Tirzepatide Boosts Psoriasis Clearance Independent of Weight Loss

Dr Dray

Clinical evidence shows GLP-1 drugs reduce inflammatory skin disease through direct receptor signaling rather than weight reduction alone, forcing dermatologists to target systemic metabolic drivers.

AI-assisted summary of Can Ozempic & Wegovy Improve Your Skin? Skin Benefits of GLP-1s — original source. Check the original for full context.

Source published: 2026-08-28

Key ideas

In the phase 3b TOGETHER-PsO trial, combining tirzepatide with guselkumab resulted in 27.1% of patients achieving complete psoriasis clearance alongside at least 10% weight loss, compared to just 5.8% receiving guselkumab alone. (3:44)
Evidence indicates that GLP-1 receptor agonists deliver therapeutic benefits in inflammatory skin disease both through adipose reduction and direct, weight-independent anti-inflammatory signaling. (10:43)
A systematic review of 19 studies involving approximately 67,000 patients found that roughly 60% of individuals with hidradenitis suppurativa experienced clinical improvement while on GLP-1 therapies. (7:48)
GLP-1 medications are not approved as universal dermatologic monotherapies; their current clinical use is anchored to patients with established metabolic indications like obesity or overweight. (14:00)

Detailed notes

## Background Published by dermatologist Dr. Dray on YouTube on August 28, 2026, this video investigates whether GLP-1 medications such as semaglutide and tirzepatide can improve inflammatory skin disorders. The presentation explores emerging clinical evidence linking metabolic health, adipose-driven inflammation, and therapeutic outcomes in conditions such as psoriasis, psoriatic arthritis, and hidradenitis suppurativa.

## TL;DR Dr. Dray explains how GLP-1 receptor agonists influence chronic inflammatory skin diseases by addressing both systemic metabolic dysfunction and independent immune pathways. Drawing on trials like TOGETHER-PsO and observational studies in hidradenitis suppurativa, she illustrates how adipose tissue secretes pro-inflammatory cytokines that fuel skin disease, while direct GLP-1 signaling may simultaneously suppress inflammatory cascades beyond the effects of weight loss alone. She emphasizes that these medications are not universal cures or standalone dermatologic treatments, as candidates typically require an underlying metabolic indication like obesity or overweight. Finally, she reviews critical adverse effects—such as gastrointestinal distress, nutritional deficiencies, and facial volume loss—and stresses the necessity of slow dose titration under proper multidisciplinary medical supervision.

## Atmosphere & style The presentation is measured, pragmatic, and clinically grounded, striking a clear balance between excitement over emerging medical trials and caution against commercial hype. Dr. Dray speaks with direct, accessible authority, translating dense endocrinologic and dermatologic data into conversational, real-world advice while firmly warning against compounded alternatives and rapid dose escalations. Watching the video feels like an unhurried, evidence-based consultation that demystifies a trending class of medications and guides patients to have informed, grounded conversations with their doctors.

## Bulletin - [03:44](https://www.youtube.com/watch?v=vESsyr2i6iA&t=224s) In the phase 3b TOGETHER-PsO trial, combining tirzepatide with guselkumab resulted in 27.1% of patients achieving complete psoriasis clearance alongside at least 10% weight loss, compared to just 5.8% receiving guselkumab alone. - [10:43](https://www.youtube.com/watch?v=vESsyr2i6iA&t=643s) Evidence indicates that GLP-1 receptor agonists deliver therapeutic benefits in inflammatory skin disease both through adipose reduction and direct, weight-independent anti-inflammatory signaling. - [07:48](https://www.youtube.com/watch?v=vESsyr2i6iA&t=468s) A systematic review of 19 studies involving approximately 67,000 patients found that roughly 60% of individuals with hidradenitis suppurativa experienced clinical improvement while on GLP-1 therapies. - [14:00](https://www.youtube.com/watch?v=vESsyr2i6iA&t=840s) GLP-1 medications are not approved as universal dermatologic monotherapies; their current clinical use is anchored to patients with established metabolic indications like obesity or overweight.

## Key takeaways - [01:47](https://www.youtube.com/watch?v=vESsyr2i6iA&t=107s) Adipose tissue functions as an active endocrine organ that secretes pro-inflammatory cytokines, directly aggravating the severity of inflammatory skin disorders rather than acting as a passive fat store. - [03:44](https://www.youtube.com/watch?v=vESsyr2i6iA&t=224s) The TOGETHER-PsO trial demonstrated that adding tirzepatide to the IL-23 inhibitor guselkumab markedly enhanced complete psoriasis skin clearance (PASI 100) compared to biologic monotherapy. - [03:44](https://www.youtube.com/watch?v=vESsyr2i6iA&t=224s) Some patients in psoriasis trials attained complete skin clearance without reaching the 10% body weight loss threshold, demonstrating an intrinsic anti-inflammatory mechanism separate from fat reduction. - [06:34](https://www.youtube.com/watch?v=vESsyr2i6iA&t=394s) In psoriatic arthritis, combination treatment with tirzepatide and guselkumab achieved higher rates of minimal disease activity than guselkumab monotherapy, addressing both joint symptoms and metabolic load. - [07:48](https://www.youtube.com/watch?v=vESsyr2i6iA&t=468s) Real-world data and systematic reviews in hidradenitis suppurativa show consistent reductions in inflammatory flares, pain, and purulent drainage, even if complete lesion clearance is not universally achieved. - [09:44](https://www.youtube.com/watch?v=vESsyr2i6iA&t=584s) While preliminary hidradenitis suppurativa findings are encouraging, randomized controlled trials are still needed to clarify the degree to which benefits stem from direct drug action versus mechanical weight loss. - [12:26](https://www.youtube.com/watch?v=vESsyr2i6iA&t=746s) A bidirectional relationship exists between obesity and inflammatory dermatoses: adipose tissue fuels cutaneous inflammation, while chronic systemic inflammation can alter metabolic regulation and promote weight gain. - [14:00](https://www.youtube.com/watch?v=vESsyr2i6iA&t=840s) GLP-1 receptor agonists remain adjunct options indicated primarily for patients with comorbid obesity or metabolic disease, rather than standard standalone replacements for established dermatologic biologics. - [14:00](https://www.youtube.com/watch?v=vESsyr2i6iA&t=840s) Potential adverse effects include gastrointestinal distress, micronutrient deficiencies (iron and vitamin D), telogen effluvium, gallbladder disease, pancreatitis, and facial volume loss due to dermal white adipose tissue depletion. - [16:20](https://www.youtube.com/watch?v=vESsyr2i6iA&t=980s) Clinicians emphasize a 'start low and go slow' dosing strategy to build patient tolerance and minimize severe gastrointestinal crises that frequently occur with rapid dose escalation or unvetted compounded formulations. - [16:20](https://www.youtube.com/watch?v=vESsyr2i6iA&t=980s) GLP-1 receptor agonists function as ongoing metabolic maintenance therapies rather than brief, three-month interventions that can be stopped once skin lesions improve. - [17:44](https://www.youtube.com/watch?v=vESsyr2i6iA&t=1064s) Optimal patient care often requires a multidisciplinary framework bridging dermatologists, primary care providers, and registered dietitians to manage systemic metabolic health, nutrition, and skin outcomes in tandem.

