Dermatological and metabolic benefits of semaglutide in psoriasis with obesity: a 6-month prospective cohort study.

BACKGROUND: Psoriasis is a chronic inflammatory skin disease often associated with obesity and metabolic dysfunction, which may worsen disease severity. Glucagon-like peptide-1 receptor agonists, such as semaglutide, have shown metabolic and anti-inflammatory effects, but their impact on psoriasis in patients with obesity and without diabetes remains unclear. OBJECTIVES: To evaluate the effects of a 6-month semaglutide treatment on psoriasis severity and clinical, metabolic, inflammatory and psychosocial parameters in patients with psoriasis and obesity. METHODS: In this prospective cohort study, 43 patients received weekly semaglutide along with lifestyle counselling. Psoriasis severity (Psoriasis Area and Severity Index, PASI), quality of life (Dermatology Life Quality Index, DLQI), depressive symptoms (Beck Depression Inventory, BDI), nutritional ultrasound and biochemical markers were assessed at baseline and after 6 months. Correlations between PASI improvement (ΔPASI) and baseline variables and their changes were analysed, adjusting for age and weight loss. RESULTS: After 6 months, participants showed significant reductions in PASI (-48%), body mass index (BMI), preperitoneal and superficial fat, along with improvements in DLQI, BDI and metabolic markers. Baseline disease severity, depressive symptoms, insulin resistance and preperitoneal fat were negatively associated with PASI improvement. These associations remained significant after adjustment [e.g. Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), r = -0.82; preperitoneal fat, r = -0.66]. ΔPASI was most strongly correlated with reductions in superficial fat (r = 0.89), DLQI (r = 0.55) and BDI (r = 0.51). Changes in BMI and glycaemic markers were not significantly associated after adjustment. CONCLUSIONS: In patients with psoriasis and obesity, semaglutide improves both skin disease and systemic health. The clinical benefit appears associated with specific fat loss and psychosocial improvement, beyond overall weight reduction.