Using GLP-1s for Psoriasis and Hidradenitis Suppurativa

A question has been arising more frequently in-clinic. A 42-year-old woman with long-standing plaque psoriasis, on a stable biologic, asks if the “Ozempic” she is starting for weight loss might also help her skin. A 35-year-old man with Hurley stage II hidradenitis suppurativa (HS) and obesity tells you his primary care physician wants to start a weekly injection to help him lose weight and control his prediabetes. 

Both want to know the same thing: will this medicine also help my skin disease?

Glucagon-like peptide-1 receptor agonists (GLP-1s) such as semaglutide, liraglutide, and tirzepatide have transformed metabolic care. Dermatologists are now observing the downstream effects in their own waiting rooms. Emerging data in psoriasis and HS suggest that these agents may improve inflammatory skin disease activity in at least a subset of patients who already have a clear metabolic indication for treatment. The evidence remains early, but it is strong enough to guide thoughtful, real-world use.

This article focuses on what matters most to dermatologists: which patients to consider, what to expect clinically, how to discuss GLP-1s and weight in the exam room, and how to co-manage safety and access with colleagues in primary care, endocrinology, and ophthalmology.

Why GLP-1s Make Sense for Inflammatory Skin Disease

A detailed immunology review is not necessary for everyday practice, but a brief rationale helps frame conversations with patients and colleagues. GLP-1 receptors are expressed not only in pancreatic beta cells but also in immune cells, endothelial cells, and, to some extent, the skin. GLP-1–based therapies improve glycemic control and promote weight loss, but they also appear to dampen systemic inflammation through both weight-dependent and weight-independent effects. A recent review in the Journal of Clinical Investigation summarized data showing that GLP-1–based drugs reduce key inflammatory mediators and alter innate and adaptive immune responses across multiple organ systems.¹ Preclinical work has shown GLP-1 receptor–positive infiltrates in psoriatic skin, suggesting a potential role for GLP-1 in moderating cutaneous inflammation.²

For the practicing dermatologist, the key point is simple: GLP-1s are not “just weight loss drugs.” They are metabolic agents with credible anti-inflammatory properties in diseases where obesity, insulin resistance, and chronic inflammation intersect.

Psoriasis: Whom to Consider and What to Expect

Psoriasis has long been recognized as a systemic inflammatory disease with strong links to obesity, metabolic syndrome, and cardiovascular risk. Many patients who sit down in our clinics already meet criteria for pharmacologic weight loss or diabetes therapy, and GLP-1s are now a dominant option.

Prospective and observational data suggest that semaglutide can improve psoriasis severity in patients with obesity. In a 6-month cohort of adults with moderate-to-severe psoriasis and obesity treated with weekly semaglutide, investigators observed clinically meaningful improvements in Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI), alongside weight loss and better metabolic parameters.³ Analyses suggested that changes in specific fat depots and measures of well-being tracked closely with skin improvement, implying that more than simple weight loss may be at play. Earlier work with liraglutide in patients with psoriasis and type 2 diabetes also suggested PASI improvement and reductions in lesional inflammatory cytokines.⁴ Not every study has been positive, particularly in short-duration trials in nondiabetic obese patients, but the overall signal favors benefit in the right population.⁵

In practice, I consider GLP-1s in psoriasis when 3 elements converge. First, the patient meets a clear metabolic indication for therapy, such as obesity with weight-related comorbidities or type 2 diabetes. Second, psoriasis remains at least partially active despite topical and guideline-directed systemic or biologic therapy. Third, the patient is motivated to engage with lifestyle change and medical weight loss as part of a broader plan for their health.

I frame GLP-1 therapy as an adjunct, not a replacement, for dermatologic systemic treatment. Patients should continue their biologic or oral agent while we monitor how their skin and systemic health respond over several months. I tell patients that when benefits occur, they usually emerge gradually and may include “softer” improvements such as better energy, mood, and sleep in addition to changes in plaques and pruritus. For many, the idea that one medication could address weight, diabetes risk, cardiovascular risk, and possibly their skin is highly motivating. 

HS: A Logical (If Earlier) Target

Hidradenitis suppurativa is closely linked to obesity, metabolic dysfunction, and smoking. Weight gain and insulin resistance worsen mechanical stress, systemic inflammation, and the hormonal milieu that contributes to disease progression. Conversely, weight loss and metabolic improvement can reduce friction, sweating, and inflammatory burden in intertriginous areas.

Real-world data now suggest that GLP-1s may reduce HS morbidity. A large multicenter claims–EHR analysis found that exposure to GLP-1s in patients with HS was associated with fewer HS-related surgical procedures and a modest reduction in hospitalizations compared with matched controls.⁶ Smaller prospective cohorts and case series have reported reductions in flare frequency, pain, tunnel activity, and DLQI among patients with HS and obesity who initiated semaglutide for metabolic indications.^7,8 These studies are not randomized and cannot eliminate confounding by weight loss or concurrent therapy changes, but they align with clinical experience: when patients with HS have meaningful weight loss, their systemic inflammation improves and they often do better.