## Detailed walkthrough ### [00:00](https://www.youtube.com/watch?v=vESsyr2i6iA&t=0s) Emerging Frontiers: GLP-1s in Inflammatory Skin Disorders

Dr. Dray introduces GLP-1 receptor agonists—such as semaglutide and tirzepatide—noting that unless viewers have "been living under a rock," they are already intimately familiar with their role in managing type 2 diabetes and obesity. However, she highlights a novel, rapidly evolving area of medical research: the use of GLP-1 medications to treat severe, chronic inflammatory skin disorders.

Rather than merely attributing skin improvements to shedding excess body weight or achieving tighter glycemic control, Dr. Dray emphasizes that there is something fundamentally unique occurring at the molecular level. Emerging data suggests that these medications offer therapeutic benefits that extend well beyond simple weight reduction, showing particular promise as potential game-changers for conditions such as psoriasis, psoriatic arthritis, and hidradenitis suppurativa (HS).

- **Core Medication Class:** Glucagon-like peptide-1 (GLP-1) receptor agonists, including semaglutide and the dual GIP/GLP-1 agonist tirzepatide. - **Key Target Conditions:** Psoriasis, psoriatic arthritis, and hidradenitis suppurativa (HS). - **Primary Mechanism of GLP-1 Hormone:** Naturally secreted to regulate blood sugar, delay gastric emptying, and promote satiety.

[01:47](https://www.youtube.com/watch?v=vESsyr2i6iA&t=107s) The Adipose-Inflammation Axis

Historically, obesity was viewed by the medical community as an incidental comorbidity that simply coexisted alongside inflammatory skin disorders. Dermatologists have long recognized that patients presenting with severe psoriasis or hidradenitis suppurativa frequently struggle with obesity, insulin resistance, and broader cardiovascular risks. However, modern endocrinology and dermatology now recognize that adipose tissue is not an inert reservoir where the body passively stores surplus calories.

Instead, adipose tissue functions as a biologically active endocrine organ capable of secreting significant volumes of signaling molecules, specifically pro-inflammatory cytokines. In individuals carrying substantial excess adipose tissue, this cytokine output surges, creating widespread systemic inflammation that acts as "fuel for the inflammatory disease." While excess adiposity does not directly originate psoriasis or HS, nor does reducing it magically cure them, adipose-driven inflammation causes these diseases to become vastly more aggressive, widespread, and resistant to standard dermatologic therapies. Consequently, modern dermatologic management cannot stay confined strictly to surface-level topical treatments; systemic metabolic health must be targeted in parallel.

```mermaid flowchart TD accTitle: The Adipose Inflammation Feedback Loop accDescr: Flowchart illustrating how excess adipose tissue produces cytokines that fuel systemic inflammatory skin conditions.

subgraph Metabolic Burden A["Excess Adipose Tissue"] --> B["Active Secretion of Pro-inflammatory Cytokines"] B --> C["Elevated Total Systemic Inflammation"] end

subgraph Disease Manifestation C --> D["Severe Inflammatory Skin Burden\n(Psoriasis & Hidradenitis Suppurativa)"] D --> E["Stubborn, Treatment-Resistant Lesions"] end ```

[03:44](https://www.youtube.com/watch?v=vESsyr2i6iA&t=224s) The TOGETHER-PsO Trial: Tirzepatide in Psoriasis

The strongest clinical evidence currently available centers on psoriasis, an inflammatory disease characterized by systemic involvement and disrupted immune pathways, notably cytokines such as interleukin-17. In modern practice, advanced biologic agents like guselkumab specifically target these dysregulated inflammatory cascades. This spurred researchers to investigate what occurs when guselkumab is paired with the GLP-1/GIP receptor agonist tirzepatide in patients living with both moderate-to-severe psoriasis and overweight or obesity.

The phase 3b randomized clinical trial, titled **TOGETHER-PsO**, evaluated 274 adults randomized to receive either guselkumab monotherapy or guselkumab combined with tirzepatide. The results at week 36 demonstrated marked divergence between the two study arms:

- **Combined Clearance & Weight Endpoint:** 27.1% of participants in the combination arm achieved complete psoriasis clearance alongside at least a 10% reduction in total body weight, compared to only 5.8% in the guselkumab monotherapy arm. - **Complete Skin Clearance (PASI 100):** Looking purely at dermatologic clearance, an impressive proportion of patients in the combination group reached a Psoriasis Area and Severity Index (PASI) reduction of 100%, compared to just 29% of those receiving guselkumab alone. - **Weight-Independent Effects:** Intriguingly, some participants achieved 100% skin clearance without meeting the trial's 10% weight-loss benchmark, suggesting that tirzepatide may exert direct, intrinsic anti-inflammatory effects on the skin independent of weight loss.

Dr. Dray cautions viewers against assuming that everyone with psoriasis should immediately demand a prescription for tirzepatide, or that it is poised to replace established first-line biologic therapies. Rather, the findings underscore that dermatologists "can't just stay in their lane" by evaluating solely the skin's surface; addressing systemic metabolic comorbidities dramatically elevates the probability of achieving total skin clearance.

[06:34](https://www.youtube.com/watch?v=vESsyr2i6iA&t=394s) Psoriatic Arthritis and Systemic Disease Control

A companion TOGETHER trial evaluated adults diagnosed with both psoriatic arthritis and overweight or obesity, comparing guselkumab monotherapy directly against guselkumab combined with tirzepatide. Similar to the cutaneous psoriasis trial, patients receiving dual therapy achieved significantly higher rates of the composite study endpoint, demonstrating both meaningful weight loss and joint symptom reduction.

A larger share of patients on combination therapy attained minimal disease activity (MDA) compared to those on guselkumab alone. While Dr. Dray stresses that this does not establish GLP-1 medications as standalone monotherapies for joint disease, it reinforces that psoriatic disease is an integrated, whole-body illness accompanied by metabolic and cardiovascular derangements rather than isolated skin plaques or joint stiffness.

[07:48](https://www.youtube.com/watch?v=vESsyr2i6iA&t=468s) Hidradenitis Suppurativa (HS) and Retrospective Evidence

Turning to hidradenitis suppurativa (HS), Dr. Dray explores a devastating chronic inflammatory condition marked by extremely painful, deep-seated boils, draining sinus tracts, and thick dermal scarring in intertriginous skin folds—including the axillae, inframammary regions, groin, and gluteal cleft. These lesions frequently lead to functional impairment and restricted mobility. Much like psoriasis patients, individuals with HS experience a high prevalence of obesity and cardiometabolic comorbidities, where hyperactive adipose tissue serves as a continuous nidus of systemic inflammation.

While HS lacks the large-scale randomized controlled trials seen in psoriasis, real-world observational evidence, case series, and literature reviews reveal a compelling therapeutic signal:

- **Systematic Review Findings:** A review analyzing 19 distinct studies encompassing approximately 67,000 patients identified clinical improvement in roughly 60% of HS patients treated with GLP-1 agonists. - **Outcome Improvements:** Patients documented measurable decreases in disease extent, objective reductions in inflammatory and metabolic biomarkers, and substantial quality-of-life gains. - **Symptomatic Relief:** Broader literature reviews report reductions in painful inflammatory flares, purulent wound drainage, and day-to-day physical pain.

[09:44](https://www.youtube.com/watch?v=vESsyr2i6iA&t=584s) GLP-1s and Hidradenitis Suppurativa: Symptom Relief and Study Gaps

In patients with hidradenitis suppurativa (HS), GLP-1 receptor agonists do not necessarily clear lesions completely for every individual, but they consistently appear to ease the most debilitating aspects of the condition. Patients frequently experience meaningful reductions in severe pain, persistent drainage, and frequent inflammatory flares, effectively making the disease far more bearable to live with day-to-day.

Unlike the clear-cut psoriasis findings—such as those seen in the TOGETHER-PsO trial where tirzepatide improved skin clearance independently of weight loss—the current literature on hidradenitis suppurativa is less definitive about whether these clinical improvements stem solely from body fat reduction or from separate pharmacological mechanisms. Rigorous randomized controlled trials are still needed to firmly establish GLP-1s as a standard dermatologic treatment protocol for HS. Even so, the preliminary signal is remarkably promising, and patients who struggle with excess adiposity alongside HS should not be surprised if their dermatologist raises the topic of these medications during an appointment.

[10:43](https://www.youtube.com/watch?v=vESsyr2i6iA&t=643s) The Independence of Weight Loss and Direct Anti-Inflammatory Effects

A common critique in public discourse is that GLP-1 medications are merely an unnecessary "band-aid," with critics arguing that individuals should simply rely on diet and exercise. While foundational lifestyle habits remain the non-negotiable cornerstone of long-term health, this perspective misses a critical pharmacological discovery: GLP-1 receptor agonists appear to reduce systemic inflammation independently of caloric restriction and adipose reduction.

Excess adipose tissue undeniably acts as an active endocrine organ that amplifies inflammatory signaling throughout the body. While GLP-1 receptor agonists tamp down that background "noise from the fat compartment" over time by curbing appetite and shrinking adipose mass, research increasingly indicates that direct GLP-1 signaling exerts an independent, systemic anti-inflammatory effect. Consequently, a patient who maintains an ideal body weight through nutrition and exercise might still experience marked dermatologic improvements from the medication's direct suppression of inflammatory cascades.

