Celebrities With Psoriasis: Kim Kardashian. People love her and people hate her, but there seems to be no getting away from her. Socialite and TV personality Kim Kardashian is known for many things, both good and bad.
First attracting attention in the instant blockbuster hit for E! “Keeping Up with the Kardashians,” she later on gained public attention for her boutique, a perfume named after her and her other business ventures — as well as notoriety for her fickle 72-day marriage with basketball player Kris Humphries, her homemade sex tape with singer Ray J. She’s also attracted scorn for her being a “celebutante” and a socialite. [Ed’s note: Actually, Kardashian’s first claim to fame is her sex tape which came first before her TV hit.]
The people who hate her say she’s vapid, shallow, selfish and phony. But one good thing going for her is her brave admission of having psoriasis — and how that’s brought much-needed attention to the neglected, but often treacherous, skin disease.
Kardashian learned she has psoriasis in an episode of “Keeping Up with the Kardashians” aired on July 2011. Alarmed after finding red, itchy patches on her legs, Kardashian headed to dermatologist Dr. Harold Lancer who quickly diagnosed her itchy, scaly skin condition as psoriasis.
“I cannot have psoriasis,” Kardashian told her dermatologist on the reality TV show. “My career is doing ad campaigns and swimsuit photo shoots,” she said. “People don’t understand the pressure on me to look perfect. When I gain a pound, it’s in the headlines. Imagine what the tabloids would do to me if they saw all these spots.” But then, she went on to work her way around her ailment.
Pleased with the TV diva’s openness about of her skin condition, the National Psoriasis Foundation in the United States has hailed Kardashian on its website, saying it hopes her openness will brings more awareness to a disease.
What’s psoriasis?
A common but chronic skin condition, it’s not only painful — but it can cause disfigurement and disability. Psoriasis forms raised, red, scaly plaques that can itch, crack and bleed. In about one-fifth of cases, it’s so severe that no amount of creams and ointments is enough to control it.
What’s worse, there’s growing evidence that the condition is linked with high cholesterol, diabetes, obesity, hypertension, heart disease and arthritis.
About one in every 10 persons with psoriasis will develop arthritis, and those with extensive, severe skin disease are three or four times more likely to get the painful, degenerative joint disease. In most instances, the skin condition appears before the arthritis.
The disease can develop at any age, but usually it starts in the 20s and 30s. Believed to be caused by a combination of genes, the immune system, and the environment, psoriasis can be localized — it can break out on the scalp or elbows — or it can be all over the body.
But genes are key cause of the condition: nearly half (or 40 percent to be precise) of patients have family members with psoriasis. “I’ve heard of it before, because my mom has always had it,” Kardashian says on her show. “But she didn’t have red flaky dots all over,” Kardashian said.
An abnormality in the body’s immune system — which in normal conditions fights infection and allergic reactions — is thought to behind psoriasis.
T cells — a type of white blood cells that fights off infections in the body — attack healthy skin cells in persons with psoriasis. When the dead skin cells and white blood cells can’t clear, they form rash.
In the U.S., about four percent of the population has psoriasis. That’s about seven million people — including about three million who have never been diagnosed.
The severity of psoriasis depends on the person. For some it’s just a small nuisance, but others can be covered in these patches, while in other people, it’s associated with arthritis. Often, the patches flare up because of stress, infections, smoking, cold weather and drinking a lot of alcohol.
Psoriasis linked to heart disease, hypertension, metabolic syndrome
Even worse, emerging studies have linked psoriasis to insulin resistance, abnormal cholesterol levels, obesity and cardiovascular disease.
This was a recent warning of Dr. Joel M. Gelfand, an assistant professor of dermatology and epidemiology at the University of Pennsylvania Perelman School of Medicine in Philadelphia. Dr. Gelfand made his warning at the American Academy of Dermatology’s 70th Annual Meeting held on March 16 at San Diego, California.
According to him, new research shows that excessive inflammation is a critical feature of psoriasis — which is also a characteristic of serious medical conditions, namely, insulin resistance, abnormal cholesterol levels, obesity and cardiovascular disease.
Psoriasis patients — especially those with severe cases — should thus monitor their health very closely for signs of these diseases, the dermatologist warned.
Cardiovascular disease concerns
People with the painful skin condition psoriasis may be at increased risk for health problems that affect the heart, Dr. Gelfand said. According to him, studies have linked more severe cases of psoriasis to higher rates of major cardiovascular events like heart attacks.
One study also that found that patients with severe psoriasis die about five years younger than patients who don’t have the disease, he said. Half of these deaths were caused by cardiovascular disease.
But while the report indicates an association between psoriasis and cardiovascular risks, it didn’t prove a cause-and-effect relationship, he admitted. “Future research is necessary to better determine how skin-disease severity affects the risk of developing insulin resistance, obesity, abnormal cholesterol levels and cardiovascular disease, and whether successful treatment of psoriasis alters these risks,” Gelfand said in the news release.
Cholesterol concerns
Research has also found that psoriasis patients have changes in cholesterol that can increase that chances that they will develop a hardening of their arteries — which often leads to heart attacks.
Using innovative techniques to evaluate cholesterol composition and function, researchers have shown that psoriasis patients have LDL — or “bad” — cholesterol that consists of smaller and denser cholesterol particles, Dr. Gelfand also revealed. A pattern also seen in people with diabetes, the smaller and denser particles are also more likely to promote the hardening arteries.
