Running head: CAT- PSORIASIS AND OBESITY
Critical Appraisal Topic (CAT)
Psoriasis and Obesity
University of Mary
Chelsey L. Richter
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CAT- PSORIASIS AND OBESITY
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Date: 8/1/2015
Appraised by: Chelsey L. Richter
Clinical Scenario
F.K. is a morbidly obese 46-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 severity and 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.
CAT- PSORIASIS AND OBESITY
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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.
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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