GLP-1 Candidacy and Prescribing Considerations in Psoriasis

Joel Gelfand, MD, MSCE, dermatologist, professor of dermatology and epidemiology, and director of the Center for Clinical Sciences in Dermatology and the Psoriasis and Phototherapy Treatment Center at the University of Pennsylvania Perelman School of Medicine, recently reviewed the evolving role of GLP-1 medications in psoriasis care during Fall Clinical 2026. He addressed how dermatologists can approach weight conversations, identify candidates for therapy, and decide between prescribing and referring. Gelfand also described an upcoming trial of GLP-1 monotherapy in mild to moderate psoriasis.

Talking With Patients About Weight and Psoriasis

Gelfand said dermatologists should be comfortable asking patients whether they are having problems with their weight. Patients who say yes are likely interested in learning how weight affects psoriasis treatment, the likelihood of getting clear and staying clear, and joint outcomes. Patients then understand why their dermatologist is raising the topic and feel taken seriously.

“I think all dermatologists need to feel comfortable talking about GLP-1 medications and talking about weight and psoriasis,” Gelfand said.

Identifying Candidates for GLP-1 Therapy

Gelfand said candidacy becomes more likely as BMI rises, particularly into the mid 30s with other metabolic morbidities. These include elevated blood pressure, elevated A1C, prediabetes, a history of cardiovascular disease, abnormal liver function tests, and fatty liver disease. He suggested asking patients about snoring and waking short of breath to identify obstructive sleep apnea.

He framed the benefit as overall patient health, not only skin and joints. Patients with ongoing psoriatic arthritis may gain additional benefit, as may those who are hard to treat. Gelfand pointed to the TOGETHER-PsO trial (NCT06588283), whose difficult-to-treat population had an average BMI of about 40.

Prescribing vs Referring

Gelfand said every dermatologist should know who is a good candidate, how to discuss GLP-1 therapy with the patient, and where to refer if they will not prescribe. Ideally, dermatologists would also be comfortable prescribing when the situation calls for it.

“In my own practice, I work closely with endocrinology. It’s easy to refer, but sometimes I’ll prescribe the medication because it’s too hard for them to get in with endocrinology,” Gelfand said.

Upcoming GLP-1 Monotherapy Trial

The next step, Gelfand said, is a trial launching soon of GLP-1 monotherapy in people with mild to moderate psoriasis. GLP-1 receptors are expressed on T regulatory cells in the skin of people with psoriasis, and GLP-1 therapy may have anti-inflammatory effects. Some patients with mild to moderate disease may do well on a GLP-1 alone, and the trial aims to answer this question definitively.

“This may really change the paradigm of our disease. This idea of treating the comorbidity to improve the skin disease,” Gelfand said.

Gelfand noted patients with hidradenitis suppurativa often struggle with treatment response and with their weight. “It’d be great to start seeing similar trials in hidradenitis suppurativa to see if patients get meaningfully clinically better outcomes in their skin,” he said.