Reprogramming immunity at the metabolic-epidermal interface in obesity-associated psoriasis.

Obesity and psoriasis are chronic inflammatory disorders, now recognized to be interconnected, in which metabolic overload drives immune dysregulation and therapeutic resistance. Excess adiposity converts adipose tissue into an inflammatory organ that releases adipokines and cytokine-like mediators, reprogramming keratinocytes and immune cells to sustain cytokine-driven inflammatory circuits in the skin. Excess nutrients and lipotoxic stress impair mitochondrial function, enhance glycolysis, and induce epigenetic remodeling in myeloid and epithelial lineages, generating metabolic memory that perpetuates inflammation. Increased body mass index and insulin resistance are clinically associated with reduced responses to biologics targeting tumor necrosis factor, interleukin (IL)-17, and IL-23, whereas metabolic interventions including caloric restriction and glucagon-like peptide-1 receptor agonists improve responsiveness. Recent multi-omics, single-cell, and spatial studies demonstrate that obesity reshapes dermal and adipose immune niches and rewires epidermal innate immunity, attenuating cytokine blockade. Obesity-associated psoriasis thus represents a metabolically imprinted inflammatory state driven by chronic metabolic stress. This review integrates mechanistic and clinical insights and discusses strategies to restore metabolic-immune plasticity to sustain disease remission.