Psoriasis and Nonalcoholic Fatty Liver Disease

Area of Science:

• Hepatology
• Dermatology
• Metabolic Syndrome

Background:

• Nonalcoholic fatty liver disease (NAFLD) is the most common liver condition in Western countries.
• Psoriasis patients exhibit higher prevalence and severity of NAFLD, with a worse prognosis.
• Chronic inflammation and peripheral insulin resistance are key pathogenic links between psoriasis and NAFLD.

Purpose of the Study:

• To highlight the importance of ruling out NAFLD in psoriasis patients.
• To discuss the implications of co-existing psoriasis and NAFLD on treatment strategies.
• To review the hepatotoxic risks associated with conventional and biologic therapies.

Main Methods:

• Literature review on the association between psoriasis and NAFLD.
• Analysis of pathogenic mechanisms linking the two conditions.
• Evaluation of treatment options and their potential liver toxicity.

Main Results:

• NAFLD should be screened for in psoriasis patients, particularly those with metabolic syndrome or requiring systemic therapy.
• Concomitant psoriasis and NAFLD present treatment challenges due to potential drug-induced liver injury.
• Conventional treatments (e.g., acitretin, methotrexate) and some biologics carry hepatotoxic risks requiring monitoring.

Conclusions:

• Close monitoring is essential for psoriasis patients undergoing systemic treatment due to potential liver toxicity.
• Anti-tumor necrosis factor agents may offer benefits but also carry risks of liver injury.
• Current evidence does not support benefits or adverse effects of anti-p40 or anti-interleukin 17 agents in this context.