The role of GLP-1s in dermatology

By Allison Evans, Assistant Managing Editor, January 1, 2026

Over the past five years, the approvals of glucagon-like peptide-1 receptor agonists (GLP-1s), particularly semaglutide and tirzepatide, have sparked a revolutionary approach to managing obesity and its comorbid conditions.

This class of drugs, often considered “miracle drugs,” mimics the GLP-1 hormone in the body that helps control insulin and blood glucose levels and promotes feelings of satiety by slowing down gastric emptying. GLP-1s effectively lower glucose levels and reduce body weight, making them valuable in treating type 2 diabetes, cardiovascular disease, obesity, and dyslipidemia, as well as other metabolic diseases associated with obesity.

Obesity plays a significant role in dermatology, notably for patients with psoriasis, hidradenitis suppurativa (HS), polycystic ovary disease (PCOS), and other diseases. While the current research surrounding the use of GLP-1s in dermatology is limited, GLP-1s may offer a novel approach to managing chronic inflammatory skin disorders in patients who struggle with weight management — and will likely become increasingly important in the practice of dermatology.

Obesity in dermatology

Contrary to both popular and (often) clinical opinions, obesity is a chronic disease, said Jennifer Soung, MD, FAAD, founder and director of clinical research at Southern California Dermatology and clinical faculty at Harbor University of California Los Angeles, where she conducts clinical trials in addition to private practice. “It is not a lack of willpower. It’s a complex medical condition influenced by genetic, environmental, and metabolic factors, requiring a multifactorial approach.”

With Dr. Soung’s expertise in both inflammatory skin conditions and weight management, she prescribes GLP-1s to select patients, while also advising patients to seek behavioral therapy and work with a trainer and dietitian. “These drugs are like any other new biologic that we need to learn,” Dr. Soung said, adding that dermatologists can adopt them easily.

“If they meet the criteria for prescription of a GLP-1, whether that’s obesity or diabetes, and they have an inflammatory skin disease that is not under appropriate control with an approved therapy, then we start to have a conversation about weight management,” said Michelle Tarbox, MD, FAAD, associate professor, chair, and program director at Texas Tech University Health Sciences Center.

“Either I will prescribe the medication, or I will help their doctors that treat their obesity or diabetes understand that it might improve more than one disease state to address the patient’s metabolic abnormalities,” she added.

GLP-1s possibly have anti-inflammatory and immunological properties beyond weight-reduction that directly address underlying chronic inflammation. At the molecular level, GLP-1 receptors are found on certain immune cell subpopulations, including regulatory T cells, which play a role in regulating inflammation, said Dr. Soung.

“We know that excess adipose tissue produces inflammatory cytokines that worsen many of the disease states that we treat,” said Dr. Tarbox. “We have a conversation with the patients about the fact that adipose tissue produces the same things that drive the processes for these skin conditions we’re trying to address.”

“If they meet the criteria for prescription of a GLP-1, whether that’s obesity or diabetes, and they have an inflammatory skin disease that is not under appropriate control with an approved therapy, then we start to have a conversation about weight management.”

Psoriasis

Obesity is characterized by low-grade chronic inflammation and is an independent risk factor for inflammatory skin conditions like psoriasis. Weight loss, however, can improve the severity of psoriasis because of the reduction of the inflammatory mediators. Adipose tissue is not simply a storage molecule, said Dr. Soung, but an active endocrine organ, releasing numerous cytokines that amplify systemic and cutaneous inflammation in psoriasis. Dr. Soung noted that the global prevalence of obesity in patients with psoriasis is 25%, and that having a BMI that’s 35 or greater nearly doubles the risk of psoriasis.

Joel M. Gelfand, MD, MSCE, FAAD, director of the Psoriasis and Phototherapy Treatment Center at the Perelman Medical School of the University of Pennsylvania, discussed how he and his colleagues’ research demonstrated that increasing body surface area affected by psoriasis is directly related to an increasing BMI; additionally, obesity is a risk factor for developing psoriatic arthritis independent of its effects on psoriasis severity. “Despite the strong relationship between psoriasis and obesity, most of our treatments, except for, perhaps, apremilast, have no benefit on adiposity, and TNF and JAK inhibitors may even promote weight gain.”

