- Allison Truong, MD, FAAD
- Comorbidities, Expert Insights, Patient Care Resources, Quality of Life, Research, Treatment
As Director of Clinical Research at Southern California Dermatology and Clinical Faculty at Harbor-UCLA Medical Center, Dr. Jennifer Soung has been a leader in advancing psoriasis treatments through her clinical research on novel therapeutic agents. She has also championed for a holistic approach to psoriasis care, working in collaboration with obesity medicine experts to investigate the novel use of GLP-1 agonists as a potential treatment strategy in psoriasis and other inflammatory skin conditions. In a recent interview, Dr. Soung shared her clinical expertise in managing psoriasis patients receiving these anti-diabetic, anti-obesity medications.
GLP-1 Agonists: : A Multifaceted Approach to Treatment
Obesity and psoriasis, although entirely distinct disease processes, share similar inflammatory pathways. Given the potential interplay between the two conditions, addressing obesity may offer a promising approach to improving psoriasis as well as other inflammatory skin diseases. Glucagon-like peptide-1 (GLP-1) agonists, also known as GLP-1 receptor agonists, GLP-1 analogs, or incretin mimetics, are novel therapeutic agents developed to manage type 2 diabetes and obesity through the regulation of blood sugar levels and increased satiety. Currently, in the United States, the FDA has approved the following GLP-1 agonists: dulaglutide, exenatide, liraglutide, lixisenatide, semaglutide, and tirzepatide (a dual GLP-1/GIP agonist).
“Psoriasis is a systemic disease, and by treating inflammation from multiple sources – including obesity, we can help patients manage their condition better,” says Dr. Soung. She explains that her treatment approach is often multifactorial, integrating FDA-approved psoriasis therapies such as biologic agents with targeted management of psoriasis comorbidities, including cardiovascular disease, fatty liver disease, diabetes, and more. Dr. Soung adds, “While weight loss alone is not a cure for psoriasis, GLP-1 agonists can help target systemic inflammation, which is a core component of the disease [psoriasis].”
Impact of Weight Loss on Psoriasis and Comorbidities
Research has shown that losing only 5-10% of body weight can significantly impact a patient’s overall health, including improved cardiovascular markers such as blood pressure, total cholesterol, and diabetes control.1 Although 5-10% weight loss produced improvement, greater weight loss was associated with even greater improvement. GLP-1 agonists can lead to an average weight loss of 5-15% of body weight over a year, with some studies demonstrating even greater losses. For example, semaglutide has been shown to produce an average weight loss of 15% over 68 weeks,2 whereas tirzepatide has shown an average weight loss of 20.9% over 72 weeks.3
Dr. Soung shares her clinical observations, noting that many psoriasis patients experience improved disease control and clearer skin following weight loss through GLP-1 therapy. While there is still no formal study directly linking GLP-1 agonists to psoriasis improvement, studies are currently underway. “In our practice, we’ve seen that patients who have lost over 10% of their body weight often maintain improved results with psoriasis treatments, leading to more complete clearance or better long-term response,” Dr. Soung says. However, Dr. Soung also cautions that the reverse can occur – patients who regain weight may experience a diminished response to biologic therapies.
The Role of GLP-1 in Obesity and Psoriasis Management
Before the discovery of GLP-1 agonists, patients often struggled to achieve significant weight loss, essential in managing psoriasis and its comorbidities. However, medications like semaglutide and liraglutide have changed the game, allowing patients to lose a substantial amount of weight quickly.
Dr. Soung acknowledges that GLP-1 is the first treatment that has allowed patients to lose significant weight, with some seeing up to a 21% weight reduction. This weight loss not only improves psoriasis symptoms but also reverses some comorbidities like hypertension and diabetes.
“We’ve seen a reversal of diabetes in patients who have lost more than 10% of their body weight, which significantly reduces the risk of cardiovascular issues,” Dr. Soung notes. This multifaceted approach—treating psoriasis, obesity, and metabolic health together—has become a cornerstone of treatment in Dr. Soung’s clinic.
Challenges and the Need for a Holistic Treatment Approach
Despite the benefits of GLP-1 treatments, Dr. Soung emphasizes that weight loss alone is not a magic bullet. “It’s important to recognize that managing obesity and psoriasis requires more than just medication—it requires a team approach,” says Dr. Soung. Dr. Soung currently does not prescribe the GLP-1 agonist as a dermatologist because she works alongside experts in obesity medicine to co-manage patients with psoriasis on GLP-1 therapies. However, she encourages dermatologists to address obesity and psoriasis concurrently, which may mean dermatologists will incorporate GLP treatments into their practice.
Patients need consistent, multidisciplinary support, including access to dieticians, cognitive behavioral therapy (CBT), and counseling to achieve lasting lifestyle changes, says Dr. Soung. Moreover, long-term success requires more than simply relying on medications since not all patients can afford prolonged use of GLP-1 agonists. Patients must also commit to sustainable dietary changes and exercise routines. Without proper management and expert guidance, Dr. Soung warns that patients may experience adverse effects from GLP-1 therapy, such as malnutrition, constipation, and other complications. Additionally, many patients regain weight and experience a return of appetite after discontinuing GLP-1 treatment.
“Changing your relationship with food and incorporating regular physical activity are crucial for long-term success,” Dr. Soung explains. While GLP-1 treatments provide a valuable jumpstart, they are not a substitute for the necessary lifestyle modifications that help patients maintain their weight loss and improve their overall health.
GLP-1 agonists offer a promising approach for psoriasis patients, particularly those struggling with obesity and its associated comorbidities. While more research is needed to understand the full scope of their impact on psoriasis, early results indicate that weight loss and the reduction of systemic inflammation can significantly improve both skin conditions and overall health. Dr. Soung highlights the importance of a holistic, multifaceted treatment plan that combines effective therapeutic agents, lifestyle changes, and psychological support to optimize psoriasis patient outcomes.
References
- Brown JD, Buscemi J, Milsom V, et al. Effects on Cardiovascular Risk Factors of Weight Losses Limited to 5-10%. Transl Behav Med. 2016;6(3):339-346. doi:10.1007/s13142-015-0353-9.
- Wilding JPH, Batterham RL, Calanna S, et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021;384(11):989-1002. doi:10.1056/NEJMoa2032183.
- Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med. 2022;387(3):205-216. doi:10.1056/NEJMoa2206038.
