METABOLIC and bariatric surgery (MBS) is emerging as a potential therapeutic option for improving psoriasis in obese patients, according to a new systematic review. Obesity is a recognised risk factor for psoriasis, and the two conditions frequently coexist, contributing to a heavy burden of comorbidity and significantly reducing quality of life.
While weight loss is known to alleviate psoriasis severity and improve metabolic health, achieving and maintaining significant weight reduction through lifestyle measures alone is often challenging. In such cases, MBS has become an increasingly popular intervention, prompting researchers to explore its impact on psoriasis outcomes.
The review analysed 14 studies involving 169 patients who had undergone MBS, primarily gastric bypass or sleeve gastrectomy. The average age was 46.8 years, and the majority were female. Prior to surgery, patients had typically received a range of treatments for psoriasis, including topical therapies, systemic drugs, and biologics. At baseline, most patients had moderate disease, with a smaller proportion presenting with severe or mild forms.
Following surgery, all studies reported significant weight loss, with average body mass index (BMI) dropping from 43.7 to 32.9 kg/m². More importantly, 97.2% of patients experienced a reduction in psoriasis severity to mild levels or complete resolution. Although four patients saw a worsening of their condition, these cases were rare. Many patients also downgraded their psoriasis treatment post-surgery, shifting from systemic medications to topical therapies or none at all. Quality of life improvements were reported, though statistically significant changes were observed in only one study.
The beneficial effects of MBS on psoriasis may be linked to a reduction in inflammatory mediators such as tumour necrosis factor-α, C-reactive protein, and leptin. These factors play a role in psoriasis pathogenesis, particularly by influencing immune pathways associated with keratinocyte proliferation. However, limitations of the review include inconsistent reporting standards, potential bias, and a reliance on case studies.
While the findings are promising, larger controlled trials are needed to confirm the long-term efficacy of MBS as an adjunctive strategy for psoriasis management in obese individuals.
Reference
Branyiczky MK et al. The association between bariatric surgery and improvement in psoriasis: a systematic review. J Am Acad Dermatol. 2025;DOI:10.1016/j.jaad.2025.05.1412.
