Psoriasis and overweight. Psoriasis and excess weight. Psoriasis and obesity.

 

Psoriasis and overweight. Psoriasis and excess weight. Psoriasis and obesity. The relationship between the 2 conditions is probably bidirectional, with obesity predisposing to psoriasis and psoriasis favoring obesity. Although this is still a polemic issue, evidences point to a bidirectional relationship.

 

 

 

Obesity, particularly abdominal obesity, is currently considered a chronic low-grade inflammatory condition that plays an active role in the development of the pathophysiologic phenomena responsible for metabolic syndrome and cardiovascular disease through the secretion of proinflammatory adipokines and cytokines. In recent years, a close link has been established between psoriasis and obesity that includes genetic, pathogenic, and epidemiologic issues with important implications for human health. The relationship between the 2 conditions is probably bidirectional, with obesity predisposing to psoriasis and psoriasis favoring obesity. (1) Obesity also has important therapeutic impacts such as a greater risk of adverse effects in the case of conventional systemic drugs and the decrease of efficacy and/or increase of cost related to biologic agents for which dosage should be adjusted to the patient's weight. (2)

 

Obesity is defined as a chronic condition characterized by excess weight due to an increase in energy deposits stored as body fat. In the last years, a close relation has been established between psoriasis and obesity that matches up with the opinion to consider both conditions as inflammatory chronic processes and the important consequences for human health, to a large extent, through the increase of cardiovascular risk and the elements of metabolic syndrome.

 

Although this is still a polemic issue, evidences point to a bidirectional relationship. (3) In this way, some epidemiologic studies take us to the conclusion that obesity is a independent risk factor leading to a high risk to suffer from psoriais and a bad prognosis for this long term dermatosis, while, according to the final results of other works, obesity could be more an effect of psoriasis than a risk factor of it.(4-6) The adipose tissue (AT) is the largest organ of the adult human body. It composed of adipocytes in charge of storing the energy in form of triglycerides. Recent evidences show that AT, and especially abdominal fat, is an active endocrine organ which helps to regulate several body functions, including insulin-mediated processes, lipid and glucose metabolism, and vascular biology, and plays a role in coagulation and some aspects of inflammation. All these effects are mediated by various substances that come from adipokines and a wide variety of proinflammatory cytokines, including C-reactive protein (CRP), transforming growth factor β, plasminogen activator inhibitor-1 (PAI-1), interleukin (IL) 1β, IL-6, and tumor necrosis factor-alpha (TNF-α). The direct and indirect effects of these molecules are the key to the inflammatory nature of obesity and its relationship with other inflammatory processes including psoriasis.  

 

In obesity, the structure and composition of AT is altered and these changes enhance the proinflammatory effect. Leptin has an important immunomodulatory effect which would be a marker of the severity and chronicity of psoriasis. Leptin may stimulate angiogenesis and keratinocyte proliferation and, along with obesity, may predispose patients to psoriasis. (4-5)

 

Another study involving 16 851 patients with psoriasis, in which psoriatic patients under 35 years of age were shown to be more likely to be obese (OR,2.2) than those aged over 65 years (OR,1.6) relative to healthy controls. Overall, the findings of these studies suggest that a positive correlation exists between body weight and the prevalence and severity of psoriasis.

 

The treatment of obese patients with psoriasis poses numerous difficulties. On the one hand, obesity has been associated with a decreased response to systemic and biologic therapies. This may be due to pharmacokinetic factors and mainly affects more the drugs administered in fixed doses than those in which dose is adjusted to the patient's weight. On the other hand, obesity can be associated with conditions such as metabolic syndrome and hepatic steatosis, which can increase the risk of adverse effects to conventional systemic treatment.

 

In addition to the potential decrease in the effectiveness of treatment and the greater risk of adverse effects, obesity also substantially increases the cost of treatment with drugs prescribed in weight-adjusted doses. One of the aims to treat obese patients suffering from psoriasis should be to reduce obesity, and therefore, the associated inflammation so as to enhance efficacy and tolerance, particularly in the case of drugs administered at fixed doses and thus, to decrease toxicity risk. (6)

 

Bibliography:

1. Samaras K, Kelly PJ, Chiano MN, Spector TD, Campbell LV.

Genetic and environmental influences on total-body and central abdominal

fat: the effect of physical activity in female twins. Ann Intern Med.

1999;130:873---82.

2. WHO. Physical status: the use and interpretation of anthropometry.

Report of a WHO Expert Committee. WHO

Technical Report Series 854. Geneva: World Health Organization;

1995 [consultado Mar 2012]. Disponible en:

http://whqlibdoc.who.int/trs/WHO TRS 854.pdf 3. The World Health Report 2002. Reducing risks, promoting healthy life. Geneva, Switzerland: World Health Organization; 2002.

4. Henseler T, Christophers E. Disease concomitance in psoriasis.

J Am Acad Dermatol. 1995;32:982---6.

5. Lindegard B. Diseases associated with psoriasis in a general population of 159,200 middle-aged, urban, native Swedes.

Dermatologica. 1986;172:298---304.

6. Heron M, Hinckley M, Hoffman M, Papenfuss J, Hansen C, Callis C, et al.

Impact of obesity and smoking on psoriasis presentation and management. Arch Dermatol. 2005;141:

1527---34.

 

 

 

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