GLP-1 receptor agonists are revolutionizing the treatment of type 2 diabetes and obesity. With widespread consumer advertising campaigns, GLP-1 usage is becoming commonplace. National polls show up to one-fifth of American adults have tried GLP-1s for weight loss or to address health conditions, such as heart disease. As the understanding of GLP-1s deepens, so does their potential. Since recent research has shown GLP-1s have anti-inflammatory effects independent of weight loss, dermatologists are now evaluating the role GLP-1s may play in treating inflammatory skin conditions.
An article in the December Journal of Drugs in Dermatology reviews the use of GLP-1s for hidradenitis suppurativa (HS), including whether GLP-1s can also address HS-related comorbidities, including metabolic syndrome. For the science behind GLP-1s for HS as well as how GLP-1s should interface with currently available treatments, I interviewed the article’s lead author, Sawyeh Maher, BS, of the Rosalind Franklin University of Medicine & Science Chicago Medical School.
What led you to research GLP-1 agonists for HS?
HS is a chronic inflammatory skin disease with a large physical and psychosocial burden; however, patient satisfaction with current treatment modalities unfortunately is not as successful as we’d like. Even with advances in biologics and procedural management, a lot of patients continue to experience incomplete disease control. Notably, HS seems to disproportionately affect those with metabolic and inflammatory comorbidities such as obesity, insulin resistance, type 2 diabetes, and cardiovascular disease. This association with systemic disease led us to exploring therapeutic strategies capable of addressing both cutaneous inflammation and underlying comorbid conditions. GLP-1 receptor agonists have therefore emerged as a promising adjunct in the HS treatment landscape, given their established metabolic benefits and emerging evidence suggesting anti-inflammatory effects.
You note that patients are mixed on their satisfaction with currently available HS treatments, and these patients often have concurrent conditions. How could GLP-1s meet multiple needs in these patients?
GLP-1 receptor agonists are uniquely positioned to address several overlapping drivers of disease in HS. Beyond their role in weight reduction, which itself can lessen mechanical friction and inflammation in intertriginous areas, GLP-1s improve insulin sensitivity, cardiometabolic risk factors, and may reduce systemic inflammation–all of which can be more prevalent in HS patients. By targeting metabolic dysfunction while addressing inflammatory pathways, GLP-1s offer a means of treating HS within a broader context of multimorbidity rather than as an isolated cutaneous condition. This more holistic approach can translate into improvements in overall quality of life and treatment satisfaction for patients who manage multiple chronic conditions.
What’s the science behind how GLP-1 agonists can improve HS?
The biologic plausibility of GLP-1 receptor agonists for HS lies in their immunomodulatory and anti-inflammatory properties. Preclinical and clinical data suggest that GLP-1 signaling can downregulate pro-inflammatory cytokines, such as TNF-α and IL-6, inhibit NF-κB–mediated inflammatory cascades, and reduce oxidative stress. These pathways are highly relevant to HS pathogenesis, which involves dysregulated innate immunity, chronic inflammation, and oxidative damage. Additionally, by improving insulin resistance and adipose-driven inflammation, GLP-1 agonists may reduce metabolic contributors that further perpetuate HS activity. While current clinical evidence is preliminary, emerging case reports and observational studies provide early support for these mechanisms.
How could GLP-1s serve as a compliment to existing HS treatments?
Rather than replacing the established therapies for HS, GLP-1 receptor agonists may function best as adjunctive tools. Biologic therapies effectively target specific inflammatory mediators, but do not directly address metabolic dysfunction or oxidative stress, both of which contribute to HS severity. GLP-1s may therefore complement biologics by targeting parallel inflammatory pathways and systemic drivers of disease. In select patients–particularly those with obesity or metabolic syndrome–this combo approach can enhance disease control, reduce flare frequency, and potentially decrease reliance on repeated antibiotic courses or escalating immunosuppressants.
Practically, how can a dermatology clinician implement GLP-1s as a treatment option?
In clinical practice, dermatologists can begin by identifying HS patients with concurrent metabolic comorbidities who may benefit most from GLP-1 therapy. Implementation typically involves collaboration with PCPs or endocrinologists to initiate and titrate treatment, monitor metabolic parameters, and manage adverse effects. Dermatologists can then assess HS response using standardized severity measures and patient-reported outcomes. Informing patients on potential side effects, gradual dose escalation, and contraindications is essential to ensure safety and adherence. This multi-disciplinary approach allows GLP-1s to be incorporated into HS care without overextending the scope of dermatologic practice.
What should dermatology clinicians know about cost and insurance approval of GLP-1s for HS patients?
Cost and insurance coverage remain major barriers to widespread use of GLP-1 receptor agonists in HS, as this is currently an off-label indication. Coverage is typically more feasible when prescriptions are tied to FDA-approved indications such as type 2 diabetes, obstructive sleep apnea, or obesity; however policies vary widely across different insurance providers. Prior authorization requirements and restrictions are common, so providers should be prepared for variability in patient access.
What’s needed in order to fully implement GLP-1s as a treatment option for HS?
To fully integrate GLP-1 receptor agonists into HS management, high-quality randomized controlled trials are needed to evaluate their efficacy, safety, and role as monotherapy or adjunctive treatment. In parallel, improved recognition of HS as a systemic inflammatory disease and clearer insurance coverage pathways would enhance access. Together, these advances could support the incorporation of GLP-1s into a more comprehensive, multimodal treatment strategy for HS.
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