Weight and Psoriasis

Are people with psoriasis heavier? Does weight loss help psoriasis?

Does a person’s weight have an effect on their psoriasis? This is a question which sometimes come up when talking about psoriasis. Unfortunately, as with many other aspects of this disease, the answer is not clear.

Some things seem fairly self-evident, however. If one has psoriasis in a “skin fold” area due to “fat rolls” or the like, the skin rubbing against itself can make everyday life a hell (this can happen to thin people as well, it’s just that they have fewer skin fold areas). Skin folds can also create a natural occlusion, within which people should avoid using certain drugs, such as Dovonex. Sweating, which larger people do more of, can also irritate psoriasis and/or “rinse” topical drugs away. Putting “extra” weight onto arthritic joints can also, obviously, be detrimental.

Turning to the medical literature for a moment, we actually don’t find much. In 1986, Lindegard found obesity to be more frequent than normal — amongst the women only — in a population of “middle-aged, urban, native Swedes.” Somewhat more-inclusive was a Henseler and Christophers study published in 1995, which found more obesity among German psoriatics. Finally, Naldi, et al found, in 1996, that psoriasis was more common in patients of Italian out-patient clinics with higher body mass indices, though they call their results “largely explorative.”

Way back in 1975, Binazzi, et al wrote that they’d found “that psoriasis is statistically correlated with heredity for diabetes and obesity,” though it doesn’t appear that this line of inquiry has been followed up. Two more articles, by Raychaudhuri and Gross and Krueger and Duvic might shed more light on this issue, since they refer to “reports” linking psoriasis and obesity which I may not be able to find online.

So, there are a few studies mentioned above suggest that there is a correlation between psoriasis and weight, but does that mean anything in terms of what a person with psoriasis might be able to do? Unfortunately, no. In years of looking, I have not found a single article which suggests that losing (or gaining) weight will result in a change (preferrably for the better) in psoriasis symptoms. In other words, there are no studies which show that losing weight will might result in a reduction of psoriasis, or that gaining weight will induce a flare-up.

As should be obvious, getting and staying close to your particular optimum weight will probably be best for your overall health, but there is absolutely no medical evidence that it will help psoriasis symptoms in particular. A person who is very much overweight is at far more of a risk for a heart attack than they appear to be for any severe psoriasis effects.

However, in a small attempt to help answer the question of whether weight loss can relieve psoriasis symptoms (in general, not just the “skin fold” and other problems mentioned above), I took what I call a “retroactive poll” of the psoriasis newsgroup. I went to Google’s archive of the group, and searched it for the keywords “weight gain OR loss OR gained OR lost.” At the time, the search resulted in 602 posts, and from most of them, I was able to find 93 different people who had written about their body weight in relation to their psoriasis symptoms. Using different search words could probably turn up more, but 93 is a halfway decent sample, and covers posts spanning six years.

(Note that much of the remainder of this article is a re-edited and slightly updated version of my April 27, 2002, newsgroup post about this research.)

I found that 28 people fell easily into the category of “people for whom weight loss may lead to a reduction of psoriasis symptoms.” Three of these were clearly “odd,” in that they said that after just a week of dieting (!) and/or “a few pounds,” their psoriasis was already much better. (I believe that the speed with which they saw results meant something else was going on.) When the actual number of pounds lost was mentioned (14 people), it varied from between “a few” (which I counted as 3) up to 50, and averaged 21.1 lbs lost. When mentioned, weight-loss methods included Pagano’s diet (5 people), unspecified low-carb diet (4 people), the Spot-Free Diet (1 person), finding Jesus (1), the Atkins diet (1), a no tryptophan diet (1), a restricted diet (1), an alkaline-producing diet (1), a general low-calorie diet (1), avoiding sugar (1), hospitalization after an accident (1), phen/fen (1), and fasting (1).

28 other people fell easily into the category of “people for whom weight loss had no effect on their psoriasis symptoms.” This includes one person who lost 74 lbs, but still had bad psoriatic arthritis. Another found no change in psoriasis while low-carb dieting, but when she added some carbs back in, her psoriasis got better. One thought her psoriasis got worse when she gained weight, but didn’t get better with weight loss. When the actual number of pounds lost was mentioned (10 people), it varied from 7 to 74, and averaged 33.8 lbs lost. When mentioned, weight-loss methods included general diet and exercise (2 people), Pagano’s diet (4), the Atkins diet (3), the Spot-Free diet (1), unspecified low-carb diet (6), the Zone diet (1), chromium piccolinate (1), a macrobiotic/vegan/no-alcohol diet (1), Eat Right for Your Type (1), Suzanne Somer’s diet (1), and a gluten-free diet (1).

Six more people fell into the category of “people for whom weight loss may lead to worse psoriasis.” Two of these people had psoriasis “worse than ever” after losing weight. When the actual number of pounds lost was mentioned (3 of them), it varied from 18 to 35, and averaged 24.3 lbs lost. When mentioned, weight-loss methods included the Atkins diet (1), quitting alcohol (1), Suzanne Somer’s diet (1), and general diet and exercise (1).

