Psoriasis improvement after bariatric surgery.

BACKGROUND

Psoriasis is a chronic inflammatory skin disease known to be associated with obesity and metabolic syndrome. Single case reports and small series suggest remission or improvement after bariatric surgery, hypothetically through a GLP-1 mediated mechanism. The objective of this study was to investigate on the effect of bariatric surgery on the clinical behavior of psoriasis in obese patients.

METHODS

A total of 33 morbidly obese individuals with psoriasis who were on active medical treatment were identified. Demographic characteristics and follow-up data were extracted from our database. Medication usage and percentage of affected body surface area (%ABSA) were recorded preoperatively and at least 6 months after bariatric surgery.

RESULTS

Nine (27.2%) patients were on systemic therapy at baseline. At a mean follow-up time of 26.2±20.3 months, a mean excess weight loss (EWL) of 48.7± 26.6% was achieved. This was associated with improvement of psoriasis based on downgrade of medication and %ABSA in 30.3% and 26.1% of patients, respectively. In total, 13 of 33 patients (39.4%) had improvement based on either criteria. Eight (24.2%) patients were not on any psoriasis medication at the latest follow-up (P = .001). Older age at the time of surgery (54.8±8.1 versus 48.1±10.4 years, P = .047), Roux-en-Y gastric bypass versus nonbypass procedures (52.4% versus 16.7%, P = .043), and greater EWL (64.2±26.0% versus 43.4± 23.6%, P = .036) predicted improvement. Only 1 (3%) patient experienced worsening after surgery.

CONCLUSION

Almost 40% of our cohort showed improvement of psoriasis several months after bariatric surgery. Improvement is directly related to the degree of postoperative weight loss and is associated with the Roux-en-Y configuration.