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Yan L, Yu C, Zhao Z, Zhang Y, Wang R, Li C. Higher IL-9 Level is Associated with Psoriasis Vulgaris Complicated by Metabolic Syndrome. Clin Cosmet Investig Dermatol 2023; 16:2297-2307. [PMID: 37641663 PMCID: PMC10460594 DOI: 10.2147/ccid.s422355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/15/2023] [Indexed: 08/31/2023]
Abstract
Purpose The underlying pathophysiology linking psoriasis vulgaris (PV) and metabolic syndrome (MetS) is not fully understood. The present study aimed to investigate the serum level of interleukin (IL)-9 and tissue levels of IL-9 and its receptor in PV patients with MetS and analyze the correlation of IL-9 levels with psoriasis disease severity and MetS. Methods This study enrolled 75 PV patients with MetS, 57 PV patients without MetS, 20 healthy blood donors, and 7 healthy skin donors. Clinical, socio-demographic, and anthropometric data were obtained from all individuals. Fasting blood glucose, insulin, lipid profile levels, and serum levels of IL-9 and IL-17A were measured. The expression of IL-9 and its receptor in skin specimens in PV patients and healthy controls was determined using immunohistochemistry. Normal human epidermal keratinocytes were stimulated with five pro-inflammatory cytokines (tumor necrosis factor-α, oncostatin M, IL-22, IL-17A, and IL-1α) to establish a psoriatic keratinocyte model and subsequently treated with IL-9. Their mRNA levels of antimicrobial peptides and chemokines were measured using quantitative real-time polymerase chain reaction. Results Serum level of IL-9 and tissue levels of IL-9 and its receptor were upregulated in PV patients with MetS. IL-9 level was positively correlated to IL-17A level; however, no significant correlation of IL-9 level with psoriasis area severity index was observed. IL-9 level had a positive correlation with the presence of MetS and its components. Correspondingly, IL-9 level positively correlated with waist circumference, body mass index, homeostasis model assessment-insulin resistance, blood pressure, and triglyceride level and negatively correlated with high-density lipoprotein cholesterol level. Additionally, IL-9 stimulated the expression of antimicrobial peptides and chemokines in a psoriatic keratinocyte model. Conclusion Our findings confirmed that higher IL-9 level is associated with PV complicated by MetS, suggesting that IL-9 may be a link between PV and MetS.
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Affiliation(s)
- Liang Yan
- Department of Dermatology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
- Department of Dermatology, General Hospital of Central Theater Command of PLA, Wuhan, Hubei, 430070, People’s Republic of China
| | - Chongli Yu
- Department of Dermatology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
| | - Zhenkai Zhao
- Department of Dermatology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
| | - Yuan Zhang
- Department of Dermatology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
| | - Rui Wang
- Department of Dermatology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
| | - Chengxin Li
- Department of Dermatology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
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Biologic Treatment in Combination with Lifestyle Intervention in Moderate to Severe Plaque Psoriasis and Concomitant Metabolic Syndrome: Rationale and Methodology of the METABOLyx Randomized Controlled Clinical Trial. Nutrients 2021; 13:nu13093015. [PMID: 34578893 PMCID: PMC8471656 DOI: 10.3390/nu13093015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/19/2021] [Accepted: 08/27/2021] [Indexed: 01/04/2023] Open
Abstract
Inflammatory diseases including psoriasis are associated with metabolic and cardiovascular comorbidities, including obesity and metabolic syndrome. Obesity is associated with greater psoriasis disease severity and reduced response to treatment. Therefore, targeting metabolic comorbidities could improve patients’ health status and psoriasis-specific outcomes. METABOLyx is a randomized controlled trial evaluating the combination of a lifestyle intervention program with secukinumab treatment in psoriasis. Here, the rationale, methodology and baseline patient characteristics of METABOLyx are presented. A total of 768 patients with concomitant moderate to severe plaque psoriasis and metabolic syndrome were randomized to secukinumab 300 mg, or secukinumab 300 mg plus a tailored lifestyle intervention program, over 24 weeks. A substudy of immunologic and metabolic biomarkers is ongoing. The primary endpoint of METABOLyx is PASI90 response at week 24. Other endpoints include patient-reported outcomes and safety. METABOLyx represents the first large scale clinical trial of an immunomodulatory biologic in combination with a standardized lifestyle intervention.
