Unveiling the Metabolic Burden: A Clinicopathological Study of Chronic Plaque Psoriasis and Its Association With Metabolic Syndrome

Introduction Psoriasis is a chronic, immune-mediated inflammatory skin disease with systemic manifestations. Among its significant comorbidities, metabolic syndrome (MS) - a constellation of obesity, hypertension, dyslipidemia, and insulin resistance - has gained recognition due to its association with increased cardiovascular risk and reduced life expectancy. Chronic systemic inflammation, shared immunological pathways, and elevated pro-inflammatory cytokines are thought to underlie this association. This study aimed to explore the relationship between histopathologically confirmed chronic plaque psoriasis and MS. Methods A single-center, cross-sectional, hospital-based observational study was conducted between January 2022 and June 2023 at Smt. B. K. Shah Medical Institute and Research Centre, Gujarat. A total of 43 patients with histopathologically confirmed chronic plaque psoriasis were enrolled. Skin biopsies were stained with hematoxylin-eosin and analyzed microscopically. Metabolic parameters, including lipid profile, fasting blood glucose, and HbA1c, were measured using automated analyzers. MS was diagnosed based on National Cholesterol Education Program Adult Treatment Panel III criteria. Patients were categorized into two groups: MS (n=6, 14%) and non-MS (n=37, 86%). Clinical severity was assessed using the Psoriasis Area and Severity Index (PASI) and Body Surface Area (BSA) scoring systems. Statistical analysis was performed using IBM SPSS Statistics (IBM Corp., Armonk, USA), with significance set at p<0.05. Results Six out of 43 patients had MS (14%), with a mean age of 47.83 ± 21.78 years and male predominance of 83.3%. MS was more prevalent among married (6/6, 100%), middle-class (4/6, 66.7%), and non-vegetarian (5/6, 83.3%) male patients. PASI scores were higher (5-6) in 4/6 (66.7%) patients within the MS group, though this difference was not statistically significant. However, moderate BSA involvement (3-10%) was significantly more common among MS patients than non-MS patients. Specifically, 4/6 MS patients (66.7%) had moderate BSA involvement, whereas the majority of non-MS patients had mild involvement (<3%). This difference was found to be statistically significant (p=0.036). Compared to non-MS patients, those with MS had significantly higher weight, BMI, waist circumference, and systolic and diastolic blood pressure (all p<0.05). Biochemically, MS patients exhibited significantly elevated levels of random blood glucose, total cholesterol, triglycerides, very low-density lipoprotein, and low-density lipoprotein, alongside lower high-density lipoprotein levels (all p<0.05). Conclusion The study highlights a significant association between chronic plaque psoriasis and MS, reinforcing the need for early screening and integrated management of metabolic risk factors in psoriatic patients. A significant proportion of patients with chronic plaque psoriasis exhibit features of MS, even in the absence of clinically severe disease. These findings reinforce the need for routine MS screening in all psoriatic patients, regardless of severity scores (PASI or BSA). Dermatologists, often the first point of contact for these patients, can play a vital role in the early identification and management of metabolic risk factors through lifestyle modification and multidisciplinary care. Larger, multi-centric studies with control groups are recommended to confirm these associations and explore the pathophysiological mechanisms further.