 100%.<ref name="Richard2013"/> There is no increased risk of [[melanoma]] associated with psoriasis.<ref name="Richard2013"/> People with psoriasis have a higher risk of developing cancer.<ref>{{cite journal | vauthors = Trafford AM, Parisi R, Kontopantelis E, Griffiths CE, Ashcroft DM | title = Association of Psoriasis With the Risk of Developing or Dying of Cancer: A Systematic Review and Meta-analysis | journal = JAMA Dermatology | date = October 2019 | volume = 155 | issue = 12 | pages = 1390–1403 | pmid = 31617868 | pmc = 6802036 | doi = 10.1001/jamadermatol.2019.3056 }}
*{{lay source |template = cite news|vauthors = Bakalar N |url= https://www.nytimes.com/2019/10/16/well/live/psoriasis-tied-to-increased-cancer-risk.html|title= Psoriasis Tied to Increased Cancer Risk|date = 16 October 2019 |website= The New York Times }}</ref>