Deciphering the Association Between Psoriasis and Obesity: Current Evidence and Treatment Considerations
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METABOLISM (M DALAMAGA, SECTION EDITOR)
Deciphering the Association Between Psoriasis and Obesity: Current Evidence and Treatment Considerations Kyriaki Paroutoglou 1 & Evangelia Papadavid 1 & Gerasimos Socrates Christodoulatos 2 & Maria Dalamaga 1,2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Obesity and psoriasis represent chronic inflammatory states that are interconnected in a vicious cycle, sharing also a degree of synergy. In this review, we aim to decipher the various lines of evidence supporting the bidirectional association between psoriasis and obesity highlighting their pathophysiologic connections as well as we attempt to strategize a therapeutic holistic approach for obese psoriatic patients. Recent Findings Recent meta-analyses have shown that (1) genetically higher BMI increased the odds of psoriasis occurrence; (2) obesity is associated with higher incidence and prevalence of psoriasis as well as psoriasis severity; (3) obesity is associated with lower efficacy to anti-TNF agents and may predict biologic treatment discontinuation; and (4) weight loss through diet and physical exercise may improve pre-existing psoriasis and prevent from de novo psoriasis. Methotrexate, acitretin, and cyclosporine could worsen hypertension, liver steatosis, and dyslipidemia. Since infliximab and ustekinumab are weight adjusted, they may be ideal drugs to treat obese psoriatic patients. IL-17 inhibitors are very effective independently from body weight; however, they tend to present better clearance rates in normal weight patients. There is a paucity on weight data regarding the efficacious IL-23 inhibitors. Apremilast may induce weight loss as an adverse effect presenting also some beneficial metabolic actions. Finally, simvastatin and some antidiabetic drugs could decrease psoriasis severity. Summary More mechanistic, observational studies and well-conducted RCTs are necessary to decipher the enigmatic link between psoriasis and obesity, and to provide evidence-based specific guidelines for the screening and management of obese psoriatic patients. Keywords Adiponectin . Adipose tissue . Anti-TNF agent . Apremilast . IL-17 inhibitor . IL-23 inhibitor . Leptin . Obesity . Psoriasis . Resistin
This article is part of the Topical Collection on Metabolism * Maria Dalamaga [email protected] Kyriaki Paroutoglou [email protected] Evangelia Papadavid [email protected] Gerasimos Socrates Christodoulatos [email protected] 1
2nd Department of Dermatology and Venereology, School of Medicine, National and Kapodistrian University of Athens, Attikon General University Hospital, 1 Rimini Street, Chaidari, 12462 Athens, Greece
2
Department of Biological Chemistry, School of Medicine, National and Kapodistrian University of Athens Medical School, 27 Mikras Asias Street, Goudi, 11527 Athens, Greece
Abbreviations BMI CI CVD t2DM GLP-1 GWASs HMW adiponectin HR IFN IL MD MetS NAFLD OR OSAH PASI
Body mass index Confidence interval Cardiovascular disease Diabetes mellit
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