```mermaid flowchart TD accTitle: GLP-1 Dual Mechanism in Inflammatory Skin Disease accDescr: Diagram illustrating how GLP-1 receptor agonists improve skin diseases both through metabolic weight loss and direct anti-inflammatory pathways.

subgraph DirectPath["Direct Pathway"] A["GLP-1 Receptor Agonist"] -->|"Direct Receptor Signaling"| B["Systemic Inflammation Reduction"] B --> C["Suppression of Inflammatory Cascades"] end

subgraph MetabolicPath["Metabolic Pathway"] A -->|"Reduced Caloric Intake"| D["Decreased Adipose Tissue"] D -->|"Lowers Adipokine 'Noise'"| E["Reduced Systemic Inflammation"] end

C --> F["Skin Disease Improvement\n(Psoriasis & HS Symptoms)"] E --> F ```

[12:26](https://www.youtube.com/watch?v=vESsyr2i6iA&t=746s) The Complex Bidirectional Relationship Between Obesity and Skin Disease

Obesity cannot be dismissed as an innocent bystander or something that is merely "along for the ride" in inflammatory skin conditions. Although excess weight does not directly cause psoriasis or HS—as evidenced by the many lean patients who suffer from these conditions—adipose tissue actively fuels disease severity. Conversely, the systemic inflammation intrinsic to these disorders may alter metabolic tone, satiety cues, and energy regulation, predisposing affected individuals to gain weight. This establishes a vicious cycle: chronic skin inflammation drives fat accumulation, which then generates further inflammatory signals that worsen the dermatologic pathology.

- **Non-guaranteed resolution**: Successfully losing weight or treating obesity does not guarantee total disease clearance, reinforcing that these are complex, multifactorial autoimmune and inflammatory conditions. - **Mandatory consideration in care**: Because obesity carries independent, serious health consequences regardless of skin involvement, dermatologists must proactively factor body composition and metabolic health into the patient's overarching treatment strategy.

[14:00](https://www.youtube.com/watch?v=vESsyr2i6iA&t=840s) Clinical Indications and Significant Side Effects

Despite the encouraging therapeutic data, GLP-1 receptor agonists are not currently recommended as universal, primary therapies for every single patient with psoriasis or HS. The present medical rationale remains anchored to patients who already have an established metabolic indication, such as obesity, overweight, or associated metabolic comorbidities. Because these powerful pharmaceutical agents carry clear risks, clinicians must continually balance potential dermatologic upside against known adverse reactions.

The most prevalent adverse events involve the gastrointestinal tract, notably nausea, vomiting, diarrhea, constipation, and abdominal discomfort. However, clinicians and patients must also navigate several broader concerns:

- **Nutritional deficiencies**: Reduced oral intake frequently leads to micronutrient gaps, most commonly iron deficiency and low vitamin D levels. - **Organ complications**: Rare but severe risks include acute gallbladder disease and pancreatitis. - **Hair and facial changes**: Telogen effluvium (hair loss) can follow rapid weight reduction. Furthermore, loss of dermal white adipose tissue (DWAT)—a specialized facial fat depot essential for wound healing and healthy follicular cycling—contributes to accelerated facial volume depletion, commonly dubbed "Ozempic face." - **Thyroid C-cell tumor warnings**: Medications such as semaglutide and tirzepatide carry a black box warning and remain strictly contraindicated in patients with a personal or familial history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). While public alarm often runs high, this warning originates strictly from rodent studies; humans have not shown equivalent tumor induction in clinical trials.

[16:20](https://www.youtube.com/watch?v=vESsyr2i6iA&t=980s) Dosing Strategies, Compounding Risks, and Treatment Longevity

