Skin changes and manifestations associated with the treatment of obesity

Mucocutaneous alterations and complications in amphetamine abusers: a narrative review

Amphetamines are the second most commonly used illicit drug worldwide. Amphetamine use can result in significant cutaneous morbidity. This review highlights the dermatological manifestations of amphetamine abuse.

Does weight loss lead to improvement of dermatological conditions: What is the evidence?

Obese and overweight individuals may have a wide gamut of cutaneous features and can have more severe manifestations of multiple dermatological conditions. There have been multiple expert opinions on the favorable effects of weight reduction in improving skin conditions. Over the past decade, there have been few studies evaluating the response of exercise and other modes of weight loss on various dermatoses such as psoriasis, acne, hidradenitis suppurativa, acanthosis nigricans. In this review, we have attempted to provide a summary of the benefits of reduction of body weight on various skin aliments.

The Link Between Obesity and the Skin

Obesity as a multi-organ disease that affects the entire human organism. Notably, the skin is no exclusion from this postulate. Skin changes in obese patients have been widely studied with regards to mechanical friction, skin infections, and skin hypertrophic conditions, such as acanthosis nigricans and, most commonly, fibromas (skin tags). Almost 60–70% of obese patients present with a variety of skin changes. Herein, we discuss our own experience and review the complex skin changes in obesity. The role of metabolic syndrome and obesity are responsible for the epidemiological prevalence and are involved in the pathogenesis of chronic inflammatory skin diseases, such as psoriasis, atopic dermatitis, and skin malignancies. Here, we comment on the role of nutritional interventions in these patients as it has been proven that low-calorie diet and weight loss is related to improvement of inflammatory skin diseases. The readership of this paper will receive up-to-date overview on the connection between obesity and the skin that is of a practical importance to any clinician working in the field.

Bariatric Surgery-Induced Telogen Effluvium (Bar SITE): Case Report and a Review of Hair Loss Following Weight Loss Surgery

Bariatric surgery is a potential modality for the management of obesity. Bariatric patients may experience skin disorders and hair loss postoperatively. A 24-year-old woman with polycystic ovarian syndrome-associated obesity successfully underwent bariatric surgery. Within seven weeks after surgery, she developed diffuse and progressive hair loss, characteristic of telogen effluvium. Alopecia following bariatric surgery may be acute in onset, occurring within the first three months and often associated with telogen effluvium. In addition, bariatric surgery postoperative hair loss may be the result of nutritional deficiencies; in this setting, it is often chronic in onset, occurring six months after surgery. Also, hair loss in bariatric patients may be multifactorial in etiology. We introduced an acronym to facilitate the description of patients who experience bariatric surgery-induced telogen effluvium: Bar SITE.

Evaluating the need for dermatological care in a postsurgical bariatric sample

BACKGROUND

Bariatric surgery rates are increasing in tandem with obesity in the United States. patients after surgery bariatric can lose up to or more than one-third of their excess weight within the first year. This sudden loss of weight can lead to skin redundancy and increased susceptibility to dermatological issues. There is a paucity of literature addressing the issue of skin redundancy and associated factors following bariatric surgery.

OBJECTIVES

To evaluate the prevalence and severity of dermatological concerns among postbariatric surgery patients and assess the impact of these issues on patients' quality of life.

SETTING

Surgical Weight Loss Clinic at an academic medical center in south-central Pennsylvania.

METHODS

A cross-sectional survey was administered from September 9 to November 30, 2020 to adult postoperative patients. Data were collected via self-report questionnaires with a retest issued approximately 72 hours later. The survey included questions regarding occurrences of skin disturbances and the Dermatology Life Quality Index. All analyses were conducted using SAS version 9.4.

RESULTS

A total of 575 patients were invited to participate, with 103 participating and 69 completing the retest. The health questionnaire indicated that 69.6% of patients had challenges with skin rashes or irritation due to loose skin; 80.6% were interested in having skin removal surgery; and only 5.8% were referred to a dermatologist for their concerns.

CONCLUSION

The presence of skin concerns was associated with impaired HRQOL among postbariatric patients. This suggests a need to further educate the bariatric interdisciplinary team to evaluate the impacts of skin pathology on postbariatric patients.

Skin manifestations after bariatric surgery

Background

Skin signs observed in morbid obesity may change as the weight reduces, especially post-bariatric surgery (BaS). Data concerning the skin findings exclusively in post-BaS patients remain limited.

Methods

Seventy post-BaS patients were examined for cutaneous abnormalities. The patients were divided into those with successful weight loss (% excessive body weight loss (EBWL) of at least 50%) and a non-successful group (%EBWL < 50%).

Results

Forty-six patients with successful weight loss demonstrated a significantly lower prevalence of acanthosis nigricans on the neck, axillae and inguinal areas, keratosis pilaris (KP) and pebble fingers. However, a higher prevalence of alopecia was observed. After adjustment with patients’ factors, KP (adjusted odds ratio (aOR) = 0.21, 95%CI 0.06–0.74, p = 0.02) and pebble fingers (aOR = 0.09, 95%CI 0.01–0.89, p = 0.04) remained significantly less likely in patients with successful weight loss. Laboratory results comparing pre- and post-surgery values revealed significant decreases in fasting plasma glucose, hemoglobin A1c, and triglyceride and an increase of high-density lipoproteins in both groups. However, significant decreases of liver aminotransferases (AST and ALT) were observed only in the successful group (p = 0.04, 0.003). Nonetheless, a decrease in vitamin B12 (p = 0.01) was observed in the successful group.

Conclusion

Weight loss after BaS provided an improvement for metabolic profiles. Successful weight reduction resulted in better skin improvement. However, nutritional supplements may be necessary.

Trial registration

Thai Clinical Trials Registry TCTR20171003002. Registered October 3. 2017, retrospectively registered.