According to Karan Lal, DO, MS, FAAD, a double-certified pediatric and cosmetic dermatologist in Scottsdale, Arizona, “There are exciting studies underway assessing the effectiveness of adding tirzepatide to ixekizumab therapy in adults with plaque psoriasis and psoriatic arthritis who are obese or overweight, shedding light on whether GLP-1s have an additional benefit in treating these patients.”

“Small randomized controlled trials and meta-analyses show significant improvements in PASI scores and quality of life indices with agents such as liraglutide and exenatide, even in patients without diabetes,” said Adam Friedman, MD, FAAD, professor and chair of dermatology at George Washington School of Medicine and Health Sciences.

“GLP-1s are exciting because this is the first time that patients can lose more than 10% of their body weight without bariatric surgery,” Dr. Soung said, who worked with the National Psoriasis Foundation to develop a quick guide to obesity. “We can reverse diabetes, high blood pressure, and hypertension, because we’re seeing that when you lose more than 10% of your body weight, you start to change cardiometabolic risk factors.”

Patients with psoriasis have a high risk of developing diabetes because of common pathogenic mechanisms between the two diseases. “Most of our psoriasis patients have these other comorbidities, like obesity, diabetes, high blood pressure, and even fatty liver,” she said. “Psoriasis and obesity are both systemic inflammatory diseases that share overlapping inflammatory pathways and comorbidities,” Dr. Soung said.

The higher a patient’s BMI, the higher their risk of getting psoriasis as well as a greater likelihood of more severe PASI skin scores, Dr. Soung said. “When I started seeing psoriasis patients who were on GLP-1s, as they lost weight their psoriasis would improve,” although, she noted that this does not apply to all patients.

“When you think of an autoimmune disease, which is truly systemic, anything that influences our immune system is going to influence the skin,” Dr. Soung said. “In that subset of patients, GLP-1s make the biggest difference because that excess weight is another source of 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.

“GLP-1s are an additional tool to help my psoriasis patients in a comprehensive way and address not only their skin but the rest of their health as well,” she added.

Hidradenitis suppurativa

HS remains a challenging condition to treat, and patients with HS are at an increased risk of developing obesity, type 2 diabetes, and dyslipidemia. These metabolic abnormalities contribute to the increased inflammation that plays a key role in the pathogenesis of the disease. “Prospective cohort studies have demonstrated improvements in BMI, inflammatory markers, disease stage, and quality of life after GLP-1 treatment,” noted Dr. Friedman.

While research has demonstrated that weight loss on its own can improve HS, GLP-1s may directly affect immune cells by reducing production of proinflammatory cytokines.

Dr. Lal emphasized that the impact of GLP-1s on HS patients extends far beyond their skin, significantly improving overall well-being and quality of life.

A retrospective study found that patients with HS who started taking GLP-1s (semaglutide was most prescribed) experienced reductions in a long list of disease measures, including severity, flares, and pain. Six months after treatment began, 54% had a 1-point or greater reduction in the Hidradenitis Suppurativa Physician’s Global Assessment score, while 60% had reductions in recent flares (doi:10.1001/jamadermatol.2025.2723).

“We tell our HS patients that they need to lose weight, but these patients have skin lesions that hurt and drain — and get worse with sweating and friction,” Dr. Tarbox said. “Telling them to lose weight on their own when they also have an out-of-balance metabolic system can be a cruel thing to do. The efficacy of these agents and their general safety make them a very attractive option for patients who truly need them.”

The immunoregulative effects of the GLP-1s can also improve HS. Studies have shown that HS patients with high BMIs often display increased expression of the IL-17 receptor, a key pro-inflammatory cytokine involved in HS pathogenesis and a marker of systemic inflammation. The analysis further revealed that HS patients had a threefold increased risk of developing diabetes compared to the general population (doi: 10.1016/j.jaad.2017.08.042).

