ADDIS ABEBA UNIVERSITYCOLLEGE OF HEALTH SCIENCE

DEPARTMENT OF DERMATOVENEROLOGY

A research paper on prospective study on magnitude of metabolic

syndrome in psoriasis patients in alert center from May 2022-Sep
2022

By: Tsigereda abera (MD, Dermatovenereology Resident)

Advisors: Dr Amel Beshir, (MD, Ass. Prof in Dermatovenereology)

Dr Edom Mulubirhan (MD, Ass. Prof in Dermatovenereology)

A Research paper submitted to the Department of Dermatovenereology,

Addis Ababa University, in Partial Fulfillment of the Requirements for the
Specialty Degree in Dermatovenereology
Addis Ababa, Ethiopia
September, 2022

Acknowledgement

First, I would like to thank AAU, Dermatovenorology department

for giving me the chance to do this research paper which will
have significant value to my future career.

Next my deepest gratitude goes for my advisors Dr abulnasir, Dr.

Amel Beshir & Dr. Edom Mulubirhan for their valuable advice &
comments while doing this paper
 Summary
Background

Psoriasis is a chronic inflammatory and immune-mediated disease

associated with several comorbidities, such as obesity, hypertension,
diabetes mellitus, dyslipidemia and cardiovascular disorder.

The early recognition and assessment of these comorbidities and

selecting appropriate treatments for psoriasis, and giving the correct
recommendations.

Objective: the aim of this study was to assess the magnitude

of metabolic disorder among psoriasis patients visiting alert
center dermatovenorology clinic.

Methodology: - cross-sectional prospective study was

conducted at alert dermatovenereology clinic over 4 month.

Metabolic syndrome was defined using the revised

harmonized criteria for metabolic syndrome & severity was
measured via body surface area involved

Result :-

Conclusion :-
Introduction
Worldwide 125 million people have psoriasis (3).Psoriasis affects
men and women equally, and is seen in all races. Although psoriasis
can begin at any age, there seem to be two peaks in onset: one
between ages 20 and 30 and another between 50 and 60 (16)

Clinical features of psoriasis vary in morphology, extent of disease,

duration, periodicity of flares, and response to therapy. The most
common morphology is inflamed, edematous skin plaques, and
coalescing papules covered with silvery white scales (6)

The characteristic redness and edema of inflammation are more

obvious in white skinned persons, whereas in blacks, it is less
conspicuous or absent.

The clinical types include plaque psoriasis, guttate psoriasis,

pustular psoriasis, erythrodermic psoriasis, scalp psoriasis, nail
psoriasis, and psoriatic arthritis.(8)
Although genetic predisposition clearly plays a role in the
development of psoriasis environmental and behavioral factors
frequently affect the course of disease. Numerous potential
"triggers" for psoriasis have been identified, such as infection,
physical or psychological stress, and medications; however, they are
not common to every patient.()

A survey by the National Psoriasis Foundation in USA found that

75% of patients with psoriasis reported a moderate to large
negative impact of the disease on the quality of their life, with an
alteration of everyday activities. (28)

The negative impact of psoriasis may not be limited to its cutaneous

or psychosocial manifestations. Previous studies have suggested a
link between psoriasis, a common inflammatory disorder, and
individual components of the metabolic syndrome, such as obesity,
hypertension, diabetes, and dyslipidemia (28)

Psoriasis is a prototypical Th-1 inflammatory disease characterized

by expansion and activation of Th-1 T cells, antigen presenting cells,
and Th-1 cytokines. Specifically, chronic inflammation in Psoriasis
leads to increased insulin-like growth factor-II (IGF-II) in the skin
and blood of Psoriasis patients.(30,33,10)

IGF-II promotes epidermal proliferation and is also implicated in

promoting atherosclerosis, in modulating body fat mass and lipid
metabolism. Circulating levels of Th-1 cytokines, adhesion
molecules such as ICAM-1 and E-selectin, and angiogenic factors,
such as vascular endothelial growth factor (VEG-F) are elevated in
Psoriasis, obesity, and coronary artery disease.(38)

Chronic inflammation can also lead to dysfunction in a variety of

organ systems. Th-1 inflammatory cytokines such as TNF-α are
elevated in the skin and blood of patients with Psoriasis and are
critical to recruiting T cells to the skin and joints, promoting
angiogenesis, and epidermal hyper-proliferation.

