Obesity and the skin: state of affairs

“Body fat is an organ that is disturbed when people have obesity,” said Dr Mariëtte Boon (Leiden University Medical Center, the Netherlands) [1]. “Hormonal and metabolic changes, inflammatory processes, and mechanical stress have widespread effects throughout the body.” This is why obesity is linked to 200 different diseases, including various skin conditions. Approximately 60–70% of patients with obesity have significant skin changes [2].

Skin issues in patients with obesity are mostly related to mechanical stress (e.g. striae, hyperkeratosis of the heel), insulin resistance (e.g. acanthosis nigricans, skin tags), infections (e.g. increased risk of severe disease course with viral or bacterial infections, cellulitis), and the link between obesity and autoinflammatory skin diseases such as psoriasis, atopic dermatitis, and hidradenitis suppurativa.

The first available treatment option for obesity is a lifestyle intervention. In the Netherlands, this entails a 2-year programme including interventions directed at diet, physical activity, and sustainable behavioural changes, with a specific focus on the underlying causes of the disease. “Research assessing the efficacy of these interventions is ongoing, but it is clear that healthcare professionals need to keep monitoring patients with obesity undergoing lifestyle interventions strictly,” added Dr Boon. If this intervention fails, pharmacological options can be considered. The 2 agents that are currently approved for the treatment of obesity target the feeling of satiety.

Naltrexone/bupropion decreases appetite and increases the ‘feeling of reward’. This agent can be prescribed to patients with a BMI of >30 kg/m² or patients with a BMI >27 kg/m² with at least 1 complication, such as type 2 diabetes or hypertension. This intervention is continued for 3 months after which a patient must have lost at least 5% of body weight. If this is not the case, the intervention will be stopped. A randomised controlled trial showed that patients lose on average 8% weight in 56 weeks of therapy [3].

Liraglutide is a second approved agent for the treatment of obesity. On top of a lifestyle intervention, this agent led to an average body weight loss of 10% after 56 weeks of therapy [4]. If a 1-year lifestyle intervention did not result in significant weight loss, this agent can be prescribed to patients with a BMI >40 kg/m² or to patients with a BMI >35 kg/m² who have at least 1 complication. If liraglutide does not show a clear benefit after 12 weeks of therapy, the treatment should be stopped.

Additionally, Dr Boon showed data from a meta-analysis that demonstrated that treatment with liraglutide improves psoriasis in patients with type 2 diabetes [5]. This effect could be explained by weight loss, but it is suspected that there is a direct anti-inflammatory effect of this agent as well, improving symptoms of autoinflammatory skin diseases.

“Another agent in the pipeline is semaglutide, which displayed an average 17% reduction in body weight in patients who were treated with this agent on top of a lifestyle intervention,” mentioned Dr Boon [6]. If pharmacological therapies fail, bariatric surgery is the final option to deal with obesity.

1. Boon M, et al. Obesitas en de huid: stand van zaken en nieuwe behandelopties. Blok 3, Dermatologendagen 2023, 9–10 March, Ermelo, the Netherlands.
2. Darlenski R, et al. Front Nutr. 2022;9:855573.
3. Apovian CM, et al. Obesity (Silver Spring). 2013;21(5):935–943.
4. Pi-Sunyer X, et al. N Engl J Med 2015;373:11–22.
5. Chang G, et al. J Dermatol Treat. 2022;33(3):1299–1305.
6. Wilding JPH, et al. N Engl J Med 2021;384:989–1002.

Posted on 10 May, 202328 March, 2024