Two other people mentioned losing weight, but not stopping their psoriasis or arthritis medications. I took this to mean that they were still using the same medications they had been, prior to losing weight, but that assumption is not supported by their newsgroup posts.

With 18 of the people, the picture was confused by the use of other therapies for psoriasis, or other diseases concurrent to weight loss:

· One had a weight loss concurrent with pneumonia and the use of a potent steroid, and his psoriasis cleared up.

· One had a weight gain and fluid retension on Avandia, but his psoriasis cleared up. Afterwards, he lost the extra weight, and his psoriasis came back.

· Four people mentioned weight gain as a side effect of steroid therapies (either oral or topical).

· One developed psoriatic arthritis when gaining weight by “bulking up” on supplements.

· One got psoriasis and gained weight after terminating Prozac.

· One person credited weight loss and nine other therapies for his/her elimination of psoriasis, but didn’t know which contributed the most.

· Another had his first flare-up while an Olympic-level athlete, but said his longest remission was after dropping 70 lbs of weight gained later on (this also coincided with about nine other things that could have had an effect, including Soriatane).

· One person said she’d put on weight, but her psoriasis was better after a mix of treatments.

· Six people mentioned that they’d lost weight, and had less psoriasis, but also mentioned other therapies used at the same time: steroids (3), alternative medicine (1), B-12/coal tar (1), and UVB (1).

· And one person lost 40 lbs on low-carb diet for 4 months, but her psoriasis vanished only in last 6 weeks, including 4 weeks also using coal tar products.

Four people mentioned just psoriasis onset in relation to weight:

· Two had weight gain coincident to psoriasis onset, but one of them said he didn’t think they were linked.

· One said she’d gained weight, yo-yo dieted for a while, then lost 70 lbs, and then got psoriasis.

· And one person said little more than he’d gained weight after getting psoriasis.

And then there were the eight stories which are hard to fit into any of the above categories:

· One person claimed a 30-lb weight loss after several months using natural and herbal supplements, but said his psoriasis was gone in the first three weeks.

· One person once claimed her psoriasis got worse after losing weight through exercise, but a year later said she’d lost more weight due to stress (and changed her diet a little), and found her psoriasis was better.

· One poster said she had an overweight sister with moderate psoriasis, and a triathlete brother with severe psoriasis.

· One lost some weight and his psoriasis while on an extremely restricted diet, but said his psoriasis flares whenever he eats something other than the five or six foods he’d been sticking to.

· One person got rid of psoriasis with a self-created detoxification diet. The odd thing here was that despite the new diet having only half the daily calorie count of his previous eating habits, he lost no weight at all.

· One person lost weight with diet and exercise, and her psoriasis got better, but it flared when she decided to also quit drinking alcohol.

· One person had his onset of psoriasis while at a normal weight, then he gained 20 pounds, dieted that off, and since has noticed his psoriasis vanishes when he gets sick (a major illness dropping 20 pounds from his frame).

· And finally, one person dropped 60 lbs after clearing his psoriasis with UV. He thought that his better self-image (he’d had lots of facial psoriasis) allowed him to finally lose the weight.

Finally, there was one person who claimed that “several people” he knew used the Atkins diet for weight loss, but were “pleasantly surprised” that it helped with psoriasis, too. He did not give any more details, though, not even an actual number of people, so this is really impossible to include anywhere above (it’s simply not a good piece of data).

Obviously, all of the different stories above demonstrate that weight loss is no sure thing for getting rid of psoriasis symptoms. At best, there were 34 people who assuredly did not find relief from psoriasis through weight loss (28 who said just that, plus six who said their psoriasis got worse after weight loss). Comparing this figure to the rest of the 93 people sampled (clearly the incorrect thing to do, yet favoring the “weight loss helps” hypothesis) results in just 63.44% of people for whom weight loss may have helped. If, on the other hand, we reasonably ignore the 27 stories which were complicated or tough to classify, that result drops to just 48.48%, or less than half.

(Of course, there are many reasons why “polls” like this one aren’t necessarily accurate, including self-selection of participants, lack of follow-up, self-reporting of conditions, bias on my part, etc. The percentages above, therefore, should be considered tentative at best, and not substanial evidence of an effect or lack thereof.)

Despite such a mixed bag of results from people’s personal reports of weight loss (or gain) in relation to psoriasis, if you could stand to “lose a few pounds,” you should probably discuss diet and exercise options with your doctor. Losing extra weight provides many health benefits, even if a reduction in psoriasis symptoms is not one of them.

In other words, if you’re thinking about making a change for the better with regard to your weight, you should probably do so with the expectation that it will do nothing for your skin. If it does, that’s icing on the cake, but there doesn’t seem to be much reason to believe that it will.