Could GLP1 weight loss/diabetes medications benefit skin conditions like psoriasis or hidradenitis suppurativa?

As we gain 20+ years of experience with GLP1-based treatment, I continue to be fascinated by the diversity of potential benefits that we are finding in clinical trials and in clinical practice. A fascinating article was recently published reviewing the potential benefits of GLP1-based medication to skin conditions.

Psoriasis is an autoimmune condition that has been hypothesized to benefit from GLP1 medication. People with type 2 diabetes and people with obesity have a higher risk of psoriasis. There are GLP1 receptors in the skin, around hair follicles and also in immune cells that can infiltrate the skin. Potential mechanisms by which GLP1 have been hypothesized to be of benefit to psoriasis include anti inflammatory effects, improvement in blood sugars, and weight loss. However, the data on this topic are sparse, with mixed results. While a small randomized trial of 20 people did not show benefit with liraglutide, there are multiple case series of psoriasis improving with GLP1 treatment. Authors also report on one case of psoriasis worsening with liraglutide. Personally, I’ve certainly heard many a colleague (including myself) sharing cases of psoriasis improving with GLP1 based medication.

Interestingly, some data (mostly case reports/series and retrospective cohort studies, as reviewed here) suggest that bariatric surgery often improves psoriasis. This article suggests several possible mechanisms including a reduction in inflammatory hormones. As bariatric surgery also increases our own GLP1 production, one wonders whether this may be at play here as well. On the flip side, could it be that improvement in psoriasis with GLP1 medication is related to the reduction in general chronic inflammation seen with weight loss, and not due to the GLP1 itself? We need mechanistic studies and proper randomized controlled clinical trials of GLP1 medication as a treatment of psoriasis for a better understanding.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by nodules and abscesses in intertriginous areas (eg armpit and groin). Chronic inflammation, bacterial infection, and sweat gland dysfunction contribute, and is significantly more common in people with obesity. Diabetes is also a risk factor for developing HS. There are data that suggest a potential benefit of GLP1 to HS. Whether benefit is related simply to weight loss (reducing mechanical friction and inflammation), or whether there is something particular to GLP1 medication that benefits, is again a much-needed area of exploration and research. Weight loss from bariatric surgery may improve HS, though there are cases reported of worsening or even new onset HS after surgery (more on this here and here) .

BOTTOM LINE: GLP1-based obesity medication and bariatric surgery could potentially benefit skin conditions like psoriasis and hidradenitis suppurativa, but data are sparse. If there is a benefit of these treatments to these skin conditions, is it mediated by GLP1, by inflammation, and/or by weight loss itself? This area is ripe for clinical trials to explore further!

Disclaimer: I receive honoraria as a continuing medical education speaker and consultant from the maker of liraglutide (Novo Nordisk). I am/have been an investigator in clinical trials of liraglutide.

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