Skin changes in the obese patient
Abstract
Obesity is a worldwide major public health problem with an alarmingly increasing prevalence over the past 2 decades. The consequences of obesity in the skin are underestimated. In this paper, we review the effect of obesity on the skin, including how increased body mass index affects skin physiology, skin barrier, collagen structure, and wound healing. Obesity also affects sebaceous and sweat glands and causes circulatory and lymphatic changes. Common skin manifestations related to obesity include acanthosis nigricans, acrochordons, keratosis pilaris, striae distensae, cellulite, and plantar hyperkeratosis. Obesity has metabolic effects, such as causing hyperandrogenism and gout, which in turn are associated with cutaneous manifestations. Furthermore, obesity is associated with an increased incidence of bacterial and Candida skin infections, as well as onychomycosis, inflammatory skin diseases, and chronic dermatoses like hidradenitis suppurativa, psoriasis, and rosacea. The association between atopic dermatitis and obesity and the increased risk of skin cancer among obese patients is debatable. Obesity is also related to rare skin conditions and to premature hair graying. As physicians, understanding these clinical signs and the underlying systemic disorders will facilitate earlier diagnoses for better treatment and avoidance of sequelae.
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Obesity creates variations in skin physiology, including skin barrier function, epidermal changes, dermal changes, and changes to vascular and capillary recruitment function.
“Recent studies have shown that obesity creates variations in skin physiology5,35–38. These changes include but are not limited to skin barrier function, epidermal changes, dermal changes, and changes to the vascular and capillary recruitment function.”
From Synthetic photoplethysmography (PPG) of the radial artery through parallelized Monte Carlo and its correlation to body mass index (BMI) (2021) · cites this paper as [36]
Trans-epidermal water loss is disrupted in the obese, and as BMI increases, TEWL increases, contributing to dry skin and skin irritation.
“Trans-epidermal water loss (TEWL) the process where water evaporates through the epidermis from the dermis is disruption in the obese36. As BMI increases so does TWEL66, and this effect directly contributed to dry skin and skin irritation often seen in the obese population.”
From Synthetic photoplethysmography (PPG) of the radial artery through parallelized Monte Carlo and its correlation to body mass index (BMI) (2021) · cites this paper as [36]
Boonya-ananta et al. used Monte Carlo simulations that predicted a 40% loss of PPG signal amplitude due to increased skin thickness in obese individuals, specifically on the wrist as the simulated radial artery increases in depth from 2.5 to 3.5 mm.
“For example, the increase in skin thickness affects the vessel depth, and Boonya-ananta et al. used Monte Carlo simulations that predicted a 40% loss of PPG signal amplitude due to this effect in obese individuals, specifically on the wrist as the simulated radial artery increases in depth from 2.5 to 3.5 mm [74].”
From Sources of inaccuracy in photoplethysmography for continuous cardiovascular monitoring (2021) · cites this paper as [74]
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References 262 · Cited by 182
- Authors
- Hirt, P. A., Castillo, D. E., Yosipovitch, G., & Keri, J. E.
- Affiliations
- University of Miami (US)
- Corresponding author
- Keri, Jonette E.
- Venue
- Journal of the American Academy of Dermatology
- Publisher
- Elsevier BV
- Published
- 2019-11
- Volume
- 81
- Issue
- 5
- Pages
- 1037-1057
- ISSN
- 0190-9622 (ISSN-L)
- OpenAlex
- W2979474988
- Cited by
- 182
- References
- 262
- Citations by year
- 2026: 22 · 2025: 26 · 2024: 41 · 2023: 23 · 2022: 31 · 2021: 25 · 2020: 13 · 2019: 1
- FWCI
- 3.40
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American Academy of Dermatology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Dermatology › Skin Diseases and Diabetes
- Health Sciences › Medicine › Dermatology › Dermatology and Skin Diseases
- Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
- Keywords
- obesity, body mass index, skin barrier, collagen, wound healing, sebaceous glands, sweat glands, acanthosis nigricans, acrochordons, keratosis pilaris, striae, cellulite, plantar hyperkeratosis, hyperandrogenism, gout, bacterial skin infections, onychomycosis, hidradenitis suppurativa, psoriasis, rosacea, atopic dermatitis, skin cancer risk
- MeSH terms
- Dermatitis, Humans, Obesity, Skin, Skin Diseases, Skin Diseases, Infectious
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