Glycemic Control in the Treatment of Psoriasis

Psoriasis is a common chronic inflammatory skin disease that manifests as scaly erythematous plaques as a consequence of keratinocyte hyperproliferation and inflammation. It is commonly associated with diabetes, obesity, and the metabolic syndrome. While there are numerous approved treatment options available, they have limitations including availability, toxicities such as immunosuppression, and high cost. There is increasing evidence to suggest that several hypoglycemic agents used in the treatment of type 2 diabetes, including glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors, thiazolidinediones and biguanides, exert beneficial effects in psoriasis. In this review, we summarize the growing evidence supporting the therapeutic role of hypoglycemic agents in psoriasis and discuss the potential underlying mechanisms. We suggest that dermatologists consider the use of hypoglycemic agents in psoriasis especially in cases with coexisting diabetes and in cases in which immunosuppression is contraindicated. Earlier referral to endocrinology in patients with concomitant diabetes may be appropriate.