The impact of obesity on skin disease and epidermal permeability barrier status

Background Obese subjects frequently show skin diseases. However, less attention has been paid to the impact of obesity on skin disorders until now. Objective The purposes of this study are: to highlight the incidence of some dermatoses in obese subjects and to study the water barrier function of the obese skin using transepidermal water loss (TEWL). Methods Sixty obese subjects and 20 normal weight volunteers were recruited. Obese group was further divided into three body mass index (BMI) classes: class I (BMI 30–34.9 kg/m²), class II (BMI 35–39.9 kg/m²) and class III (BMI 40 g/m²). All subjects attended dermatological examination for skin diseases. To assess barrier function, TEWL measurements were performed on the volar surface of the forearm using a tewameter. Results The results of this study showed that: (i) obese subjects show a higher incidence of some dermatoses compared with normal‐weight controls; in addition the dermatoses are more, frequent as BMI increases; (ii) the rate of TEWL is lower in obese subjects, than in the normal‐weight subjects, particularly in patients with intra‐abdominal obesity. Conclusion Specific dermatoses as skin tags, striae distensae and plantar hyperkeratosis, could be considered as a cutaneous stigma of severe obesity. The low permeability of the skin to evaporative water loss is observed in obese subjects compared with normal weight control. Although the physiological mechanisms are still unknown, this finding has not been previously described and we believe that this may constitute a new field in the research on obesity.     

The effect of obesity on skin disease and epidermal permeability barrier status in children

Abstract: Obese adult patients have many dermatoses, such as skin tags, candida infection, cellulite, and intertrigo, but only limited data have been published on obese children and the barrier function of their skin. Sixty‐five overweight and obese children (n = 40, BMI 85th–95th percentile; n = 25, BMI > 95th percentile) (aged 8–15; mean age 11.6) and 30 normal‐weight controls (aged 7–15; mean age 11.1) underwent a clinical evaluation and calculation of transepidermal water loss (TEWL). Higher weight percentile was associated with a higher incidence of some dermatoses. Skin tags were found in 40% of subjects in the 95th percentile and 2.5% of those in the 85th percentile. Striae distensae were observed in 32% of patients in the 95th percentile and 22.5% of those in the 85th percentile. Plantar hyperkeratosis was observed only in 20% of the 95th percentile subjects and was not observed in the other groups. TEWL values at the forearm site were significantly higher (p < 0.05) in obese children than in the control group, but no significant differences in TEWL values according to BMI level were found between the two groups of obese children. Degree of obesity influences the incidence of some associated dermatoses; skin tags, striae distensae, and plantar hyperkeratosis were more frequent in children in the 95th percentile of BMI. Obesity increases the TEWL rate, suggesting that obese children might become more easily overheated as weight increases, with more profuse sweating because of the thick layers of subcutaneous fat.     

Clear cell papulosis: a unique disorder in early childhood characterized by white macules in milk-line distribution [letter; comment]

Abstract: Cushing disease (CD) is a common cause of endogenous hypercortisolism in childhood. Its skin manifestations include striae, facial acne, hirsutism, acanthosis nigricans, fungal infections, hyperpig-mentation and easy bruisability. We followed 36 children and adolescents with CD (14 boys and 22 girls), to define the natural history of skin disease in endogenous hypercortisolism. Physical examination and 24 hour urinary free Cortisol (UFC) and 17-hydroxycorticosteroid (17-OHS) excretion values were obtained preoperatively and quarterly for 18 months. Preoperatively our patients exhibited purple subcutaneous striae (77.7%), steroid-induced acne (58.3%), hirsutism (63.7% of the 22 girls), acanthosis nigricans (27.7%), ecchymoses (27.7%), hyperpigmentation (16.6%), and fungal infections (11.1%). The levels of UFC and 17-OHS preoperatively were 351.84 ± 243.85 μg/m²/day (mean ± SD) and 17.92 ± 7.86 mg/g creatinine/day, respectively. No correlation was found between these levels and the severity of the lesions. All patients were cured. Symptoms decreased dramatically within the 3 postoperative months and progressively disappeared within the first year of the follow-up period with the exception of light-colored striae; they were present in 5.6% of the patients at 18 months postoperatively. No acanthosis nigricans or hyperpigmentation were observed at 3 months postoperatively. Hirsutism was not present at 9 months postoperatively. We conclude that in children with CD the skin is affected at multiple sites; however, the severity of the manifestations does not correlate with the biochemical indices of the disease. With the exception of striae, cutaneous effects of endogenous hypercortisolism completely heal within the first year after surgical cure of the disease.     

