Do Skin Diseases Signal Deeper Trouble: Unmasking the Link Between Inflammatory Dermatoses and Lipid Disturbances?

🔍 Key Finding Lipid alterations are common in inflammatory skin diseases like psoriasis, lichen planus, and atopic dermatitis, impacting both blood and skin lipid composition, and are linked to increased risk of metabolic syndrome and cardiovascular issues. Further research, particularly on skin lipidomics, is needed to refine disease understanding, personalized treatments, and prognostic tools.

🔬 Methodology Overview

• Design: Discursive review
• Data Sources: PubMed database
• Search Terms: lipidomics AND lipids AND (psoriasis OR atopic dermatitis OR lichen planus OR hidradenitis suppurativa OR seborrheic dermatitis OR acne vulgaris OR rosacea)
• Language Inclusion: Polish, English, French, and German
• Inclusion Criteria: Human studies only (adult or child studies considered)
• Analysis Approach: Qualitative synthesis of findings related to lipid alterations and metabolism disturbances in the specified inflammatory skin diseases.
• Scope: Lipidomic aspects in selected inflammatory dermatoses, focusing on psoriasis, atopic dermatitis, lichen planus, hidradenitis suppurativa, acne vulgaris, rosacea, and seborrheic dermatitis.

📊 Results

• Psoriasis: Patients show elevated total cholesterol, triglycerides, LDL, VLDL, and apolipoprotein B, along with decreased HDL. Psoriatic epidermis exhibits decreased free fatty acids and increased cholesterol, with abnormal ceramide composition.
• Lichen Planus: Significantly increased hypertriglyceridemia prevalence. Tendency for increased LDL and decreased HDL. One study found significantly higher total and free cholesterol, cholesteryl esters, LDL, and intermediate-density lipoproteins. Increased risk of atherosclerosis based on carotid intima-media thickness.
• Atopic Dermatitis: Conflicting association with metabolic syndrome. Large study found less frequent metabolic syndrome and diabetes overall, but more frequent dyslipidemia. Adults with moderate-to-severe AD showed increased prevalence of metabolic syndrome components. Lesional skin shows lower levels of several ceramide subclasses, while non-lesional skin shows reduced ceramide chain length correlated with barrier dysfunction.
• Hidradenitis Suppurativa: Odds ratio of 2.66 for metabolic syndrome. Significant association with general and abdominal obesity. Association with dyslipidemia, diabetes mellitus, and hypertension. Lesional skin shows increased 5-LO-derived metabolites of omega-6 fatty acids and decreased omega-3 fatty acids and docosahexaenoic acid.
• Seborrheic Dermatitis: One study found significantly higher total cholesterol and LDL, along with lower HDL. Another found only lower HDL. Older studies showed decreased squalene, free fatty acids, and wax esters in lesional skin, with elevated cholesterol, triglycerides, and paraffins.
• Rosacea: Significantly associated with dyslipidemia, higher total cholesterol, LDL, and triglycerides. No significant correlation with HDL. One small study found no differences in skin surface lipids between patients and controls.
• Acne Vulgaris: Patients with more severe acne had higher total cholesterol and LDL. Increased concentrations of sphinganine, sphingosine, O-Phosphoethanolamine, and sphingomyelin (d18:1/18:0) in plasma. Skin surface lipids show increased total lipids, fatty acids, glycerophospholipids, unsaturated fatty acids, and squalene, along with decreased ceramide chain length.

💡 Clinical Impact This review highlights the significant impact of lipid alterations in several inflammatory skin diseases, emphasizing the need for clinicians to consider lipid profiles and metabolic comorbidities in patients with these conditions to improve management and prevent cardiovascular complications. Further research into skin lipidomics could lead to personalized treatments and prognostic tools for these diseases.

🤔 Limitations

• Studies did not clearly define participant age groups (adults vs. children).
• Ethnicity not always specified, despite potential impact on disease course.
• Studies did not always account for disease subtypes and varying courses.
• Skin lesion severity not consistently considered or objectively measured.
• Confounding factors like diet, lifestyle, and nutrition status not always analyzed.
• Limited data on skin lipidomics in LP and SD.
• Insufficient investigation of the relationship between seborrhea and lipid composition in SD.

✨ What It Means For You Doctors should be aware of the frequent lipid abnormalities in inflammatory skin diseases like psoriasis, lichen planus, and atopic dermatitis, and consider screening for metabolic syndrome and cardiovascular risk. Understanding the interplay between skin disease and lipid metabolism can inform treatment choices and improve patient outcomes by mitigating comorbidity risks and enhancing quality of life. Further research into skin lipidomics could lead to personalized therapies and prognostic tools.

Reference Nowowiejska J, Baran A, Flisiak I. Lipid Alterations and Metabolism Disturbances in Selected Inflammatory Skin Diseases. Int. J. Mol. Sci. 2023;24:7053. https://doi.org/10.3390/ijms24087053