Psoriasis: A review of systemic comorbidities and dental management considerations.

Abstract

There is a growing body of evidence to substantiate that cutaneous psoriasis is associated with an increased risk for a multitude of systemic disorders. Although there is an extensive array of medical publications regarding psoriasis, the dental literature has almost exclusively been focused on erythema migrans and occasionally, with oral psoriatic mucositis, chronic periodontitis, and psoriatic arthritis of the temporomandibular joint. This report will review the diversity of systemic comorbidities, namely cardiovascular, neurologic, renal, liver, gastrointestinal, pulmonary, endocrine, ocular, arthritic (including temporomandibular joint), nail, cutaneous, and psychologic (including suicide) disorders; neoplasia; infection; dyslipidemia; vitamin D deficiency; substance abuse; higher mortality; and oral mucosal involvement. A discussion of the oral and maxillofacial relevance of these comorbidities is also provided. The author conducted a PubMed search from 1975 through August 2017 for articles on comorbidities associated with psoriasis. For select topics, some relevant case reports were examined. A search on PubMed yielded almost 44,000 articles on psoriasis and nearly 1,300 with the keywords psoriasis and comorbidities. Articles selected for discussion consisted mostly of recent systematic reviews and meta-analyses. Case reports were included when there was a restricted number of psoriatic patients with a particular comorbidity. When a patient presents with a history of psoriasis, the dental practitioner should expand the medical history process to ascertain possible correlated diseases. Information gleaned from this interview process may prompt the attending dental clinician to seek consultation with the patient's physician to gain greater insight to the severity of any prevailing comorbidities and engage in discussions for possible modifications in dental management. Knowledge of psoriatic comorbidities and their possible impact on dental care may improve clinical outcomes.