Metabolic syndrome affects narrow-band UVB phototherapy response in patients with psoriasis

Abstract

Psoriasis is a chronic inflammatory skin disease. Metabolic syndrome (MS) is a combination of central obesity, dyslipidemia, glucose intolerance, and elevated blood pressure. Many epidemiological surveys have revealed the association of psoriasis with MS. Narrowband ultraviolet radiation b (NB-UVB) is an effective and widely used treatment for psoriasis. The purpose of this study was to investigate whether the presence of MS in patient with psoriasis affects NB-UVB treatment and whether this syndrome correlates with systemic inflammation.From June 2016 to December 2016, 243 adults with a diagnosis of psoriasis vulgaris eligible to treatment with NB-UVB were admitted to the phototherapy unit of Dermatology department, Chinese PLA General Hospital. Fifty-five included patients were grouped based on the presence of MS. They accepted the treatment of NB-UVB and the following data were collected: serum levels of IL-17 (interleukin), TNF-α (tumor necrosis factor) and IL-6, Psoriasis Area and Severity Index (PASI) scores before and after 10 sections of NB-UVB treatment.Significant PASI improvement was observed in psoriatic patients without MS after 10 sections of phototherapy, while patients with MS showed a less improvement (P < .001). There was statistically significant difference in percentage of patients achieving 50% reduction in PASI scores between the 2 groups (P < .05). Multivariate logistic regression analysis showed MS was an independent factor that affecting the treatment of NB-UVB (P < .05). Psoriatic patients with MS showed a much less reduction of IL-17 and IL-6 before and after 10 sections of NB-UVB treatment respectively than patients without MS (P < .05).Psoriatic patients with MS have poorer improvement in comparison those without MS using NB-UVB treatment. MS was an independent factor that affecting the treatment of NB-UVB. In addition, psoriatic patients with MS showed a much less reduction of systemic biomarkers (interleukin—IL-17, TNF-α, IL-6) than patients without MS. Namely, they may need a longer course of treatment to achieve improved skin lesions.

Serum cytokine measurements and biological therapy of psoriasis – Prospects for personalized treatment?

“…Moreover, TNF inhibition is associated with weight gain, while drugs targeting the IL‐23/Th17 axis are not . In addition, high BMI has been associated with poor treatment response . Further, we found that IL‐22 and IL‐1RA correlated with BMI.…”

Systematic Review of the Effects of Ultraviolet Radiation on Markers of Metabolic Dysfunction

“…Nearly all studies were done in populations with mean/median body mass index (BMI) >25 kg/m 2 (indicative of overweight/obesity), except for Rui et al, who differentiated outcomes by presence or absence of metabolic syndrome (MetS), such that those without MetS reported mean BMI <25 kg/m 2 . 19 Skin type was reported in 4 of the 10 studies, with some variability in Fitzpatrick skin type between reports (Table 2). In 5 of the 10 studies, findings were reported for data collected following the final treatment compared to that collected prior to treatment (at baseline).…”

“…In three of four studies, blood concentrations of C-reactive protein (CRP), a marker of acute inflammation, were reduced following treatment with nbUVB, 23,27,28 with no difference reported in the fourth study, which was much shorter in therapy duration (2 weeks), 26 compared to the other three (of 8-12 weeks in length). Interleukin-6 (IL-6) was measured in four studies, with one reporting no effect 20 and others reporting reduced concentrations in blood 19,28,29 after nbUVB. Other less frequently measured markers of inflammation that were reduced in blood following nbUVB included ferritin, 23 interleukins IL-8, 20 IL-17, 19 IL-22, 20 and TNF 19 (although TNF was not reduced in Mehta et al 28 ).…”

“…Interleukin-6 (IL-6) was measured in four studies, with one reporting no effect 20 and others reporting reduced concentrations in blood 19,28,29 after nbUVB. Other less frequently measured markers of inflammation that were reduced in blood following nbUVB included ferritin, 23 interleukins IL-8, 20 IL-17, 19 IL-22, 20 and TNF 19 (although TNF was not reduced in Mehta et al 28 ).…”

“…not stated in two of three studies for IL-6). 19,20 Other issues included a lack of specific reporting of data for some outcomes (with data not reported in two of three studies for body weight, 20,22 and in one of four studies for IL-6 20 ), or units of measurement (e.g. for CRP in one of three studies, 28 for IL-6 in one of four studies 19 ) or reported as log-adjusted data (in one of four studies for IL-6 28 ).…”