Panelists discussed the connections between obesity, inflammation, and inflammatory skin diseases during a morning session at the Skin of Color Update in New York City last week, highlighting the potential benefits of glucagon-like peptide-1 receptor agonists (GLP-1 ras) for weight loss and disease management.1
The panel, “Addressing Comorbidities in Dermatologic Disorders: Spotlight on Psoriasis and Hidradenitis Suppurativa-An Expert Discussion on Multidisciplinary Approaches Including the Po# Obesity’s Impact on Inflammatory Skin Diseases: Psoriasis, HS, and PsA
Obesity is increasingly recognized as a critically important factor influencing the pathogenesis and treatment outcomes of inflammatory skin diseases like psoriasis, hidradenitis suppurativa (HS), and psoriatic arthritis (PsA). Experts discussed this complex relationship at the American Academy of dermatology (AAD) 2024 annual Meeting.
The Role of Inflammation
According to Jenny Soung, MD, obesity is not simply a cosmetic concern but a state of chronic low-grade inflammation. Adipose tissue, particularly visceral fat, releases numerous cytokines that amplify systemic and cutaneous inflammation in psoriasis.
The link between obesity and psoriatic arthritis is even clearer: the higher the body mass index (BMI), the higher the risk of psoriatic arthritis; those with the disease have more systemic inflammation.
Evidence shows that patients who are obese and have psoriasis may experience a greater disease burden and exhibit lower responses to certain biologic therapies. In these patients,obesity or high BMI influences the longevity of their treatment response.
Lal expanded on this topic, noting that biologic treatment failures are complicated by a lack of weight-based dosing. Since moast medications are administered in standardized doses regardless of weight, he hypothesized that the amount of free drug circulating in the system is very different for someone with a normal vs an elevated BMI.
As for HS, Lal considers it a much more complicated disease, in which obesity plays a big role. Because many patients have a follicular phenotype of HS, it is often missed and diagnosed as folliculitis. Additionally, HS is common in those with darker skin tones and who are obese.
Lal noted that treating HS is very different than treating psoriasis, as he frequently enough starts by managing all the factors he cannot see. Consequently, the first visit includes discussing obesity with patients, screening for diabetes, and checking for hypertension. He noted that many patients are not doing this regularly since they do not see primary care providers; because patients care more about the disease they can see, Lal said dermatologists often become that primary care figure.
Patient-Centered Discussions on Weight and Skin Health
The conversation then turned to the best way to address the relationship between obesity and inflammatory skin diseases with patients. Soung noted that this topic could be very personal for them, so it must be approached carefully. She encouraged providers to start by expressing their concern that the patients’ weight may be impacting their skin or treatment response. Then, they should ask permission to talk about the patients’ weight.
“I find that if you give the patient the power to make that decision,and you’re asking for permission,they’re a lot more excited,” Soung said.
Due to the social stigma surrounding obesity, Soung added that she often uses the terms weight and weight management instead, claiming that patients feel less ashamed discussing the topic in this manner. Lal added that he discusses his own experience with patients to put them on an equal footing.
“…I’ve been obese my whole life, so I share with people my story, my journey, because I think it sets a level playing field,” he said. “…I can tell you, when I was 300 pounds and people would tell me about diet and all these things, it’s the kind of thing that you know already, but it’s hard to implement depending on what you’re doing in your life. Luckily, we have drugs that can help now.”
GLP-1 RAs and Their Impact on Inflammatory Skin Diseases
Pivoting to GLP-1 RAs, Soung explained that they both decrease appetite and food cravings and are very different from the weight loss drugs of the p