RESUMO
Psoriasis is a chronic systemic disease with important skin manifestations, affecting 2 % of the population. It is more frequent and severe in obese patients, and both have been associated with a higher cardiovascular risk. Recent studies suggest that weight loss may improve psoriasis and metabolic comorbidities in obese patients. We reviewed our prospective electronic database for all patients with psoriasis who underwent bariatric surgery between 2008 and 2011. We assessed surgical complications, weight progression, and psoriasis-related outcomes. The Dermatology Life Quality Index was used retrospectively to assess quality of life (QoL) before and after the operation. Ten patients were included; body mass index was 38.8 ± 5.2 kg/m(2). Pre-surgical treatment for psoriasis was topical (50 %) and systemic (40 %). Eight patients underwent laparoscopic Roux-en-Y gastric bypass and two underwent laparoscopic sleeve gastrectomy. At follow-up, the mean percent excess weight loss 1, 6, and 12 months after surgery was 45 %, 80 %, and 88 %, respectively. Comorbidity resolution was 75 % for diabetes mellitus, 100 % for insulin resistance, and 57 % for hypertension. Related to psoriasis, 70 % of the patients stayed in remission 6 months after surgery and three of the four patients who were previously medicated with systemic drugs discontinued medication. The impact of psoriasis on QoL improved from 14.9 ± 6.8 before surgery to 5 ± 6.3 after surgery (p = 0.005). Bariatric surgery for positive metabolic, skin, and quality of life results should be considered as a useful adjuvant therapy for obese patients with psoriasis.
Assuntos
Gastrectomia/métodos , Derivação Gástrica/métodos , Obesidade Mórbida/complicações , Obesidade Mórbida/cirurgia , Psoríase/complicações , Qualidade de Vida , Adulto , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos , Psoríase/imunologia , Indução de Remissão , Fatores de Risco , Resultado do Tratamento , Fator de Necrose Tumoral alfa/imunologia , Redução de PesoRESUMO
Epidemiological studies have shown that patients with psoriasis have a higher risk of developing certain metabolic disorders, particularly obesity. Psoriasis and obesity are linked through a common pathophysiological mechanism of chronic low-grade inflammation. Not only is obesity associated with a higher incidence of psoriasis and greater severity, but it also affects response to treatment. The dermatologic management of these patients must therefore take their overall metabolic situation into consideration. We present a review of the recent literature on this subject and practical recommendations on the management of this group of patients, including relevant additional tests and advice on diet and a healthy lifestyle.
