A.R. Shipman; G.W.M. Millington

Disclosures

The British Journal of Dermatology. 2011;165(4):743-750. 

In This Article

Abstract and Introduction

Abstract

Obesity is a serious global health problem, perhaps the biggest public health issue of our times. Excess body weight may be a factor in carcinogenesis in general, as well as contributing to the pathogenesis of metabolic, cardiovascular and musculoskeletal disorders. Obesity also has many cutaneous features, which form the basis for this review article. Many of these clinical entities are common to the majority of obese patients, e.g. striae distensae, plantar hyperkeratosis and an increased risk of skin infections. However, it may also be associated with poor wound healing, malignant melanoma and an increased risk of inflammatory dermatoses, such as psoriasis, as well as some rarer disorders. Therapeutic interventions for obesity, whether over-the-counter, prescription medicines or surgical interventions, are increasingly commonplace. All of these treatment modalities potentially have dermatological side-effects too.

Introduction

Obesity [a body mass index (BMI) > 30 kg m−2] is a medical problem of increasing prevalence. It may present at any age from early childhood onwards, but it most commonly develops in mid-life.[1] In 1980, 8% of women and 6% of men in England were obese, but by 1998 this had increased to 21% of women and 17% of men.[1] This trend shows no signs of abating and it has a major impact on virtually all aspects of healthcare provision, including in dermatology.

As clinicians, we will see more patients with medical problems linked to obesity and this article covers some of the dermatological associations of excess fat deposition. One of the commonest consequences of obesity is insulin resistance and consequent type 2 diabetes mellitus[2] (Table 1). The presence of diabetes[2] will amplify the effects of obesity on other common skin problems, such as prolonged wound healing,[3] ulcers,[4] cutaneous infections,[3] psoriasis[5] and the effects of androgenization.[6] So diabetes and its associations form a secondary theme throughout this review.[2–6] The complex interactions between psoriasis, obesity and other cardiovascular risk factors, including diabetes mellitus in particular, are discussed in two separate sections.[5]

Other conditions more specific to obesity, such as varicose eczema and lymphoedema, are covered in more general terms, as these topics are well reviewed elsewhere.[7] There may also be links between obesity and other inflammatory dermatoses such as atopic eczema,[8] and also with skin cancer.[9] Finally, rarer associations and the complications of the treatment of obesity are outlined in the final paragraphs. This review starts, however, with an outline of the physiology and pathophysiology of cutaneous adipose tissue.[6,10–22]

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