Dermatoses in overweight and obese children and their relationship with insulin and skin color

Background/Aim

The aim of the present study was to investigate the prevalence of obesity-related dermatoses in obese children, and the association between these dermatoses and insulin resistance as well as skin color.

Methods

Obese, overweight, and normal weight children according to body mass index who were followed up and treated in the outpatient clinics were included in the study. Dermatological examinations of the participants were performed, and fasting insulin and glucose levels were checked.

Results

The obese and overweight children were evaluated as the patient group (70 girls, 41 boys, mean age: 12.37 ± 3.14 years). One hundred one healthy children with normal weight were determined as the control group (59 girls, 42 boys, mean age: 12.15 ± 2.43). The first five common dermatoses in the patient group when compared with the control group were keratosis pilaris (KP), striae distensae, hyperhidrosis, acanthosis nigricans (AN), and plantar hyperkeratosis. The first five dermatoses which were positively correlated with formation and insulin resistance were KP, striae distensae, AN, hyperhidrosis, and plantar hyperkeratosis. According to the Fitzpatrick skin scale, we found that the darker the skin color, the higher the probability of AN and KP (OR, 0.298; 95% CI, 0.106–0.834, p = 0.021; OR, 0.306; 95% CI, 0.117–0.796, p = 0.015, respectively).

Conclusion

Some dermatoses associated with obesity and insulin resistance were not found in obese children, or there was no significant association. These results indicate that many skin morbidities may be prevented by preventing and treating obesity and insulin resistance in the early period.     

Risankizumab as a promising therapeutic approach in obese patients

Obesity and increased waist circumference are associated with all the factors constituting the metabolic syndrome (type 2 diabetes, sleep apnea, hypertension, dyslipidaemia, acute myocardial infarction…) and also with an increased mortality. One of the main methods to determine the obesity is through the body mass index (BMI), which is calculated as weight in kilograms, divided by height in metres squared. Obesity is considered to be when the BMI is greater than 30 kg/m². The association with psoriasis has been revealed in different epidemiological studies and clinical trials and mainly affects patients who develop more severe forms of psoriasis. We report an obese patient under treatment with Risankizumab with successful and sustained response over 52 weeks, as a very promising therapeutic approach as an efficient treatment in this patients     

Associations of acanthosis nigricans with metabolic abnormalities in polycystic ovary syndrome women with normal body mass index

Acanthosis nigricans (AN) usually correlates to insulin resistance (IR) or obesity in obese populations, but adequate studies on the significance of AN in people with normal body mass index (BMI) have not been performed and discussed. Three hundred and thirty‐nine polycystic ovary syndrome (PCOS) patients with normal BMI (<23 kg/m²) were recruited. The anthropometric and biochemical parameters of these patients were measured. In these patients with normal BMI, 33 (9.7%) women had AN, and six (1.77%) women were diagnosed with metabolic syndrome. Most of the anthropometric and biochemical variables associated with metabolic status were more unfavorable in the AN‐positive group compared with the AN‐negative groups. The prevalence of central obesity, IR and reduced high‐density lipoprotein cholesterol (HDL‐C) level were also significantly higher in the AN‐positive group (P < 0.05). In multiple regression analysis, presence of AN was still significantly associated with IR (odds ratio [OR] = 2.952, 95% confidence intervals [CI] = 1.367–6.376] and reduced HDL‐C level (OR = 2.668, 95% CI = 1.160–6.135) after adjustments for age and BMI. Sensitivity, specificity, and positive and negative predictive values for AN to detect IR were 18.6%, 92.6%, 39.4% and 81.4%, respectively. In conclusion, presence of AN correlated with IR and reduced HDL‐C level in PCOS women with normal BMI. AN status had high specificity to detect IR, but lack of sensitivity.     