When dermatologists evaluate initiating a GLP-1 receptor agonist for an inflammatory skin condition, the recommended clinical guideline is to "start low and go slow." Adopting a slow titration schedule preserves patient tolerance and prevents severe, debilitating GI distress that typically accompanies rapid dose escalations.

``` "Slow and steady wins the race, so to speak. No need to go gangbusters in there right away, make the patient sick, unwell, having diarrhea." ```

In response to widespread supply shortages and insurance hurdles, many patients circumvent formal medical channels by turning to direct-to-consumer websites, wellness spas, and compounding pharmacies. These alternative outlets frequently administer excessively high starting doses or escalate titration far too quickly, driving an influx of preventable, severe gastrointestinal crises. Furthermore, patients must understand that GLP-1 agonists function as long-term metabolic maintenance regimens; they are not short-term "quick 3-month courses" designed to temporarily clear the skin and then be stopped.

[17:44](https://www.youtube.com/watch?v=vESsyr2i6iA&t=1064s) The Role of the Dermatologist and Multidisciplinary Management

The prospect of dermatologists managing GLP-1 therapies naturally raises boundaries around clinical scope of practice:

| Provider Role | Clinical Focus & Contributions | |:--- |:--- | | **Dermatologist with Advanced Internal Medicine Training** | Some specialists possess dual board certifications or fellowships (e.g., in rheumatology or endocrinology), making them uniquely qualified to initiate and oversee GLP-1 therapies directly without reservation. | | **Standard Dermatologist** | Evaluates skin disease severity, tracks lesion responses, identifies metabolic co-drivers, and refers out for systemic metabolic drug management to stay "in our lane." | | **Registered Dietitian (RD)** | A critical non-negotiable partner who closes dietary deficiencies, customizes macro intake, and ensures adequate daily protein consumption to prevent skeletal muscle wasting. |

Ultimately, GLP-1 therapies represent a paradigm shift in dermatologic care. They bridge the gap between systemic metabolic regulation and targeted skin pathology, showing that clearing inflammatory disease often requires treating systemic metabolic health alongside targeted cutaneous inflammation.

[19:11](https://www.youtube.com/watch?v=vESsyr2i6iA&t=1151s) Patient-Doctor Conversations, Caveats, and Additional GLP-1 Resources

Dr. Dray concludes by grounding the discussion in practical medical ethics, reiterating that this overview is intended strictly as educational content rather than a directive telling viewers that a GLP-1 receptor agonist is "the best thing you must be doing." Instead, the goal is to provide patients with enough foundational understanding of the intersection between metabolic health, adipose signaling, and systemic inflammation so that they feel equipped to raise the topic with their own dermatologist or primary care provider. She emphasizes that having an inflammatory skin condition does not automatically make someone an appropriate candidate for these medications: "It doesn't mean it's going to be a good thing for you, okay? Always talk about this stuff with your doctor." She stresses plainly that her channel provides educational perspective rather than individualized medical or treatment advice.

For viewers seeking more depth on how these medications impact the body and skin, Dr. Dray points to several companion videos linked in the description box and pinned comment. She notes that there is an enormous amount of emerging nuance surrounding this class of drugs, particularly as their widespread use grows and patients navigate both therapeutic effects and unwanted consequences. She encourages anyone currently taking a GLP-1, those who have been identified as potential candidates, or those who are simply curious because "everyone's taking them" to explore these additional resources to make well-informed choices:

- **Nutritional deficiencies:** Managing reduced caloric intake and potential micronutrient shortfalls during rapid appetite suppression. - **Hair loss:** Addressing acute telogen effluvium and hair shedding triggered by rapid metabolic shifts and weight reduction. - **Dermatologic and structural changes:** Understanding "Ozempic face," facial fat pad volume loss, cutaneous aging effects, and how GLP-1 signaling influences wound healing.

She wraps up the video with her signature reminder to viewers to like and share the discussion, subscribe to the channel, and above all, "don't forget sunscreen."

## Notable quotes > [00:00](https://www.youtube.com/watch?v=vESsyr2i6iA&t=0s) been living under a rock — Dr. Dray

> [01:47](https://www.youtube.com/watch?v=vESsyr2i6iA&t=107s) fuel for the inflammatory disease — Dr. Dray

> [03:44](https://www.youtube.com/watch?v=vESsyr2i6iA&t=224s) can't just stay in their lane — Dr. Dray

> [10:43](https://www.youtube.com/watch?v=vESsyr2i6iA&t=643s) noise from the fat compartment — Dr. Dray

> [12:26](https://www.youtube.com/watch?v=vESsyr2i6iA&t=746s) along for the ride — Dr. Dray

> [14:00](https://www.youtube.com/watch?v=vESsyr2i6iA&t=840s) Ozempic face — Dr. Dray

> [16:20](https://www.youtube.com/watch?v=vESsyr2i6iA&t=980s) start low and go slow — Dr. Dray

> [16:20](https://www.youtube.com/watch?v=vESsyr2i6iA&t=980s) Slow and steady wins the race, so to speak. No need to go gangbusters in there right away, make the patient sick, unwell, having diarrhea. — Dr. Dray

> [16:20](https://www.youtube.com/watch?v=vESsyr2i6iA&t=980s) quick 3-month courses — Dr. Dray

> [17:44](https://www.youtube.com/watch?v=vESsyr2i6iA&t=1064s) in our lane — Dr. Dray

> [19:11](https://www.youtube.com/watch?v=vESsyr2i6iA&t=1151s) It doesn't mean it's going to be a good thing for you, okay? Always talk about this stuff with your doctor. — Dr. Dray

> [19:11](https://www.youtube.com/watch?v=vESsyr2i6iA&t=1151s) don't forget sunscreen — Dr. Dray

## Mentioned Dr. Dray, Semaglutide, Tirzepatide, Ozempic, Wegovy, Mounjaro, Zepbound, Guselkumab, TOGETHER-PsO, Interleukin-17

## Video description Can GLP-1 medications like semaglutide and tirzepatide actually improve inflammatory skin diseases? Dermatologist Dr. Dray explores the emerging research connecting GLP-1 medications, weight loss, metabolic health, and inflammation, including what this could mean for psoriasis, psoriatic arthritis, and hidradenitis suppurativa (HS).

GLP-1 medications are best known for treating type 2 diabetes and obesity, but researchers are increasingly investigating their potential effects on inflammation. This video explains why adipose tissue can contribute to systemic inflammation, how GLP-1 signaling may influence inflammatory pathways, and whether improvements in skin disease can occur beyond the effects of weight loss.

Dr. Dray discusses the latest evidence, including the TOGETHER-PsO trial, which investigated tirzepatide in people with moderate-to-severe psoriasis and overweight or obesity, as well as emerging research on GLP-1 medications and hidradenitis suppurativa.

The video also covers:

• What GLP-1 medications are and how they work • Semaglutide vs. tirzepatide • Why obesity and inflammation are connected • GLP-1 medications and psoriasis • Tirzepatide and psoriasis clearance • GLP-1 medications and psoriatic arthritis • GLP-1 medications and hidradenitis suppurativa • Whether GLP-1s have anti-inflammatory effects beyond weight loss • Why metabolic health matters in inflammatory skin disease • Whether everyone with psoriasis or HS should take a GLP-1 • Common GLP-1 side effects and risks • Why GLP-1 medications require medical supervision • What happens when GLP-1 medications are discontinued • The potential future role of GLP-1 medications in dermatology

⏱️ TIMESTAMPS

