Challenges in Managing Metabolic Syndrome in Psoriasis: A Narrative Review of Pharmacological and Surgical Treatments
DOI:
https://doi.org/10.12775/QS.2025.40.59483Keywords
metabolic syndrome, obesity, psoriasis, hypoglycemic agents, bariatric surgeryAbstract
Introduction: Psoriasis is a chronic inflammatory disorder associated with multiple systemic comorbidities, most notably metabolic syndrome, which affects approximately one-third of individuals with the disease. Metabolic syndrome—characterized by obesity, insulin resistance, dyslipidemia, and hypertension—exacerbates systemic inflammation, further complicating disease management and treatment outcomes.
Aim of Study: This review explores the multidisciplinary approach to managing metabolic syndrome in psoriasis, with a particular focus on pharmacological and surgical interventions. It examines the challenges associated with these treatments and their implications for therapeutic efficacy.
Brief Description of the State of Knowledge: Psoriasis and metabolic syndrome share a complex, reciprocal relationship driven by chronic inflammation and metabolic dysregulation. While lifestyle modifications remain the cornerstone of management, many patients require additional pharmacological or surgical interventions. However, the presence of metabolic syndrome can alter the safety and effectiveness of systemic and biologic psoriasis therapies, underscoring the need for a personalized treatment approach.
Conclusions: Effective management requires interdisciplinary collaboration. Pharmacological treatments should minimize metabolic risks, while bariatric surgery may benefit selected patient groups. Further studies are needed to optimize treatment strategies and improve outcomes.
References
1. Parisi, R., et al., National, regional, and worldwide epidemiology of psoriasis: systematic analysis and modelling study. Bmj, 2020. 369: p. m1590.
2. Michalek, I., B. Loring, and S. John, WHO Global report on psoriasis. 2016.
3. Cao, F., et al., Global burden and cross-country inequalities in autoimmune diseases from 1990 to 2019. Autoimmun Rev, 2023. 22(6): p. 103326.
4. Hao, C., et al., Global incidence trends of autoimmune diseases from 1990 to 2021 and projections to 2050: A systemic analysis of the global burden of disease study 2021. Autoimmun Rev, 2024: p. 103621.
5. Luo, H., Global burden and cross-country inequalities in six major immune-mediated inflammatory diseases from 1990 to 2021: A systemic analysis of the Global Burden of Disease Study 2021. Autoimmun Rev, 2024. 23(10): p. 103639.
6. Deng, Y., C. Chang, and Q. Lu, The Inflammatory Response in Psoriasis: a Comprehensive Review. Clin Rev Allergy Immunol, 2016. 50(3): p. 377-89.
7. Georgescu, S.R., et al., Advances in Understanding the Immunological Pathways in Psoriasis. Int J Mol Sci, 2019. 20(3).
8. Saumya, C., et al., The Association of Metabolic Syndrome and Psoriasis: A Systematic Review and Meta-Analysis of Observational Study. Endocrine, Metabolic & Immune Disorders - Drug Targets, 2020. 20(5): p. 703-717.
9. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation, 2002. 106(25): p. 3143-421.
10. Alberti, K.G., P. Zimmet, and J. Shaw, Metabolic syndrome--a new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabet Med, 2006. 23(5): p. 469-80.
11. Grundy, S.M., et al., Diagnosis and Management of the Metabolic Syndrome. Circulation, 2005. 112(17): p. 2735-2752.
12. Montecucco, F., F. Mach, and A. Pende, Inflammation is a key pathophysiological feature of metabolic syndrome. Mediators Inflamm, 2013. 2013: p. 135984.
13. Hao, Y., et al., Metabolic Syndrome and Psoriasis: Mechanisms and Future Directions. Front Immunol, 2021. 12: p. 711060.
14. McEvoy, J.W., et al., 2024 ESC Guidelines for the management of elevated blood pressure and hypertension: Developed by the task force on the management of elevated blood pressure and hypertension of the European Society of Cardiology (ESC) and endorsed by the European Society of Endocrinology (ESE) and the European Stroke Organisation (ESO). European Heart Journal, 2024. 45(38): p. 3912-4018.
