CAT- PSORIASIS AND OBESITY 1
Critical Appraisal Topic (CAT)
Psoriasis and Obesity
University of Mary
Chelsey L. Richter
Date: 8/1/2015
Appraised by: Chelsey L. Richter
Clinical Scenario
F.K. is a morbidly obese46-year-old female with a history of severe psoriasis, hypertension, hyperlipidemia, and type II diabetes mellitus. She has tried multiple treatment options for her psoriasis in the past including: topical corticosteroids, salicylic acid, moisturizers, phototherapy, and methotrexate, all of which produced little improvement. She comes to the clinic today wondering if there are any other treatment options to try.
Background
“The relationship between psoriasis and obesity is well-documented, appears to be positively associated with severityand is perhaps the most pressing comorbidity affecting psoriasis patients” (Kimball, Alavian, Alora-Palli, & Bagel, 2012). The prevalence of obesity in patients suffering from psoriasis is greater than in the general population (Naldi, Conti, Cazzaniga, Patrizi, Pazzaglia, Lanzoni, Veneziano, Pellacani, & the Psoriasis Emilia Romagna Study Group, 2013).
PICO Question
For obese patients suffering from psoriasis, does the implementation of weight loss intervention versus no weight loss intervention improve the severity of psoriasis?
Article 1 Summary
Naldi et al. (2013)clearly suggest that a dietary physical exercise program to assist in weight reduction is capable of producing significant improvement in psoriasis in both the overweight and obese patient populations. This study was simple is design, with a total of 303 overweight or obese patients suffering from psoriasis randomly selected to receive either a 20-week quantitative and qualitative dietary plan and physical exercise plan or information counseling about weight loss and the control of psoriasis in addition to their systemic treatment. One downfall of the study was there all interactions were passive and there was no adequate monitoring of compliance. Another downfall could be the short follow up period of only 20 weeks. Further weight loss and decrease in severity of psoriasis may be better documented with a longer time frame for follow up. Regardless, they were able to document an average Psoriasis Area and Severity Index (PASI) score reduction of 48% in the active intervention group undergoing dietary planning and physical exercise, in comparison to 25.5% decrease in the group receiving only the dietary information(Naldi et al., 2012).
This article would be considered a Level II, as it is a well-designed randomized control trial.
Article 2 Summary
Kimball, Alavian, Alora-Palli, and Bagel (2012), completed a study to determine whether implementing weight loss counseling in a phototherapy setting in which patients were already attending nurse visits three times weekly was beneficial in producing reduced psoriasis severity through weight reduction. This patient population already has access to substantial support and time spent with them during the phototherapy visits. A total of 20 overweight or obese patients with chronic moderate to severe plaque type psoriasis were randomly assigned to either the Ornish or South Beach diets or no dietary intervention to determine if weight loss or specific diets would have an impact on the response to phototherapy. A blinded physician completed PASI assessments at baseline and weeks 4, 8, and 12. Those patients randomized to the Ornish or South Beach diets lose an average of 8% and 7% of their body weight over the 12 week course, both significantly better than the no intervention group. At 12 weeks, the Ornish diet demonstrated an average 78% improvement in PASI score, while the South Beach diet group was 72%. The no dietary intervention group showed 71% improvement.
This study was limited in the fact that it was a small sample size, which lacked formal nutritional counseling. It was able to showcase weight loss by merely providing the patients with counseling in a convenient and supportive atmosphere capitalizing on the fact that they were already being seen by nursing staff multiple times a week.
Clinical Bottom Line
These studies demonstrate the significant role that dietary and physical activity programs can play in weight loss and reduction in the severity of chronic plaque psoriasis. This conveys optimism that simple interventions, such as increasing physical activity and implementing healthier dietary choices, could have substantial beneficial impact on not only the patient’s psoriasis severity, but also the other comorbidities that accompany obesity.
REFERENCES
Kimball, A.B., Alavian, C., Alora-Palli, M., Bagel, J. (2012). Weight loss in obese patients with psoriasis can be successfully achieved during a course of phototherapy. Journal of the European Academy of Dermatology and Venereology, 26, p. 1581-1586. DOI: 10.1111/j.14682011.04361.x
Naldi, L., Conti, A., Cazzaniga, S., Patrizi, A., Pazzaglia, M., Lanzoni, A., Veneziano, L., Pellacani, G., & the Psoriasis Emilia Romagna Study Group. (2013). Diet and physical exercise in psoriasis: a randomized controlled trial. British Journal of Dermatology, 170, p. 634-642. DOI 10.1111/bjd.12735