Although many people think of psoriasis primarily as a skin disease, it is a systemic condition that affects other organs as well. People with psoriasis have increased inflammation throughout the body, which increases the risk of developing comorbid conditions (more than one chronic disease at the same time). For example, people with psoriasis have a higher prevalence of fatty liver disease compared to the general population.

There are two classifications of fatty liver disease: nonalcoholic fatty liver disease (NAFLD) and alcohol-associated fatty liver disease. Nonalcoholic fatty liver disease and alcohol-associated fatty liver disease are similar except that one is associated with unhealthy alcohol use.

What Is Fatty Liver Disease?

NAFLD is caused by the accumulation of fat in the liver. The liver is essential because it processes nutrients and regulates the immune system, digestion, hormones, cholesterol, blood sugar, and blood clotting. When lipids (fat molecules) build up, it can impair normal liver function and lead to NAFLD.

Nonalcoholic fatty liver disease is often mild and may only be detectable in lab tests. However, NAFLD can progress to nonalcoholic steatohepatitis (NASH). With NASH, cells in the liver are damaged. NASH can further progress to liver fibrosis (liver healing leading to scarring) and cirrhosis (liver scarring) as well as liver failure or cancer.

How Is Psoriasis Connected To NAFLD?

Psoriasis is associated with a higher risk for developing obesity (high body mass index), insulin resistance, and metabolic syndrome — factors that can also increase the risk of NAFLD. A person may be diagnosed with metabolic syndrome if they have three of the following:

• Abdominal obesity
• High triglyceride levels
• Low HDL cholesterol levels
• High glucose levels
• Hypertension (high blood pressure)

People with metabolic syndrome and severe psoriasis are at a higher risk of developing NAFLD.

Research studies suggest that psoriasis may also increase the severity of NAFLD. Chronic inflammation and elevated cytokines (inflammatory molecules) in psoriasis likely contribute to lipid buildup. In one recent study, researchers found that the severity of psoriasis correlated with NAFLD severity. In other words, people with worse psoriasis generally had worse NAFLD.

Recent studies have also suggested that low levels of vitamin D may contribute to the development of NAFLD. Low vitamin D is also associated with psoriasis.

How Do Psoriasis Treatments Affect the Liver?

Systemic (whole-body) therapy may be used for moderate to severe psoriasis to manage symptoms. However, systemic treatments can have varying effects on the liver.

Methotrexate is a psoriasis treatment that can cause NAFLD. People with metabolic syndrome may have a higher risk of NAFLD on methotrexate treatment. People taking methotrexate should monitor their liver function carefully. Talk to your doctor about the benefits and risks of methotrexate regarding your psoriasis and your liver.

Biologic treatments for psoriasis have a varied effect on liver disease as well. To detect these issues, the use of these medications requires regular blood testing and monitoring by your physician.

How Is Fatty Liver Disease Diagnosed in People With Psoriasis?

A person with fatty liver disease may not have any symptoms, so a doctor may find liver damage through routine blood tests. If a doctor suspects liver disease, they can also perform liver function tests (also called LFTs) to detect liver enzymes in the blood that signal liver damage.

If liver damage is detected, your health care provider may refer you to a hepatologist (a doctor who specializes in the liver). A hepatologist may request a biopsy to confirm a diagnosis of NAFLD. During a biopsy, a very small sample of the liver is taken for evaluation. Alternatively, elastography may be used to evaluate liver disease. Elastography uses an ultrasound to view the liver and help the doctor determine the severity of NAFLD.

What Can I Do To Reduce My Risk of Fatty Liver Disease?

Reducing risk factors for metabolic disease and liver disease is likely the best approach to minimize the risk of NAFLD. For individuals who are overweight, weight loss is an important step in preventing and treating NAFLD. Clinical research studies have shown that even a 5 percent weight loss can improve NAFLD. Your doctor or a nutritionist can help you get started on a diet and exercise plan that works for you.

Controlling alcohol intake is another approach to reduce the risk of liver disease. The liver removes molecules that can harm the body, including alcohol. Limiting or avoiding alcohol consumption can help reduce stress on the liver.

Consuming coffee and caffeine may also help protect your liver, research suggests. A review of studies showed that people diagnosed with NAFLD or NASH who drank caffeinated coffee regularly had lower levels of liver fibrosis.

People with NAFLD who have low levels of vitamin D may benefit from vitamin D supplements.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 108,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Are you living with psoriasis? Do you have fatty liver disease? Share your experience in the comments below, or start a conversation by posting on MyPsoriasisTeam.