0:00 Could GLP-1 medications help inflammatory skin disease? 1:03 What are GLP-1 medications? 1:47 Why would a weight-loss medication help a skin disease? 3:44 GLP-1s and psoriasis 5:33 What does this mean for psoriasis treatment? 6:34 GLP-1s and psoriatic arthritis 7:48 GLP-1s and hidradenitis suppurativa 10:43 Could the benefit be independent of weight loss? 12:26 Why does obesity matter so much in these diseases? 14:00 Should everyone with psoriasis or HS take a GLP-1? 14:30 What about side effects? 16:20 Start low and go slow 17:26 What happens if you stop? 17:44 Who should manage the GLP-1? 18:43 Where does this leave us?

中文简报

替尔泊肽独立于减重机制显著提升银屑病皮损清除率临床证据表明，GLP-1类药物并非仅依靠减重，而是通过直接的受体信号通路减轻炎症性皮肤病，促使皮肤科医生针对全身性代谢驱动因素进行干预。 Dr. Dray解释了GLP-1受体激动剂如何通过改善全身性代谢紊乱以及调控独立的免疫途径，来影响慢性炎症性皮肤病。结合TOGETHER-PsO等临床试验以及化脓性汗腺炎的观察性研究，她阐述了脂肪组织分泌的促炎细胞因子如何加剧皮肤病变，同时GLP-1的直接信号传导可能在减重效应之外抑制炎症级联反应。她强调，这些药物并非万能疗法或单独的皮肤科治疗手段，适用人群通常需要具备肥胖或超重等潜在的代谢适应症。最后，她梳理了包括胃肠道不适、营养缺乏以及面部容积流失在内的关键不良反应，并强调在专业多学科医疗监督下进行缓慢剂量滴定的必要性。在3b期TOGETHER-PsO试验中，替尔泊肽联合古塞奇尤单抗（guselkumab）使27.1%的患者在实现至少10%体重减轻的同时达到了银屑病皮损完全清除，而仅接受古塞奇尤单抗治疗的患者这一比例仅为5.8%。 (3:44) 证据表明，GLP-1受体激动剂在炎症性皮肤病中的治疗获益既源于脂肪组织的减少，也得益于直接且独立于减重的抗炎信号传导。 (10:43) 一项涉及约67,000名患者的19项研究系统评价发现，大约60%的化脓性汗腺炎患者在接受GLP-1类药物治疗期间病情出现临床改善。 (7:48) GLP-1类药物目前尚未被批准作为通用的皮肤科单药疗法；其目前的临床应用仍局限于伴有肥胖或超重等明确代谢适应症的患者。 (14:00)

Reading summary

Dr. Dray reports that GLP-1 receptor agonists—such as semaglutide and tirzepatide—show significant potential in treating severe inflammatory skin conditions like psoriasis and hidradenitis suppurativa, operating through both metabolic weight reduction and direct anti-inflammatory signaling. The Adipose Axis and Direct Anti-Inflammatory Signaling (1:47) Adipose tissue is not an inert fat store, but a biologically active endocrine organ that secretes pro-inflammatory cytokines. While excess adiposity does not directly originate conditions such as psoriasis or hidradenitis suppurativa (HS), elevated cytokine output increases systemic inflammation, making these diseases more severe, widespread, and resistant to standard therapies. Furthermore, chronic inflammation and metabolic dysregulation can create a bidirectional feedback loop that promotes additional weight gain. Critiques suggesting that GLP-1 therapies are merely redundant substitutes for diet and exercise overlook evidence that these drugs exert dual mechanisms. Beyond reducing adipose mass and lowering systemic cytokine levels, direct GLP-1 receptor signaling appears to suppress inflammatory cascades independently of weight loss and caloric restriction. Consequently, patients who achieve ideal weights or those who clear skin plaques without hitting standard weight-reduction thresholds may still benefit directly from pharmacological anti-inflammatory pathways. Trial Data in Psoriasis and Hidradenitis Suppurativa (3:44) The phase 3b TOGETHER-PsO trial evaluated 274 adults with moderate-to-severe psoriasis and overweight or obesity, comparing guselkumab monotherapy against guselkumab combined with tirzepatide over 36 weeks. In the combination arm, 27.1% achieved complete skin clearance alongside at least a 10% reduction in body weight, compared to 5.8% in the monotherapy arm. Complete clearance (PASI 100) was markedly higher with dual therapy than the 29% achieved with guselkumab alone, with some combination participants clearing skin lesions without meeting the 10% weight-loss benchmark. A companion trial in psoriatic arthritis similarly demonstrated higher rates of minimal disease activity. In hidradenitis suppurativa, evidence currently relies on observational data, case series, and reviews rather than large-scale randomized trials. A systematic review of 19 studies covering roughly 67,000 patients found clinical improvement in approximately 60% of HS patients treated with GLP-1 agonists, accompanied by reductions in pain, purulent drainage, and flare frequency. However, the degree to which these HS outcomes rely strictly on body fat loss versus direct receptor-mediated effects remains unconfirmed. Prescribing Criteria, Side Effects, and Titration Strategy (14:00) Dr. Dray emphasizes that GLP-1 agonists are not currently indicated as standalone or universal first-line therapies for all dermatology patients; use remains anchored to individuals with concurrent metabolic indications like obesity or overweight. Common side effects include gastrointestinal issues such as nausea, vomiting, diarrhea, constipation, and abdominal pain. Secondary risks include nutritional gaps (notably iron and vitamin D deficiencies), acute gallbladder disease, pancreatitis, telogen effluvium hair shedding, and loss of facial dermal white adipose tissue (DWAT), commonly described as 'Ozempic face.' A black box warning for thyroid C-cell tumors remains noted from rodent models, contraindicating use in patients with a history of medullary thyroid carcinoma or MEN 2. To manage adverse effects, clinicians advocate a 'start low and go slow' dosing schedule. Patients are warned against turning to unauthorized compounding pharmacies or wellness clinics that employ rapid dose escalations. Because GLP-1 medications function as long-term metabolic regimens rather than temporary clearance courses, comprehensive management often requires collaboration between dermatologists, primary care providers, and registered dietitians to protect lean muscle mass and ensure adequate nutrition. GLP-1 receptor agonists represent an evolving bridge between systemic metabolic control and targeted dermatologic care, but Dr. Dray cautions that weight reduction does not guarantee disease resolution, nor should these agents replace established biologics without personalized medical evaluation and further randomized trials in conditions like hidradenitis suppurativa.

Source quotes

[0:00] Dr. Dray: been living under a rock [1:47] Dr. Dray: fuel for the inflammatory disease [3:44] Dr. Dray: can't just stay in their lane [10:43] Dr. Dray: noise from the fat compartment [12:26] Dr. Dray: along for the ride [14:00] Dr. Dray: Ozempic face [16:20] Dr. Dray: start low and go slow [16:20] Dr. Dray: Slow and steady wins the race, so to speak. No need to go gangbusters in there right away, make the patient sick, unwell, having diarrhea. [16:20] Dr. Dray: quick 3-month courses [17:44] Dr. Dray: in our lane [19:11] Dr. Dray: It doesn't mean it's going to be a good thing for you, okay? Always talk about this stuff with your doctor. [19:11] Dr. Dray: don't forget sunscreen

Original transcript

[0:00] Well, hey guys, welcome back. If you're [0:01] new here, I'm Dr. Dray. I'm a [0:03] board-certified dermatologist. Unless [0:05] you've been living under a rock, there's [0:06] a good chance you have heard of the [0:08] GLP-1s. This is a class of medications [0:10] that include semaglutide and [0:12] tirzepatide, to name a few, which are [0:14] used to treat type 2 diabetes and [0:16] obesity. But, there's another really [0:18] interesting area of research emerging [0:21] with GLP-1 medications when it comes to [0:24] treating specific skin disorders. I'm [0:26] not just talking about improving your [0:28] skin because you once struggled with [0:30] having excess body fat and now you no [0:32] longer have it because of these [0:33] medications, or because the medications [0:36] are giving you better diabetes control. [0:38] No, this is actually a unique aspect of [0:40] these drugs that y'all need to be aware [0:42] of, okay? I'm talking about the [0:43] potential to be a game-changer for [0:46] things like psoriasis, psoriatic [0:48] arthritis, hidradenitis suppurativa, [0:50] otherwise referred to as HS. The [0:52] research that is emerging with regards [0:54] to using these drugs for these [0:55] conditions specifically suggests that [0:58] they're having benefits above and beyond [1:00] weight loss for the control of these [1:02] diseases. GLP-1 stands for glucagon-like [1:05] peptide-1. It's a hormone