Psoriasis and Hidradenitis Suppurativa Share Immunological Links with MASLD; GLP-1 RAs Show Therapeutic Promise

Patients with chronic inflammatory skin conditions such as hidradenitis suppurativa (HS) and psoriasis vulgaris frequently suffer from metabolic dysfunction-associated steatotic liver disease (MASLD), with prevalence rates reaching as high as 57%. This comorbidity significantly exacerbates disease burden and complicates management. Current standard-of-care for these skin conditions often overlooks the underlying metabolic dysfunction, creating a critical gap in holistic patient care. Understanding the shared immunological mechanisms is crucial for developing integrated therapeutic strategies that address both dermatological and metabolic aspects, particularly exploring agents like glucagon-like peptide-1 receptor agonists (GLP-1 RAs) known for their anti-inflammatory and metabolic benefits.

This narrative review systematically explored the existing literature on the immunological connections between hidradenitis suppurativa (HS), psoriasis vulgaris, and metabolic dysfunction-associated steatotic liver disease (MASLD). The authors synthesized evidence on chronic systemic inflammation and immune dysregulation as shared mechanisms driving these comorbidities. The review also evaluated potential pharmacological interventions, specifically highlighting glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and biologics, while identifying gaps in current research regarding their efficacy and safety in this complex patient population. The primary objective was to enhance awareness among dermatologists regarding these critical links and potential therapeutic avenues.

The review established a significant epidemiological link, noting that hidradenitis suppurativa and psoriasis vulgaris exhibit a substantially elevated prevalence of MASLD, with studies indicating rates as high as 57% among affected individuals. This comorbidity is driven by shared underlying immunological mechanisms, primarily chronic systemic inflammation and immune dysregulation. Key pathways implicated include dysregulation of cytokines, adipokines, and innate immune responses that contribute to both skin inflammation and hepatic steatosis. The authors emphasized that these shared pathways create a rationale for integrated therapeutic approaches. > The review specifically identified glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and biologics as promising pharmacological interventions for patients with concurrent HS or psoriasis and MASLD, due to their known anti-inflammatory and metabolic benefits. However, the review also underscored the critical need for further research to definitively elucidate the efficacy and safety of these treatments in this specific patient cohort, as current evidence is largely observational or extrapolated.