Clear differences in adiponectin level and glutathione redox status revealed in obese and normal-weight patients with psoriasis

Background Several studies have shown increased prevalence of obesity in patients with psoriasis. Objectives To characterize both inflammatory‐ and oxidative stress‐related differences between obese patients with psoriasis (OPP) and normal‐weight patients with psoriasis (NWPP). Methods The plasma concentrations of adiponectin and interleukin (IL)‐6 were analysed by quantitative sandwich enzyme immunoassay technique in 10 patients with a body mass index (BMI) < 25 and 12 patients with a BMI > 30. Total glutathione and oxidized glutathione levels were measured spectrophotometrically. Results Plasma concentration of adiponectin in NWPP was more than twice the level in healthy normal‐weight controls (P < 0·001), while such an elevation did not occur in OPP. OPP were characterized by a significantly increased IL‐6 level, which correlated negatively with the adiponectin level (r = ?0·85, P < 0·001). The glutathione redox status, which was also inversely correlated with the adiponectin level (r = ?0·63, P < 0·05), was associated with significantly increased oxidative stress in the OPP compared with the NWPP or controls. Conclusions Obesity in patients with psoriasis is associated with both decreased plasma levels of protective adiponectin compared with NWPP, and enhanced systemic inflammation and oxidative stress. These findings are in concordance with high prevalence of diseases related to lower adiponectin levels among psoriasis patients.     

Changes in inflammatory markers correlated with increased testosterone after laparoscopic sleeve gastrectomy in obese Chinese men with acanthosis nigricans

Bariatric surgery is an effective method for severe obesity and its related comorbidities. This study was performed to explore the alterations of sex hormones and inflammatory markers following laparoscopic sleeve gastrectomy (LSG) among obese Chinese men with acanthosis nigricans (AN). Sixty‐five obese men who underwent LSG were enrolled, comprising simple obesity without AN (OB group, n = 20) and obesity with AN (AN group, n = 45). There were 31 healthy male controls with normal body mass index (BMI) included. Anthropometry data, inflammatory markers, sex hormones and metabolic parameters were compared preoperatively and 12 months post‐operatively. At baseline, patients in the AN group were associated with more severe metabolic abnormalities than the OB and control groups. Twelve months after surgery, AN patients obtained significant improvement in skin condition and reduction in AN score. BMI, fasting insulin (FINS), and Homeostatic Model Assessment of Insulin Resistance (HOMA‐IR), tumor necrosis factor‐α (TNF‐α) and total testosterone (TT) were significantly changed in both groups, while interleukin (IL)‐6, IL‐8 and C‐reactive protein were changed significantly only in the AN group. Moreover, FINS, HOMA‐IR, TT and IL‐6 levels were changed more in the AN group than those in the OB group. Multivariate regression analysis revealed that TT increase correlated significantly with reduction in FINS and HOMA‐IR in both groups, but correlated with changes in IL‐6 only in the AN group. In conclusion, LSG is effective in improving the skin condition of obese men with AN. The increased TT in AN patients correlated with amelioration of inflammatory state in addition to insulin resistance after LSG.     

