Recognising obesity-related skin conditions in general practice: a practical guide

BackgroundObesity, defined as a body mass index (BMI) ≥30 kg/m 2 , affects up to 30% of UK adults. 1 Its dermatological consequences are well established, 1-3 but potentially under-appreciated in general practice.Examination may be hindered by larger skin folds and reduced visibility, while psychosocial barriers such as body image concerns may delay presentation.When patients do seek care, GPs have an opportunity to address both the skin condition and broader weight-related health.Understanding how obesity contributes to skin disease and the distinct management needs of this population is essential to improving outcomes in primary care. How do obesity-related mechanisms cause changes in the skin? Friction and moisture in skin foldsObesity is associated with extensive skin folds in the axillary, neck, submammary, abdominal, and inguinal regions.4 Subcutaneous fat impairs thermoregulation, promoting sweating, friction, and moisture retention.1,4,5 This humid microenvironment predisposes to intertrigo and secondary infections, especially in those with diabetes or reduced mobility.1,4 The skin surface pH in obesity tends to be more alkaline than in normal-weight individuals, favouring fungal colonisation by Candida albicans.2 Erythrasma, caused by Corynebacterium minutissimum, is another common skin fold infection.2,3