Based on the presentation by José-Manuel Carrascosa, “Obesity and Psoriasis,” delivered at the EADV 2026 Congress in Vienna.
Psoriasis is a disease in which inflammation extends beyond visible skin lesions. Therefore, treatment decisions should take into account not only the condition of the skin but also the patient's metabolic health. One important contributing factor is obesity.
Adipose Tissue Contributes to Inflammation
In obesity, fat cells enlarge, and immune cells become activated in the surrounding tissue. Together, they release substances that sustain inflammation, including TNF, IL-6, and leptin. These signals may amplify the immune processes involved in psoriasis.
Conversely, in psoriasis, inflammatory changes can be detected in the subcutaneous adipose tissue, even beneath areas of skin without visible lesions. These changes are more pronounced when psoriasis and obesity coexist.
In a study presented during the talk, treatment with secukinumab, a drug that blocks IL-17, reduced inflammatory changes in the subcutaneous adipose tissue as well. This demonstrates how closely these processes are interconnected.
How Body Weight Affects the Disease
Genetic studies support a causal relationship: a higher body mass index contributes to the development of psoriasis. In people who already have the disease, excess body weight is also associated with a higher risk of psoriatic arthritis and a less pronounced response to biologic therapy.
Obesity is one of several factors that influence the course of the disease. Its presence does not mean that psoriasis treatment will be ineffective.
Weight Loss as Part of Treatment
The presentation considers obesity management an important component of care for patients with psoriasis. It complements skin-directed treatment and allows clinicians to address metabolic and cardiovascular risks simultaneously.
A weight-loss plan should be individualized and include a moderate calorie deficit and regular physical activity suited to the patient's abilities. When joint symptoms are present, exercise should be adapted to the condition of the joints. Strict diets and the elimination of entire food groups are generally unnecessary unless medically indicated.
When appropriate, a physician may recommend pharmacological treatment. Particular attention in the presentation was given to GLP-1 receptor agonists and dual GLP-1/GIP receptor agonists. These medications help regulate appetite and reduce body weight.
Small studies have reported improvements in psoriasis during treatment with these medications. However, further research is needed to determine how much of this improvement is attributable to weight loss and how much may result from additional effects of the medications on inflammation.
Their primary indication is the treatment of obesity or diabetes. Potential skin improvement is considered an additional benefit: these medications do not currently replace psoriasis-directed therapy.
A Comprehensive Approach
The management of patients with psoriasis includes assessing body weight, blood pressure, lipid profile, and markers of glucose metabolism. When necessary, the dermatologist coordinates care with a primary care physician and other specialists.
Treatment of the skin and management of obesity can complement each other. This approach addresses not only skin manifestations but also joint, metabolic, and cardiovascular risks.