Dermatosis en pacientes con sobrepeso y obesidad y su relación con la insulina

IntroductionThe prevalence of obesity has increased worldwide in recent years. Some authors have described skin conditions associated with obesity, but there is little evidence on the association between insulin levels and such disorders.ObjectiveTo describe the skin disorders present in overweight and obese patients and analyze their association with insulin levels.Material and methodsThe study included nondiabetic male and female patients over 6 years of age who were seen at our hospital between January and April 2011. All the patients were evaluated by a dermatologist, who performed a physical examination, including anthropometry, and reviewed their medical history and medication record; fasting blood glucose and insulin were also measured. The patients were grouped according to degree of overweight or obesity and the data were compared using analysis of variance or the χ² test depending on the type of variable. The independence of the associations was assessed using regression analysis.ResultsIn total, 109 patients (95 adults and 13 children, 83.5% female) were studied. The mean (SD) age was 38 (14) years and the mean body mass index was 39.6 ± 8 kg/m². The skin conditions observed were acanthosis nigricans (AN) (in 97% of patients), skin tags (77%), keratosis pilaris (42%), and plantar hyperkeratosis (38%). Statistically significant associations were found between degree of obesity and AN (P = .003), skin tags (P = .001), and plantar hyperkeratosis. Number of skin tags, AN neck severity score, and AN distribution were significantly and independently associated with insulin levels.ConclusionsAN and skin tags should be considered clinical markers of hyperinsulinemia in nondiabetic, obese patients.     

Obesity and dermatology

Obesity is associated with a number of dermatoses. It affects cutaneous sensation, temperature regulation, foot shape, and vasculature. Acanthosis nigricans is the most common dermatological manifestation of obesity. Skin tags are more commonly associated with diabetes than with obesity. Obesity increases the incidence of cutaneous infections that include: candidiasis, intertigo, candida folliculitis, furunculosis, erythrasma, tinea cruris, and folliculitis. Less common infections include cellulitis, necrotizing fasciitis, and gas gangrene. Leg ulcerations, lymphedema, plantar hyperkeratosis, and striae are more common with obesity. Hormonal abnormalities and genetic syndromes (Prader-Willi) are related to obesity and its dermatoses; however, cellulite is not related to obesity.     

Obesity and the skin: skin physiology and skin manifestations of obesity

Obesity is widely recognized as an epidemic in the Western world; however, the impact of obesity on the skin has received minimal attention. The purpose of this article is to highlight the association between obesity and dermatologic conditions. We review the impact of obesity on the skin, including skin physiology, skin manifestations of obesity, and dermatologic diseases aggravated by obesity. Obesity is responsible for changes in skin barrier function, sebaceous glands and sebum production, sweat glands, lymphatics, collagen structure and function, wound healing, microcirculation and macrocirculation, and subcutaneous fat. Moreover, obesity is implicated in a wide spectrum of dermatologic diseases, including acanthosis nigricans, acrochordons, keratosis pilaris, hyperandrogenism and hirsutism, striae distensae, adiposis dolorosa, and fat redistribution, lymphedema, chronic venous insufficiency, plantar hyperkeratosis, cellulitis, skin infections, hidradenitis suppurativa, psoriasis, insulin resistance syndrome, and tophaceous gout. We review the clinical features, evidence for association with obesity, and management of these various dermatoses and highlight the profound impact of obesity in clinical dermatology. LEARNING OBJECTIVE: After completing this learning activity, participants should be aware of obesity-associated changes in skin physiology, skin manifestations of obesity, and dermatologic diseases aggravated by obesity, and be able to formulate a pathophysiology-based treatment strategy for obesity-associated dermatoses.     

Manifestaciones cutáneas en niños con diabetes mellitus y obesidad

Obesity and diabetes are chronic diseases that affect people all over the world, and their incidence is increasing in both children and adults. Clinically, they affect a number of organs, including the skin. The cutaneous manifestations caused or aggravated by obesity and diabetes are varied and usually bear some relation to the time that has elapsed since the onset of the disease. They include soft fibromas, acanthosis nigricans, striae, xerosis, keratosis pilaris, plantar hyperkeratosis, fungal and bacterial skin infections, granuloma annulare, necrobiosis lipoidica, psoriasis, and atopic dermatitis.In this review article we present the skin changes found in children with diabetes mellitus and obesity and related syndromes and highlight the importance of the skin as a tool for establishing clinical suspicion and early diagnosis of systemic disease.     

