Psoriasis is a common chronic inflammatory skin disease with a complex pathogenesis consisting of a genetic component, immune dysfunction, and environmental factors. It is associated with numerous comorbidities including psoriatic arthritis, cardiovascular disease, metabolic syndrome, and obesity. Evidence suggests that obesity is a risk factor for incident psoriasis, aggravates existing psoriasis, and that weight reduction may improve the severity of psoriasis in overweight individuals. Excess body weight may interfere with the medical treatment used in psoriasis and adds to the cardiovascular risk profile in these patients, which underscores the importance of effective weight control regimens. In this review we examine the current literature with regard to the association between obesity and psoriasis.

1.
Christophers E: Psoriasis - epidemiology and clinical spectrum. Clin Exp Dermatol 2001;26:314-320.
2.
Griffiths CEM, Barker JNWN: Pathogenesis and clinical features of psoriasis. Lancet 2007;370:263-271.
3.
Grozdev I, Kast D, Cao L, Carlson D, Pujari P, Schmotzer B, et al: Physical and mental impact of psoriasis severity as measured by the compact Short Form-12 Health Survey (SF-12) quality of life tool. J Invest Dermatol 2012;132:1111-1116.
4.
Gladman DD, Antoni C, Mease P, Clegg DO, Nash P: Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis 2005;64(suppl 2):ii14-ii17.
5.
Margolis D, Bilker W, Hennessy S, Vittorio C, Santanna J, Strom BL: The risk of malignancy associated with psoriasis. Arch Dermatol 2001;137:778-783.
6.
Gelfand JM, Berlin J, Van Voorhees A, Margolis DJ: Lymphoma rates are low but increased in patients with psoriasis: results from a population-based cohort study in the United Kingdom. Arch Dermatol 2003;139:1425-1429.
7.
Khalid U, Hansen PR, Gislason GH, Lindhardsen J, Kristensen SL, Winther SA, et al: Psoriasis and new-onset diabetes: a Danish nationwide cohort study. Diabetes Care 2013;36:2402-2407.
8.
Ungprasert P, Sanguankeo A, Upala S, Suksaranjit P: Psoriasis and risk of venous thromboembolism: a systematic review and meta-analysis. Q J Med 2014;107:793-797.
9.
Xu T, Zhang Y-H: Association of psoriasis with stroke and myocardial infarction: meta-analysis of cohort studies. Br J Dermatol 2012;167:1345-1350.
10.
Armstrong AW, Harskamp CT, Armstrong EJ: Psoriasis and metabolic syndrome: a systematic review and meta-analysis of observational studies. J Am Acad Dermatol 2013;68:654-662.
11.
Armstrong AW, Harskamp CT, Armstrong EJ: The association between psoriasis and obesity: a systematic review and meta-analysis of observational studies. Nutr Diabetes 2012;2:e54.
12.
Michalak-Stoma A, Pietrzak A, Szepietowski JC, Zalewska-Janowska A, Paszkowski T, Chodorowska G: Cytokine network in psoriasis revisited. Eur Cytokine Netw 2011;22:160-168.
13.
Zhu K-J, Zhang C, Li M, Zhu C-Y, Shi G, Fan Y-M: Leptin levels in patients with psoriasis: a meta-analysis. Clin Exp Dermatol 2013;38:478-483.
14.
Pedersen JK, Svendsen AJ, Hørslev-Petersen K: Incidence of rheumatoid arthritis in the southern part of Denmark from 1995 to 2001. Open Rheumatol J 2007;1:18-23.
15.
Patterson CC, Dahlquist GG, Gyürüs E, Green A, Soltész G: Incidence trends for childhood type 1 diabetes in Europe during 1989-2003 and predicted new cases 2005-20: a multicentre prospective registration study. Lancet 2009;373:2027-2033.
16.
Icen M, Crowson CS, McEvoy MT, Dann FJ, Gabriel SE, Maradit Kremers H: Trends in incidence of adult-onset psoriasis over three decades: a population-based study. J Am Acad Dermatol 2009;60:394-401.
17.
Moroni L, Bianchi I, Lleo A: Geoepidemiology, gender and autoimmune disease. Autoimmun Rev 2012;11:A386-A392.
18.
Flegal KM: Prevalence and trends in obesity among US adults, 1999-2008. JAMA 2010;303:235.
19.
World Health Organization: Overweight/obesity: overweight by country. Global Health Observatory Data Repository 2008-2013. Geneva, WHO, 2013.
20.
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;130:873-882.
21.
