Zehn Skin and Health

A summary of Lal and Herringshaw, The Use of GLP-1 Agonists in the Management of Cutaneous Disease, J Clin of Aesthet Dermatol. 2024;17(9):34–37.

A look at Psoriasis, Hidradentitis, Acanthosis Nigricans, and Hailey-Hailey Disease.

GLP-1 agonists are a class of medications currently used to treat type 2 diabetes and obesity. These medications work by mimicking a hormone that helps regulate blood sugar and appetite. Recent studies suggest that GLP-1 agonists may also have a role in the management of various skin diseases due to their anti-inflammatory effects.  

How GLP-1 Agonists Work

GLP-1 agonists suppress appetite, delay gastric emptying, and regulate glucose homeostasis. They are prescribed for type 2 diabetes mellitus (T2DM) and obesity.  

GLP-1 agonists interact with key cytokines involved in the development and persistence of skin diseases, such as TNF-α, IL-23, IL-17, and IL-22. These cytokines are important in the inflammatory response. By downregulating them, GLP-1 agonists may help reduce inflammation in skin conditions.  

Additionally, GLP-1 agonists have been shown to promote wound healing by upregulating keratinocyte migration. Keratinocytes are the major cells in the epidermis, the outermost layer of the skin, and their migration is essential for wound closure.  

Potential Benefits for Skin Conditions

Several case studies have shown promising results for the use of GLP-1 agonists in treating various skin conditions, including psoriasis, hidradenitis suppurativa, acanthosis nigricans, and Hailey-Hailey disease.  

Psoriasis

• A 59-year-old male with psoriasis, inadequately controlled diabetes, hypertension, and hypercholesterolemia was prescribed liraglutide. Within a few days of starting liraglutide, his psoriasis improved, itching stopped, and scaling was reduced. Over 12 weeks, he experienced a reduction in his hemoglobin A1c (HbA1c), weight, and Physician Global Assessment (PGA) scale.  
• A 73-year-old male patient with chronic obstructive pulmonary disease (COPD), Class III obesity, and T2DM demonstrated rapid resolution of severe psoriasis with improved glycemic control and reduced body weight.  
• A 50-year-old female patient with obesity and T2DM was started on semaglutide. Over the duration of 10 months, attenuation signals, markers related to obesity (weight, body mass index [BMI], waist circumference), lipids (LDL, triglycerides), inflammation (CRP, IL-6, ESR), and glycemic control (HbA1c) were reduced. Her psoriasis was also improved and had less of an impact on her quality of life.  
• A prospective cohort study of seven patients with T2DM and psoriasis demonstrated improvement in psoriasis treated with GLP-1 agonists through the reduction of inflammation, blood sugar improvement, and weight loss.  

Hidradenitis Suppurativa

• A 31-year-old female patient with Hurley Stage II HS demonstrated a significant improvement in cutaneous presentation and pain level after treatment with liraglutide.

Acanthosis Nigricans

• A 42-year-old woman with obesity and T2DM experienced improvement in the clinical appearance and epidermal insulin signaling of AN after treatment with liraglutide.  

Hailey-Hailey Disease

• A 60-year-old woman experienced significant improvement in her HHD after being prescribed liraglutide.  

Dive into GLP-1’s potential role for HS in this more comprehensive analysis.

Conclusion

GLP-1 agonists offer a potential new treatment option for various skin diseases, especially those associated with obesity and inflammation. While more research is needed to fully understand their safety and efficacy in dermatologic conditions, the current evidence suggests that GLP-1 agonists may be a valuable tool for managing these conditions.