Pharmacological treatment of moderate-severe psoriasis in patients with cardio-metabolic comorbidities

Psoriasis is a chronic inflammatory skin disease affecting 2-3% of worldwide population. The extent of skin involvement is variable, ranging from a few localised plaques to generalised involvement. Moderate to severe psoriasis (>10% of body surface area) is frequently associated with psoriatic arthritis and metabolic diseases, like abdominal obesity, diabetes, nonalcoholic fatty liver disease, dyslipidemia and the metabolic syndrome. A common genetic background links psoriasis to these comorbidities. From a clinical prospective, the understanding of the patients in the context of these comorbidities is very important to ensure that treatment is tailored to meet the individual patient needs as some pharmacological treatments may negatively affect cardio-metabolic comorbidities, and have important interactions with drugs that are commonly used to treat them. Finally, patients with moderate to severe psoriasis are at increased cardiovascular risk, and need appropriate screening for comorbidities and early, aggressive interventions, such as diet and physical exercise, in order to reduce their global cardio-vascular risk.