Photo Credit: Eakgrunge
A presentation at the 2025 Winter Clinical meeting focused on pearls of wisdom for psoriasis treatment, including a breakdown of how obesity impacts therapies.
In a session at the 2025 Winter Clinical meeting in Hawaii, Mark Lebwohl, MD, shared how obesity affects treatment considerations for patients with psoriasis.
“What we know very well is that patients [with obesity] don’t do as well on biologic therapies. The rate of them improving, achieving PASI75 or PASI90, is reduced by 25% to 30%,” Dr. Lebwohl said during the session. “Obesity has an adverse impact on response to drugs.”
Dr. Lebwohl was also involved in an expert consensus panel that evaluated the relationship between obesity and psoriasis to improve clinical practice. The panel sourced 500 articles and selected 22 for analysis. Their recommendations were recently published in the Journal of the American Academy of Dermatology.
The Panel’s 10 Consensus Statements
The panel reported the following consensus statements, labeled A, B, or C, in accordance with the strength of each recommendation:
- Psoriasis is associated with obesity. (A)
- Obesity is an independent risk factor for the development of psoriasis. (A)
- Patients with obesity and psoriasis have a higher risk for diabetes, metabolic syndrome, and cardiovascular disease. (A)
- Obesity decreases efficacy of psoriasis treatment with biologics. (A)
- Obesity may decrease efficacy and potentiate side effects of conventional oral psoriasis therapies (eg, methotrexate, cyclosporine, and acitretin). (A)
- Limited data exists for the potential impact of obesity on apremilast and deucravacitinib efficacy. (C)
- Patients with obesity and psoriasis may require larger quantities of topical therapies and may experience increased difficulty in applying medications and adverse events. (C)
- Obesity impacts drug survival for psoriasis therapies. (A)
- Treatment of obesity may improve efficacy of psoriasis therapies. (B)
- Weight control is an important part of psoriasis management. (B)
Recommendations for Clinical Practice
Regarding weight control, the panel offered several recommendations for dermatologists, noting that the joint American Academy of Dermatology and National Psoriasis Foundation guidelines encourage clinicians to screen for weight and lifestyle modifications.
Traditionally, patients adopt dietary changes and follow exercise regimens to manage weight. However, some patients with psoriasis may not find new exercise approaches feasible due to comorbidities such as arthritis. The panelists wrote that clinicians may consider weight loss drug therapy for these patients.
“The majority of panel participants (6/11) have prescribed weight loss drugs for their patients with psoriasis and believe this is something dermatologists should be considering. Otherwise, patients should be advised to follow up closely with their primary care physician,” the authors wrote.
The panelists also cautioned that patients of lower socioeconomic status may have trouble accessing weight loss drugs, and evidence is inconclusive regarding the efficacy of surgical weight loss for patients with psoriasis.
“Weight control is a vital component of caring for patients with psoriasis, and there are growing therapeutic options available,” the authors concluded. “The panel’s consensus recommendations can guide clinicians in the management of patients with obesity and psoriatic disease.”
