Psoriasis completely resolves after gastric bypass

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The first study is a single case report regarding a morbidly obese 55-year-old male, who weighed 131 kg with Body Mass Index (BMI) of 41 kg/m2, and underwent a roux-en-y gastric bypass (RYGBP). He also had a 15-year history of severe psoriasis and was being medically treated. Approximately 12 months after RYGBP he had lost 39 kg (68% of excess weight), had complete resolution of the psoriasis and had discontinued all preoperative medications related to the disease. At 2 years after RYGBP, the psoriasis has not recurred (ref1).

In a second (separate) study a morbidly obese 56-year-old man with BMI of 46.9 kg/m2 and hypertension, had suffered with severe psoriasis for almost 40 years without any remission on multiple treatments. Psoriatic papules and plaques were noted on his face, backs of his hands, buttocks, knees, and elbows. He underwent open Roux-en-Y gastric bypass. Four months later he had lost 23 kg (34.8% of excess weight) and had complete remission of the psoriasis without medications (ref 2).

Comment: Both studies show dramatic and complete resolution of psoriasis following weight-loss surgery. For morbidly obese patients with psoriasis, weight loss surgery may offer an extremely effective solution, both for losing weight and for resolving their psoriasis. Moreover, the presence of psoriasis should always an additional factor to be taken into account when considering a patient’s suitability for weight-loss surgery. However, larger studies with long-term follow-up are needed to establish the impact of weight-loss surgery on chronic psoriasis.

References:
1. Higa-Sansone G, Szomstein S, Soto F et al. Psoriasis remission after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg 2004; 14:1132-4.
2. de Menezes Ettinger JE, Azaro E, de Souza CA et al. Remission of psoriasis after open gastric bypass. Obes Surg 2006; 16:94-7.

Article prepared by:
Dr David Ashton MD PhD
27 April 2009