Psoriasis and Obesity: A Clinical Review of the Bidirectional Link and Management Implications

Psoriasis and obesity are increasingly recognized as comorbid conditions linked by chronic systemic inflammation. This clinical review examines the bidirectional relationship between these 2 diseases, highlighting the shared pathophysiologic pathways involving tumor necrosis factor (TNF) α, interleukin (IL) 6, IL-17, and IL-23. Obesity acts as an independent risk factor for the onset and exacerbation of psoriasis, while psoriatic inflammation promotes metabolic dysregulation. Clinical evidence demonstrates that obesity is associated with greater psoriasis severity, lower quality of life, and a diminished response to systemic therapies, particularly fixed-dose biologics. We discuss the critical role of the dermatologist in early comorbidity screening for metabolic syndrome, liver disease, and psoriatic arthritis. Furthermore, this review evaluates management strategies, emphasizing that weight loss of 5% to 10% can improve cutaneous outcomes and restore therapeutic efficacy. Emerging metabolic therapies, including glucagonlike peptide-1 receptor agonists, represent a promising intersection between dermatologic and metabolic care, with potential benefits for systemic inflammation and psoriasis severity. An integrated treatment approach addressing both inflammatory skin disease and metabolic health is essential for optimal patient care.