our bodies [1:07] naturally produce. It helps with [1:08] regulating our blood sugar and slowing [1:10] stomach emptying. It has a big influence [1:12] on our appetite and satiety levels. [1:14] Medications that mimic this hormone, [1:15] they've been used to treat diabetes for [1:17] a long time, but more recently more [1:19] medications in this family have become [1:21] more widely available for the treatment [1:23] of obesity. And you guys are likely [1:25] familiar with these, and in fact, I have [1:26] a lot of videos already on my channel [1:28] about effects of these medications as [1:31] far as potential side effects with the [1:33] weight loss, like Ozempic face and hair [1:36] loss, as well as the warning signs of [1:38] nutritional deficiencies on these. But, [1:40] today we need to talk about the skin [1:44] benefits one might experience on these [1:46] drugs. Why would a diabetes/weight [1:49] loss medication also help with skin [1:51] disease? For a long time, obesity was [1:54] something that was thought to just [1:55] coexist with other skin conditions. For [1:59] example, we know that obesity is super [2:02] super common in patients who have [2:03] psoriasis. We also know there's a really [2:06] strong association with having obesity [2:08] and having hidradenitis suppurativa. And [2:10] we know that patients with these skin [2:12] diseases also often have other metabolic [2:15] health issues like insulin resistance as [2:18] well as cardiovascular disease. But [2:20] we're increasingly understanding that [2:21] obesity isn't just simply sitting there [2:23] in the background as an associated [2:26] finding. Adipose tissue is biologically [2:28] active. In other words, fat tissue is [2:31] not just a storage tissue where the body [2:33] puts excess calories. It also produces [2:35] signaling molecules including a variety [2:38] of different inflammatory compounds [2:39] known as cytokines. In other words, when [2:41] someone has excess adipose tissue, they [2:44] can have excessive cytokine production [2:46] and excessive total body inflammation as [2:48] a result. And when you have an [2:50] underlying inflammatory skin condition, [2:52] this increase in total systemic [2:54] inflammatory burden really is fuel for [2:57] the inflammatory disease. While obesity [2:59] doesn't necessarily cause psoriasis or [3:02] cause hidradenitis suppurativa and [3:04] merely reducing excess adipose tissue [3:07] does not cure these diseases, but having [3:10] excess adipose tissue without a doubt [3:12] creates a lot more inflammation and [3:14] makes these diseases a lot more [3:16] involved, a lot more inflamed, and a lot [3:18] more stubborn to treat. So that's really [3:20] changed how we approach managing these [3:23] skin conditions. In other words, [3:25] we don't just stay in the lane of [3:27] treating the surface of the skin. [3:29] Addressing the underlying obesity we've [3:31] known for a long time can have a huge [3:34] impact on the overall disease burden and [3:36] our ability to actually treat the [3:37] disease of the skin. So that's where the [3:39] GLP-1 medications become really [3:42] interesting in the treatment algorithm. [3:44] I want to start with psoriasis cuz this [3:45] is an area where we have probably the [3:47] most compelling evidence. Psoriasis is [3:49] an inflammatory disease that also [3:52] affects the skin in addition to the rest [3:54] of the body in a variety of ways. And it [3:56] involves abnormal inflammatory pathways [3:59] including something known as interleukin [4:00] 17. We have highly effective medications [4:03] for psoriasis that specifically target [4:05] IL-17 and one of these is known as [4:07] guselkumab. So researchers started [4:10] asking a really interesting question. [4:11] What happens when you treat psoriasis [4:13] with guselkumab plus you treat obesity [4:17] and metabolic disease with a GLP-1 [4:19] tirzepatide. So this was studied as part [4:22] of a trial known as the TOGETHER PSO. [4:25] This was a phase 3b randomized clinical [4:27] trial. It involved 274 adults with [4:31] moderate to severe psoriasis. They also [4:33] had overweight or obesity. And they [4:35] received either guselkumab alone or [4:38] guselkumab plus tirzepatide. The results [4:40] are really interesting because at week [4:42] 36, 27.1% [4:45] of people receiving the combination of [4:47] both medications achieved complete [4:50] psoriasis clearance. And they also had [4:52] at least a 10% weight loss. The [4:55] psoriasis clearance rate however for the [4:56] group getting just guselkumab was only [4:59] 5.8% when researchers looked just at [5:03] complete skin clearance, they noted that [5:05] receiving the combination [5:10] achieved a psoriasis associated severity [5:13] index reduction of 100% [5:16] compared with 29% receiving guselkumab [5:20] alone. In other words, the combination [5:23] was better than guselkumab alone for [5:25] treating psoriasis and getting [5:26] clearance. Some people actually achieved [5:29] total clearance of their skin, but they [5:31] didn't hit the weight loss target. In [5:33] other words, this raises the possibility [5:35] that the tirzepatide is treating the [5:37] skin disease independent of treating the [5:40] obesity or overweight. In other words, [5:42] the clearance of the skin disease is [5:43] happening independent of weight loss. [5:46] But I want to be really clear here, this [5:47] doesn't mean that if you have psoriasis, [5:49] you need to jump on tirzepatide, or that [5:51] tirzepatide is going to be the new go-to [5:53] psoriasis medication and can replace [5:56] whatever psoriasis medication you're [5:57] already on. And it doesn't necessarily [5:59] mean that everyone who has psoriasis is [6:01] going to get their disease to completely [6:03] go away if they go on one of these [6:04] medications. What it does suggest, [6:06] however, is that for patients who have [6:08] moderate to severe psoriasis and either [6:11] overweight or obesity, treating both [6:13] conditions bodes well and better for the [6:16] chances of clearing the psoriasis than [6:18] solely focusing and just on the skin. In [6:21] other words, dermatologists can't just [6:23] stay in their lane, per se, and only [6:26] focus on the surface of the skin. They [6:27] have to, as has always been the case, [6:30] okay, focus on the whole patient, [6:33] including what's going on internally. [6:35] We're also seeing something very similar [6:37] with another associated condition with [6:40] psoriasis, and that is psoriatic [6:42] arthritis. Because another TOGETHER [6:44] trial looked at patients who had both [6:46] psoriatic arthritis and overweight or [6:48] obesity. They received either guselkumab [6:51] alone or guselkumab plus tirzepatide. [6:54] Again, the combination group had better [6:56] results for achieving the study's [6:58] combined endpoint of psoriatic arthritis [7:01] reduction and reduction in overweight or [7:03] obesity weight reduction. And more of [7:05] the patients who received the [7:06] combination therapy achieved minimal [7:09] disease activity compared to those just [7:11] getting the guselkumab. Overall, this [7:14] isn't proof that GLP-1 receptor [7:16] medications are going to be like the [7:18] go-to treatment for psoriatic arthritis [7:21] stand-alones for treating those. But [7:23] again, it supports the idea that [7:25] treating the metabolic [clears throat] [7:26] aspect of this disease, the overweight, [7:28] the obesity, is just as important for [7:30] getting control of the psoriatic [7:32] arthritis as it appears to be for [7:34] getting control of the skin disease. [7:36] Remember what I said, psoriasis, it's [7:38] not just a skin disease. It's not just [7:39] an arthritis. It is a total systemic [7:42] illness. Psoriasis patients often also [7:44] cope with a variety of