Review
Obesity and psoriasis: From the Medical Board of the National Psoriasis Foundation

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An association between obesity and psoriasis has been reported. For a variety of reasons, obese persons with psoriasis are often more difficult to treat. We sought to review the literature on obesity and psoriasis and to discuss efficacy and safety data that could be utilized by clinicians who are making treatment decisions for obese persons with psoriasis. We performed a literature review using the terms “obesity and psoriasis” and “metabolic syndrome and psoriasis.” Evidence from relevant literature was evaluated and categorized according to the criteria of Shekelle et al (published 1999). Numerous reports cite an association between obesity and psoriasis. When compared with non-obese patients with psoriasis, obese patients with psoriasis are more likely to experience certain adverse effects to medications and are less likely to respond favorably to systemic therapies. The amount of category I evidence for objectively determining the best treatment choices for obese patients with psoriasis was scarce and thus did not allow for the development of a treatment algorithm that could be generally applied for all psoriasis patients who are obese. Efficacy and safety concerns affected by obesity are important considerations for clinicians who are making decisions on proper treatment of psoriasis.

Introduction

The association between obesity and psoriasis has been the focus of several recent reviews.1, 2, 3, 4 Obesity is defined as a body mass index (BMI) of 30 or greater, whereas morbid obesity is defined as a BMI of 35 or greater. Lindegard5 first described an association between obesity and psoriasis in a study of 159,200 registered Swedish citizens over a 10-year period. This association has been confirmed in many more recent publications.6, 7, 8, 9, 10, 11, 12, 13 In an Italian case-control study with 560 psoriatic patients, the odds of having psoriasis with a BMI between 26 and 29 or above 30 were 1.6 and 1.9, respectively, compared to non-obese control subjects.7 A study from the United Kingdom of 127,706 patients with mild psoriasis (defined as those who were not treated with systemic therapies or phototherapies) and 3,854 patients with severe psoriasis (defined as those who were treated with systemic therapies or phototherapies) demonstrated higher adjusted odds of obesity in patients with severe psoriasis (odds ratio [OR] = 1.8) than in patients with mild psoriasis (OR = 1.3) compared with patients without psoriasis.8 In a report encompassing 16,851 individuals with psoriasis, patients younger than 35 years old were more likely to demonstrate obesity (OR = 2.2) than patients older than 65 years of age (OR = 1.6) compared with normal controls.9 In another study, morbidly obese patients self-reported the presence of inverse psoriasis in 13% of cases compared to 11% of obese and 5% of non-obese patients.10 In combination, these studies suggest a positive correlation between body weight and both prevalence and severity of psoriasis.

According to National Health and Nutrition Examination Survey data, 30% of all adult U.S. citizens were obese in the 4-year period of 1999-2002.14 Given that approximately 2% of the general population has psoriasis,15 and given that psoriasis is associated with obesity, it will become increasingly important for clinicians to become familiar with appropriate treatment regimens for patients with both of these conditions. Furthermore, ongoing genetic and pathophysiologic studies offer the promise of understanding how these two common conditions are related.

Section snippets

Methods

MEDLINE and PubMed were both searched for a combination of the following terms: “obesity and psoriasis” and “metabolic syndrome and psoriasis.” Literature relevant to psoriasis and obesity or the metabolic syndrome was reviewed. Literature was additionally acquired through citations from reviews in our initial search and by searching “psoriasis” concurrently with the name of a medication or class of medications. Reports in the literature were evaluated according to the criteria of Shekelle

Obesity and psoriasis: association studies

The question of which comes first, psoriasis or obesity, is a common question. In our review of the literature, two studies provide data that psoriatic patients gain weight after the onset of psoriasis. Herron et al10 present data from 557 patients with psoriasis wherein patients were asked to recall their body size at 18 years of age (before the onset of psoriasis) and to then evaluate their current size (after the onset of psoriasis). By means of this retrospective method, self-reported

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    Funded by the National Psoriasis Foundation, Portland, OR.

    Disclosures: Dr Bremmer has no disclosures to report. Dr Van Voorhees has been a consultant, investigator, or speaker for Abbott, Amgen, Astellas, Centocor, Genentech, Incyte, Connetics, Warner Chilcott, Photomedix, Roche, and Synta; she also has a significant conflict of interest with Merck. Dr Hsu has been a consultant for Abbott, Amgen, Biogen Idec, Centocor, and Genentech; she has been a clinical investigator for Amgen and Centocor. Dr Korman has been an investigator or speaker for Abbott, Amgen, Astellas, Centocor, and Genentech. Dr Lebwohl has been a consultant for Abbott, Amgen, Astellas, Centocor, Genentech, UCB Pharma, Stiefel, Triax, Pharmaderm, Medicis, Novartis, and Warner Chilcott; he has been a speaker for Abbott, Amgen, Astellas, Centocor, and Genentech. Ms Young has been a consultant or speaker for Abbott, Amgen, Astellas, Biogen Idec, Centocor, and Genentech. Dr Bebo is employed by the National Psoriasis Foundation. The Foundation receives unrestricted financial support from Abbott, Centocor, Amgen, Wyeth, Genentech, Astellas, Stiefel, Galderma, Warner Chilcott, and Photomedix. Dr Blauvelt has been a consultant, investigator, or speaker for Abbott, Amgen, Centocor, Genentech, Anacor, Coria, Vascular Biogenics, PM Toleikis & Associates, MacroGenics, Eli Lilly, CombinatoRx, Cerimon, Barrier Therapeutics, Pfizer, and Novo Nordisk.

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