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. http://whqlibdoc.who.int/trs/WHO_TRS_854.pdf.
22.
The World Health Report 2002: reducing risks, promoting healthy life. Geneva, World Health Organization, 2002.
23.
Cao H: Adipocytokines in obesity and metabolic disease. J Endocrinol 2014;220:T47-T59.
24.
Gómez R, Conde J, Scotece M, Gómez-Reino JJ, Lago F, Gualillo O: What's new in our understanding of the role of adipokines in rheumatic diseases? Nat Rev Rheumatol 2011;7:528-536.
25.
Miller IM, Ellervik C, Yazdanyar S, Jemec GBE: Meta-analysis of psoriasis, cardiovascular disease, and associated risk factors. J Am Acad Dermatol 2013;69:1014-1024.
26.
Versini M, Jeandel P-Y, Rosenthal E, Shoenfeld Y: Obesity in autoimmune diseases: not a passive bystander. Autoimmun Rev 2014;13:981-1000.
27.
Yang D, Yang W, Tian Z, van Velkinburgh JC, Song J, Wu Y, et al: Innate lymphoid cells as novel regulators of obesity and its associated metabolic dysfunction. Obes Rev 2016;17:485-498.
28.
Wellen KE, Hotamisligil GS: Inflammation, stress, and diabetes. J Clin Invest 2005;115:1111-1119.
29.
Shibata S, Saeki H, Tada Y, Karakawa M, Komine M, Tamaki K: Serum high molecular weight adiponectin levels are decreased in psoriasis patients. J Dermatol Sci 2009;55:62-63.
30.
Coimbra S, Oliveira H, Reis F, Belo L, Rocha S, Quintanilha A, et al: Circulating levels of adiponectin, oxidized LDL and C-reactive protein in Portuguese patients with psoriasis vulgaris, according to body mass index, severity and duration of the disease. J Dermatol Sci 2009;55:202-204.
31.
Wang Y, Chen J, Zhao Y, Geng L, Song F, Chen H-D: Psoriasis is associated with increased levels of serum leptin. Br J Dermatol 2008;158:1134-1135.
32.
Corbetta S, Angioni R, Cattaneo A, Beck-Peccoz P, Spada A: Effects of retinoid therapy on insulin sensitivity, lipid profile and circulating adipocytokines. Eur J Endocrinol 2006;154:83-86.
33.
Lindegård B: Diseases associated with psoriasis in a general population of 159,200 middle-aged, urban, native Swedes. Dermatologica 1986;172:298-304.
34.
Henseler T, Christophers E: Disease concomitance in psoriasis. J Am Acad Dermatol 1995;32:982-986.
35.
Naldi L, Chatenoud L, Linder D, Belloni Fortina A, Peserico A, Virgili AR, et al: Cigarette smoking, body mass index, and stressful life events as risk factors for psoriasis: results from an Italian case-control study. J Invest Dermatol 2005;125:61-67.
36.
Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB, Gelfand JM: Prevalence of cardiovascular risk factors in patients with psoriasis. J Am Acad Dermatol 2006;55:829-835.
37.
Cohen AD, Sherf M, Vidavsky L, Vardy DA, Shapiro J, Meyerovitch J: Association between psoriasis and the metabolic syndrome. Dermatology 2008;216:152-155.
38.
Herron MD, Hinckley M, Hoffman MS, Papenfuss J, Hansen CB, Callis KP, et al: Impact of obesity and smoking on psoriasis presentation and management. Arch Dermatol 2005;141:1727-1534.
39.
Mallbris L, Granath F, Hamsten A, Ståhle M: Psoriasis is associated with lipid abnormalities at the onset of skin disease. J Am Acad Dermatol 2006;54:614-621.
40.
Setty AR, Curhan G, Choi HK: Obesity, waist circumference, weight change, and the risk of psoriasis in women: Nurses' Health Study II. Arch Intern Med 2007;167:1670-1675.
41.
Bryld LE, Sørensen TI, Andersen KK, Jemec GB, Baker JL: High body mass index in adolescent girls precedes psoriasis hospitalization. Acta Derm Venereol 2010;90:488-493.
42.
Zamboni S, Zanetti G, Grosso G, Ambrosio GB, Gozzetti S, Peserico A: Dietary behaviour in psoriatic patients. Acta Derm Venereol Suppl (Stockh) 1989;146:182-183.
43.
Brembilla NC, Boehncke W-H: Dermal adipocytes' claim for fame in psoriasis. Exp Dermatol 2016, Epub ahead of print.
