TNF and obesity due to melanocortin 4 receptor deficiency: Indeed, patients with psoriasis have an increased prevalence of classic cardiovascular risk factors, including obesity, hypertension, diabetes, dyslipidemia, metabolic syndrome, and nonalcoholic fatty liver disease.13, 14, 15, 16 However, psoriasis may provide an additional and independent cardiovascular risk factor, most likely because several cytokines (tumor necrosis factor-alpha, interferon, interleukin-17, interleukin-6) released by skin lesions can directly favor the development and progression of atherosclerosis.17