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Choudhary S, Pradhan D, Pandey A, Khan MK, Lall R, Ramesh V, Puri P, Jain AK, Thomas G. The Association of Metabolic Syndrome and Psoriasis: A Systematic Review and Meta-Analysis of Observational Study. Endocr Metab Immune Disord Drug Targets 2020; 20:703-717. [DOI: 10.2174/1871530319666191008170409] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/14/2019] [Accepted: 09/16/2019] [Indexed: 02/06/2023]
Abstract
Background:
Metabolic syndrome worsens complications in psoriasis patients by predisposing
them to cardiovascular diseases. Psoriasis has been widely associated with metabolic syndrome;
however, it has still not been proven owing to a limited number of studies and some of those reporting
conflicting results.
Objective:
Psoriasis has reportedly been associated with metabolic syndrome; however, it has yet not
been established beyond doubt owing to conflicting literature. The present meta-analysis of observational
studies aims to evaluate the prevalence of metabolic syndrome in psoriasis patients and establish
an inferring point that psoriasis patients are certainly susceptible to metabolic syndrome. The study
will benefit clinicians to assess and monitor psoriasis patients for several associated comorbid conditions
and in its treatment.
Methods:
A systematic web search for ‘Psoriasis’, ‘Metabolic Syndrome’, ‘Hypertension’, ‘Plasma
Glucose’, ‘Dyslipidaemia’, ‘Waist Circumference’ was performed, collecting all original observational
studies on humans up to April 30, 2018. Depending on the inclusion and exclusion criteria, articles
were screened for eligibility. Due to the presence of significant heterogeneity, the Odds Ratio (OR)
was calculated using a random-effect model with Der-Simonian and Laird method. The statistical heterogeneity
was determined using I2 statistics. Comprehensive Meta-Analysis Software, Version 3 was
used to perform all the analysis.
Results:
Sixty-three studies encompassing 15,939 psoriasis patients and 103,984 controls were included
in this meta-analysis. Among them, 30.29 % of psoriasis patients were reported with metabolic
syndrome in comparison to 21.70 % of subjects in the control group. The present study clearly indicates
an increased prevalence of metabolic syndrome among psoriasis patients (OR: 2.077 [95% CI,
1.84 - 2.34]).
Conclusions:
The findings support the fact that psoriasis patients have a higher incidence of metabolic
syndrome. Our study also recommends that psoriasis patients should be regularly monitored for metabolic
syndrome complications and its associated risk factors such as hypertension, raised triglyceride,
lowered HDL Cholesterol, increased fasting plasma glucose, and waist circumference.
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Affiliation(s)
- Saumya Choudhary
- Department of Molecular and Cellular Engineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Allahabad, India
| | - Dibyabhaba Pradhan
- Computational Genomics Centre, Informatics, Systems and Research Management (ISRM) Division- Indian Council of Medical Research, New Delhi, India
| | - Anamika Pandey
- Department of Soil Science and Plant Nutrition, Selcuk University, Turkey
| | - Mohd. Kamran Khan
- Department of Soil Science and Plant Nutrition, Selcuk University, Turkey
| | - Rohit Lall
- Department of Molecular and Cellular Engineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Allahabad, India
| | - V. Ramesh
- Department of Skin and STD, Vardhman Mahavir Medical College, Safdarjung Hospital, New Delhi, India
| | - Poonam Puri
- Department of Skin and STD, Vardhman Mahavir Medical College, Safdarjung Hospital, New Delhi, India
| | - Arun K. Jain
- Biomedical Informatics Centre, National Institute of Pathology - Indian Council of Medical Research, New Delhi, India
| | - George Thomas
- Department of Molecular and Cellular Engineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Allahabad, India
