Association between metabolic syndrome and prevalent skin diseases: A systematic review and meta-analysis of case-control studies

Abstract

Background and aim: Metabolic syndrome (MetS) is a well-known noncommunicable disease that plays a significant role in emerging other chronic disorders and following complications. MetS is also involved in the pathophysiology of numerous dermatological diseases. We aim to evaluate the association of MetS with the most prevalent dermatological diseases.

Methods: A systematic search was carried out on PubMed, Science Direct, Web of Science, Cochrane, as well as the Google Scholar search engine. Only English case-control studies regarding MetS and any skin disease from the beginning of 2010 up to November 15, 2022, were selected. The study was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA).

Results: A total of 37 studies (13,830 participants) met the inclusion criteria. According to our result, patients with psoriasis, hidradenitis suppurativa (HS), vitiligo, androgenetic alopecia (AGA), and lichen planus (LP) have a higher chance of having MetS compared to the general population. Furthermore, people with seborrheic dermatitis (SED) and rosacea are more prone to insulin resistance, high blood pressure (BP), and higher blood lipids. After pooling data, the meta-analysis revealed a significant association between MetS and skin diseases (pooled odds ratio [OR]: 3.28, 95% confidence interval: 2.62-4.10). Concerning the type of disease, MetS has been correlated with AGA (OR: 11.86), HS (OR: 4.46), LP (OR: 3.79), and SED (OR: 2.45). Psoriasis also showed a significant association but with high heterogeneity (OR: 2.89). Moreover, skin diseases and MetS are strongly associated in Spain (OR: 5.25) and Thailand (OR: 11.86). Regarding the metaregression model, the effect size was reduced with increasing age (OR: 0.965), while the size increased with AGA (OR: 3.064).

Conclusions: MetS is closely associated with skin complications. Dermatologists and other multidisciplinary teams should be cautious while treating these patients to prevent severe complications resulting from MetS.

Keywords: androgenic alopecia; dermatology; hidradenitis suppurativa; insulin resistance; lichen planus; metabolic syndrome; psoriasis; rosacea; seborrheic dermatitis; skin disease; vitiligo.

Figure 1

PRISMA 2020 flow diagram for new systematic reviews, which included searches of databases and registers only. PRISMA, preferred reporting items for systematic reviews and meta‐analysis.

Figure 2

A forest plot of the association between seven skin diseases and metabolic syndrome.

Figure 3

Forest plot showing the association between seven skin diseases and metabolic syndrome based on skin disease type subgroup analysis.

Figure 4

Forest plot showing the association between seven skin diseases and metabolic syndrome based on country subgroup analysis.

Figure 5

Bubble plot with a fitted meta‐regression line of the effect size and age relationship. Circles are sized according to each estimate's precision (it should be mentioned that the effect size is the logarithmic form of the odds ratio).

Figure 6

Bubble plot with a fitted meta‐regression line of the effect size and androgenic alopecia relationship. Circles are sized according to each estimate's precision (it should be mentioned that the effect size is the logarithmic form of the odds ratio).

Figure 7

Begg's funnel plot for publication bias (it should be mentioned that the effect size is the logarithmic form of the odds ratio).