Psoriasis and Liver Ailment: Exploring the Link, Diagnosis, and Management Strategies
Psoriasis and a condition known as non-alcoholic fatty liver disease (NAFLD), now often referred to as metabolic-associated fatty liver disease (MAFLD), share common inflammatory and metabolic pathways. Both conditions are associated with systemic inflammation, metabolic syndrome features, and pro-inflammatory cytokine activity that can exacerbate each other.
The Connection Between Psoriasis and NAFLD
Psoriasis, a chronic immune-mediated skin disease, frequently coexists with NAFLD/MAFLD. The inflammatory mediators secreted in obesity and metabolic syndrome (e.g., TNF-α, IL-6, IL-1β) promote both psoriatic lesion inflammation via Th17 pathway activation and fat accumulation/inflammation in the liver, contributing to NAFLD development and progression. Conversely, NAFLD can worsen psoriasis symptoms by amplifying systemic inflammation.
Risk Factors
Shared risk factors include obesity, insulin resistance/type 2 diabetes, metabolic syndrome, dyslipidemia, and chronic systemic inflammation. Inflammatory cytokines (TNF-α, IL-6) impair insulin signaling and promote liver fat deposition and psoriatic skin inflammation. Certain medications for comorbidities can also worsen psoriasis.
Diagnosis
For psoriasis, clinical skin examination and severity scoring such as PASI (Psoriasis Area and Severity Index) are used. In contrast, diagnosing NAFLD/MAFLD typically involves liver imaging (ultrasound, elastography) to detect steatosis and fibrosis, blood tests for liver enzymes and metabolic parameters, and sometimes liver biopsy if advanced disease is suspected. Ankle-brachial index may be used in comorbidity screening due to vascular risk in related conditions.
Treatment
Psoriasis treatments include topical agents, systemic immunosuppressants, and biologics targeting IL-17/IL-23 pathways. When cardiovascular/metabolic comorbidities are present, treatments that avoid hypertensive effects, such as cyclosporine, are preferred. NAFLD treatment focuses on managing underlying metabolic disorders: lifestyle changes (weight loss, diet, exercise), glycemic control, and emerging pharmacotherapies like semaglutide (shown to reduce liver fat and inflammation).
Outlook
The coexistence of psoriasis and NAFLD worsens outcomes due to mutual amplification of systemic inflammation and metabolic dysfunction. Early identification and integrated management of metabolic risk factors can improve skin disease control and halt liver disease progression. Advanced NAFLD (MASH) may lead to fibrosis, cirrhosis, liver cancer, and is a leading cause of liver transplantation. Cardiovascular disease is also a leading cause of mortality in these patients. Ongoing research into anti-inflammatory and metabolic-targeted therapies aims to improve prognosis for both conditions.
Caution with Certain Medications
Methotrexate, cyclosporin, dimethyl fumarate (DMF), acitretin, TNF inhibitors (such as adalimumab, infliximab, and etanercept) may be toxic to the liver and increase the risk of liver disease. To diagnose psoriasis, doctors may take a small sample of skin tissue for examination under a microscope.
Managing both conditions concurrently is crucial to improving long-term outcomes. People with psoriasis who experience symptoms of liver disease, including fatigue and abdominal discomfort, should contact a doctor as soon as possible. People can attend screenings for conditions known to occur alongside psoriasis to increase the chances of curing or successfully managing the condition.
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