Skin Disorders Associated with Obesity in Children and Adolescents: A Population‐Based Study

Obesity in children is a major public health concern in the United States. The objectives of the current study were to determine the prevalence of various groups of cutaneous disorders in obese children and adolescents and to compare the use of dermatology services in obese subjects with that those with a normal body mass index (BMI). This was a retrospective, population‐based study at the Kaiser Permanente Northern California Managed Healthcare System. The main outcome measures were the relative risk of cutaneous disorders associated with insulin resistance, androgen excess, bacterial infection, fungal infection, viral infection, inflammation, mechanical changes, and other skin conditions (hidradenitis, hyperhidrosis) in three weight groups (normal, overweight, obese) and the number of dermatology visits. A total of 248,775 subjects were included. Bivariate analyses showed a higher proportion of insulin resistance disorders, bacterial infection, fungal infection, inflammatory disorders, mechanical changes, and other skin conditions in obese subjects than in subjects with a normal BMI (p < 0.001). Disorders of androgen excess and viral infection were significantly less common in obese subjects (p < 0.001). Obese subjects had significantly lower odds of having at least one dermatology encounter than subjects with a normal BMI (odds ratio = 0.92, 95% confidence interval 0.88, 0.96, p = 0.003). Early onset obesity is associated with cutaneous disorders characterized by hyperproliferation, inflammation, bacterial and fungal infection, and mechanical changes but lower rates of disorders of androgen excess and viral infection. The use of dermatology services was not greater in obese patients. Heightened recognition and further analysis of adipose tissue as an endocrine organ that is capable of affecting the skin is warranted.     

Factors influencing skin ageing in a Mediterranean population from Turkey

Background. Skin ageing is a continuous process, with intrinsic factors determining which extrinsic factors (chronic sun exposure and other environmental factors, particularly smoking) have the greatest effect. Aim. To investigate the effects of lifestyle and environmental factors on skin ageing in a Mediterranean population from Ankara, Turkey. Methods. In total, 574 (337 women, 237 men; age range 18–89 years) were enrolled into the study. Data were collected on age, gender, weight, height, body mass index (BMI), skin phototype, smoking status, consumption of alcohol (> 3 units/week) and coffee (> 1 cup/day), sun exposure, use of sunscreen and sunglasses, and involvement in sports and physical activities. The Daniell skin‐wrinkling grading system was used as a marker of skin ageing. Results. We found that male gender, chronic sun exposure and number of pack‐years of cigarette smoking significantly contributed to the formation of facial wrinkles. There was a negative correlation between facial wrinkling and the use of sunscreen and sunglasses and facial wrinkling (P < 0.001 for both). We did not find any significant association between wrinkling score and alcohol consumption, coffee consumption, sports participation or d skin phototype. Moreover, wrinkling score was significantly higher in patients with a BMI < 25 kg/m² than in patients with a BMI > 25 kg/m² (P < 0.018). Multiple logistic regression analysis was conducted after adjusting for age, gender, smoking status, alcohol consumption, skin phototype, sun exposure, and use of sunglasses and topical sun protection. We found that gender and age were significantly associated with skin ageing (P < 0.014 and < 0.001, respectively). Conclusion. In this study, older age, male gender, low BMI, smoking and chronic sun exposure had a negative influence on skin ageing in a Turkish population.     

