The link between psoriasis and obesity was examined at the recent 2026 American Academy of Dermatology (AAD) Annual Meeting. Moving toward treating and evaluating systemic inflammation as a whole and related challenges in patient care were also discussed.

Following these presentations, featured expert Jennifer Soung, MD, was interviewed by Conference Reporter Associate Editor-in-Chief Rick Davis, MS, RPh. Clinical perspectives from Dr Soung on these findings are presented here.

There has been a shift in understanding that obesity is a chronic disease that contributes to systemic inflammation. So, as I discussed during my session at the 2026 AAD Annual Meeting, psoriasis and obesity do not just happen to coexist, but rather they are both states of chronic inflammation. With growing experience, and with the discovery of GLP-1 drugs, we really see obesity as a complex condition involving genetic, metabolic, and environmental factors. It is not simply a matter of breaking the cycle between willpower and genetics. More than one-third of our patients with psoriasis are overweight or obese, so now you have both problems that contribute biologically to systemic inflammation, and you cannot treat one without the other.

We have known for years that there is a link between psoriasis and obesity. Patients who are obese are at higher risk of developing psoriasis, and there is a linear relationship between psoriasis and weight: the higher the body mass index, the worse the severity of psoriasis. The old way of thinking was that adipose tissue is just energy storage. However, it is really an active immune organ, and the inflammatory signals coming from that adipose tissue can amplify the same pathways that drive psoriasis.

Regarding psoriasis management, many of our current treatment options are so good that we often do not need to consider obesity initially. With our newest generation of biologics (ie, the IL-17 and IL-23 drugs), weight is less of a factor in initial treatment decision making. What you do see is that, in those patients who are a little more resistant to treatment or who may require switching due to loss of response, weight is an independent risk factor for durability of response to a biologic.

An international study of approximately 200 patients from Sweden, Spain, and the United States looked at patients who had a Psoriasis Area and Severity Index (PASI) of 2 or less and were well controlled on their biologic; their CRP levels were measured to assess residual inflammation. The authors found that, despite well-controlled psoriasis, the presence of obesity and fatty liver disease contributed to a persistence of residual inflammation.

I think that we all intuitively know that obesity can play a role, but medicine has always been so focused on each specialty treating their own domain. So, this is really challenging us to rethink our approach to patients in a more holistic and integrative way because, ultimately, we want our patients to be healthy in addition to their skin being clear.

We also need to reframe how we define obesity and acknowledge the fact that many of us bring biases into how we think of weight. It is important to acknowledge that stigma and to shift toward more neutral and patient-centered language. For example, asking for permission to discuss the topic is important so that your patient feels comfortable proceeding with that conversation. As I discussed during my presentation at this year’s AAD meeting, to help start the conversation, I may say, “I am worried that weight is impacting your health. Would it be okay to talk about this today?”

Some of the most common questions I get from my patients are not directly about weight. They come in a quieter and more subtle way. The patient might say, “Is there something about my diet I should change that is making my psoriasis worse?” or “Are there certain foods I should avoid?” What they are really getting at, in an indirect way, is, “Is there something about my weight, body, and/or lifestyle that is making my psoriasis worse?”

There is a lot of interest right now in GLP-1 drugs. They are transforming chronic disease management, and they touch all aspects of health. At the 2026 AAD Annual Meeting, there was an exciting late-breaking abstract presented by Joseph Merola, MD, MSc, FAAD, on the TOGETHER-PsA trial, which is the first study to evaluate the combination of ixekizumab and tirzepatide vs ixekizumab alone in adults with psoriatic arthritis who are overweight or obese. Researchers found that the combination demonstrated superior disease control compared with ixekizumab alone. The TOGETHER-PsO trial also showed a benefit for this combination in patients with plaque psoriasis.

My purpose in giving this talk at this year’s AAD meeting was to help dermatologists become more informed about these therapies, including how they can have so many broad health effects (eg, potentially, a direct anti-inflammatory effect on immune cells and regulatory cells).