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von Stebut E, Boehncke WH, Ghoreschi K, Gori T, Kaya Z, Thaci D, Schäffler A. IL-17A in Psoriasis and Beyond: Cardiovascular and Metabolic Implications. Front Immunol 2020; 10:3096. [PMID: 32010143 PMCID: PMC6974482 DOI: 10.3389/fimmu.2019.03096] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 12/18/2019] [Indexed: 12/14/2022] Open
Abstract
Interleukin 17A (IL-17A) is one of the currently known six members of the IL-17 cytokine family and is implicated in immune responses to infectious pathogens and in the pathogenesis of inflammatory autoimmune diseases like psoriasis. Psoriatic skin is characterized by high expression of IL-17A and IL-17F, which act on immune and non-immune cell types and strongly contribute to tissue inflammation. In psoriatic lesions, IL-17A, IL-17E, and IL-17F are involved in neutrophil accumulation, followed by the formation of epidermal micro abscesses. IL-17A together with other Th17 cytokines also upregulates the production of several chemokines that are implicated in psoriasis pathogenesis. IL17A-targeting antibodies show an impressive clinical efficacy in patients with psoriasis. Studies have reported an improvement of at least 75% as measured by the psoriasis area and severity index (PASI) in >80% of patients treated with anti-IL-17A therapy. Psoriasis skin manifestations, cardiovascular as well as metabolic disease in psoriasis appear to share pathogenic mechanisms evolving around IL-17A and its proinflammatory role. Thus, anti-IL-17A therapy not only improves skin manifestations of psoriasis, but also cardiovascular inflammation as well as metabolic factors and different domains of psoriatic arthritis (PsA) including peripheral arthritis, enthesitis, dactylitis, and axial involvement. This review summarizes the biological role of IL-17A, before reviewing currently available data on its role in the physiology and pathophysiology of the skin, as well as the cardiovascular and the metabolic system. In conclusion, clinical recommendations for patients with moderate to severe psoriasis based on the current available data are given.
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Affiliation(s)
| | - Wolf-Henning Boehncke
- Division of Dermatology and Venereology, Geneva University Hospitals, Geneva, Switzerland.,Department of Pathology and Immunology, Faculty of Medicine, University de Geneva, Geneva, Switzerland
| | - Kamran Ghoreschi
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tommaso Gori
- Center of Cardiology-Cardiology I, University Medical Center Mainz, Mainz, Germany.,German Center for Cardiovascular Research, University Center Mainz, Mainz, Germany
| | - Ziya Kaya
- Department of Internal Medicine III, University of Heidelberg, Heidelberg, Germany
| | - Diamant Thaci
- Institute and Comprehensive Center of Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - Andreas Schäffler
- Department of Internal Medicine III, Giessen University Hospital, Giessen, Germany
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Bernardini N, Skroza N, Tolino E, Mambrin A, Anzalone A, Balduzzi V, Colapietra D, Marchesiello A, Michelini S, Proietti I, Potenza C. IL-17 and its role in inflammatory, autoimmune, and oncological skin diseases: state of art. Int J Dermatol 2019; 59:406-411. [PMID: 31663126 PMCID: PMC7216999 DOI: 10.1111/ijd.14695] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 08/05/2019] [Accepted: 09/20/2019] [Indexed: 01/02/2023]
Abstract
Recent data support the theory of the involvement of IL‐17 in the pathogenesis of several chronic inflammatory skin diseases (psoriasis, atopic dermatitis, acne, hidradenitis suppurativa) and autoimmune skin diseases (alopecia areata, vitiligo, bullous diseases). Even if the role of IL‐17 in inflammatory and autoimmune diseases has been reported extensively, its role in tumor is still controversial. Some reports show that Th17 cells eradicate tumors, while others reveal that they promote the initiation and early growth of tumors. Herein, we review the role of IL‐17 in the involvement of some common dermatologic diseases: psoriasis, atopic dermatitis, hidradenitis suppurativa, acne, vitiligo, melanoma, and nonmelanoma skin cancers.
