Regarding: Obesity treatment in adolescents and adults in the era of personalized medicine

Abstract

Dear Editor,

We were interested to read the review by Sundbom et al. presenting a practical method to the personalized treatment of obesity [1]. To support the concept of multidisciplinary therapeutic decisions, the authors consider exemplary cases when obesity is associated with neuropsychiatric disorders, stress, high alcohol intake, sleep disorders, and economic difficulties.

Considering the varied possibilities in the current therapeutic armamentarium for obesity, the presence of comorbidities is considered a selective clinical criterion. Therefore, we wondered whether chronic cutaneous conditions may also have a potential role in the selection of treatments for patients living with obesity and how cutaneous disorders may influence medication response and tolerability.

A twofold relationship between obesity and chronic inflammatory skin disorders exists: one may contribute to the development of the other, and conversely weight loss can improve skin conditions [2].

In this context, the cutaneous effects of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are emerging, highlighting their potential in obesity-associated skin conditions. Recent studies have shown that GLP-1 RAs can significantly improve psoriasis severity independently of weight loss or glycemic control, potentially due to their immunomodulatory effects. GLP-1 RAs, such as liraglutide, have direct anti-inflammatory properties that reduce cytokine expression induced by TNF and IL-17 and inhibit NF-κB [3, 4]. Sun et al. compared the effects of different hypoglycemic drugs on psoriasis treatment, specifically GLP-1 RAs, dipeptidyl peptidase-4 (DPP-4) inhibitors, and thiazolidinediones (TZDs): All three classes reduced the psoriasis area and severity index (PASI) scores by a mean of −9.75, −3.14, and −13.02, respectively [5]. The study also found that combining hypoglycemic medications with systemic treatment for psoriasis led to a significantly better outcome, with a nearly fourfold increase in the PASI75 ratio compared to using a single medication.

Hidradenitis suppurativa (HS) is primarily linked to obesity and smoking. Jennings et al. presented a case of HS showing a positive response to liraglutide as well as to subsequent weight loss [6].

Moreover, these drugs could be valuable treatment options in diabetic patients with wound injuries not only for their hypoglycemic effect but also for their role in facilitating wound healing due to their vascular protective effect. Diabetes disrupts inflammatory responses and impairs vascular function in wounds; the activation of GLP-1R reduces inflammation and promotes angiogenesis during the early proliferation phase of wound healing in diabetic individuals [7]. Additionally, GLP-1R activation supports tissue regeneration through transforming growth factor-β and matrix metalloproteinase pathways during the maturation phase [7].

Taken together, these preliminary reports highlight the role of GLP-1 RAs in treating obesity, in reducing inflammation mediated by IL-17, TNF, and NF-κB and in promoting angiogenesis. These pleiotropic effects support further research in psoriasis and HS patients with obesity where GLP-1 RAs could be implemented in future management strategies.

In conclusion, dermatologists are called to contribute to a holistic and tailored management of obesity, guiding therapeutic choices according to patient comorbidities, suggesting skin-targeted treatment to improve patient compliance and lifestyle changes that contribute to weight loss.

The authors have stated explicitly that there are no conflicts of interest in connection with this article.