Relationships between obesity and the clinical severity of psoriasis in Taiwan

Background Obesity has been found to be associated with an increased risk of psoriasis in general population. However, studies addressing the relationship between obesity and clinical severity of psoriasis are still scarce, especially in Asian people. Objectives In this study, we investigated the relationship between levels of obesity and the clinical severity of psoriasis in Taiwanese psoriasis patients. Methods This was a hospital‐based cross‐sectional study. A total of 399 patients with chronic plaque psoriasis were recruited. Their body mass index (BMI) was calculated as weight in kilograms divided by height in metres squared and was categorized into four groups (BMI < 24, normal; 24 ≤ BMI < 27, overweight; 27 ≤ BMI < 30, mild obesity; and BMI ≥ 30, moderate‐to‐severe obesity). Disease severity was assessed by Psoriasis Area and Severity Index. Cumulative logistic regression models were used to estimate the association between BMI and Psoriasis Area and Severity Index. Results After adjusting for potential confounders (age, gender, cigarette smoking and duration of disease), moderate‐to‐severe obesity was significantly associated with an increased risk of clinically more severe psoriasis when compared with normal BMI [odds ratio, 2.70; 95% confidence interval,1.42–5.11]. There is a significant linear trend for clinically more severe psoriasis across increasing of BMI categories (P for trend = 0.004). The effect of obesity on the severity of psoriasis was greater in men than in women (test for interaction, P = 0.03). Conclusions In psoriasis patients, obesity is associated with a more severe disease, especially in men. Bodyweight control may be important for the management of psoriasis.     

Prevalence and significance of acanthosis nigricans in an adult obese population.

BACKGROUND AND DESIGN--Acanthosis nigricans develops commonly in obese individuals, yet its prevalence and significance in an unselected adult obese population has not been determined. To address these issues, 34 patients enrolled in the Adult Obesity Clinic at Parkland Memorial Hospital (Dallas, Tex) were chosen at random and examined. RESULTS--Acanthosis nigricans was observed in fully 74% of patients; its prevalence correlated positively with severity of obesity. Black obese patients demonstrated a greater propensity for manifesting the cutaneous disorder than did white obese individuals. Patients with acanthosis nigricans exhibited fasting plasma insulin levels that were markedly higher than those of nonacanthotic cohorts. CONCLUSIONS--Obesity is a significant risk factor for the development of acanthosis nigricans. Conversely, acanthosis nigricans is a reliable cutaneous marker of hyperinsulinemia in obese individuals.     

Association between atopic dermatitis and obesity in adulthood

Background Obesity in early childhood is associated with increased risk for and severity of atopic dermatitis (AD). Objective  To determine whether obesity in adulthood is associated with risk of AD. Methods This was a retrospective case–control study of 2090 adults using questionnaire, height and weight, and skin‐prick testing between January 1994 and December 2003. Results  Obesity in adults was associated with increased AD [multinomial logistic regression: adjusted odds ratio (aOR) 1·43, 95% confidence interval (CI) 1·08–1·89; P = 0·01], but not nonatopic dermatitis (aOR 0·59, 95% CI 0·21–1·68; P = 0·32). Obesity was also associated with increased atopic asthma (aOR 1·98, 95% CI 1·47–2·66, P < 0·0001), but not associated with nonatopic asthma (P = 0·20), atopic or nonatopic rhinoconjunctivitis (P = 0·08 and 0·31, respectively), food allergies (P = 0·67 and 0·35, respectively) or atopy (P = 0·40). The association between obesity and AD remained significant even when controlling for history of asthma, rhinoconjunctivitis and food allergies (aOR 1·40, 95% CI 1·05–1·86; P = 0·02) or in subset analyses of subjects with AD alone (aOR 1·96, 95% CI 1·02–3·75; P = 0·04) and with comorbid asthma, rhinoconjunctivitis and/or food allergies (aOR 1·40, 95% CI 1·03–1·91; P = 0·03). Conclusion Obesity in adulthood is associated with AD. Further studies are warranted to determine if weight loss may prevent or mitigate AD in adults.     

