Romero-Talamás Héctor, Aminian Ali, Corcelles Ricard, Fernandez Anthony P, Schauer Philip R, Brethauer Stacy
Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
Departments of Dermatology and Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio.
Surg Obes Relat Dis. 2014 Nov-Dec;10(6):1155-9. doi: 10.1016/j.soard.2014.03.025. Epub 2014 Apr 18.
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.
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.
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.
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.
银屑病是一种慢性炎症性皮肤病，已知与肥胖和代谢综合征有关。单例报告和小样本系列研究表明，减肥手术后银屑病可缓解或改善，推测是通过胰高血糖素样肽-1（GLP-1）介导的机制。本研究的目的是调查减肥手术对肥胖患者银屑病临床症状的影响。
共纳入33例正在接受积极药物治疗的重度肥胖银屑病患者。从我们的数据库中提取人口统计学特征和随访数据。记录术前及减肥手术后至少6个月的用药情况和体表面积受累百分比（%ABSA）。
9例（27.2%）患者基线时接受全身治疗。平均随访时间为26.2±20.3个月，平均超重减轻（EWL）达48.7±26.6%。这分别与30.3%和26.1%的患者银屑病改善相关，改善基于用药降级和%ABSA降低。总共33例患者中有13例（39.4%）根据任一标准有改善。8例（24.2%）患者在最近一次随访时未使用任何银屑病药物（P = 0.001）。手术时年龄较大（54.8±8.1岁对48.1±10.4岁，P = 0.047）、采用Roux-en-Y胃旁路术而非非旁路手术（52.4%对16.7%，P = 0.043）以及更大的EWL（64.2±26.0%对43.4±(23.6%，P = 0.036)预示着病情改善。仅1例（3%）患者术后病情恶化。
我们队列中近40%的患者在减肥手术后数月银屑病有改善。改善与术后体重减轻程度直接相关，并与Roux-en-Y术式有关。
