TNF and obesity due to melanocortin 4 receptor deficiency: The explanation of associations between PS and CVD is further complicated by the fact that traditional systemic antipsoriatic treatments such as acitretin, cyclosporine, and corticosteroids may contribute to the development of CVD risk factors such as hypertension, obesity, diabetes, and dyslipidemia [8] whilst anti-TNF-α treatment does not have this side effect [23].