There is a strong association between psoriasis and metabolic comorbidities, including obesity, hypertension, diabetes mellitus, dyslipidemia, and fatty liver disease. |
The presence of metabolic comorbidities significantly influences the selection and effectiveness of pharmacological treatments. |
Pharmacological and non-pharmacological interventions, such as a low-calorie diet, alcohol abstinence, physical activity, and smoking avoidance, could be very useful in the global management of patients with psoriasis with metabolic comorbidities. |
1 Introduction
2 Epidemiology Data Supporting the Association Between Psoriasis and Metabolic Comorbidities
3 Shared Pathomechanisms Between Psoriasis and Metabolic Comorbidities
4 Therapies Approved for Psoriasis and Their Potential Effects on Metabolic Comorbidities
4.1 Conventional Systemics
4.1.1 Methotrexate
4.1.2 Cyclosporine
4.1.3 Acitretin
4.1.4 Dimethyl Fumarate
4.2 Biologics
4.2.1 TNF-α Inhibitors
4.2.2 IL-12/23 Inhibitors
4.2.3 IL-17 Inhibitors
4.2.4 IL-23 Inhibitors
4.2.5 Small Molecules
5 Pharmacological and Non-pharmacological Interventions Targeting Metabolic Comorbidities
Complete blood count | Hemoglobin, white blood cell count, platelet count |
Glucose levels | Fasting glucose, glycated hemoglobin |
Lipids | Total cholesterol, low-density lipoprotein, high-density lipoprotein, triglycerides |
Liver enzymes | Alanine transaminase, aspartate transaminase |
Renal function tests | Serum creatinine, blood urea nitrogen, glomerular filtration rate |
5.1 Diet
Study | Study design | Number of patients | Duration | Intervention | Additional therapy allowed | Main results |
---|---|---|---|---|---|---|
Schultz et al. [89], 2020 | RCT-IB | 25 | 24 wk | Balanced protein-to-fat-to-carbohydrate ratio diet (intervention) vs usual diet (controls) | Topical treatments | No difference in PASI vs controls |
Naldi et al. [74], 2014 | RCT-IB | 303 | 20 wk | Diet and exercise (intervention) vs informative counseling at baseline (controls) | Systemic treatments | Median PASI reduction at 20 wk: 48% vs 25.5% (p = 0.02) PASI50 at 20 wk: 49.7% vs 34.2% (p = 0.006) |
Al-Mutairi et al. [76], 2014 | RCT | 262 | 24 wk | Low calorie diet (≤1000 kcal/day) (intervention) vs normal diet (controls) | Biologics | PASI75 at 24 wk: 85.9% vs 59.3% (p < 0.001) |
Guida et al. [77], 2014 | RCT-IB | 44 | 6 mo | Energy-restricted diet enriched in n-3 polyunsaturated fatty acids (intervention) vs usual diet (controls) | Systemic treatments (MTX, CsA, biologics) | Mean ± SD PASI at 3 mo: 5.3 ± 4.3 vs 7.8 ± 4.1 (p < 0.05). At 6 mo: 2.6 ± 3.0 vs 7.8 ± 1.9 (p < 0.05) |
Jensen et al. [78], 2013 | RCT | 60 | 16 wk | Low energy diet (800–1000 kcal/day) for 8 wk, then 1200 kcal/day for further 8 wk (intervention) vs normal healthy diet (controls) | Systemic treatments | Mean change in PASI at 16 wk: −2.3 vs −0.3 (p = 0.06) |
Del Giglio et al. [79], 2012 | RCT-IB | 42 | 24 wk | Low-calorie diet (intervention) vs normal diet (controls) | None (patients previously taking MTX, stopped during study) | No significant difference in psoriasis severity vs controls |
Kimball et al. [88], 2012 | RCT | 30 | 12 wk | Ornish diet vs South Beach diet (interventions) vs no dietary intervention (controls) | nb-UVB phototherapy | PASI75 at 12 wk: 83% (Ornish diet) vs 56% (South Beach diet) vs 38% (controls) [p = 0.30 between the two diet groups] |
Gisondi et al. [9], 2008 | RCT-IB | 61 | 24 wk | CsA + low-caloric diet (intervention) vs CsA alone (controls) | None | PASI75 at 24 wk: 66.7% vs 29.0% (p < 0.001) |