IJCS | Volume 33, Nº2, March / April 2020

DOI: https://doi.org/10.36660/ijcs.20200021 Traditionally, psoriasis has been regarded as a disease affecting only the skin and joints. Unfortunately, this is still the view among many doctors. In this issue, Campos et al., 1 published an interesting observational study on cardiovascular (CV) risk factors and riskmeasurement in patients with psoriatic arthritis, which allow us, in this editorial, to put the spotlight on some points of great interest in this area. As the understanding of psoriasis has evolved, the perception of the disease pathophysiology changed from an organ-specific hyperkeratotic disorder of keratinocytes to an underlying dysregulation of the immune system mediated by cytokines. These concepts led to a further shift in its classification froma skin disease to a T-cell mediated disease. 2 In the last years, a number of studies have demonstrated that psoriasis, mainlywith systemic involvement (psoriatic arthritis), is associated with a higher prevalence of CV and metabolic diseases, and the prevalence of CV risk factors are increased in patients with psoriatic arthritis, including hypertension, diabetes, obesity, dyslipidemia andmetabolic syndrome. 3 The results of the cross-sectional study by Campos et al., 1 support these associations. The close association of skin inflammation with CV disease and metabolic syndrome is a relative new topic in medicine. Inflammatory skin diseases, such as atopic dermatitis and psoriasis, produce a wide range of proinflammatory cytokines and chemokines not only in the lesional skin, but also in the circulation, causing systemic inflammation, insulin resistance and endothelial dysfunction,whichmay lead toatherosclerosis,myocardial infarction and CV comorbidities – the so called psoriatic march 4 or inflammatory skin march 5 (Figure 1). The chronic state of inflammation appears to be a central mechanism underlying the pathophysiology of insulin resistance, visceral adiposity, hypertension and dyslipidemia. 6 But, what are the molecular mechanisms responsible for the association between psoriasis and cardiovascular comorbidities? In 2012, Flammer and Ruschitzka 7 proposed the theory of two plaques for one syndrome . The cytokine profiles of Systemic inflammation Poorly controlled psoriasis or atopic dermatitis Cytokine release from keratinocytes Obesity Insulin resistance Endothelial dysfunction Arteriosclerosis Cardio-vascular involvement Figure 1 – The concept of inflammatory skin march. Modified from ref 4,5 . 109 EDITORIAL International Journal of Cardiovascular Sciences. 2020; 33(2):109-111 Mailing Address: José Laerte Boechat Av Marques de Parana, 303. Postal Code: 24230-030, Niterói, RJ – Brazil E-mail: jl_boechat@id.uff.br Psoriatic March, Skin Inflammation and Cardiovascular Events – Two Plaques for one Syndrome José Laerte Boechat 1, 2 Universidade Federal Fluminense - Clinical Immunology Unit, 1 Niterói, RJ - Brazil Universidade do Porto - Basic and Clinical Immunology Unit, Department of Pathology Porto, 2 Porto – Portugal Psoriasis; Dermatitis,Atopic; Risk Factors; Systemic Inflammatory Response Syndrome; Arthritis, Psoriatic; Inflammation; Comorbidity. Keywords