cardiovascular [7:47] and metabolic diseases as well. Now, I [7:49] want to shift gears and talk about [7:50] another inflammatory skin condition. I [7:52] know a lot of you out there deal with. [7:54] You found me through my videos on it and [7:56] that is hidradenitis suppurativa, [7:58] abbreviated HS. If you're not familiar [8:00] with HS, it's a chronic inflammatory [8:02] skin condition and you get these painful [8:04] boils that form these sinus tracts [8:06] beneath the surface of the skin and [8:08] drain this discharge. They scar down. [8:11] This can be incredibly, incredibly [8:13] painful and it can form these scars that [8:16] actually can end up restricting [8:18] mobility. It happens in the skin folds [8:20] under the arms. It can happen under the [8:21] breast in women, in the groin area, [8:24] between the butt cheeks. Uh, what role [8:26] do GLP-1s have here? Because we know [8:29] that a lot of patients who have [8:31] hidradenitis suppurativa, like those [8:33] with psoriasis, they struggle with [8:34] overweight or obesity. Like I said, that [8:37] excess body fat, it is a nidus of [8:40] inflammation that drives the skin [8:41] disease. And these patients often have a [8:44] variety of other cardiometabolic uh, [8:46] health problems just like patients who [8:48] have psoriasis as a matter of fact. [8:50] While the evidence here is not as strong [8:52] as the data that we got in the [8:54] randomized psoriasis trial, a lot of the [8:56] data are coming now from retrospective [8:59] studies, surveys, case series, and [9:02] systematic review. So, not as like [9:04] rigorous in terms of the study designs, [9:06] but the signal is still really [9:08] interesting and bears mention here. Um, [9:10] a recent systematic review actually [9:12] identified 19 different studies total [9:14] involving 67,000 patients. They found [9:18] that about 60% achieved clinical [9:21] improvement in their HS with [9:23] improvements not just in the overall [9:25] appearance of the disease and extent of [9:27] disease, but also quality of life. And [9:30] also inflammatory and metabolic markers [9:33] as well. And then another review of the [9:36] available literature has shown [9:37] improvements in HS symptoms, which [9:40] include an improvement in flares, [9:42] overall pain, drainage, quality of life [9:44] among patients getting these drugs. In [9:47] other words, the drugs don't necessarily [9:49] clear it up for every single person, but [9:51] it seems like at any rate, they often do [9:54] improve a lot of the most debilitating [9:56] aspects of the disease like the pain and [9:59] the drainage, the flares. In other [10:01] words, they make it maybe a little bit [10:03] more bearable if anything. It's also not [10:05] as clear with the HS research if the [10:08] outcomes, the benefits are solely tied [10:11] to any weight loss that may be [10:13] happening. As opposed to the psoriasis [10:15] study where we saw clearly that patients [10:17] got better with the addition of [10:19] tirzepatide independent of losing [10:22] weight. We still need randomized control [10:24] trials in other words to really [10:25] establish this as a treatment technique [10:29] for HS, but it does show a lot of [10:31] promise and don't be surprised if you go [10:34] to your dermatologist and maybe they [10:35] entertain this [10:37] conversation with you about these drugs, [10:40] especially if you're somebody who has [10:41] really struggled with excess body fat. [10:43] So, anytime I talk about these drugs, I [10:45] always get comments from people saying, [10:48] "Well, these drugs are just a band-aid. [10:50] People need to learn to manage their [10:52] weight with diet and exercise." That [10:53] still remains a cornerstone regardless [10:56] of these drugs. You need to have healthy [10:58] lifestyle habits in order to support [11:00] your health and if you don't have those [11:02] and you have excess body fat, you know, [11:04] it all plays together. So, that part of [11:06] the conversation never left the room. [11:09] However, it's really important to note [11:11] here that some of these benefits for the [11:13] skin may have nothing to do with the [11:15] drugs helping people lose weight. And [11:17] that makes some sense because it appears [11:20] as though GLP-1 medications might have [11:23] another effect and that is just in [11:25] reducing total body inflammation. In [11:27] other words, maybe you're someone with [11:29] one of these diseases and you don't [11:31] necessarily have overweight or obesity, [11:33] like you are actually able to manage [11:35] your weight, your ideal body weight with [11:38] diet, exercise, and lifestyle things. [11:40] Does that still mean that these drugs [11:42] could not help you? These studies begin [11:45] to hint at the idea that you might still [11:47] derive benefit for your skin disease on [11:50] some level, again, not everyone will, [11:52] independent of weight loss effects, [11:55] because of that reduction in [11:57] inflammatory signal. And I said that [11:59] excess adipose tissue drives [12:01] inflammatory signal. But, what I'm [12:03] pointing out here is that these GLP-1 [12:05] receptor agonist medications, not only [12:07] do they actively help you to reduce the [12:09] noise from the fat compartment by [12:12] reducing your intake and reducing your [12:15] fat compartment over time, but they may [12:17] also have additional anti-inflammatory [12:20] benefits that come in and lead to [12:22] improvements in skin disease independent [12:24] of any effect on weight. And a lot of [12:27] this research that has come out over the [12:29] past several years and that we have come [12:31] to learn really shows us that when we [12:34] think about patients who have these [12:36] diseases and we approach helping them [12:37] out, we can't just view the obesity as [12:40] something along for the ride. Like, it's [12:43] intimately linked with the disease. It [12:45] doesn't mean that if you have these [12:47] diseases, they are caused by obesity. As [12:50] I pointed out, there are a lot of [12:51] patients who do not have obesity and [12:54] have these diseases. But, it's clear [12:56] that the obesity drives the disease to [12:59] be a more involved. There's something [13:01] about having the disease that also [13:03] likely seems to lead someone to be more [13:06] inclined to have overweight or obesity. [13:09] That could be because of inflammation, [13:12] other factors that impact your [13:13] metabolism, your energy, your appetite, [13:16] your satiety, those things that [13:18] influence how many calories you take in, [13:20] and ultimately play a role in the [13:22] accumulation of excess adipose tissue [13:24] that then, unfortunately, drives the [13:26] disease even further. Treating the [13:28] obesity and overweight does not [13:30] guarantee that the disease will [13:31] completely go away. However, and many [13:33] patients have disease and do not have [13:36] overweight or obesity. Um in other [13:38] words, we need to pay attention to it. [13:40] We need to be aware of the intimate [13:41] association, the risk for it, the [13:43] implications, and we need to always [13:46] factor it in in our treatment plan, [13:48] addressing it in order to get the [13:50] disease to clear and optimize the [13:52] patient's overall health and well-being [13:54] because having obesity, having [13:56] overweight, it's not good for your [13:57] health, period, regardless of if you [13:59] have psoriasis or HS. Does this mean [14:01] that everyone with psoriasis should take [14:03] a GLP-1? No. Right now, the strongest [14:05] rationale for using a GLP-1 receptor [14:07] medication in dermatology is in patients [14:10] who already have a metabolic indication. [14:13] They already have obesity, they already [14:15] have overweight, um or they