People living with both psoriasis and diabetes often have particular concerns, especially when the second condition has only recently been diagnosed. In this article, I answer some of the questions I encounter most frequently and explain the general principles we consider when managing and treating psoriasis in people with diabetes.
Psoriasis and diabetes are both chronic conditions affecting millions of people worldwide and, if not appropriately managed, can have a significant impact on health and quality of life. Although they may appear very different, there are important clinical and metabolic associations between them that should be considered when both conditions are present in the same patient.
In this article, I explain what we currently know about their relationship, the factors they may share and what their coexistence means for patients and healthcare professionals.
The relationship between psoriasis and diabetes
Psoriasis is primarily recognised as an inflammatory skin disease, while diabetes is a metabolic disorder. However, research has shown an association between psoriasis and diabetes, particularly type 2 diabetes. This relationship is complex and appears to involve several overlapping factors, including systemic inflammatory activity, obesity, insulin resistance and other components of metabolic syndrome.
Type 2 diabetes: the form most strongly associated with psoriasis
There are several types of diabetes, with type 1 and type 2 being the most common. Type 1 diabetes is an autoimmune disease in which the immune system damages the insulin-producing beta cells of the pancreas, resulting in insulin deficiency. Type 2 diabetes is much more common and develops when the body becomes resistant to insulin and, over time, may also produce insufficient insulin to maintain normal glucose levels. It is type 2 diabetes that has the clearest epidemiological association with psoriasis, partly because the two conditions share several cardiometabolic risk factors, including obesity and insulin resistance.
Inflammation: one of the shared mechanisms
Psoriasis is a chronic immune-mediated inflammatory disease. Type 2 diabetes is primarily a metabolic disease, but low-grade chronic inflammation also plays an important role in insulin resistance and metabolic dysfunction. For this reason, inflammatory pathways represent one of several possible biological links between psoriasis and type 2 diabetes.
People with psoriasis, particularly those with more severe disease, have been shown in population studies to have a higher prevalence and incidence of type 2 diabetes. However, this does not mean that psoriasis directly causes diabetes in every patient. Conventional risk factors such as age, family history, weight, physical activity and overall metabolic health remain highly relevant.
Obesity, inflammation, psoriasis and type 2 diabetes
Obesity is a well-established risk factor for type 2 diabetes and is also more common among people with psoriasis. Adipose tissue is metabolically active and produces inflammatory mediators that can contribute to insulin resistance and systemic inflammatory activity.
Obesity may therefore contribute to both poorer metabolic health and greater psoriasis burden in some patients. The relationship can be bidirectional and complex: excess weight may make psoriasis more difficult to control, while living with chronic inflammatory disease may also affect activity levels, psychological wellbeing and other health behaviours. For this reason, weight and metabolic health are important components of a comprehensive approach to psoriasis.
Ongoing research into psoriasis and diabetes
Research is helping us understand more precisely the shared risk factors, inflammatory mechanisms and metabolic pathways involved, as well as how different psoriasis treatments may affect metabolic parameters. This knowledge may allow us to refine treatment strategies and make them increasingly individualised, always with patient safety as a priority.
Management and treatment of psoriasis in people with diabetes
When psoriasis and diabetes coexist, treatment should balance efficacy and safety while taking into account the patient's metabolic health, other medical conditions and current medication. The aim is to achieve good control of psoriasis without compromising diabetes management or increasing avoidable risks.
Psoriasis treatment options: topical, systemic and advanced therapies
Treatment should be individualised rather than determined by diabetes alone. The main options include:
Topical treatments: Topical medicines are commonly used for mild and some moderate forms of psoriasis. They generally have limited systemic absorption, but practical considerations are still important in people with diabetes. For example, psoriasis lesions or topical medication in areas used for continuous glucose monitors, insulin pumps or injections may interfere with adhesion, comfort or skin integrity. These areas should therefore be reviewed individually.
Systemic treatments: Systemic treatments may be considered when psoriasis is moderate to severe, affects high-impact areas, has a substantial effect on quality of life or has not responded adequately to topical treatment. These medicines may be given orally or by injection and act throughout the body. Some require particular monitoring of liver function, kidney function, blood pressure, lipid levels or other metabolic parameters, all of which may already be relevant in a patient with diabetes. Treatment selection should therefore take the patient's overall clinical and metabolic profile into account.
Advanced targeted therapies: Advanced targeted treatments, including biological therapies, act on specific inflammatory pathways involved in psoriasis. These treatments can achieve high levels of disease control in appropriately selected patients and may be suitable for people who also have diabetes. However, no single class of treatment is automatically the safest or most appropriate option for every patient with diabetes. The choice should depend on psoriasis severity and location, previous treatment response, cardiovascular and metabolic risk, liver and kidney health, other comorbidities and the safety profile of the specific medicine. Regular dermatological follow-up remains important.
Maintain good diabetes control
Good diabetes management is essential for reducing the risk of diabetic complications and maintaining overall health. Stable blood glucose control may also make it easier to manage other aspects of health, including infection risk, wound healing and cardiovascular risk. However, it should not be assumed that lowering blood glucose will directly reduce psoriasis flare-ups in every patient. People with diabetes should continue their regular follow-up with their endocrinologist, GP or internal medicine specialist, depending on how their diabetes is managed.
Maintain healthy lifestyle habits
Lifestyle is an important part of the management of both psoriasis and type 2 diabetes. Particular attention should be paid to:
Diet: a balanced diet rich in vegetables, fruit, whole grains, pulses and healthy fats can support metabolic and cardiovascular health. For many patients, the Mediterranean diet is an appropriate dietary model because of its recognised benefits for cardiometabolic health. Reducing excessive intake of ultra-processed foods and added sugars can also be helpful, particularly for glucose and weight management. Diet should complement, not replace, appropriate medical treatment for either psoriasis or diabetes.
Physical activity: Regular physical activity can help with weight management, improve insulin sensitivity and glucose control, support cardiovascular health and improve psychological wellbeing. The type and intensity of exercise should be adapted to each person's health, fitness level and any complications related to diabetes or psoriasis.
Smoking and alcohol: Smoking is harmful to cardiovascular and general health and is also associated with poorer outcomes in psoriasis. Excessive alcohol consumption may affect metabolic control, liver health and the safety of certain psoriasis treatments. For these reasons, avoiding smoking and limiting alcohol are important components of overall health management.
Collaboration between patients and healthcare professionals
Close communication between the patient, dermatologist, endocrinologist or diabetes team, GP and other healthcare professionals can be particularly valuable when psoriasis and diabetes coexist. Treatment plans should take both conditions into account, including possible interactions, comorbidities and the monitoring required for each medication. Regular assessment allows disease control, treatment effectiveness and safety to be reviewed and medication to be adjusted when clinically necessary.
Conclusions on psoriasis and diabetes
Psoriasis and diabetes are distinct chronic diseases, but they share several important clinical and metabolic factors, particularly in the case of type 2 diabetes. Obesity, insulin resistance, cardiometabolic risk and inflammatory pathways all contribute to the association between the two conditions and remain active areas of research.
When psoriasis and diabetes coexist, treatment should therefore be individualised and comprehensive. This means treating the psoriasis appropriately, maintaining good diabetes control, addressing cardiovascular and metabolic risk factors and selecting medication according to the patient's overall health. With coordinated follow-up between the patient, dermatologists expert in psoriasis, diabetes specialists and other healthcare professionals when required, both conditions can often be managed effectively and safely.
I invite you to share this article about the management and treatment of psoriasis in people with diabetes with anyone who may find it useful.