44.
Van der Meer JWM, Netea MG: A salty taste to autoimmunity. N Engl J Med 2013;368:2520-2521.
45.
Manzel A, Muller DN, Hafler DA, Erdman SE, Linker RA, Kleinewietfeld M: Role of “western diet” in inflammatory autoimmune diseases. Curr Allergy Asthma Rep 2014;14:404.
46.
Brown K, DeCoffe D, Molcan E, Gibson DL: Diet-induced dysbiosis of the intestinal microbiota and the effects on immunity and disease. Nutrients 2012;4:1095-1119.
47.
Bulló M, García-Lorda P, Megias I, Salas-Salvadó J: Systemic inflammation, adipose tissue tumor necrosis factor, and leptin expression. Obes Res 2003;11:525-531.
48.
Johnston A, Arnadottir S, Gudjonsson JE, Aphale A, Sigmarsdottir AA, Gunnarsson SI, et al: Obesity in psoriasis: leptin and resistin as mediators of cutaneous inflammation. Br J Dermatol 2008;159:342-350.
49.
Coimbra S, Oliveira H, Reis F, Belo L, Rocha S, Quintanilha A, et al: Circulating adipokine levels in Portuguese patients with psoriasis vulgaris according to body mass index, severity and therapy. J Eur Acad Dermatol Venereol 2010;24:1386-1394.
50.
Takahashi H, Tsuji H, Honma M, Ishida-Yamamoto A, Iizuka H: Increased plasma resistin and decreased omentin levels in Japanese patients with psoriasis. Arch Dermatol Res 2013;305:113-116.
51.
Özdemir M, Yüksel M, Gökbel H, Okudan N, Mevlitoğlu İ: Serum leptin, adiponectin, resistin and ghrelin levels in psoriatic patients treated with cyclosporin. J Dermatol 2012;39:443-448.
52.
Kawashima K, Torii K, Furuhashi T, Saito C, Nishio E, Nishida E, et al: Phototherapy reduces serum resistin levels in psoriasis patients. Photodermatol Photoimmunol Photomed 2011;27:152-155.
53.
Çerman AA, Bozkurt S, Sav A, Tulunay A, Elbaşı MO, Ergun T: Serum leptin levels, skin leptin and leptin receptor expression in psoriasis. Br J Dermatol 2008;159:820-826.
54.
Xue K, Liu H, Jian Q, Liu B, Zhu D, Zhang M, et al: Leptin induces secretion of pro-inflammatory cytokines by human keratinocytes in vitro - a possible reason for increased severity of psoriasis in patients with a high body mass index. Exp Dermatol 2013;22:406-410.
55.
Shibata S, Tada Y, Hau C, Tatsuta A, Yamamoto M, Kamata M, et al: Adiponectin as an anti-inflammatory factor in the pathogenesis of psoriasis: induction of elevated serum adiponectin levels following therapy. Br J Dermatol 2011;164:667-670.
56.
Takahashi H, Tsuji H, Takahashi I, Hashimoto Y, Ishida-Yamamoto A, Iizuka H. Plasma adiponectin and leptin levels in Japanese patients with psoriasis. Br J Dermatol 2008;159:1207-1208.
57.
Zhu K-J, Shi G, Zhang C, Li M, Zhu C-Y, Fan Y-M: Adiponectin levels in patients with psoriasis: a meta-analysis. J Dermatol 2013;40:438-442.
58.
Jin Y, Zhang F, Yang S, Kong Y, Xiao F, Hou Y, et al: Combined effects of HLA-Cw6, body mass index and waist-hip ratio on psoriasis vulgaris in Chinese Han population. J Dermatol Sci 2008;52:123-129.
59.
Berends MAM, Snoek J, de Jong EMGJ, van de Kerkhof PCM, van Oijen MGH, van Krieken JH, et al: Liver injury in long-term methotrexate treatment in psoriasis is relatively infrequent. Aliment Pharmacol Ther 2006;24:805-811.
60.
Malatjalian DA, Ross JB, Williams CN, Colwell SJ, Eastwood BJ: Methotrexate hepatotoxicity in psoriatics: report of 104 patients from Nova Scotia, with analysis of risks from obesity, diabetes and alcohol consumption during long term follow-up. Can J Gastroenterol 1996;10:369-375.
61.
Montaudié H, Sbidian E, Paul C, Maza A, Gallini A, Aractingi S, et al: Methotrexate in psoriasis: a systematic review of treatment modalities, incidence, risk factors and monitoring of liver toxicity. J Eur Acad Dermatol Venereol 2011;25:12-18.