Association between obesity measured by different parameters and severity of psoriasis

Background Obesity has been associated with the severity of psoriasis, but this relationship is not completely understood. Objectives This study aimed to evaluate associations between the severity of psoriasis and weight excess as determined using a variety of parameters. Methods A cross‐sectional study was performed in 296 psoriasis patients. Their body mass index (BMI), waist circumference (WC), and waist : hip ratio (WHR) values were compared with results on a psoriasis area severity index (PASI). Results The frequency of severe psoriasis was higher in men (P < 0.05). Direct correlations were established between PASI scores and each of BMI (R = 0.0154, P = 0.01), WC (R = 0.207, P = 0.001), and WHR (R = 0.164, P = 0.007). Conclusions This study extends previous reports of an association between psoriasis and obesity and shows a direct correlation between obesity as measured according to different parameters and psoriasis severity.     

Modifiable lifestyle factors associated with metabolic syndrome in patients with psoriasis

Background. Psoriasis is a chronic inflammatory skin disease, which is associated with obesity and with cardiovascular morbidity and mortality. Aim. To evaluate modifiable lifestyle factors including stress level, physical activity and nutrition, which may be associated with metabolic syndrome in patients with psoriasis. Methods. In total, 65 patients with psoriasis and 52 control subjects from our university dermatology clinic were enrolled in this case–control pilot study. The study questionnaire included the Perceived Stress Scale (PSS), the Godin Leisure‐Time Exercise Questionnaire (GLTEQ) and the Rapid Eating Assessment for patients (REAP). For subjects with psoriasis, the Psoriasis Area and Severity Index (PASI) was measured. Results. Subjects with psoriasis (mean BMI 27.72) displayed a trend towards a higher BMI compared with controls (mean BMI 25.67). Subjects with psoriasis were not found to have an increased prevalence of self‐reported metabolic syndrome‐associated diseases including diabetes, heart disease, high cholesterol, hypertension or stroke compared with controls (P = 0.25, P = 0.46, P = 0.96, P = 0.26, and P = 0.16, respectively). There was no significant difference in exercise or stress between patients with psoriasis and controls (P = 0.06 and P = 0.26, respectively). However, compared with controls, subjects with psoriasis (mean REAP score = 2.23) did report poorer overall nutrition as assessed by the REAP score (mean = 2.38, P < 0.01). Among subjects with psoriasis, the factors of stress, smoking and systemic therapy were associated with increased PASI (r = 0.13, r = 3.47 and r = 3.19, respectively). Conclusions. Our study suggests that poor dietary and exercise habits may be factors contributing to obesity and metabolic syndrome in patients with psoriasis. Further studies with larger numbers are needed to confirm these results.     

Impact of obesity on the effectiveness of adalimumab for the treatment of psoriasis: a retrospective study of 30 patients in daily practice

Background

The relationship between obesity and psoriasis is probably bidirectional.

Objectives

To assess whether the effectiveness of adalimumab was affected by obesity in patients with psoriasis.

Materials & methods

Retrospective study of 30 adalimumab naïve patients (13 men, 17 women, mean age 49.5 years) with moderate to severe psoriasis. Response to treatment (PASI 50, 75, 90, 100) was assessed over the course of six clinical visits, with a median between 1.9 months for visit 1 and 20.8 months for visit 6 after the start of adalimumab treatment. Body mass index (BMI) was categorized as normal weight (18.5–24.9 kg/m²) (n = 13), overweight (25–29.9 kg/m²) (n = 7), and obese (>30 kg/m²) (n = 10).

Results

Patients were followed for a median of 17.2 months (minimum 2.7 months, maximum 34.4 months). The percentage of patients who were in complete remission (PASI 100) increased from 23.3% at visit 1 to 60% at visit 6. 70% of patients presented a PASI 90 response at visit 4 and this percentage remained unchanged at visits 5 and 6. Differences in response to adalimumab according to weight subgroups were not observed. The median time to achieve PASI 75, PASI 90 and PASI 100 responses was 20.1, 31.4 and 57.6 weeks, respectively.

Conclusion

Adalimumab proved to be effective for the treatment of moderate to severe psoriasis in daily practice. Obesity did not appear to affect the efficacy of adalimumab in terms of PASI response, although patients with a BMI ≥30 kg/m² discontinued treatment earlier.