title: Psoriasis improvement after bariatric surgery.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Héctor
authors.initials: H
authors.lastname: Romero-Talamás
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Ali
authors.initials: A
authors.lastname: Aminian
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Ricard
authors.initials: R
authors.lastname: Corcelles
authors.affiliation: Departments of Dermatology and Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Fernandez
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Schauer
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: brethas@ccf.org.
authors.forename: Stacy
authors.initials: S
authors.lastname: Brethauer
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000379:methods*; D015992:Body Mass Index; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods; D015391:Gastroplasty / Q000379:methods; D052216:Glucagon-Like Peptide 1 / Q000032:analysis; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D011237:Predictive Value of Tests; D011565:Psoriasis / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D015431:Weight Loss
chemical_list: D052216:Glucagon-Like Peptide 1
keywords: Bariatric surgery; GLP-1; Gastric bypass; Metabolic syndrome; Psoriasis