36-Year-Old Severely Obese Male with Worsening Psoriasis

  • Deeti J. Pithadia
  • Kelly A. Reynolds
  • Jashin J. Wu
Part of the Clinical Cases in Dermatology book series (CLIDADE)


A morbidly obese 36-year-old male with moderate-to-severe psoriasis was refractory to adalimumab therapy. Obesity is thought to induce systemic inflammation that may augment psoriasis severity. Infliximab is the only commonly-utilized biologic for psoriasis that employs weight-based dosing, and its efficacy at a uniform dose has been demonstrated to be consistent across various body mass indices. After 2 months on infliximab coupled with weight loss on a new diet and exercise regimen, the patient’s affected body surface area decreased dramatically.


Obesity Inflammation Biologics Infliximab 


  1. 1.
    Fernández-Armenteros JM, Gómez-Arbonés X, Buti-Soler M, et al. Psoriasis, metabolic syndrome and cardiovascular risk factors. A population-based study. J Eur Acad Dermatol Venereol. 2019;33(1):128–35.CrossRefGoogle Scholar
  2. 2.
    Paller AS, Mercy K, Kwasny MJ, et al. Association of pediatric psoriasis severity with excess and central adiposity: an international cross-sectional study. JAMA Dermatol. 2013;149(2):166–76. Scholar
  3. 3.
    Lindegård B. Diseases associated with psoriasis in a general population of 159,200 middle-aged, urban, native Swedes. Dermatologica. 1986;172(6):298–304.CrossRefGoogle Scholar
  4. 4.
    Sterry W, Strober BE, Menter A. Obesity in psoriasis: the metabolic, clinical and therapeutic implications. Report of an interdisciplinary conference and review. Br J Dermatol. 2007;157(4):649–55. Scholar
  5. 5.
    Langan SM, Seminara NM, Shin DB, et al. Prevalence of metabolic syndrome in patients with psoriasis: a population-based study in the United Kingdom. J Invest Dermatol. 2012;132(3 Pt 1):556–62. Scholar
  6. 6.
    Danielsen K, Wilsgaard T, Olsen AO, Furberg AS. Overweight and weight gain predict psoriasis development in a population-based cohort. Acta Derm Venereol. 2017;97(3):332–9. Scholar
  7. 7.
    Bremmer S, Van voorhees AS, Hsu S, et al. Obesity and psoriasis: from the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol. 2010;63(6):1058–69.CrossRefGoogle Scholar
  8. 8.
    Hotamisligil GS, Arner P, Caro JF, et al. Increased adipose tissue expression of tumor necrosis factor-alpha in human obesity and insulin resistance. J Clin Invest. 1995;95:2409–15. Scholar
  9. 9.
    Herron MD, Hinckley M, Hoffman MS, et al. Impact of obesity and smoking on psoriasis presentation and management. Arch Dermatol. 2005;141(12):1527–34. Scholar
  10. 10.
    Sathyanarayana Rao TS, Basavaraj KH, Das K. Psychosomatic paradigms in psoriasis: psoriasis, stress and mental health. Indian J Psychiatry. 2013;55(4):313–5. Scholar
  11. 11.
    Højgaard P, Glintborg B, Kristensen LE, Gudbjornsson B, Love TJ, Dreyer L. The influence of obesity on response to tumour necrosis factor-α inhibitors in psoriatic arthritis: results from the DANBIO and ICEBIO registries. Rheumatology (Oxford). 2016;55(12):2191–9. Scholar
  12. 12.
    Naldi L, Addis A, Chimenti S, et al. Impact of body mass index and obesity on clinical response to systemic treatment for psoriasis. Evidence from the Psocare project. Dermatology (Basel). 2008;217(4):365–73. Scholar
  13. 13.
    Lebwohl M, et al. Impact of weight on the efficacy and safety of ustekinumab in patients with moderate to severe psoriasis: rationale for dosing recommendations. J Am Acad Dermatol. 2010;63:571–9.CrossRefGoogle Scholar
  14. 14.
    Yanaba K, Umezawa Y, Ito T, et al. Impact of obesity on the efficacy of ustekinumab in Japanese patients with psoriasis: a retrospective cohort study of 111 patients. Arch Dermatol Res. 2014;306(10):921–5. Scholar
  15. 15.
    Reich K, Menter A, Plotnick M, Guzzo C, Li S, Gottlieb AB. Consistency of infliximab response across subgroups of patients with psoriasis: integrated results from randomized controlled clinical trials. Psoriasis Forum. 2007;13:21–6.CrossRefGoogle Scholar
  16. 16.
    Gisondi P, Del Giglio M, Girolomoni G. Considerations for systemic treatment of psoriasis in obese patients. Am J Clin Dermatol. 2016;17(6):609–15. Scholar
  17. 17.
    Jensen P, Zachariae C, Christensen R, et al. Effect of weight loss on the severity of psoriasis: a randomized clinical study. JAMA Dermatol. 2013;149(7):795–801. Scholar
  18. 18.
    Gisondi P, Del Giglio M, Di Francesco V, Zamboni M, Girolomoni G. 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):1242–7. Scholar
  19. 19.
    Sako EY, Famenini S, Wu JJ. Bariatric surgery and psoriasis. J Am Acad Dermatol. 2014;70(4):774–9.CrossRefGoogle Scholar
  20. 20.
    Faurschou A, Zachariae C, Skov L, Vilsbøll T, Knop FK. Gastric bypass surgery: improving psoriasis through a GLP-1-dependent mechanism? Med Hypotheses. 2011;77(6):1098–101. Scholar
  21. 21.
    Papp K, Reich K, Leonardi CL, et al. Apremilast, an oral phosphodiesterase 4 (PDE4) inhibitor, in patients with moderate to severe plaque psoriasis: results of a phase III, randomized, controlled trial (Efficacy and Safety Trial Evaluating the Effects of Apremilast in Psoriasis [ESTEEM] 1). J Am Acad Dermatol. 2015;73(1):37–49.CrossRefGoogle Scholar
  22. 22.
    Vujic I, Herman R, Sanlorenzo M, et al. Apremilast in psoriasis—a prospective real-world study. J Eur Acad Dermatol Venereol. 2018;32(2):254–9. Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Deeti J. Pithadia
    • 1
  • Kelly A. Reynolds
    • 2
  • Jashin J. Wu
    • 3
  1. 1.Medical College of GeorgiaAugusta UniversityAugustaUSA
  2. 2.University of CincinnatiCollege of MedicineCincinnatiUSA
  3. 3.Founder and CEODermatology Research and Education FoundationIrvineUSA

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