For those with chronic inflammatory skin diseases, including psoriasis and hidradenitis suppurative (HS), adding any medication can trigger a flareup. GLP-1s are gaining popularity in managing glucose levels and weight, but they may also have surprising benefits for skin health. According to Dr. Daniel Walker of U.S. Dermatology Partners Grapevine and Keller, “Recent research on GLP-1s and inflammatory skin health highlights how many of these medications also modulate immune function, reduce C-reactive protein (CRP), and downregulate inflammatory pathways. That’s a clinical way of saying that these medications seem to be supporting proper immune function. This conclusion has many dermatologists wondering if GLP-1 medications may function as a supportive therapy for inflammatory skin conditions.” In this blog, Dr. Walker answers your burning questions like what is a GLP-1 receptor agonist, how do they work, and how could they work as an additional line of defense in the management of inflammatory skin conditions?
What Is a GLP-1 Receptor Agonist (GLP-1RA)?
Glucagon-like peptide-1 receptor agonists are often simply called GLP-1s or GLP-1 RAs. They are medications that mimic GLP-1s, which are the main hormone involved in regulating glucose, signaling hunger, and balancing metabolic rate. GLP-1 RA medications like semaglutide, liraglutide, Tirzepatide, and dulaglutide stimulate GLP-1 receptors, improving insulin sensitivity, regulating blood sugar, and reducing appetite. GLP-1s are only approved for the treatment of Type 2 diabetes and weight management, but the added dermatologic benefits indicate overlap between the systemic pathways involved metabolic disease and chronic inflammation. This has spurred exploration into the potential use of GLP-1s both indirectly and directly in the treatment of inflammatory skin conditions.
How GLP-1RAs Influence Inflammation and the Immune System
When it comes to the anti-inflammatory and immune-regulatory effects of GLP-1 RAs, Dr. Walker says, “Many inflammatory skin conditions are difficult to manage because the cause of these concerns goes deeper than the skin. Topical treatments play their part in management, but it’s also essential to regulate overall immune system response and inflammation. While we can’t prescribe GLP-1 RAs for the treatment of inflammatory skin conditions, those that utilize them for metabolic disease may also achieve healthier skin.” Some of the many benefits of GLP-1s for immune regulation and inflammation reduction include:
- Downregulation of inflammatory pathways – downregulation is a biological process that decreases the number of receptors that trigger inflammatory response that leads flareups in skin health concerns.
- Regulation of immune response – GLP-1s can suppress or balance immune response through key cells involved in inflammatory skin disease, including the T lymphocytes that drive plaque formation in psoriasis and eczema, and iNKT cells active in the autoimmune system. Modulating these cells regulates immune overactivity.
- Reduction of inflammatory markers – C-reactive protein (CRP), a biomarker of inflammation, is directly correlated with reactivity and flareups in psoriasis, hidradenitis suppurativa, and atopic dermatitis. Lowering CRP may mean fewer or less severe flareups.
- Antioxidant benefits – GLP-1 RAs reduce oxidative stress. When skin is exposed to free radicals that cause oxidative stress, it can trigger inflammation and flareups on chronic skin conditions.
Effects of GLP-1RAs on Specific Inflammatory Skin Diseases
While research is still ongoing, early indications are that GLP-1s may offer benefits for inflammatory skin diseases, including:
- Psoriasis – immune dysregulation related to T cells and cytokines leads to systemic inflammation, skin discoloration, and thickening plaques. Those who have diabetes and metabolic syndrome often struggle to manage psoriasis symptoms. GLP-1s offer a solution that may address symptoms of both conditions.
- Hidradenitis suppurativa (HS) – there are close links between diagnosis of HS and comorbidities, including metabolic disease, chronic inflammation, obesity, and hormonal dysregulation. GLP-1s may decrease the frequency of flareups in HS by modifying immune pathways and lowering CRP.
