[Psoriasis: a systemic disease].

Psoriasis is an inflammatory immune-mediated disorder which mainly affects the skin but which also has pathogenic effects with systemic impact. It represents a major psychological burden. During the past decade, inflammatory, cardiovascular, metabolic, and neuropsychiatric comorbidities of psoriasis have been described, especially in young patients with severe psoriasis. Whether psoriasis is an independent risk factor for these comorbidities remains a topic of scientific debate. Interpretation of available epidemiologic data is complex because of bias concerning data recruitment in the studies and non-consideration of other confounding risk factors and employed treatment. The hypothesis of an etiologic role of psoriasis in its cardiovascular and metabolic comorbidities is powered by pathophysiologic concepts establishing a link between chronic inflammation in psoriasis, endothelial dysfunction, formation of atherosclerotic plaques, and the different compounds of metabolic syndrome. Since psoriasis is recognized as a systemic disease, patient management has to be multidisciplinary. It implicates identification and treatment of psychological disorders, addictions, and associated cardiovascular and metabolic diseases. Preliminary experimental and epidemiological data indicate that adequate systemic treatment of psoriasis may prevent some comorbidities.