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What You Should Know About Psoriasis and Nonalcoholic Fatty Liver Disease

Many psoriasis patients develop liver disease. Here’s what we know about how the conditions are related. By Sandy McDowellMedically Reviewed by Sanjai Sinha, MDReviewed: September 14, 2017Medically ReviewedPeople with psoriasis should talk to their doctor about ways to keep their liver healthy.ShutterstockUp to 47 percent of psoriasis patients develop nonalcoholic fatty liver disease (NAFLD), a potentially life-threatening condition involving fat deposits in the liver not caused by alcohol abuse. The connection between psoriasis and NAFLD is not entirely understood, but it may have something to do with a group of health risk factors known as metabolic syndrome. Both psoriasis and NAFLD increase your risk for heart disease. “It remains unclear whether having psoriasis and NAFLD together results in an even higher risk of cardiovascular disease than having either condition alone,” says Junko Takeshita, MD, PhD, a dermatologist and epidemiologist at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. RELATED: What Is Nonalcoholic Fatty Liver Disease? NAFLD can progress to a more severe form known as steatohepatitis (NASH), which can lead to cirrhosis. About 25 percent of the people who develop cirrhosis will die within five years. The cause is complications from liver cancer or end-stage liver disease, which may require a liver transplant.

Metabolic Syndrome

The connection between the two diseases appears to be metabolic syndrome, which is more common in people with psoriasis, and is a risk factor for NAFLD. Metabolic syndrome is a combination of health problems. To be diagnosed with metabolic syndrome, you must have at least three of the following health issues:Elevated fasting blood sugar levels (hyperglycemia), defined as 100 milligrams per deciliter (mg/dL) or higherHigh triglyceride levels (hypertriglyceridemia), defined as 150 mg/dL or higherAbdominal obesity, defined as a waist measurement equal to or exceeding 40 inches, or 102 centimeters (cm), in men and 35 inches (88 cm) in womenHigh blood pressure (hypertension), defined as higher than 130/85 millimeters of mercuryLow high-density lipoprotein (HDL) cholesterol, defined as less than 40 mg/dL in men or 50 mg/dL in women In a study published online in February 2016 in the Polish journal Gastroenterology Review, researchers found “that psoriasis with NAFLD was positively associated with three components of metabolic syndrome: hyperglycemia, hypertriglyceridemia, and abdominal obesity.” The study reported a higher number of people with obesity having psoriasis and NAFLD, compared with those who just had psoriasis. It also found that people with both conditions had higher blood pressure. “People who have psoriasis, particularly those with more severe disease, are more likely to have risk factors for NAFLD,” says Dr. Takeshita.

Screening Liver Function

When you’re diagnosed with psoriasis, your dermatologist or primary care doctor will likely take blood to test your liver’s function. “Most NAFLD will be identified by dermatologists based on elevated liver function tests during routine drug-monitoring labs for oral systemic or biologic medications,” says Takeshita. But that may leave many cases undetected because the changes in liver enzymes may be unnoticeable or very slight. Also, the disease often doesn’t cause many symptoms until it’s advanced. You may also have elevated liver enzymes but not have NAFLD. “To date, there are no U.S. guidelines on screening patients with psoriasis for NAFLD,” says Takeshita. Like other researchers, Takeshita says further study on the association between psoriasis and NAFLD is needed in order to determine best screening recommendations.

Prevention Tips

Many NAFLD risks are behaviors that you have some control over. First, talk with your doctor about ways to keep your liver healthy. Also, consider these actions: Stay at a healthy weight or lose weight if you’re overweight or obese. You can improve the health of your liver by losing 7 to 10 percent of your weight. For a 200-pound (lb) person, that means losing 14 to 20 lbs. Eat a healthy diet. This can help you control your glucose and triglyceride levels as well as your blood pressure. Avoid saturated fats and fructose-sweetened drinks. Exercise regularly. This can help increase your HDL levels. Limit how much alcohol you drink. Alcohol increases your risk for liver disease. Ask your doctor how much is safe for you to drink. Takeshita says, “Alcohol can sometimes exacerbate psoriasis. Unless a patient with psoriasis has other contraindications to alcohol, such as taking methotrexate or having severe liver disease or cirrhosis, I personally don’t make recommendations to limit alcohol intake beyond the recommendations for the general population.” Take any medicines that you’ve been prescribed. Follow your doctor's advice on taking drugs to lower blood glucose, cholesterol, or triglycerides. NEWSLETTERS

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