The Role of Bariatric Surgery in the Management of Psoriasis: a Systematic Review and Meta-Analysis

Abstract

Background: Psoriasis is a chronic immune-mediated skin disease that is more prevalent and severe in obese patients. To the best of our knowledge, no systematic review about the influence of bariatric surgery in the management of psoriasis has been conducted until now. Therefore, we aimed to systematically review all the current literature about the presumptive positive effects of bariatric surgery in the management of psoriasis, evaluating the impact of surgery on psoriasis improvement. Methods: We conducted our systematic review and meta-analysis in accordance with the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched three major databases: PubMed, Scopus, and Web of Science. We evaluated qualitatively the included studies and in our meta-analysis, we focused on evaluating the dichotomous variable of "Downgrade of systemic medication after surgery," an indirect measure of psoriasis improvement, analyzing the proportion of patients experiencing this outcome. Results: The analysis included four studies with a total of 127 participants and 69.3% of them were women. Roux-en-Y Gastric Bypass was the most common procedure (78%). Three studies evaluated psoriasis improvement post-surgery, showing improvements ranging from 39.4% to 70% based on DLQI score, ABSA score, and even on subjective evaluation by the patients. Metabolic comorbidities improvement was confirmed in two studies and older age was also associated with a higher probability of improvement. Results from the meta-analysis showed that out of 67 patients using systemic medications, 45% (Proportion=0.45, 95% CI [0.33;0.57]) experienced reduced medication post-surgery. Conclusion: Although there is promising evidence of psoriasis improvement following bariatric surgery, the limited number of studies and participants prevents broad generalization to real-world situations. This underscores the necessity for additional research, particularly randomized studies, to determine whether bariatric surgery offers superior outcomes compared to alternative weight loss interventions for managing and improving psoriasis in obese patients.