Does Weight Loss Reduce the Severity and Incidence of Psoriasis or Psoriatic Arthritis?

A Critically Appraised Topic

S.K. Mahil; S.M. McSweeney; E. Kloczko; B. McGowan; J.N. Barker; C.H. Smith


The British Journal of Dermatology. 2019;181(5):946-953. 

In This Article

Clinical Scenario

A 55-year-old man with severe chronic plaque psoriasis since the age of 18 years attended a tertiary psoriasis clinic for optimization of disease management. He was experiencing secondary failure to infliximab and had previously failed to achieve sustained disease control with topical therapies, phototherapy, five oral immunosuppressant agents and six biologic agents. His comorbidities included psoriatic arthritis (PsA), morbid obesity, nonalcoholic fatty liver disease, hypertension and chronic kidney disease.

Clinical examination revealed erythrodermic psoriasis, with Psoriasis Area and Severity Index (PASI) 33, and clinically detectable synovitis affecting his ankles and the proximal interphalangeal joint of his right ring finger. His Dermatology Life Quality Index was 26 (reference range 0–30) and his body mass index (BMI) was 50·6 kg m−2.

He enquired whether losing weight would improve his psoriasis and whether his unaffected children should lose excess body weight to reduce their risk of developing psoriasis.