62.
Murray ML, Bergstresser PR, Adams-Huet B, Cohen JB: Relationship of psoriasis severity to obesity using same-gender siblings as controls for obesity. Clin Exp Dermatol 2009;34:140-144.
63.
Shibata N, Hayakawa T, Hoshino N, Minouchi T, Yamaji A, Uehara M: Effect of obesity on cyclosporine trough concentrations in psoriasis patients. Am J Health Syst Pharm 1998;55:1598-1602.
64.
Maza A, Montaudié H, Sbidian E, Gallini A, Aractingi S, Aubin F, et al: Oral cyclosporin in psoriasis: a systematic review on treatment modalities, risk of kidney toxicity and evidence for use in non-plaque psoriasis. J Eur Acad Dermatol Venereol 2011;25:19-27.
65.
Gisondi P, Del Giglio M, Di Francesco V, Zamboni M, Girolomoni G: Weight loss improves the response of obese patients with moderate-to-severe chronic plaque psoriasis to low-dose cyclosporine therapy: a randomized, controlled, investigator-blinded clinical trial. Am J Clin Nutr 2008;88:1242-1247.
66.
Micha R, Imamura F, Wyler von Ballmoos M, Solomon DH, Hernán MA, Ridker PM, et al: Systematic review and meta-analysis of methotrexate use and risk of cardiovascular disease. Am J Cardiol 2011;108:1362-1370.
67.
Ritchie SA, Connell JMC: The link between abdominal obesity, metabolic syndrome and cardiovascular disease. Nutr Metab Cardiovasc Dis 2007;17:319-326.
68.
Naldi L, Addis A, Chimenti S, Giannetti A, Picardo M, Tomino C, et al: Impact of body mass index and obesity on clinical response to systemic treatment for psoriasis. Dermatology 2008;217:365-373.
69.
Saraceno R, Schipani C, Mazzotta A, Esposito M, Di Renzo L, De Lorenzo A, et al: Effect of anti-tumor necrosis factor-alpha therapies on body mass index in patients with psoriasis. Pharmacol Res 2008;57:290-295.
70.
Kofoed K, Clemmensen A, Mikkelsen UR, Simonsen L, Andersen O, Gniadecki R: Effects of anti-tumor necrosis factor therapy on body composition and insulin sensitivity in patients with psoriasis. Arch Dermatol 2012;148:1089.
71.
Pérez-Pérez L, Allegue F, Caeiro JL, Zulaica JMFA: Severe psoriasis, morbid obesity and bariatric surgery. Clin Exp Dermatol 2009;34:e421-e422.
72.
Porres JM: Jejunoileal bypass and psoriasis. Arch Dermatol 1977;113:983.
73.
Farias MM, Achurra P, Boza C, Vega A, de la Cruz C: Psoriasis following bariatric surgery: clinical evolution and impact on quality of life on 10 patients. Obes Surg 2012;22:877-880.
74.
De Menezes Ettinger JEMT, Azaro E, de Souza CAM, dos Santos Filho PV, Mello CAB, Neves M, et al: Remission of psoriasis after open gastric bypass. Obes Surg 2006;16:94-97.
75.
Higa-Sansone G, Szomstein S, Soto F, Brasecsco O, Cohen C, Rosenthal RJ: Psoriasis remission after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg 2004;14:1132-1134.
76.
Hossler EW, Maroon MS, Mowad CM: Gastric bypass surgery improves psoriasis. J Am Acad Dermatol 2011;65:198-200.
77.
Upala S, Sanguankeo A: Effect of lifestyle weight loss intervention on disease severity in patients with psoriasis: a systematic review and meta-analysis. Int J Obes 2015;39:1197-1202.
78.
Jensen P, Zachariae C, Christensen R, Geiker NRW, Schaadt BK, Stender S, et al: Effect of weight loss on the severity of psoriasis: a randomized clinical study. JAMA Dermatol 2013;149:795-801.
79.
Jensen P, Christensen R, Zachariae C, Geiker NR, Schaadt BK, Stender S, et al: Long-term effects of weight reduction on the severity of psoriasis in a cohort derived from a randomized trial: a prospective observational follow-up study. Am J Clin Nutr 2016;104:259-265.
80.
Naldi L, Conti A, Cazzaniga S, Patrizi A, Pazzaglia M, Lanzoni A, et al: Diet and physical exercise in psoriasis: a randomized controlled trial. Br J Dermatol 2014;170:634-642.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.