already have [14:17] some weight-related health complication. [14:19] We're not at the point, in other words, [14:21] where we can say, "Oh, yeah, GLP-1 [14:23] receptor medications, they're a [14:24] treatment for psoriasis." Because these [14:26] drugs, while they are showing a lot of [14:29] promise for helping a lot of people out, [14:31] they're not without side effects, okay? [14:33] So, we always need to balance risks [14:35] versus benefits, okay? Um obviously, [14:37] these are not harmless. Uh and you've [14:40] heard a lot about the side effects from [14:42] me already and from other sources if [14:45] it's something you're interested in. A [14:46] lot of you guys take these drugs. For [14:47] example, the most common's going to be [14:49] the gastrointestinal, nausea, vomiting, [14:52] diarrhea, constipation, abdominal [14:54] discomfort. Not related symptoms to that [14:57] are also common. We've talked about [14:58] nutritional deficiencies on here [15:00] associated with the GLP-1 receptor [15:02] agonist medications like iron [15:04] deficiency, um low vitamin D. There's [15:06] also the potential for uh gallbladder [15:08] disease, pancreatic disease. Hair loss, [15:11] of course, can occur. And we've talked [15:13] about the skin, the facial aging [15:15] changes, the quote-unquote Ozempic face. [15:17] We've talked about how these drugs might [15:19] actually have some impact on a specific [15:21] fat compartment in the face that is very [15:24] actually important and that's the DWAT, [15:26] the dermal white adipose tissue, which [15:29] is really important actually for wound [15:30] healing and for healthy hair growth. So, [15:33] not all fat is foe, right? Um and so, [15:35] that's something else to factor in. And [15:37] you probably are aware that um there's [15:39] an important uh black box warning on [15:41] these uh thyroid C-cell tumors. So, for [15:45] medications like semaglutide and [15:47] tirzepatide, they might be [15:48] contraindicated if you have a personal [15:51] or family history of medullary thyroid [15:53] carcinoma or the hereditary disease [15:55] multiple endocrine neoplasia syndrome [15:58] type 2. A lot of people do fearmonger [16:02] the thyroid tumor warning. Keep in mind [16:04] it is coming from rodent-based studies [16:07] at this point. So, we're not mice, we're [16:09] not rodents, and a lot of times things [16:11] that are shown to be the case in mouse [16:13] studies do not actually bear out in [16:16] reality in humans. We don't have any [16:17] evidence that these medications actually [16:19] cause tumors in humans. Then, another [16:21] important thing that I've highlighted in [16:23] some of my other GLP-1 medication videos [16:25] is dosing. For the treatment of these [16:28] skin diseases, it's recommended [16:30] dermatologists interested in initiating [16:32] them start low, on the low end of [16:34] dosing, and go really slow. That is, you [16:37] know, having that conservative approach [16:38] is good because patients are more likely [16:40] to develop debilitating gastrointestinal [16:42] side effects at the higher doses. Slow [16:45] and steady wins the race, so to speak. [16:47] No need to go gangbusters in there right [16:49] away, make the patient sick, unwell, [16:52] having diarrhea. The reason I point that [16:54] out is cuz now more than ever a lot of [16:56] patients are actually going straight to [16:58] getting these drugs and bypassing the [17:00] doctor prescribing, and they're going to [17:03] um these direct-to-consumer sources, [17:05] which I get it, you know, access has [17:07] become an issue, and so this is an [17:09] avenue for people. I totally get it. But [17:11] a lot of times these direct-to-consumer [17:13] um sites, they do prescribe or spas and [17:16] things like that where they're doing [17:17] compounding in particular, they are [17:19] giving very high doses to people and [17:21] that's where we're seeing a lot more of [17:23] the more serious side effects. Patients [17:24] have with gastrointestinal things [17:26] especially. What happens if you stop the [17:28] drugs? Well, um GLP-1 medications are [17:31] generally used as a long-term treatment [17:34] for these chronic metabolic diseases [17:36] rather than as a short course. Like it's [17:39] not like we just do a quick 3-month [17:41] course of tirzepatide, clear up your [17:43] psoriasis, and you're done so. point a [17:45] lot of you guys are going like, all [17:47] right, I don't know. Do I really want my [17:48] dermatologist doing all this? Uh it's an [17:51] important question honestly because we [17:53] do like to stay reasonably in our lane, [17:56] okay? Um and it kind of all depends. [17:58] Some dermatologists, you'd be surprised, [18:00] they have a lot of advanced training in [18:01] internal medicine. Like some of them [18:03] have done full-on fellowships and things [18:06] like endocrinology and uh rheumatology. [18:09] So, they have just as much uh board [18:11] certification in internal medicine as [18:13] they do in dermatology. So, you know, [18:15] they're probably going to be a lot more [18:18] inclined to use these drugs without [18:20] reservation or try them out in patients. [18:22] But, without a doubt, it's definitely [18:24] prudent to have a multidisciplinary [18:26] team. Having a registered dietitian on [18:28] board is a must-have because of the need [18:31] to address nutritional gaps, nutritional [18:33] deficiencies, help you build in the [18:35] appropriate diet. Protein actually is an [18:38] important part of of the diet here for [18:40] muscle maintenance. I mean, we've gone [18:42] over that. I'm not going to reiterate [18:43] all that in today's video. These drugs [18:45] are showing promise for the treatment of [18:47] skin disease. Yes, they help with the [18:49] weight part of things that does yes [18:51] drive these diseases, but they also can [18:53] help with the diseases independent of [18:55] the weight, okay? So, don't just cut [18:57] them off as, oh, oh, oh, I need to just [19:00] do a 30-day cleanse and and and lose all [19:02] the weight and I I I I don't need to be [19:04] on drugs for the rest of my life. They [19:06] could still help potentially, okay? It's [19:08] definitely worth knowing about, okay? [19:10] That's what I'm here for, to provide [19:11] educational content, not to tell you [19:14] this is the best thing you must be doing [19:16] it, all right? But now you have a little [19:17] bit of understanding about how this [19:18] might be something of help to you, [19:20] something you might want to bring up to [19:22] your dermatologist. It doesn't mean it's [19:23] going to be a good thing for you, okay? [19:25] Always talk about this stuff with your [19:27] doctor. My videos are not medical [19:29] advice, treatment advice, anything of [19:31] the sort, just educational only. I hope [19:33] you all enjoyed today's video in the [19:35] pinned comment below and in the [19:37] description box. I'm going to put some [19:38] of my other GLP-1 videos, the [19:41] nutritional deficiency one, the one [19:43] about hair loss, the Duowart video, the [19:46] video about what we've learned about [19:48] Duowart and Ozempic face and wound [19:50] healing. I mean, there's a lot to know [19:52] about these drugs. If you're taking [19:53] them, if you've been told you might be a [19:55] candidate for them, or you're just [19:57] curious because you think you might [19:58] benefit from them, everyone's taking [20:00] them, you want to know more, check those [20:02] videos out. I hope they are a good [20:03] resource for you all. But if you enjoyed [20:05] today's video, give it a thumbs up, [20:07] share it with your friends, and as [20:08] always, don't forget sunscreen and [20:10] subscribe. I'll talk to you guys [20:11] tomorrow. Bye. [20:13] >> [music] [20:27] [music]