‘If not you, then who?’ Expert urges dermatologists to prescribe weight-loss medications
Key takeaways:
- Cutaneous signs of metabolic disease include skin tags, acanthosis nigricans, dorsocervical fat pad and more.
- Dermatologists should run blood panels for insulin resistance and other metabolic concerns.
ORLANDO — Dermatologists should take action to treat patients who present with cutaneous manifestations of metabolic disease, according to a speaker at the American Academy of Dermatology Annual Meeting.
“If a patient comes in for acne, skin checks or psoriasis ... [but] you notice findings in the skin that indicate metabolic disease ... what do you do?” Lindsey Bordone, MD, FAAD, assistant professor of dermatology at the Columbia University Medical Center, asked a room of dermatologists during her presentation.
According to Bordone, prescribing that patient a weight-loss medication should be considered as a treatment option.
“What I say to everyone is, if not you, then who?” Bordone said. “If you don’t flag this, it’s not like they are going to make an appointment to go to primary care, because they otherwise feel fine. So, we are the ones that need to find and help these patients.”
According to Bordone, dermatologists are uniquely positioned to help patients with subtle presentations of metabolic disease because the accompanying skin manifestations that may drive patients to seek medical advice.
“Patients are motivated by their appearance,” Bordone said. “You do not have to look at hypertension in the mirror, so they are more motivated to treat themselves if they have a physical manifestation.”
When performing skin checks, Bordone looks for the classic signs of metabolic disease, such as skin tags, acanthosis nigricans, dorsocervical fat pad, truncal obesity, enlarged earlobes and other signs of pseudoacromegaly.
If a patient presents with any of these cutaneous manifestations, Bordone suggests dermatologists order labs to evaluate their HbA1c, vitamin D, thyroid-stimulating hormone, fasting glucose, HDL cholesterol and other metabolic panels.
Bordone especially recommends dermatologists calculate patients’ HomeOstatic Model Assessment for Insulin Resistance scores, which describe a patient’s level of insulin resistance, especially for those who may have a normal HbA1c but still present with cutaneous manifestations of metabolic issues.
“It’s important to check in people who have a normal [HbA1c],” she said. “Those are the patients that dermatologists see.”
According to Bordone, dermatologists should feel empowered to prescribe weight-loss and other medications for metabolic disorders as part of a holistic approach to health care because “there are not — and statistically cannot be — enough endocrinologists in the country,” she said.
“Patients are not aware of how obesity and insulin contribute to these skin changes,” Bordone explained. “And once you explain it to them, they’re usually relieved to have an answer.”
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Bordone L, et al. Overview of metabolic disorder and affect on inflammation. Presented at: American Academy of Dermatology Annual Meeting; March 7-11, 2025; Orlando.
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