Obesity and the Skin

Obesity and Psoriasis

The association between psoriasis and obesity is the subject of a recent evidence-based review.^[5] A key question is whether obesity is causal^[29–33] or a consequence of psoriasis.^[30,34,35] It could be argued that a lack of physical activity, due either to the cosmetic impact of psoriasis or to the locomotor effect of psoriatic arthropathy, might predispose an individual to obesity.^[35] Childhood-onset obesity may particularly predispose to both psoriasis^[36] and psoriatic arthropathy,^[37] suggesting a genetic link. The association between psoriasis and obesity forms part of a wider association of psoriasis with a range of cardiovascular risk factors, namely atherosclerosis, diabetes mellitus and hypertension.^[38–53] The separate association of psoriasis with smoking may be an important confounding variable, particularly with regard to hypertension and atherosclerosis.^[52,53]

There is increasing evidence that progressive weight loss can produce significant improvements in the severity of psoriasis.^[54–58] Perhaps the most direct evidence that obesity may be causal in psoriasis is the fact that bariatric sugery can produce rapid remission from psoriasis.^[54,57,58] A confounding variable is the fact that the quality of life of the average patient undergoing bariatric surgery is significantly improved,^[59] which would reduce psychological stress and thus potentially the disease burden of psoriasis.^[5]

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