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Psoriasis — SCE Dermatology MCQ

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ModerateInflammatory DermatosesPsoriasisSCE Dermatology

A 55-year-old man with severe widespread psoriasis is being considered for a biologic. His BMI is 42. What impact does obesity have on biologic therapy for psoriasis?

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Correct answer: A — Obesity reduces biologic efficacy, particularly for weight-based dosing agents, and may require higher doses or weight-independent dosing regimens

Obesity significantly reduces the efficacy of several biologic therapies for psoriasis, particularly those with weight-based pharmacokinetics. Infliximab and Ustekinumab have demonstrated reduced efficacy in obese patients. BAD guidelines highlight obesity as a factor affecting treatment response and recommend weight management as part of holistic psoriasis care. Some newer biologics (e.g., IL-23 inhibitors like Risankizumab) show more consistent efficacy regardless of body weight due to different pharmacokinetic profiles. Weight loss can improve psoriasis independently and enhance treatment response. Bariatric surgery has been associated with significant psoriasis improvement.

Reference: BAD 2020 Biologic Psoriasis Guidelines; BJD 2019 Obesity