The Role of Weight Loss and Metabolic Health in Skin Disease
GLP-1 medications themselves may offer indirect support for those with chronic inflammatory skin diseases, but they also reduce flareups and improve symptoms by helping with weight regulation. According to Dr. Walker, “Obesity and insulin resistance are linked to an increased risk for flareups in HS and psoriasis. Additionally, poor weight management and insulin resistance make it more difficult to treat psoriasis, and they can make inflammatory skin conditions less responsive to biologic therapies. Achieving and sustaining a healthier weight and improving insulin sensitivity with GLP-1 RAs may also improve skin health.”
GIP and GLP-1 Dual Agonists in Dermatology
GLP-1 RAs offer numerous advantages, but tirzepatide offers added benefits as a dual agonist. It combines GLP-1 with gastric inhibitory polypetide (GIP) RAs, activating two metabolic pathways. Adding in GIP RAs balances insulin release, leading to decreased systemic and hormone-driven inflammation in HS.
Who May Benefit from GLP-1RA Therapy in a Dermatologic Context
It may be some time before GLP-1 RAs are prescribed as dermatologic treatments, but when prescribed for other conditions, people with chronic inflammatory skin disease may benefit from these medications, including:
- Psoriasis with cooccurring insulin resistance and obesity – may benefit from GLP-1s that can improve the efficacy of biologics and reduce systemic inflammation.
- Hidradenitis suppurativa with metabolic syndrome – this combination of conditions can lead to weight loss as well as autoimmune response regulation that can reduce the frequency and severity of flareups.
- Chronic inflammation that worsens skin disease – high CRP levels, prediabetes, and general metabolic dysfunction can all lead to worsening skin inflammation and flareups in chronic diseases.
- Those with cooccurring endocrine conditions and skin diseases – diabetes, polycystic ovary syndrome (PCOS), or obesity-related inflammation may benefit from addressing skin health concerns as well as endocrine conditions with GLP-1s. Collaborative care is essential. Dermatology, primary care, and endocrinology should all be working together.
Limitations, Risks, and Important Considerations
At the end of the day, Dr. Walker says, “GLP-1 RAs are not an FDA-cleared treatment for dermatologic use. While dermatologists are seeing potential benefits of using GLP-1s as part of a comprehensive treatment approach, no therapy is right for everyone.” Some of the limitations and risks associated with GLP-1 use include:
- Side effects – many people experience side effects like nausea, vomiting, gallbladder disease, and GI discomfort. In some cases, these symptoms are severe, making it difficult for patients to stick with the treatment.
- Contraindications – GLP-1s aren’t recommended for those with a history of thyroid carcinoma, pancreatitis, some endocrine conditions, and GI motility disorders.
- Not a replacement for skincare plans – it’s still important to maintain at-home and in-office dermatologic treatment plans for inflammatory skin conditions. GLP-1 RAs may offer support, but they need to be used in conjunction with regular management routines.
- Limited data – while early indications are positive for the use of GLP-1s as part of comprehensive treatment for chronic inflammatory conditions, there is still limited data to support this use.
Discuss Potential Benefits of GLP-1s for Inflammatory Skin Conditions
In conclusion, Dr. Walker says, “While research into the effects of GLP-1s for immune regulation continues, it’s exciting as a dermatologist to see patients already benefiting from this unique medication. Keep in mind that all patients are different. If GLP-1s have been prescribed by your physician in the treatment of diabetes or as part of a weight management plan, you may also receive the added benefit of clearer, healthier skin and reduced inflammation. This unique advantage of GLP-1 medications only further emphasizes how intertwined our skin and whole-body health are. It’s so important to take a comprehensive approach to managing health concerns.”
Schedule a Dermatology Visit
Ready to learn more about how GLP-1 receptor agonists may benefit skin health concerns? Schedule a consultation at U.S. Dermatology Partners, using our simple online request form. Once we hear from you, a team member will be in touch to answer your questions and finalize the details of your upcoming visit.
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