At Skin of Color Update 2025, panelists, including Jennifer Soung, MD, FAAD, discussed how chronic inflammatory skin diseases, such as psoriasis (PsO) and hidradenitis suppurativa (HS), intersect with metabolic health, and highlighted emerging strategies for disease control, including the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs). This article summarizes key take-home points and clinical implications for dermatology practice.
The Link Between Weight, Inflammation & Skin Disease
Individuals with increased body mass index (BMI) are at a higher risk of developing psoriasis and are more likely to have severe disease. Obesity (as measured by increased BMI) is a chronic inflammatory state, with adipose tissue functioning as an active endocrine organ that releases cytokines and adipokines that amplify systemic and cutaneous inflammation.
In HS, systemic contributors including obesity, glucose intolerance, and hypertension may worsen disease severity. Panelists emphasized that treating “what we cannot see,” including metabolic disease, may be the foundational first step in successful HS management.
Comorbid obesity may also reduce response to biologic therapy. Many treatments for both psoriasis and HS are weight-based, which means that patients with higher BMI may have lower circulating drug levels, potentially affecting treatment outcomes. Despite this association, many patients do not recognize a relationship between their weight and its impact on their skin disease, emphasizing the need for further patient education.
GLP-1 Receptor Agonists: Weight Loss and Potential Skin Benefits
GLP-1 RAs, such as semaglutide and liraglutide, have transformed metabolic disease management by helping patients achieve meaningful weight reduction, often more than 10% of baseline body weight, which was previously not possible. These treatments can improve diabetes, hypertension, and other systemic health concerns closely linked to psoriatic disease.
Beyond metabolic improvement, emerging data suggests GLP-1 RAs may have anti-inflammatory benefits. GLP-1 receptors are distributed throughout the body, including on regulatory immune cells involved in psoriatic and HS disease pathways. Early clinical evidence suggests potential benefits of GLP-1 RAs in HS. Small real-world studies have reported decreased flare frequency, reduced pain, and improved quality of life when GLP-1 RAs were added to ongoing HS therapy. Although findings are preliminary, GLP-1 RAs may serve as a valuable adjunctive option in select HS patients, particularly those with a higher BMI. Ongoing studies are evaluating whether adding GLP-1 RAs to systemic therapy may enhance skin clearance and sustain response.
Communicating With Patients: Sensitivity & Shared Decision-Making
Discussing weight is highly sensitive due to cultural stigma and emotional impact. The panelists drew on their own personal experiences and recommended a permission-based, empathetic communication style. Asking first, “Would it be okay if we discuss how weight may affect your health and your skin?”, helps patients feel supported rather than judged.
Using language like “weight management” rather than “obesity” may improve engagement. Dermatologists are often the main physician a patient sees regularly, making it essential to encourage multidisciplinary support when appropriate.
Practical Recommendations for Dermatology Practice
| Focus Area | Recommendation |
| Baseline evaluation | Record BMI and screen for metabolic comorbidities (hemoglobin A1c, lipids, blood pressure) |
| Care coordination | Partner with primary care and obesity medicine when available |
| Therapy integration | Consider addressing weight and systemic inflammation alongside skin-directed therapy |
| Patient language | Use permission-based, stigma-free communication |
| Ongoing monitoring | Track changes in BMI, metabolic control, skin activity, and quality of life |
Take Home Points:
Addressing underlying metabolic health is an integral part of treating inflammatory skin disease. Weight loss strategies and GLP-1 RAs represent a growing opportunity for dermatologists to improve outcomes in psoriasis and HS by reducing systemic inflammatory burden. While further research, particularly randomized controlled studies, is needed to define dermatologic benefits, early data and clinical experience suggest a promising multidisciplinary approach that supports both skin improvement and overall patient wellness.
References:
American Journal of Managed Care. (2025). GLP-1s support weight loss, symptom relief in psoriasis, hidradenitis suppurativa. Retrieved February 2025, from https://www.ajmc.com/view/glp-1s-support-weight-loss-symptom-relief-in-psoriasis-hidradenitis-suppurativa
Gisondi, P., Del Giglio, M., Di Francesco, V., et al. (2008). Weight loss improves the response of obese patients with moderate-to-severe chronic plaque psoriasis to low-dose cyclosporine therapy. American Journal of Clinical Nutrition, 88(5), 1242–1247.
Jensen, P., Zachariae, C., Christensen, R., et al. (2013). Effect of weight loss on the severity of psoriasis: A randomized clinical trial. JAMA Dermatology, 149(7), 795–801.
Krajewski, P. K., Matusiak, Ł., & Szepietowski, J. C. (2024). The therapeutic potential of GLP-1 receptor agonists in hidradenitis suppurativa and other skin diseases. Journal of Clinical Medicine, 13(21), 6292.
Upala, S., Sanguankeo, A. (2015). Effect of lifestyle weight loss intervention on disease severity in patients with psoriasis: A systematic review and meta-analysis. Dermatology, 231(1), 70–74.
Xu, Y., et al. (2025). Association of BMI, BMR, BSA, and body weight with psoriasis treatment response. Translational Medicine Communications, 10(1), 30–45.
This summary was prepared by Dr. Courtney Hanna, dermatology resident, who attended the session. The content reflects the resident’s notes and interpretations, may contain errors, and is provided for educational purposes only. It does not constitute official faculty endorsement and should not replace original sources or clinical judgment.
