Psoriasis is a chronic disfiguring incurable skin disease. It has been associated with comorbidities under the skin such as obesity, multiple metabolic, cardiovascular diseases and psychological disorders.

  • International studies associated obesity with psoriasis incidence, severity and with diminish response to psoriasis systemic therapy.
  • Clinical trials and bariatric surgery conducted on obese psoriasis patients showed that weight reduction can improve psoriasis and its associated comorbidities.

Case report:

  • A 52 year old obese diabetic electrician underwent Roux-en-Y gastric bypass surgery to improve his uncontrolled diabetes and morbid obesity.
  • Few days after the surgery, the patient developed a large psoriasis plaque at the site of his abdominal surgical wound.
  • Prior to the surgery he has been suffering from Insulin dependent diabetes mellitus, hypertension, diabetic neuropathy and retinopathy.
  • Within 6 months of bariatric surgery the patient lost 40 kilograms (kg) of his weight (from 129 kg to 89 kg).
  • The patient was treated with Dithranol ointment and Coal tar cream for psoriasis. Within a week his psoriasis plaques improved.
  • Patient was obese since childhood and he developed psoriasis after having a surgery to reduce his weight.
  • Physiological and psychological stress may contribute to the deterioration of psoriasis or indeed to the onset of psoriasis.

Psoriasis and obesity; nature or nurture?

  • The association between psoriasis and obesity in large population-based study identified metabolic syndrome in 34% of psoriasis patients versus 26% in the matched controls.
  • Obesity was found more common in children with psoriasis than in controls in two recent large population studies.

There is no sufficient evidence to relate the onset of psoriasis to obesity or vice versa. Not all psoriasis patients are obese and not all obese individuals develop psoriasis.

Which comes first; obesity or psoriasis?

The answer to this question is still unknown

  • Interestingly, two longitudinal prospective cohort studies found weight gain or obesity; particularly from the age of 18 years was a risk for developing psoriasis in women.
  • First study: Increased adiposity and weight gain are strong risk factors for incident psoriasis.
  • Second study: Higher BMI and weight gain are risk factors for incident psoriasis in women gaining weight since the age 18 years.

Which causes comorbidities; obesity or psoriasis?

  • Metabolically, both psoriasis and obesity are associated with hypoadiponectinemia and hyperleptinemia.
  • Leptin, adiponectin, resistin, tumour necrosis factor-α (TNF-α), interleukine-6 (IL-6) and C-reactive protein (CRP) levels appear to be correlated with psoriasis severity and patient BMI.

Impact of weight reduction in obese psoriasis patients

  • Nonsurgical weight loss and psoriasis:
    • A meta-analysis showed that nonsurgical weight loss intervention was associated with reduction in the severity of psoriasis in overweight or obese patients.
    • Seven prospective trials on the effect of combining a low calorie diet with other therapies for treating obese psoriasis patients concluded that weight reduction could decrease psoriasis severity.
    • Maintaining a healthy lifestyle or long-term lifestyle behaviour changes can manage psoriasis.
  • Surgical weight loss and psoriasis:
    • Several studies showed that Bariatric surgery was beneficial for obese psoriasis patients.
    • The cause of worsening of psoriasis in some patients after bariatric surgery needs is still unclear but Physiological and psychological stress may be one of the reason.
Citation
Aldeen T, Adebajo A (2015) Obesity and Psoriasis: Can Bariatric Surgery Trigger Psoriasis? J Clin Exp Dermatol Res 6: 305.

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