15. Visseren, F.L.J., et al., 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J, 2021. 42(34): p. 3227-3337.
16. Armstrong, A.W., C.T. Harskamp, and E.J. Armstrong, The association between psoriasis and hypertension: a systematic review and meta-analysis of observational studies. J Hypertens, 2013. 31(3): p. 433-42; discussion 442-3.
17. Abel, E.A., et al., Drugs in exacerbation of psoriasis. J Am Acad Dermatol, 1986. 15(5 Pt 1): p. 1007-22.
18. Gold, M.H., A.K. Holy, and H.H. Roenigk, Beta-blocking drugs and psoriasis: A review of cutaneous side effects and retrospective analysis of their effects on psoriasis. Journal of the American Academy of Dermatology, 1988. 19(5, Part 1): p. 837-841.
19. Song, G., et al., Antihypertensive drug use and psoriasis: A systematic review, meta- and network meta-analysis. Br J Clin Pharmacol, 2022. 88(3): p. 933-941.
20. Brauchli, Y.B., et al., Association between beta-blockers, other antihypertensive drugs and psoriasis: population-based case-control study. Br J Dermatol, 2008. 158(6): p. 1299-307.
21. Wu, S., et al., Hypertension, antihypertensive medication use, and risk of psoriasis. JAMA Dermatol, 2014. 150(9): p. 957-63.
22. Elmets, C.A., et al., Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities. Journal of the American Academy of Dermatology, 2019. 80(4): p. 1073-1113.
23. Daudén, E., et al., Clinical practice guideline for an integrated approach to comorbidity in patients with psoriasis. J Eur Acad Dermatol Venereol, 2013. 27(11): p. 1387-404.
24. Knowler, W.C., et al., Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med, 2002. 346(6): p. 393-403.
25. Singh, S. and A. Bhansali, Randomized placebo control study of insulin sensitizers (Metformin and Pioglitazone) in psoriasis patients with metabolic syndrome (Topical Treatment Cohort). BMC Dermatol, 2016. 16(1): p. 12.
26. Lin, X., et al., Peroxisome proliferator-activator receptor γ and psoriasis, molecular and cellular biochemistry. Mol Cell Biochem, 2022. 477(7): p. 1905-1920.
27. Chang, G., et al., Efficacy and safety of pioglitazone for treatment of plaque psoriasis: a systematic review and meta-analysis of randomized controlled trials. J Dermatolog Treat, 2020. 31(7): p. 680-686.
28. Chen, P., et al., The efficacy and safety of pioglitazone in psoriasis vulgaris: A meta-analysis of randomized controlled trials. Medicine (Baltimore), 2020. 99(32): p. e21549.
29. Hogan, A.E., et al., Glucagon-like peptide-1 (GLP-1) and the regulation of human invariant natural killer T cells: lessons from obesity, diabetes and psoriasis. Diabetologia, 2011. 54(11): p. 2745-54.
30. Haran, K., et al., Impact of GLP-1 Receptor Agonists on Psoriasis and Cardiovascular Comorbidities: A Narrative Review. Psoriasis (Auckl), 2024. 14: p. 143-152.
31. Sun, X., et al., Effect of Different Types of Hypoglycemic Medications on Psoriasis: An Analysis of Current Evidence. Dermatology, 2023. 239(2): p. 299-313.
32. Grundy, S.M., et al., 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 2019. 139(25): p. e1082-e1143.
33. Taylor, F., et al., Statins for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev, 2013. 2013(1): p. Cd004816.
34. Trong, H.N., et al., Efficacy of Adding Oral Simvastatin to Topical Therapy for Treatment of Psoriasis: The Vietnamese Experience. Open Access Maced J Med Sci, 2019. 7(2): p. 237-242.
35. Vasiuk Iu, A., et al., [Possibilities of atorvastatin in complex management of extensive psoriasis in patients with arterial hypertension]. Kardiologiia, 2010. 50(3): p. 37-46.
36. Garshick, M.S., et al., Statin therapy upregulates arachidonic acid status via enhanced endogenous synthesis in patients with plaque psoriasis. Prostaglandins Leukot Essent Fatty Acids, 2022. 180: p. 102428.
37. Garshick, M.S., et al., A Randomized Open-Label Clinical Trial of Lipid-Lowering Therapy in Psoriasis to Reduce Vascular Endothelial Inflammation. J Invest Dermatol, 2022. 142(6): p. 1749-1752.e4.
