Chronic inflammation in psoriasis and obesity: Implications for therapy
Introduction
In a recent case-control study, risk factors for psoriasis in 560 psoriasis patients were analysed [1]. It appeared that the frequency of psoriasis varied significantly in relation to family history of psoriasis in first-degree relatives, stressful life events, smoking and body mass index (BMI). The combined effect of these risk factors increases the risk for psoriasis even more. The risk of psoriasis was directly related to BMI; the odds ratio (OR) was 1.6 for BMI 26–29 corresponding to overweight subjects, and 1.9 for BMI greater than 29, corresponding to obese people. The OR was around 3 for smokers with a BMI > 30. In terms of population attributable risk BMI accounted for 16% of all the psoriasis cases. The combined effect of tobacco and BMI accounted for 48% of all the cases in this study population [1]. Smoking and obesity could also lead to cardiovascular comorbidity in psoriasis. Severe psoriasis, requiring hospitalisation, has been associated with increased risk for cardiovascular disease [2]. Several other studies have shown a link between psoriasis and obesity. Marino et al. showed that there is a significant association between extent of lesions in psoriasis and BMI [3]. Concerning the long-term prognostic factors which affect clinical outcomes after diagnosis of psoriasis, BMI > 25 turned out to be one of the poor prognostic factors [4]. Furthermore, there seems to be a relation between weight loss and clinical appearances of psoriasis. Higa-Sansone et al. report a patient, who showed complete resolution of psoriasis after a gastric bypass surgery [5].
As shown in above studies, there seems to be indisputably a relation between psoriasis and obesity. Here, we try to explain the relationship between these two entities.
Section snippets
Psoriasis and obesity: both characterized by a chronic low-level inflammation, a central role for TNF-α
Psoriasis is a chronic inflammatory disease of the skin affecting 2–3% of the world’s population. Histopathologically, psoriasis is characterized by hyperproliferation of epidermal keratinocytes and hyperkeratosis, as well as infiltration of immunocytes along with angiogenesis [6]. T cells are almost certainly involved in the initiation of psoriatic lesions. Activated T cells in the region of the dermal epidermal junction are thought to drive the hyperplastic proliferative response through
Hormones and their influence on inflammation
Several hormones are reported to be involved in the regulation of food intake and energy balance, including leptin, ghrelin and alpha-melanocyte stimulating hormone (α-MSH). Levels of these hormones are changed in obesity and influenced by weight loss. Beyond their effects on the central nervous system (CNS) and especially the hypothalamic region, these hormones appear to have effects on a number of other physiologic processes, including immune function and inflammation.
Leptin, which is
Implications for therapy
It appears that a network of pro-inflammatory cytokines (especially TNF-α) plays an important role in the pathophysiology of both obesity and psoriasis. The chronic low-level inflammation – as seen in obesity – may contribute to the extent of psoriatic lesions in obese patients in a negative way. In obese patients, changes in levels of the metabolic hormone leptin, may also play a role in the pathogenesis of deterioration of psoriasis by its potency to release pro-inflammatory mediators.
Because
References (31)
- 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) - et al.
Differential expression of phosphorylated NF-κB/Rel A in normal and psoriatic epidermis an downregulation of NF-κB in response to treatment with etanercept
J Invest Dermatol
(2005) - et al.
Inflammation: the link between insulin resistance, obesity and diabetes
Trends Immunol
(2004) - et al.
Neurobiologic changes in the hypothalamus associated with weight loss after gastric bypass
J Am Coll Surg
(2004) - et al.
Dietary influences on peripheral hormones regulating energy intake: potential applications for weight management
J Am Diet Assoc
(2005) - et al.
Prostaglandin production by melanocytic cells and the effect of alpha-melanocyte stimulating hormone
FEBS Lett
(2004) - et al.
Effect of sibutramine on weight maintenance after weight loss: a randomised trial
The Lancet
(2000) - et al.
Increased risk for cardiovascular mortality in psoriasis inpatients but not in outpatients
Eur J Epidemiol
(2004) - et al.
Risk factors for psoriasis: a retrospective study on 501 outpatient clinical records
Ann Ig
(2004) - et al.
Prognostic factor analysis for plaque psoriasis
Dermatology
(2005)
Psoriasis remission after laparoscopic Roux-en-Y gastric bypass for morbid obesity
Obes Surg
Psoriasis
New Engl J Med
BP-1107: a novel, synthetic thiazolidinedione that inhibits epidermal hyperplasia in psoriatic skin – SCID mouse transplants following topical application
J Pharmacol Exp Ther
TNF inhibition rapidly down-regulates multiple proinflammatory pathways in psoriasis plaques
The J Immunol
Inflammation, stress, and diabetes
J Clin Invest
Cited by (173)
Psoriatic disease and non-alcoholic fatty liver disease shared pathogenesis review
2023, Seminars in Arthritis and RheumatismTopical delivery of pharmaceutical and cosmetic macromolecules using microemulsion systems
2022, International Journal of PharmaceuticsGel incorporated lipid nanoparticles for the treatment of psoriasis
2021, Materials Today: ProceedingsCitation Excerpt :There are many disadvantages of conventional treatment, including poor drug solubility, poor concentration of the drug because of less absorption, poor permeability, speedy digestion and removal, distribution of the drugs to different tissues in accordance with elevated toxicity and limited half-life [5]. Novel system for drug delivery is auspicious solution to counteracting those aspect consequences and provide additional benefits including improve efficacy and safety, product specificity and decreased systemic drug toxicity [6,7]. In the field of dermal/transdermal delivery for the treatment of dermatological disorders nano-size carrier has established a special role such as psoriasis due to the different types of novel drug delivery haulas well as micro and nano particulate particles.
A clinical model for identifying an inflammatory phenotype in mood disorders
2019, Journal of Psychiatric ResearchCitation Excerpt :In a recent meta-analysis of 78 studies and more than 7800 individuals with moderate to severe psoriasis symptoms, psoriasis was associated with significantly elevated serum levels of pro-inflammatory cytokines and a moderate pooled effect size, indicating that a history of severe psoriasis may be a useful clinical marker of an inflammatory phenotype (Dowlatshahi et al., 2013). Clinically, individuals who suffer from psoriasis often have an increased risk of developing other co-occurring inflammatory diseases, including cardiovascular disease, diabetes, Crohn's disease, depression, and obesity (Boehncke, 2015; Davidovici et al., 2010; Di Meglio et al., 2014; Siegel et al., 2013; Hamminga et al., 2006; Harrington et al., 2017; Reich, 2012; Staniak et al., 2014). Similarly, eczema, also referred to as atopic dermatitis (AD), is well established as a chronic, inflammatory condition (Eichenfield et al., 2014), affecting multiple organs and systems (Darlenski et al., 2014) and associated with genetic and immunological pathogenesis (Bieber and Novak, 2009; Guttman-Yassky et al., 2011; Peng and Novak, 2014).