Inflammatory cells (macrophages) are increased in skin lesions of psoriasis, going as deep as the deep dermis/adipose tissue interface. Macrophages are postulated to be cells increased in adipose tissue that, in conditions of obesity, produce excess TNF and thus directly cause disrupted insulin receptor signaling in adipocytes. The extension of inflammation in skin lesions could well continue into the fat, with common inflammatory circuits then driving both skin disease and obesity/metabolic syndrome that is so common in psoriasis patients.