Psoriasis and Comorbidities: Diagnostic and Therapeutic Challenges in Madagascar

Psoriasis is a common chronic inflammatory skin disease, but it is still poorly understood by physicians. It evolves in flare-ups of varying intensity and is often associated with comorbidities that worsen the severity of the disease and complicate its management. Our objective was to identify these comorbidities in order to optimize the follow-up of patients with psoriasis in Madagascar. A retrospective, multicenter, descriptive, and analytical study was conducted over six years, including all patients with psoriasis regardless of age or gender, in the dermatology departments of Toamasina and Antananarivo, Madagascar. A total of 224 cases of psoriasis were included, with a slight male predominance and a mean age of 40.2 ± 20 years. Comorbidities were present in 61.6% of patients, mainly dominated by cardiovascular and metabolic risk factors and diseases, as well as psychoaffective disorders, particularly stress and depression. A significant association was observed between the presence of cardiovascular, metabolic, or psychoaffective comorbidities and the severity of psoriasis, suggesting that chronic systemic inflammation and high-risk lifestyles contribute to a vicious cycle of disease worsening. Unemployment, older age (50–60 years), and male sex were also correlated with moderate to severe forms. Our study highlights the importance of systematic screening for comorbidities, an early and multidisciplinary therapeutic approach, and improved awareness among healthcare professionals to enhance the prognosis and quality of life of patients with psoriasis in a resource-limited setting.