38. Socha, M., et al., The effect of statins on psoriasis severity: a meta-analysis of randomized clinical trials. Arch Med Sci, 2020. 16(1): p. 1-7.
39. Aleid, A.M., et al., The Impact of Statins on Disease Severity and Quality of Life in Patients with Psoriasis: A Systematic Review and Meta-Analysis. Healthcare (Basel), 2024. 12(15).
40. Colsman, A. and M. Sticherling, Simvastatin in psoriasis: ambiguous effects. Acta Derm Venereol, 2010. 90(4): p. 411.
41. Cozzani, E., M. Scaparro, and A. Parodi, A case of psoriasis worsened by atorvastatin. J Dermatol Case Rep, 2009. 3(4): p. 60-1.
42. Jacobi, T.C. and A. Highet, A clinical dilemma while treating hypercholesterolaemia in psoriasis. Br J Dermatol, 2003. 149(6): p. 1305-6.
43. Gonzalez-Cantero, A., et al., Statins and psoriasis: Position statement by the Psoriasis Task Force of the European Academy of Dermatology and Venerology. Journal of the European Academy of Dermatology and Venereology, 2023. 37(9): p. 1697-1705.
44. Imamura, T., et al., [Clofibrate treatment of psoriasis with hypertriglycemia--clinical, histological and laboratory analysis]. Nihon Hifuka Gakkai Zasshi, 1991. 101(6): p. 623-8.
45. Vahlquist, C., et al., Effects of gemfibrozil (Lopid) on hyperlipidemia in acitretin-treated patients. Results of a double-blind cross-over study. Acta Derm Venereol, 1995. 75(5): p. 377-80.
46. Fisher, D.A., P.M. Elias, and P.L. LeBoit, Exacerbation of psoriasis by the hypolipidemic agent, gemfibrozil. Arch Dermatol, 1988. 124(6): p. 854-5.
47. Park, A. and T.H. Heo, IL-17A-targeting fenofibrate attenuates inflammation in psoriasis by inducing autophagy. Life Sci, 2023. 326: p. 121755.
48. Kamata, M. and Y. Tada, Efficacy and Safety of Biologics for Psoriasis and Psoriatic Arthritis and Their Impact on Comorbidities: A Literature Review. Int J Mol Sci, 2020. 21(5).
49. Vahlquist, A., Long-term safety of retinoid therapy. J Am Acad Dermatol, 1992. 27(6 Pt 2): p. S29-33.
50. Laburte, C., et al., Efficacy and safety of oral cyclosporin A (CyA; Sandimmun) for long-term treatment of chronic severe plaque psoriasis. Br J Dermatol, 1994. 130(3): p. 366-75.
51. Zachariae, H. and T. Steen Olsen, Efficacy of cyclosporin A (CyA) in psoriasis: an overview of dose/response, indications, contraindications and side-effects. Clin Nephrol, 1995. 43(3): p. 154-8.
52. Novartis Pharmaceuticals Canada Inc, 2003. Neoral (Cyclosporine). Product monograph.
53. KRUPP, P. and C. MONKA, Side‐effect profile of cyclosporin A in patients treated for psoriasis. British Journal of Dermatology, 1990. 122(s36): p. 47-56.
54. Al-Yafeai, Z., et al., Novel anti-psoriasis agent-associated cardiotoxicity, analysis of the FDA adverse event reporting system (FAERS). Int J Cardiol, 2024. 402: p. 131819.
55. Kwon, H.J., et al., Case reports of heart failure after therapy with a tumor necrosis factor antagonist. Ann Intern Med, 2003. 138(10): p. 807-11.
56. Zhou, Y., et al., Anti-tumor Necrosis Factor-Alpha Therapy and Hypoglycemia: A Real-World Pharmacovigilance Analysis. Drug Safety, 2022. 45(9): p. 951-959.
57. Warren, R.B., et al., Bimekizumab versus Adalimumab in Plaque Psoriasis. New England Journal of Medicine, 2021. 385(2): p. 130-141.
