PSORIASIS, traditionally known as a chronic inflammatory skin disorder, is increasingly recognised as a multisystem disease. It not only affects the skin but also has significant implications for the cardiovascular, endocrine, joint, and gastrointestinal (GI) systems. The World Health Organization (WHO) classifies psoriasis as a severe non-communicable disease, with high comorbidity rates and considerable adverse impacts on a patient’s overall health and quality of life. The WHO estimates that over 100 million people worldwide are affected by this condition.
The relationship between psoriasis and other health issues may be due to shared genetic, environmental, and biological factors. Studies have shown a higher prevalence of inflammatory bowel disease (IBD) among psoriasis patients, with common GI symptoms such as bloating, pain, and diarrhoea being more frequently reported. Notably, increased numbers of mast cells and eosinophils have been observed in the duodenal mucosa of psoriasis patients, indicating a parallel inflammatory response at both the gut and skin barriers.
The intestinal lining plays a crucial protective role through a mucus layer and tight junctions between epithelial cells. These structures regulate the absorption of nutrients while preventing pathogens from entering the body. However, an increase in intestinal permeability may allow harmful bacteria and toxins to leak through, contributing to local tissue inflammation. Such permeability is often linked to conditions like IBD and celiac disease.
Recent research has provided further insight into this issue. Studies have shown that psoriasis patients exhibit elevated intestinal permeability, correlating with GI discomfort and the presence of activated immune cells in the gut. Notably, the presence of eosinophils in the duodenum and skin lesions suggests that these immune cells may contribute to intestinal inflammation. However, no signs of overt intestinal inflammation were observed in patients, implying that changes in the gut could represent subclinical or low-grade inflammation.
The findings underscore the systemic nature of psoriasis and suggest that it may be linked to underlying GI disturbances, offering new perspectives on how skin conditions and gut health might be interconnected. Further research is needed to better understand these connections and their clinical significance.
Katie Wright, EMJ
Reference
Lundquist P et al. Mild-to-moderate psoriasis is associated with subclinical inflammation in the duodenum and a tendency of disturbed intestinal barrier. Biochim Biophys Acta Mol Basis Dis. 2024;19;1871(3):167634.