Similarly, TNF-α is secreted in adipose tissue and is an important

feature of the chronic low level inflammation seen in obesity&
insulin resistance.(6)
The immune dysregulation is thought to be stimulated by an
undetermined antigen, provoked by environmental factors such as
trauma, infections, stress, drugs, sunlight, and metabolic
derangement.

Subsequently, there is resultant epidermal proliferation with loss of

differentiation; dilatation and proliferation of the dermal blood
vessels and accumulation of inflammatory cells such as neutrophils
and T-lymphocyte(6)

Psoriasis causes not only skin inflammation but also systemic

inflammation, leading to increased insulin resistance, vascular
endothelial damage, atherosclerosis, and myocardial infarction. This
sequence of events is known as the psoriatic march. (18)

Psoriasis is be lived to be associated with different comorbidities

like metabolic syndrome, autoimmune disorders ,uveitis ,erectile
dysfunction, psoriatic arthritis ,etc. Michado and pinto stated that
73% psoriasis patients have at least one comorbidities. (30)
march. Psoriasis causes not only
skin inflammation but also systemic
inflammation, leading to increased insulin
resistance, vascular endothelial damage,
atherosclerosis, and myocardial infarction.
This sequence of events is known as the
psoriatic march. Obesity is an aggravating
factor in this process, and continuous
systemic treatment is a suppressiMetabolic syndrome (MetS) is a
cluster of cardiovascular risk factors, including glucose intolerance
or insulinresistance,dyslipidemia,hypertension,and central obesity .
(6).
MetS is associated with greater cardiovascular risk and is a
predictor of cardiovascular disease, diabetes, and stroke . There is
strong evidence showing an association between MetS and psoriasis.
(7)

In particular, the prevalence of MetS in patients with psoriasis

ranges from 20 to 50%, with a risk of having MetS that is at least
double in psoriatic patients compared to non-psoriatic control
individuals.(18).

Statement of problem

Psoriasis is a common, chronic, inflammatory skin disease, which

affects about 2–3 % of the population worldwide while the risk of
mortality for patients with mild psoriasis is similar to that for the
general population; there is an increased overall mortality risk for
patients with severe psoriasis.

Even though psoriasis was considered to be confined to the skin

until recently, it is now accepted as a chronic inflammatory disease
with systemic manifestations mirroring those of other autoimmune
diseases, such as rheumatoid arthritis and Crohn’s disease. This
notorious, non- contagious, immune mediated, chronic
inflammatory disorder having deep psychological, social impacts
and associated with an increased cardiovascular risk.

Previous studies have suggested a link between psoriasis, a common

inflammatory disorder, and individual components of the metabolic
syndrome, such as obesity, hypertension, diabetes, and dyslipidemia

Metabolic syndrome is a significant predictor of cardiovascular

events.Moreover, an increased mortality from cardiovascular
disease in patients with severe psoriasis has been documented,
recently psoriasis may confer an independent risk of myocardial
infarction especially in young patients.

A survey by the National Psoriasis Foundation in USA found that

75% of patients with psoriasis reported a moderate to large
negative impact of the disease on the quality of their life, with an
alteration of everyday activities. The negative impact of psoriasis
may not be limited to its cutaneous or psychosocial manifestations
but also its associated comorbidities like metabolic disorders

Recent research reported an association between psoriasis and

metabolic disorders such as obesity, dyslipidemia, and type II DM
and it is shown that severe psoriasis might be associated with
increased mortality rate due to cardiovascular disorder

The broad literature linking psoriasis to metabolic disorders has led

to changes in standard of care recommendations for patients with
psoriasis. In particular, practitioners are encouraged to screen
psoriasis patients, especially when disease is severe, for metabolic
disorders and cardiovascular risk factors and institute appropriate
prevention strategies.

Despite Psoriasis is increasing in magnitude with co-morbidities of

metabolic syndrome disease in an alarming rate nationally and
globally, there are few studies done in Africa.The magnitude of
metabolic syndrome among psoriasis patients visiting health
institutions Is not well known” in Ethiopia and also patients are in
adequately investigated and followed for the subsequent
development of metabolic disorder
Significance of this study

This study will provide necessary information regarding how

prevalent is metabolic syndrome both to the patient and clinician.
AS a result, the clinician will design better treatment modalities,
improve the standard care of patients with early recognition and
assessment of these comorbidities, and improve the quality of life of
the patient based on the current generated knowledge.

It will also alert the policy makers, clinicians and patients to avail
instruments and to take protective measures associated with
metabolic disorder. In addition this study will also provide base line
information for the future studies regarding this topic.