Management of Moderate to Severe Psoriasis in Patients with Metabolic Comorbidities

Abstract

Psoriasis is a chronic inflammatory skin disease affecting 2–3% of worldwide population. The extent of skin involvement is variable, ranging from a few localized plaques to generalized involvement. Moderate to severe psoriasis (>10% of body surface area) is frequently associated with psoriatic arthritis and metabolic diseases, like abdominal obesity, diabetes, non-alcoholic fatty liver disease, dyslipidemia, metabolic syndrome, and chronic kidney disease. A common genetic background as well as several acquired risk factors links psoriasis to comorbidities. From a clinical prespective, the understanding of the patients in the context of these comorbidities is very important to ensure that treatment is tailored to meet the individual patient needs. Indeed, some pharmacological treatments may negatively affect cardio-metabolic comorbidities, and have important interactions with drugs that are commonly used to treat them. Non-pharmacological intervention such as diet, smoking cessation, and physical exercise could both improve the response to treatments for psoriasis and reduce the cardiovascular risk.

Nonalcoholic fatty liver disease - A multisystem disease?

“…The pathogenesis of both psoriasis and NAFLD depends on several cytokines, both proinflammatory (TNF-α, IL-6, leptin, visfatin) and anti-inflammatory (adiponectin) cytokines. Additionally, adiponectin levels are lower in patients affected by both NAFLD and psoriasis than in patients affected by psoriasis without NAFLD[154,155-158,164-168]. Another hypothesis is that NAFLD itself can contribute to the severity of psoriasis by releasing proinflammatory cytokines from the liver[154].…”

Psoriasis Area and Severity Index response in moderate‐severe psoriatic patients switched to adalimumab: results from the OPPSA study

“…Our analysis identified that patients without diabetes/metabolic syndrome were associated with better achievement of PASI response, particularly in the first 6 months following adalimumab treatment. Actually, moderate‐to‐severe psoriasis is frequently associated with the metabolic syndrome and its disorders such as type 2 diabetes, dyslipidemia and obesity . The underlying mechanisms affecting the efficacy of adalimumab in psoriasis patients with the metabolic syndrome are still poorly understood; however, studies exploring the genetic predispositions of patients may provide insight as to why patients respond to one biologic but not another .…”

“…Actually, moderate-to-severe psoriasis is frequently associated with the metabolic syndrome and its disorders such as type 2 diabetes, dyslipidemia and obesity. 35,36 The underlying mechanisms affecting the efficacy of adalimumab in psoriasis patients with PASI after switching to adalimumab the metabolic syndrome are still poorly understood; however, studies exploring the genetic predispositions of patients may provide insight as to why patients respond to one biologic but not another. 34 While the presence of the HLA-C*06:02 polymorphism in psoriatic patients has been shown to be associated with the efficacy of other biologics, 25 our group has previously demonstrated that the effect of adalimumab treatment was not associated with this allele.…”

Metabolic syndrome in dermatology: Treatment and Management for Dermatologists

“…Table demonstrates the adverse effects of conventional and biologic anti‐psoriatic agents on the metabolic diseases. Conventional treatment methods lead to more adverse effects than the biologics (Gisondi, Galvan, Idolazzi, & Girolomoni, ). Anti‐TNF agents can even decrease the metabolic risks (Altunel & Kartal, ).…”

“…Conventional treatment methods lead to more adverse effects than the biologics (Gisondi, Galvan, Idolazzi, & Girolomoni, 2015). Anti-TNF agents can even decrease the metabolic risks (Altunel & Kartal, 2017).…”