A recent study published in the Journal of Drugs in Dermatology showed that GLP-1 therapy reduced surgical abscess repairs and hospitalizations among people with HS, regardless of type 2 diabetes status (doi:10.36849/JDD.8926).

The use of GLP-1s in HS presents a promising therapeutic option, even before initiating biologics. GLP-1s may serve as an early intervention in HS, targeting both metabolic dysfunction and inflammation, which are critical in HS pathogenesis.

To prescribe or not to prescribe

The use of GLP-1s in psoriasis and HS is moving from theoretical to cautious exploratory clinical use, particularly in patients with metabolic comorbidities, which are quite common in these patients, Dr. Friedman said.

When prescribed in the right setting, Dr. Lal believes that GLP-1s are medically appropriate for a dermatologist to prescribe. “For patients with chronic inflammatory diseases like psoriasis and HS, we know that they are fueled in part by the inflammation that is associated with obesity, I always offer a GLP-1 in addition to whatever other medical therapy I’m doing,” Dr. Lal said.

“I do low and slow dosing in general because my goal is usually to treat for inflammation as opposed to weight loss,” he added. “I think it’s going to give us the best outcome in the long run and help avoid some of the side effects.”

In Dr. Lal’s experience, medications respond better when the patients have less weight on them. “Certain medications like biologic medications and medications for HS, a lot of them are administered in standardized doses and are not weight-based.”

He hypothesized that the amount of free drug circulating in the system is very different for someone with a normal BMI versus an elevated BMI. “How does it make sense that someone who is 400 pounds is going to get the same amount of the drug as someone who is 200 pounds?”

Most dermatologists are likely less familiar with liraglutide, which does have the longest safety record, but it requires daily dosing, which is less convenient, said Dr. Tarbox. “Semaglutide, which also has a long safety record, and tirzepatide are the GLP-1s more dermatologists are likely familiar with. Tirzepatide has great weight-loss data showing the most rapid weight loss, although patients tend to have more telogen effluvium with this medication because of the rapid weight loss.”

Dr. Friedman believes the consensus is that most dermatologists should probably hold off on prescribing these agents as frontline therapy. “Right now, these drugs should be considered adjunctive in select refractory or highly motivated patients, particularly those with metabolic comorbidities.”

Not all dermatologists need to prescribe GLP-1s, but they need to be aware of them, noted Dr. Lal. “We can’t ignore it anymore because not only are we managing the inflammation, but to some degree, we’re probably getting patients on the cosmetic side that are suffering from issues from being on a GLP-1.”

“The GLP-1 is not going to kill them. It’s the obesity and obesity-related comorbidities, which are the same comorbidities as psoriasis, that will kill them. Now we have drugs that we know reduce morbidity from these conditions,” Dr. Lal said.

Counseling and considerations

Like with any drug, GLP-1s require counseling, Dr. Soung noted. “Since GLP-1s increase hormones that make you feel full, they also slow down your gut. I explain to patients that it’s really important to hydrate to limit constipation, although the most common symptoms are nausea and GI issues.”

“We should be familiar with the data, adverse effects, and unintended cutaneous sequelae, including ‘Ozempic face,’ telogen effluvium, and even rare side effects like panniculitis or bullous pemphigoid,” Dr. Friedman said.

Some people experience many GI issues while others have none, remarked Dr. Lal, so it’s particularly important to counsel patients who have a sensitive gut and get any GI issues under control before prescribing a GLP-1.

“With weight loss comes the loss of muscle as well as fat, so you must continue to exercise and build muscle,” Dr. Soung emphasized.

“We need to talk with our patients about the importance of properly fueling their muscles and maintaining, or growing their muscles, because muscle loss also contributes to negative health metrics,” Dr. Tarbox added.

