Metabolic syndrome and the skin: a more than superficial association. Reviewing the association between skin diseases and metabolic syndrome and a clinical decision algorithm for high risk patients

Abstract

There is ongoing scientific interest regarding comorbidities associated with the metabolic syndrome (MeTS). MeTS comprises a combination of parameters that predispose individuals to the development of type 2 diabetes and cardiovascular disease (CVD). Three or more of the following criteria are necessary: fasting glucose > 110 mg/dl (5.6 mmol/l), hypertriglyceridemia > 150 mg/dl (1.7 mmol/l), HDL levels < 40 mg/dl (men)/< 50 mg/dl (women), blood pressure > 130/85 mmHg, waist circumference (values for Mediterranean populations > 94 cm (men)/> 89 cm (women). In this review we attempted to summarize relevant data by searching dermatological literature regarding associations between various skin conditions and MeTS. A multitude of studies was retrieved and a further goal of the present article is to present plausible mechanistic connections. The severity of skin conditions like psoriasis has been linked with MeTS. Parameters of MeTS like insulin resistance are present in patients with early onset androgenic alopecia, hidradenitis suppurativa acne and rosacea. Since MeTS can lead to CVD and type 2 diabetes early detection of patients would be very important. Also therapeutic intervention on MeTS could lead to improvement on the severity of skin conditions. This reciprocal relationship between skin diseases and MeTS in our opinion holds great interest for further investigation.

High prevalence of non‐alcoholic fatty liver disease among hidradenitis suppurativa patients independent of classic metabolic risk factors

“…In this regard, the values measuring liver steatosis and liver stiffness (CAP and kPa values) were significantly higher in HS patients than in controls. According to the previous literature, the prevalence of obesity, metabolic syndrome and active smoking was more frequent in the HS group. Our study did not show significant differences between the HS and the control group in T2DM, cardiovascular events and blood levels of transaminases.…”

“…Hidradenitis suppurativa is currently recognized as a systemic inflammatory condition extended beyond the skin. Accordingly, it has been associated with various systemic inflammatory conditions such as arthritis, spondyloarthropathies, inflammatory bowel disease and traditional comorbidities related to liver steatosis, such as obesity, insulin resistance, type 2 diabetes mellitus (T2DM), dyslipidaemia, metabolic syndrome and subclinical atherosclerosis …”

“…Accordingly, it has been associated with various systemic inflammatory conditions such as arthritis, spondyloarthropathies, inflammatory bowel disease and traditional comorbidities related to liver steatosis, such as obesity, insulin resistance, type 2 diabetes mellitus (T2DM), dyslipidaemia, metabolic syndrome and subclinical atherosclerosis. [4][5][6][7][8][9] Non-alcoholic fatty liver disease (NAFLD) encompasses a spectrum of conditions, ranging from simple steatosis, with a predominantly benign course, to more aggressive forms of liver necro-inflammation (non-alcoholic steatohepatitis; NASH), that may eventually lead to fibrosis, cirrhosis and hepatocellular carcinoma. 10 NAFLD is the most common chronic liver disease in Western countries and is also expected to become the most frequent indication for liver transplantation in USA by 2030.…”

Long‐term isotretinoin use does not cause parenchymal liver change: Ultrasonographic study in 50 patients

“…Metabolic syndrome is closely related to hyperlipidemia and so hepatosteatocytosis. (Stefanadi et al, ; Uzuncakmak, Akdeniz, & Karadag, ). Surprisingly, our patients did not reveal an abnormal hepatosteatocytosis on liver sonography except a few relatively older patients who could already be expected to have fatty liver.…”

<p>Could Inflammaging and Its Sequelae Be Prevented or Mitigated?</p>

“…Moreover, subjects with chronic cutaneous inflammatory diseases, such as psoriasis and eczematous dermatitis, also display an increased prevalence of aging-associated disorders, including atherosclerotic cardiovascular disease, obesity and type 2 diabetes. 8 Though anti-inflammatory regimens, such as inhibitors of IL-1βα and TNFα, as well as methotrexate, have been deployed in the management of these aging-associated disorders, the outcomes of treatments with these agents have been inconclusive. 9 It is possible that the effective, pathogenesis-based preventive regimens remain unavailable, in large part, because of the uncertainty of the pathogenesis of "inflammaging".…”