In HS, I am particularly likely to discuss GLP-1 therapy with patients who have Hurley stage II–III disease plus obesity or prediabetes/diabetes and who cycle through frequent flares, intralesional injections, antibiotics, and surgical consultations. For these patients, the potential to reduce flare frequency and surgical burden is compelling. I am explicit that data are more preliminary than in psoriasis and that we are “stacking the deck” in their favor by attacking the metabolic drivers of disease alongside established HS therapies. I continue or optimize standard HS treatments, including biologics where indicated, while the GLP-1 agent works on the metabolic side of the equation.

Talking About GLP-1s and Weight in the Dermatology Exam Room

Conversations about weight are sensitive, and the addition of GLP-1s has amplified public attention to weight-loss medications. Many patients come in with strong opinions or misinformation shaped by social media.

I have found it useful to ground the discussion in the skin disease first. For psoriasis, I explain that obesity and metabolic syndrome increase systemic inflammation and cardiovascular risk, and that both psoriasis and weight contribute to those risks independently. For HS, I describe how friction, hormonal factors, and systemic inflammation in the setting of obesity and insulin resistance make the disease harder to control. Next, I present GLP-1 therapy as one of several tools that might improve their overall health and, potentially, their skin.

I avoid framing weight as a moral issue and instead emphasize physiology and risk. I clarify that GLP-1 therapy is not cosmetic; insurers approve it when there is a medical need, such as diabetes or obesity with comorbidities. I also try to distinguish between “being thin” and “being metabolically healthier,” especially for patients who are already discouraged by past dieting attempts.

Coordination with primary care or endocrinology is essential. I generally do not prescribe GLP-1 RAs myself unless local systems and my own scope make it straightforward to manage metabolic monitoring, but I document why I think the patient would benefit and communicate directly with the prescribing clinician. This helps align expectations and promotes shared ownership of benefits and side effects.

Safety, Co-management, and Peri-procedural Considerations

For dermatologists, the practical safety questions around GLP-1s cluster into three areas: systemic adverse effects, peri-procedural management, and ocular safety.

Before I recommend GLP-1 therapy, I screen for a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2, prior pancreatitis, significant gallstone disease, severe gastroparesis, and pregnancy or planned conception. I explain the common gastrointestinal side effects, including nausea, vomiting, diarrhea, constipation, and early satiety, and the typical strategy of gradual dose escalation to allow the gut to adapt. I review practical strategies such as slower eating, adequate hydration, small frequent meals early on, and attention to protein intake.⁹

Peri-procedural management has been an area of uncertainty, particularly for higher-dose weekly agents. Updated multi-society guidance now suggests that most patients can continue GLP-1 therapy before elective procedures, including those involving anesthesia, with individualized assessment for delayed gastric emptying in patients undergoing dose-escalation phase or with significant gastrointestinal symptoms.¹⁰ For dermatologic surgery under local anesthesia, the risk of aspiration is extremely low; nonetheless, I ask patients to tell proceduralists and anesthesiologists that they are on a GLP-1 and to follow any fasting instructions provided. For patients undergoing larger reconstructive procedures or combined surgeries under monitored anesthesia or general anesthesia, I defer to anesthesia colleagues about whether a temporary hold is necessary.

Eye safety deserves specific mention. In cardiovascular outcome trials of semaglutide in type 2 diabetes, rapid improvements in glycemic control were associated with an increased rate of diabetic retinopathy complications in high-risk patients, likely reflecting the well-known phenomenon of transient retinopathy worsening when glucose control improves quickly.9 More recently, observational analyses and pharmacovigilance reports have raised a possible association between semaglutide exposure and nonarteritic anterior ischemic optic neuropathy (NAION), leading to ongoing regulatory review.¹¹ Causality has not been established, and absolute event rates are low, but the practical implications are straightforward. Patients with diabetes should not skip their eye appointments when starting GLP-1 therapy, and all patients should seek urgent ophthalmic evaluation for painless, new-onset vision loss or visual field defects. For dermatologists, awareness of these issues and clear communication with ophthalmology colleagues are sufficient; these signals are not a blanket contraindication to GLP-1 use in appropriate patients.

Aesthetic and Hair Considerations in Rapid Weight Loss

As more patients lose large amounts of weight quickly, dermatologists are increasingly managing the skin-related consequences. Patients on GLP-1s can experience accelerated changes in facial volume, skin laxity, and body contour, especially when weight loss is brisk. Telogen effluvium appears to be relatively common during rapid weight reduction, though it is usually self-limited.

Addressing these concerns directly often improves satisfaction and adherence. I tell patients early on that significant weight loss can temporarily unmask laxity in the lower face, neck, upper arms, and abdomen, and that hair shedding can occur for several months. I emphasize that adequate protein intake, resistance training, and avoidance of severe caloric restriction may mitigate some of these effects. I also discuss staged aesthetic interventions when appropriate, ranging from energy-based skin tightening and fillers to surgical options in collaboration with colleagues in dermatologic or plastic surgery. Patients appreciate when we anticipate these issues rather than reacting only after they become distressing.

