Case & review
Gastric bypass surgery improves psoriasis

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Recent studies have found that psoriasis is linked to a higher rate of obesity, and that obesity itself is a risk factor for the development of psoriasis. There are two recent reports of chronic severe psoriasis improving with weight loss after Roux-en-Y gastric bypass surgery. We have observed two patients with body mass indices greater than 50 kg/m2 who had marked improvement in their psoriasis after gastric bypass surgery. The common link between psoriasis and obesity may be a state of chronic inflammation, including elevated levels of T helper 1 (TH-1) cytokines such as tumor necrosis factor. More recent research has shown that the appetite suppressant leptin is also elevated in patients with psoriasis and obesity, and that levels decrease with weight loss. We conclude that weight loss may be a useful adjunctive therapy for obese patients with psoriasis.

Section snippets

Case 1

A 34-year-old woman was followed in our dermatology clinic for many years with severe plaque psoriasis involving up to 75% of her body requiring superpotent topical steroids, ultraviolet (UV)B phototherapy, and psoralen plus UVA treatment. Her medical history included morbid obesity, with a peak body weight of 294 lb (body mass index [BMI] 52 kg/m2), type 2 diabetes mellitus, hypercholesterolemia, hypothyroidism, and mild mental retardation. Despite enrollment in a comprehensive weight

Discussion

Obesity is more common in patients with psoriasis,4, 5, 6, 7, 8 and obese patients with psoriasis are more likely to have severe skin disease.4 In addition, obesity is a significant risk factor for the onset of psoriasis, with a significant trend toward higher risk with increasing BMI.9

We report two patients with psoriasis and comorbid obesity who experienced dramatic improvement in their skin disease after weight loss surgery. Both of our patients subjectively noted improvement with weight

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  • Cited by (0)

    Funding sources: None.

    Conflicts of interest: None declared.

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