Hair loss is another concerning side effect for those on GLP-1s. Patients will lose their hair on a GLP-1, noted Dr. Lal, although there are things they can do to minimize it. “Counsel patients to have adequate protein intake, eat at least 1,200-1,500 calories to avoid the body’s starvation mode, and even take supplements like pumpkin seed oil before you start the GLP-1.”

Dr. Tarbox also recommended that patients of child-bearing potential should be warned about increased fertility on GLP-1s since they may indirectly help regulate the metabolic process and hormonal axis as well as often improving ovulatory function in PCOS.

GLP-1s come with an FDA boxed warning. These drugs should not be given to patients with a history of medullary thyroid cancer or with multiple endocrine neoplasia syndrome type 2, a genetic disorder leading to the development of endocrine tumors, Dr. Lal said.

Some research has also shown an increased risk of non-arteric ischemic optic neuropathy (NAION) with the use of some GLP-1s. While not a universal recommendation, Dr. Lal suggests patients get a baseline ophthalmologic assessment. “It’s an idiosyncratic event that occurs, but if someone has ophthalmologic issues, I probably would refer the patient to another physician to prescribe the GLP-1 agonist.”

Looking forward

According to Dr. Soung, oral GLP-1s will likely play an even more important role in the future, as they may provide higher acceptability and better adherence than injectable GLP-1s. There are multiple oral options in phase 3 trials.

In a phase 3 randomized controlled trial, oral semaglutide (Rybelsus) demonstrated weight loss similar to what was reported with subcutaneous semaglutide 2.4 mg once weekly. It is currently FDA-approved to treat type 2 diabetes, and is in phase 3 trials for a label expansion that would include obesity.

Another experimental phase 3 oral semaglutide candidate (NN-9932) is in the pipeline, which may launch as soon as 2026. Orforglipron calcium, yet another oral option, is in phase 3 clinical trials, also projected to launch in 2026.

In addition to the oral options, there is a steady stream of injectable treatments in phase 3 trials. Encoglutide (a GLP-1 receptor agonist), retatrutide (a triple-acting GLP-1, glucose-dependent insulinotropic peptide [GIP], and glucagon receptor [GCG]) agonist), as well as mazdutide and sulvodutide (dual GLP-1 and GCG receptor agonists) are all in phase 3 clinical trials.

Dr. Tarbox is excited about new literature suggesting the potential benefit of GLP-1s in patients with chronic wounds that won’t heal. “The GLP-1s can increase collagen deposition and maturation, and they may help with angiogenesis and keratinocyte migration and proliferation. Their anti-inflammatory-like effects may help these chronically inflamed, especially lower extremity wounds, heal.”

“I predict that in the next five years, dermatology-specific clinical trials will define their place in our armamentarium,” Dr. Friedman noted.

A life-changing drug

“We are seeing an exciting accumulation of evidence for the use of GLP-1s in treating inflammatory skin diseases,” Dr. Friedman said. “However, most of these studies are small, early, or observational. At this point, while the data are promising, to me the data are not robust enough for dermatologists to uniformly feel comfortable prescribing GLP-1s solely for dermatologic disease.”

Patients are increasingly asking about GLP-1s for weight management, Dr. Friedman said. “Acknowledge the emerging data but emphasize that dermatology-specific use is still experimental. I encourage scratching the off-label itch for appropriate patients as this is how we get label extensions and new indications, although we need larger controlled trials before this becomes standard of care,” he remarked.

“For psoriatic patients in particular, GLP-1s are a great way to help patients take the first step toward improving their overall health,” Dr. Soung explained. “Because of the prior established relationship I have with these patients, I believe that dermatologists are well positioned to start that journey — we can initiate the prescription and begin the conversation — but lasting success comes from a multidisciplinary approach that includes nutrition, exercise, and behavioral support.”

GLP-1s exemplify the intersection of dermatology and systemic health, Dr. Friedman said. “They remind us that skin disease is deeply entwined with metabolic and inflammatory pathways.”

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