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CORRESPONDENCE
Year : 2020  |  Volume : 65  |  Issue : 3  |  Page : 243-244
Evaluation of the association of metabolic syndrome with psoriasis and its severity: A cross-sectional study


Department of Dermatology, Venereology, and Leprosy, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Date of Web Publication14-Apr-2020

Correspondence Address:
Satyendra K Singh
Department of Dermatology, Venereology, and Leprosy, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.IJD_541_17

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How to cite this article:
Singh SK, Tripathi R. Evaluation of the association of metabolic syndrome with psoriasis and its severity: A cross-sectional study. Indian J Dermatol 2020;65:243-4

How to cite this URL:
Singh SK, Tripathi R. Evaluation of the association of metabolic syndrome with psoriasis and its severity: A cross-sectional study. Indian J Dermatol [serial online] 2020 [cited 2020 Nov 25];65:243-4. Available from: https://www.e-ijd.org/text.asp?2020/65/3/243/282467




Sir,

Psoriasis is a chronic inflammatory disease of the skin and joints, which is now considered a systemic inflammatory disease with Th-1 cells, Th-17 cells, and inflammatory cytokines contributing to its pathogenesis. Similarly, chronic Th-1 inflammation is important to the pathophysiology of obesity, metabolic syndrome, diabetes, atherosclerosis, and myocardial infarction.[1],[2] We conducted a cross-sectional study involving 100 patients clinically diagnosed with psoriasis and 100 controls diagnosed with tinea infection at Dermatology and Venereology Outpatient Department of Sir Sunder Lal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India between July 2015 to June 2017. Inclusion criteria were age >20 years, chronic plaque psoriasis of any severity (clinically diagnosed), erythrodermic and generalized pustular psoriasis. Exclusion criteria included isolated palmoplantar and scalp psoriasis, psoriatic arthritis, pregnancy, lactation, known case of ischemic heart disease, diabetes mellitus, hypertension, renal and liver failure, patients receiving any systemic therapy (retinoids, methotrexate, cyclosporine, biologicals), or phototherapy within 1 month and topical treatment within 1 week, smoking and alcoholism. The severity of psoriasis was measured on the basis of psoriasis area severity index (PASI) (>10 as severe). Metabolic syndrome (MS) was diagnosed by the presence of three or more criteria of the National Cholesterol Education Program's Adult Treatment Panel III (NCEP-ATP III)[3]: waist circumference ≥102 cm (40”) in men or ≥88 cm (35”) in women; blood pressure ≥130/85; fasting plasma glucose ≥100 mg/dL; HDL cholesterol <40 mg/dL in men or <50 mg/dL in women; triglycerides ≥150 mg/dL.

The characteristics of the cases and controls have been compared in [Table 1]. The duration of psoriasis in our patients ranged from 6 months to 23 years while the PASI score of the 100 patients with psoriasis ranged from 2 to 32.5. Based on modified NCEP-ATP III criteria, MS was diagnosed in 44% patients with chronic plaque psoriasis and 14% in controls (P < 0.001) with an odds ratio (OR) = 2.509 with 95% confidence interval of 1.56–4.03. This was in accordance with the study by Gisondi et al.[4] Among the components of the metabolic syndrome, the following were found to be significantly more common in cases than in controls: low HDL, elevated blood pressure both systolic and diastolic, high cholesterol, LDL and CRP levels. There was a significant association of MS with severity of psoriasis (P = 0.035, OR = 2.509). Although Gisondi et al. in a study of patients with psoriasis of longer than 6 months duration observed an increased occurrence of MS, they did not find any correlation of MS with the severity of psoriasis. Moreover, Langan et al. noted a similar relationship of severity of psoriasis to the presence of obesity, hypertension and elevated fasting blood sugar, and metabolic syndrome.[5] However, they categorized the severity of disease based on the percentage of body surface area involved which might be a poor marker of the severity of inflammation.
Table 1: Comparison of cases and controls

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Thus, we conclude that all patients of psoriasis should be screened for cardiovascular risk factors, in particular, MS at the disease onset irrespective of the disease severity.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Siegel D, Devaraj S, Mitra A, Raychaudhuri SP, Raychaudhuri SK, Jialal I. Inflammation, atherosclerosis, and psoriasis. Clin Rev Allergy Immunol 2013;44:194-204.  Back to cited text no. 1
    
2.
Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med 2005;352:1685-95.  Back to cited text no. 2
    
3.
Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005;112:2735-52.  Back to cited text no. 3
    
4.
Gisondi P, Tessari G, Conti A, Piaserico S, Schianchi S, Peserico A, et al. Prevalence of metabolic syndrome in patients with psoriasis: A hospital-based case-control study. Br J Dermatol 2007;157:68-73.  Back to cited text no. 4
    
5.
Langan SM, Seminara NM, Shin DB, Troxel AB, Kimmel SE, Mehta NN, et al. Prevalence of metabolic syndrome in patients with psoriasis: A population-based study in the United Kingdom. J Invest Dermatol 2012;132:556-62.  Back to cited text no. 5
    



 
 
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