I have recently received the help of various medical and surgical colleagues (yes, doctors can fall ill too!) and aside from my general health issues, I found it interesting to hear their views on how the pandemic and these post-pandemic days are impacting on their clinical practice.
I was interested to hear from my surgical colleagues that their main issue has been that most of their patients are now overweight. I became a bit nervous at this point because I also had gained a little bit of weight in lockdown but they explained that it wasn’t just the anaesthetic risk that obesity worsens but it was the intra-abdominal fat that was making operations trickier to do. This was from not only having a bigger abdomen to deal with but the fact that the intra-abdominal fat simply got in the way of accessing the organs and also was extremely hard to keep out of the way. At this point, I had a mental image of the goose we had at Christmas which yielded enough goose fat from its innards to cook roast potatoes for 3-4 months!
It was then interesting to read the article in the April edition of Clinical and Experimental Dermatology on whether weight loss led to an improvement in dermatological conditions.
[Rout AN, Das A. Does weight loss lead to improvement of dermatological conditions: What is the evidence? Clin Exp Dermatol https://doi.org/10.1111/ced.15208]
What did the article show?
It wasn’t a study per se but a comprehensive English language literature search across various medical journal databases, such as Pubmed or EMBASE.
They looked at the role of weight loss in reported skin conditions such as psoriasis, eczema, acne, vitiligo, hidradenitis suppurativa, urticaria.
What did they find?
Not surprisingly, they found many studies showing the beneficial effects of weight loss in psoriasis and hidradenitis suppurativa and this knowledge has been around for quite some time already.
What about in eczema, acne, vitiligo and urticaria?
The evidence is not so clear cut in eczema. There are studies reporting a link between obesity and atopic dermatitis, one study reporting improvement in symptoms with reduction in weight in obese, atopic individuals and reduced ciclosporine doses in obese atopic patients after weight loss (not surprising really, less body mass for the drug to treat)
In acne, high GI foods have been reported to increase acne severity but there are few studies reporting any benefit of low GI foods on acne lesion count. Polycystic ovarian syndrome was thought to be the reason why women with difficult acne showed an improvement in acne with weight loss.
As for vitiligo, metabolic syndrome (diabetes, cardiovascular disease etc) has been linked with non-segmental vitiligo but another study found no link with higher BMI.
Much the same was also reported in urticaria where a higher BMI and metabolic syndrome where significantly associated with urticaria and longer disease duration.
There is clearly a possibility that weight loss improves skin and as usual, more studies are needed to explore this further as we still don’t know why or how weight loss has this beneficial effect.
However, now it feels as if we are now entering a new phase post-pandemic, there are plenty of reasons not to be overweight anymore!
Dr Sandy Flann, Consultant Dermatologist