For the first time, it’s also been demonstrated that psoriasis patients have impaired function of HDL — or “good” — cholesterol. This prevents HDL from removing cholesterol from the cells in the arteries.
Metabolic syndrome concerns
The more skin surface area affected by psoriasis, the higher the likelihood that a psoriasis patient will have metabolic syndrome, new studies also show.
Metabolic syndrome is a term that covers the cardiovascular risk factors that include obesity, hypertension, insulin resistance and increased triglycerides. These studies include one that involved more than 4,000 patients. In this study, Dr. Gelfand explained, a “dose-response” effect of psoriasis was found, with increasing skin disease severity more strongly associated with potentially serious metabolic disorders.
Severe hypertension
Another study — this time not cited by Dr. Gelfand, but which Health Care Zone came across — showed that people who have psoriasis and hypertension are also more likely to have more severe high blood pressure, requiring more medications to control it.
Researchers from the University of California and the Davis Health System compared 835 people who had psoriasis and hypertension with more than 2,400 people who had hypertension but no psoriasis.
Accounting for other hypertension risk factors like diabetes, smoking and high cholesterol, the researchers found that:
• Compared to hypertensive patients without psoriasis, those with both hypertension and psoriasis were nearly 20 times more likely to be on four drugs
• Patients with psoriasis were also more likely to need the highest level of blood pressure treatment — usually adrenergic inhibitors that are used in people whose high blood pressure can’t be controlled with conventional medications.
“We are beginning to find that psoriasis may represent a window into detecting cardiovascular conditions, including hypertension,” says lead study author Dr. April W. Armstrong, UC Davis assistant clinical professor of dermatology.
“Our study makes a strong case that psoriasis isn’t just a skin-deep disease,” she said in a university news release. The study is published online in PLoS One.
The findings may alert physicians who treat hypertension — a risk factor for heart disease and stroke — the researchers said. According to them, it’s unlikely that drugs used to treat psoriasis are responsible for the increased severity of hypertension.
“Hypertensive patients who also have psoriasis are likely to need closer monitoring and a more aggressive drug regimen to achieve adequate blood-pressure control,” Dr. Armstrong said.
Over the past four decades, scientists have explained the link between psoriasis and hypertension in three possible ways:
• Because it’s an inflammatory disease, psoriasis can damage to blood vessels and the heart.
• Psoriasis patients may be more likely to develop constricted blood vessels, which increases blood pressure.
• People with psoriasis have elevated levels of a protein produced by skin cells — endothelin I– that constricts blood vessels and increases blood pressure.
“Our understanding of psoriasis as a systemic disease is rapidly evolving,” Dr. Armstrong says. “A better appreciation of the other conditions that tend to accompany psoriasis could potentially drive our therapy of the disease in the future,” he concludes.
Can psoriasis patients reduce their risk of developing these serious diseases? Yes, Dr. Gelfand says, advising patients to:
• Don’t smoke.
• Limit alcohol.
• Eat a healthy, balanced diet.
• Keep to a healthy weight.
• Have an active lifestyle.
• Reduce stress.
• Have regular checks for blood pressure, blood sugar, cholesterol.
The expert also called for more research to find out “how skin disease severity affects the risk of developing insulin resistance, obesity, abnormal cholesterol levels and cardiovascular disease, and whether successful treatment of psoriasis alters these risks.”
According to Dr. Gelfand, one such project is already planned. The multi-center clinical trial — funded by the National Heart, Lung and Blood Institute — will try to find out if psoriasis treatments affect arterial inflammation, cholesterol function and metabolic disease.
Right now, there’s no way to prevent psoriasis, and treatment depends on the type of psoriasis, the amount and location of affected skin and the risks of each treatment type weighed against the benefits.
To prevent treatments from losing their effectiveness — and to decrease the risk of side effects, as well — doctors may switch treatments every 12 to 24 months.
Treatments for psoriasis include:
• Topical treatments that are applied directly to the skin.
• Daily skin care with emollients for lubrication, including petroleum jelly or unscented moisturizers.
• Corticosteroid creams, lotions and ointments. For areas of delicate skin such as the face, these are prescribed in low-strength forms; for stubborn plaques on the hands, feet, arms, legs and trunk, these are prescribed in medium and high-strength forms.
• Calcipotriol (Dovonex) that slows production of skin scales.
• Tazarotene (Tazorac) is a synthetic vitamin A derivative.
• Coal tar
• Salicylic acid to remove scales
• Phototherapy using ultraviolet B or ultraviolet A, alone or in combination with coal tar is used to treat extensive or widespread psoriasis.
• A treatment called PUVA combines ultraviolet A light treatment with an oral medication that improves the effectiveness of light treatment.
• Laser treatment also can be used, allowing for more focused and higher amounts of UV light to be used.
• Vitamin A derivatives — used to treat moderate to severe psoriasis involving large areas of the body, these powerful treatments may have severe side effects.
• Immunosuppressants. By suppressing the immune system, these drugs can treat moderate to severe psoriasis involving large body areas.
• Antineoplastic agents. More rarely, these drugs — more often used to treat cancer cells — may be prescribed for severe psoriasis.
• Biologic therapies are newer agents used for psoriasis that hasn’t responded to other treatments.
• Biologics work by acting against substances made the immune system, which trigger psoriasis. Usually, these injectables are expensive
Psoriasis sufferers may contact the National Psoriasis Foundation at 1-800-723-9166 or visit its website, www.psoriasis.org
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Celebrities With Psoriasis: Kim Kardashian. Posted 17 April 2012.