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Affiliation(s)
- Nicoletta Bernardini
- Dermatology Unit "Daniele Innocenzi", Department of Medico-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Teracina, Italy
| | - Nevena Skroza
- Dermatology Unit "Daniele Innocenzi", Department of Medico-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Teracina, Italy
| | - Ersilia Tolino
- Dermatology Unit "Daniele Innocenzi", Department of Medico-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Teracina, Italy
| | - Alessandra Mambrin
- Dermatology Unit "Daniele Innocenzi", Department of Medico-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Teracina, Italy
| | - Alessia Anzalone
- Dermatology Unit "Daniele Innocenzi", Department of Medico-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Teracina, Italy
| | - Veronica Balduzzi
- Dermatology Unit "Daniele Innocenzi", Department of Medico-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Teracina, Italy
| | - Daniela Colapietra
- Dermatology Unit "Daniele Innocenzi", Department of Medico-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Teracina, Italy
| | - Anna Marchesiello
- Dermatology Unit "Daniele Innocenzi", Department of Medico-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Teracina, Italy
| | - Simone Michelini
- Dermatology Unit "Daniele Innocenzi", Department of Medico-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Teracina, Italy
| | - Ilaria Proietti
- Dermatology Unit "Daniele Innocenzi", Department of Medico-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Teracina, Italy
| | - Concetta Potenza
- Dermatology Unit "Daniele Innocenzi", Department of Medico-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Teracina, Italy
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Pinter A, Gerdes S, Papavassilis C, Reinhardt M. Characterization of responder groups to secukinumab treatment in moderate to severe plaque psoriasis. J DERMATOL TREAT 2019; 31:769-775. [PMID: 31287332 DOI: 10.1080/09546634.2019.1626973] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background: Secukinumab is a fully human monoclonal antibody that neutralizes interleukin-17A (IL-17A), a key cytokine involved in the development of psoriasis. Here, we characterized secukinumab treatment-responder profiles and identified baseline factors affecting response.Methods: Pooled phase 3 data from moderate to severe plaque psoriasis patients treated with secukinumab for 16 weeks (FIXTURE [NCT01358578], ERASURE [NCT01365455], and CLEAR [NCT02074982]) were analyzed to characterize responder groups, identifying factors associated with treatment response, and to evaluate early response kinetics as a biomarker for treatment response. Etanercept and ustekinumab were evaluated as comparators.Results: Patients treated with secukinumab 300 mg (n = 867), ustekinumab 45/90 mg (n = 318), and etanercept 50 mg (n = 298) were evaluated. For secukinumab 300 mg, more patients were in higher responder groups than etanercept and ustekinumab. In higher response groups, fewer patients had previous systemic or biologic treatment, metabolic syndrome, hypertension, diabetes, and fewer were current smokers. Mean body weight, waist circumference, and BMI decreased as response level increased. Early onset of response (PASI50 at Week 4 or 8) correlated with sustained efficacy at Week 16.Conclusions: Baseline factors, including weight and cardiometabolic status, were associated with response to secukinumab. Early onset of response may indicate treatment efficacy later on.
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Affiliation(s)
- Andreas Pinter
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Sascha Gerdes
- Psoriasis-Center, Department of Dermatology, University Medical Center Schleswig-Holstein, Kiel, Germany
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Association Between Hidradenitis Suppurativa and Metabolic Syndrome: A Systematic Review and Meta-analysis. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2019.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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8
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Association Between Hidradenitis Suppurativa and Metabolic Syndrome: A Systematic Review and Meta-analysis. ACTAS DERMO-SIFILIOGRAFICAS 2019; 110:279-288. [PMID: 30846164 DOI: 10.1016/j.ad.2018.10.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 09/05/2018] [Accepted: 10/21/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Recent studies have shown a relationship between hidradenitis suppurativa (HS) and metabolic syndrome (MS), but the literature offers no meta-analysis restricted to studies that have been adjusted for confounders. OBJECTIVE To determine the association between HS and MS. METHODS A systematic review and meta-analysis of observational studies on HS and MS in adults. We searched MEDLINE, SCOPUS, SCIELO, Google Scholar, Science Direct, and LILACS from the inception of the databases to January 2016. We performed a random effects model meta-analysis for studies reporting adjusted and crude odds ratios (ORs) with 95% CIs. A subgroup analysis was related to the type of HS patient (general patients vs hospital patients) and age group (adults vs children and adults). RESULTS Five studies including 3950 HS patients were analyzed. We found that MS was pres-ent in 9.64% of HS patients (OR, 1.82; 95%, CI 1.39-2.25). Studies from tertiary care hospital dermatology clinics (OR, 2.82; 95% CI, 0.58-5.06) reported a greater risk for MS than studies carried out in patients treated outside hospitals (OR, 1.78; 95% CI, 1.34-2.22). Studies that included pediatric populations reported a significant association (OR, 2.10; 95% CI, 1.58-2.62). LIMITATION Few of the included studies reported adjusted ORs. CONCLUSIONS HS patients have an increased risk for MS. Clinicians should consider screening HS patients for metabolic risk factors.