Putting It All Together: A Practical Framework

GLP-1 RAs are not dermatologic drugs in the traditional sense, and dermatologists should resist the temptation to oversell them as such. At the same time, it would be a missed opportunity not to recognize their potential to improve outcomes for patients in whom metabolic disease and inflammatory skin disease intersect.

A pragmatic approach is to view GLP-1 therapy as reasonable to advocate or support in psoriasis and HS when certain conditions are met: the patient has a clear medical indication for GLP-1 therapy based on obesity or diabetes; the skin disease is clinically significant and either inadequately controlled or imposing a high burden of flares, procedures, pain, or quality-of-life impairment; and the patient is interested in engaging with both metabolic and dermatologic aspects of their treatment.

For psoriasis, the main expectations are gradual improvement in plaque burden and symptoms over months, often with concurrent improvement in energy, mood, and cardiometabolic risk profiles. For HS, the goals are fewer flares, less pain, shorter recovery times, and a reduced need for surgical interventions. In both diseases, the addition of GLP-1 therapy should complement, not replace, evidence-based dermatologic treatments.

We are still early in understanding exactly which patients benefit most, how much of the effect is independent of weight loss, and how GLP-1s compare with other metabolic interventions. Future randomized, dermatology-specific trials should stratify by obesity and diabetes status, capture early immunologic and imaging biomarkers, and focus on outcomes that matter directly to patients, such as pain, work and school attendance, and procedure burden.

Until those data arrive, dermatologists can take a balanced stance. We can acknowledge the limits of current evidence, advocate for GLP-1 therapy in eligible patients with psoriasis and HS when it aligns with broader metabolic goals, and collaborate closely with our colleagues to monitor safety and efficacy. For many of our patients, that will mean leveraging a class of medications that improves not only their weight and blood sugar but also, quite possibly, the skin disease that brought them to us in the first place. 

1. Wong CK, Drucker DJ. Antiinflammatory actions of glucagon-like peptide-1–based therapies beyond metabolic benefits. J Clin Invest. 2025;135(21):e194751. https://doi.org/10.1172/JCI194751

2. Faurschou A, Pedersen J, Gyldenløve M, et al. Increased expression of glucagon-like peptide-1 receptors in psoriasis plaques. Exp Dermatol. 2013;22(2):150-152. https://doi.org/10.1111/exd.12081

3. Lin L, Xu X, Yu Y, et al. Glucagon-like peptide-1 receptor agonist liraglutide therapy for psoriasis patients with type 2 diabetes: a randomized-controlled trial. J Dermatolog Treat. 2022;33(3):1428-1434. https://doi.org/10.1080/09546634.2020.1826392

4. Faurschou A, Gyldenløve M, Rohde U, et al. Lack of effect of the glucagon-like peptide-1 receptor agonist liraglutide on psoriasis in glucose-tolerant patients: a randomized placebo-controlled trial. J Eur Acad Dermatol Venereol. 2015;29(3):555-559. https://doi.org/10.1111/jdv.12629

5. Nicolau J, Nadal A, Sanchís P, et al. Dermatologic and metabolic benefits of semaglutide in psoriasis with obesity: a six-month prospective cohort study. Clin Exp Dermatol. Published online October 25, 2025. https://doi.org/10.1093/ced/llaf473

6. Gupta N, Zafar K, Patel P, et al. Glucagon-like peptide-1 receptor agonists reduce surgeries and hospitalizations in hidradenitis suppurativa: a multicenter TriNetX cohort study. J Drugs Dermatol. 2025;24(9):869-874. https://doi.org/10.36849/jdd.8926

7. Lyons D, Nathan AL, Pender E, et al. Semaglutide for weight loss in people with obesity as an adjunctive treatment for hidradenitis suppurativa: its impact on disease control and quality of life. Br J Dermatol. 2024;191(4):631-633. https://doi.org/10.1093/bjd/ljae216

8. Rames MM, Alavi A, Aghazadeh N. GLP-1 agonists in patients with hidradenitis suppurativa: a case series. J Cutan Med Surg. 2025;29(4):402-403. https://doi.org/10.1177/12034754251320045

9. Kindel TL, Wang AY, Wadhwa A, et al. Multisociety clinical practice guidance for the safe use of glucagon-like peptide-1 receptor agonists in the perioperative period. Clin Gastroenterol Hepatol. 2025;23(12):2083-2085. https://doi.org/10.1016/j.cgh.2024.10.003

10. US Food and Drug Administration. Ozempic (semaglutide) injection, for subcutaneous use: prescribing information. Revised January 2025. Accessed December 10, 2025. https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/209637s025lbl.pdf

11. Hathaway JT, Shah MP, Hathaway DB, et al. Risk of nonarteritic anterior ischemic optic neuropathy in patients prescribed semaglutide. JAMA Ophthalmol. 2024;142(8):732-739. https://doi.org/10.1001/jamaophthalmol.2024.2296