DENVER — Recognizing the skin signs and risks associated with metabolic disease in dermatology patients can be essential to guiding them toward optimal treatment, which can include GLP-1 therapy.

It’s also important because some patients may not routinely see any other physicians. For example, 26% of the adults overall and 18% of those aged 50-64 years in a Kaiser Family Foundation poll said they did not have a primary care physician.

“When patients come in for their skin or hair, there’s often metabolic disease that comes along for the ride,” Lindsey Bordone, MD, assistant professor of dermatology at Columbia University, New York City, said at American Academy of Dermatology (AAD) 2026 Annual Meeting.

“For many patients, the dermatologist might be their only medical visit. So we can catch these at-risk patients much younger,” Bordone added.

The skin can signal metabolic disease well before lab abnormalities, she said. Look for skin tags, acanthosis nigricans, abnormal fat distribution in the form of a dorsocervical fat pad, or hirsutism, “all signs of metabolic disease,” she noted.

Beyond Obesity

Obesity is a major driver of metabolic disease, but obesity is a multifactorial, complex condition. The comorbidities are many, including type 2 diabetes, some cancers, heart disease, stroke, obstructive sleep apnea, and depression. Obesity also continues to cause considerable frustration and stigma for patients.

“Our role is to deliver clear, practical, and nonstigmatizing guidance,” Bordone said.

The obesity epidemic in the US plateaued in 2022 and has started to decline at the same time GLP-1 use has increased. An October 2025 Gallup survey found a direct correlation between these trends.

Counseling dermatology patients about GLP-1s can yield benefits beyond weight loss. For example, GLP-1 therapy has been associated with reducing the risk for major cardiovascular events, improving heart failure, halting progression of renal disease, improving type 2 diabetes, and lowering the risk for metabolic dysfunction-associated steatotic liver disease, formerly known as nonalcoholic fatty liver disease.

Furthermore, obesity can decrease the effectiveness of biologic agents, Bordone said, and is linked to atopic disease such as asthma in adults and adolescents. Obesity also increases the risk and severity for atopic dermatitis, she said.

In addition, when chronic urticaria improves in patients with chronic spontaneous urticaria taking GLP-1s, it can be an early sign of response to treatment, she added.

GLP-1s and Skin Conditions

There is a bidirectional relationship between obesity and psoriasis, Bordone said, and patients with psoriasis have a more than 50% greater likelihood of obesity. GLP-1s are being studied to treat psoriasis and psoriatic arthritis, and emerging evidence suggests possible roles in hidradenitis suppurativa (HS) and wound healing.

Weight loss and the anti-inflammatory properties of GLP-1 agents likely each contribute to improvements in these conditions, she added.

GLP-1s also can play a role in treating HS, Ginette Okoye, MD, professor and chair of dermatology at Howard University in Washington, DC, said in a subsequent presentation at the AAD meeting. “These agents help reduce the systemic inflammation that drives most morbidity in HS.”

People with HS “start to improve once they’ve lost quite a bit of weight,” she added. Emerging evidence suggests people with comorbid obesity and/or diabetes benefit the most.

In addition, a 2025 survey of patients with HS revealed that symptoms improved after treatment with GLP-1s.

Asked to comment, Joshua Burshtein, MD, told Medscape Medical News, “we’re seeing consistent evidence across the literature that weight loss is associated with meaningful improvement in inflammatory skin diseases such as psoriasis, atopic dermatitis, and hidradenitis suppurativa.”

A paper on the association between obesity and efficacy of psoriasis treatments, published in the Journal of the American Academy of Dermatology, highlighted “the substantial impact of obesity on not only psoriasis disease severity but also the treatment response to biologic therapies,” said Burshtein, a resident at the University of Illinois in Chicago, and one of the authors.

“As our understanding of these metabolic and inflammatory links continues to evolve, incorporating GLP-1s into dermatologic treatment strategies may offer a valuable adjunct to improve outcomes across a range of conditions,” he added.

Lab Testing, Caveats

Lab tests to obtain for patients with metabolic syndrome include fasting glucose, A1c levels, triglycerides, and more. In addition, hyperinsulinemia can trigger soft tissue growth, including skin tags, which other physicians may not notice, Bordone said.

Although no routine laboratory monitoring is required with GLP-1s, Bordone recommended periodically rechecking relevant lab tests because improvements on these measures can encourage patients taking GLP-1s. She also noted that GLP-1s are contraindicated in patients with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2.

Other suggestions for counseling dermatology patients regarding GLP-1s are to ensure adequate protein intake, to hydrate and take fiber supplements to prevent constipation, and “resistance training is an absolute must,” Bordone said.

A Responsible Role

Dermatologists are often the first to see external signs of metabolic syndrome, “so we should be the first to act,” Bordone said.

“If we don’t manage their metabolic health in regard to their skin, no one will,” Okoye said.

Bordone and Burshtein reported having no relevant financial relationships. Okoye disclosed she is an advisory board member for AbbVie, Nutrafol, Sanofi Regeneron, and UCB; a consultant for Janssen Pharmaceuticals and Unilever; and an investigator for Janssen.

Damian McNamara is a freelance contributor to Medscape Medical News. He worked full-time for Medscape and WebMD from 2018 to 2024. McNamara has a BA in chemistry and an MA in science, health, and environmental reporting/journalism.