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Adışen E, Uzun S, Erduran F, Gürer MA. Prevalence of smoking, alcohol consumption and metabolic syndrome in patients with psoriasis. An Bras Dermatol 2018; 93:205-211. [PMID: 29723384 PMCID: PMC5916391 DOI: 10.1590/abd1806-4841.20186168] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 03/01/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coexistence of obesity, hypertension, insulin resistance and dyslipidemia is defined as metabolic syndrome (MBS), which is among the important risk indicators for cardiovascular diseases, diabetes and stroke. Smoking and alcohol consumption are the other factors which lead to an increase in the risk of cardiovascular disease. OBJECTIVE To investigate the prevalence of metabolic syndrome, smoking and alcohol consumption in psoriasis patients and the relationship between disease severity and these factors. METHODS This cross-sectional study enrolled 563 patients with chronic plaque-type psoriasis, all of which completed a questionnaire and underwent a complete physical examination. Data about MBS components, psoriasis severity/duration, smoking and alcohol consumption, and cardiovascular diseases were recorded. RESULTS A total of 563 patients with ages ranging from 18 to 78 years were evaluated. Metabolic syndrome was found in 12.6% of the patients [central obesity (38.7%), hypertension (14.3%), dyslipidemia (18.6%), diabetes (9.2%)], while 50.3% had smoking, and 3.3% had alcohol consumption. Patients with metabolic syndrome were older and more likely to have a longer disease duration than those without metabolic syndrome (p<0.05 for each). The prevalence of metabolic syndrome was higher in women than in men. Psoriasis was more severe in patients with central obesity, diabetes and smoking than in those without (p<0.05 for each). STUDY LIMITATIONS Retrospective design. CONCLUSIONS Our results indicate that MBS is a risk factor for psoriasis patients with advanced age. The relationship between disease severity and obesity, diabetes, and smoking in psoriasis patients indicates that the patients should be informed about the potential metabolic risks and receive therapies for behavioral changes besides anti-psoriatic treatment in order to minimize these risks.
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Affiliation(s)
- Esra Adışen
- Department of Dermatology, Gazi University Faculty of Medicine -
Ankara, Turkey
| | - Selda Uzun
- Dermatology Clinic, Kahramanmaraş Government Hospital -
Kahramanmaraş, Turkey
| | - Funda Erduran
- Department of Dermatology, Gazi University Faculty of Medicine -
Ankara, Turkey
| | - Mehmet Ali Gürer
- Department of Dermatology, Gazi University Faculty of Medicine -
Ankara, Turkey
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Rodríguez-Zúñiga MJM, García-Perdomo HA. Systematic review and meta-analysis of the association between psoriasis and metabolic syndrome. J Am Acad Dermatol 2017; 77:657-666.e8. [DOI: 10.1016/j.jaad.2017.04.1133] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 04/28/2017] [Accepted: 04/30/2017] [Indexed: 02/06/2023]
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Abstract
The association of the metabolic syndrome (MetS) and its components with immune-mediated chronic inflammatory disorders has attracted much interest within the last two decades. In addition to the well-established association of psoriasis with MetS, recent data point to an association between MetS and hidradenitis suppurativa, as well. The association of hidradenitis suppurativa with MetS and its components, such as diabetes, obesity, and dyslipidemia, has been consistently identified in controlled studies. This relationship is not only limited to older individuals but also applicable to younger patients and those with mild disease. This review documents the link between these disorders and discusses its practical implications, mainly highlighting the importance of prevention and routine screening for early diagnosis to prevent cardiovascular-related morbidity.
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Affiliation(s)
- Tulin Ergun
- Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey.
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