58. Vata, D., et al., Update on Obesity in Psoriasis Patients. Life (Basel), 2023. 13(10).
59. Gisondi, P., et al., Weight loss improves the response of obese patients with moderate-to-severe chronic plaque psoriasis to low-dose cyclosporine therapy: a randomized, controlled, investigator-blinded clinical trial. Am J Clin Nutr, 2008. 88(5): p. 1242-7.
60. Al-Mutairi, N. and T. Nour, The effect of weight reduction on treatment outcomes in obese patients with psoriasis on biologic therapy: a randomized controlled prospective trial. Expert Opin Biol Ther, 2014. 14(6): p. 749-56.
61. Enos, C.W., et al., Comorbid obesity and history of diabetes are independently associated with poorer treatment response to biologics at 6 months: A prospective analysis in Corrona Psoriasis Registry. J Am Acad Dermatol, 2022. 86(1): p. 68-76.
62. Pinter, A., et al., Characterization of responder groups to secukinumab treatment in moderate to severe plaque psoriasis. J Dermatolog Treat, 2020. 31(8): p. 769-775.
63. Talamonti, M., et al., Psoriasis Area and Severity Index response in moderate-severe psoriatic patients switched to adalimumab: results from the OPPSA study. J Eur Acad Dermatol Venereol, 2018. 32(10): p. 1737-1744.
64. Jacobi, A., S.J. Rustenbach, and M. Augustin, Comorbidity as a predictor for drug survival of biologic therapy in patients with psoriasis. Int J Dermatol, 2016. 55(3): p. 296-302.
65. Feldman, S.R., et al., Real-world treatment patterns and healthcare costs of biologics and apremilast among patients with moderate-to-severe plaque psoriasis by metabolic condition status. J Dermatolog Treat, 2021. 32(2): p. 203-211.
66. Shalom, G., et al., Factors associated with drug survival of methotrexate and acitretin in patients with psoriasis. Acta Derm Venereol, 2015. 95(8): p. 973-7.
67. Eisenberg, D., et al., 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): Indications for Metabolic and Bariatric Surgery. Surgery for Obesity and Related Diseases, 2022. 18(12): p. 1345-1356.
68. Hossler, E.W., et al., The effect of weight loss surgery on the severity of psoriasis. Br J Dermatol, 2013. 168(3): p. 660-1.
69. Farias, M.M., et al., Psoriasis following bariatric surgery: clinical evolution and impact on quality of life on 10 patients. Obes Surg, 2012. 22(6): p. 877-80.
70. Hosseininasab, A., et al., The long-term impact of bariatric surgery on psoriasis symptoms and severity: a prospective observational study. Surg Obes Relat Dis, 2024. 20(12): p. 1208-1213.
71. Higa-Sansone, G., et al., Psoriasis remission after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg, 2004. 14(8): p. 1132-4.
72. de Menezes Ettinger, J.E., et al., Remission of psoriasis after open gastric bypass. Obes Surg, 2006. 16(1): p. 94-7.
73. Babino, G., et al., Morbid obesity and psoriasis: Disease remission after laparoscopic sleeve gastrectomy. Obesity Research & Clinical Practice, 2017. 11(3): p. 370-372.
74. Laskowski, M., et al., Impact of Bariatric Surgery on Moderate to Severe Psoriasis: A Retrospective Nationwide Registry Study. Acta Derm Venereol, 2021. 101(6): p. adv00487.
75. Pérez‐Pérez, L., et al., Severe psoriasis, morbid obesity and bariatric surgery. Clinical and Experimental Dermatology, 2009. 34(7): p. e421-e422.
76. Adebajo, A. and T. Aldeen, Obesity and Psoriasis: Can Bariatric Surgery Trigger Psoriasis? Open Journal of Immunology, 2015.
77. Halawi, A., F. Abiad, and O. Abbas, Bariatric Surgery and Its Effects on the Skin and Skin Diseases. Obesity Surgery, 2013. 23(3): p. 408-413.
78. Ugale, S., et al., Laparoscopic bariatric surgery-current trends and controversies. Annals of Laparoscopic and Endoscopic Surgery, 2017. 2.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Aleksandra Bętkowska, Stanisław Dudek, Weronika Koziak, Michalina Makieła, Agata Kornacka, Wojciech Dudek, Kamila Szostak, Marta Makieła, Rafał Tomaka, Daniel Worobiej
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 52
Number of citations: 0
