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A reciprocal relationship has been demonstrated between skin diseases and metabolic syndrome (MeTS), with therapeutic interventions in patients with MeTS leading to improvement in the severity of skin conditions, according to a review published in Diabetology & Metabolic Syndrome. Investigators conducted a review in which they sought to present plausible mechanistic connections between various skin disorders and MeTS.1
It is known that MeTS is comprised of a constellation of factors that predispose individuals to the development of cardiovascular disease and type 2 diabetes. For a patient to be diagnosed with MeTS, ≥3 of the following criteria are must be met: (1) fasting glucose >110 mg/dL, (2) hypertriglyceridemia >150 mg/dL, (3) high-density lipoprotein (HDL) level <40 mg/dL in men and <50 mg/dL in women, (4) blood pressure >130/85 mmHg, and (5) visceral obesity (ie, waist circumference >94 cm in men and >89 cm in women).
The severity of skin disorders such as psoriasis has been linked to MeTS, with a recent algorithm for patients with psoriasis and MeTS having been published.2 Psoriasis is considered a chronic inflammatory, multisystem disorder, rather than a skin disease alone.
Any pathologic dysfunction that is associated with a loss of metabolic control in the body can result in cutaneous disease. The fat accumulation observed in individuals with MeTS, combined with the progressive development of insulin resistance, appears to induce a cascade of hormonal changes, such as effects on growth hormone. This can lead, in turn, to deterioration in such androgen-dependent skin disorders as acne and androgenic alopecia. Parameters of MeTS are also observed in patients with rosacea, hidradenitis suppurativa, lichen planus, systemic lupus erythematosus, atopic dermatitis, seborrheic dermatitis, skin cancer, and skin aging.
The investigators noted that a simple skin test that in the future might provide information about the metabolic status of a patient is attractive and could lead to improvement in the care of individuals with MeTS.3 They emphasized that MeTS and the skin is an ongoing field of active research, with associations also being reported with other medical conditions.
References
1. Stefanadi EC, Dimitrakakis G, Antoniou CK, et al. Metabolic syndrome and the skin: a more than superficial association. Reviewing the association between skin diseases and metabolic syndrome and a clinical decision algorithm for high risk patients. Diabetol Metab Syndr. 2018;10:9.
2. Radtke MA, Mrowietz U, Feuerhahn J, et al. Early detection of comorbidity in psoriasis: recommendations of the National Conference on Healthcare in Psoriasis. J Dtsch Dermatol Ges. 2015;13(7):674-690.
3. Fokkens BT, van Waateringe RP, Mulder DJ, Wolffenbuttel BHR, Smit AJ. Skin autofluorescence improves the Finnish Diabetes Risk Score in the detection of diabetes in a large population-based cohort: the LifeLines Cohort Study [published online October 30, 2017]. Diabetes Metab. doi:10.1016/j.diabet.2017.09.002
