26 Aprile 2022
J J Yang, K A Nguyen, M W Fleischman, O Aly, K Cheng

Psoriasis in liver disease: Associations beyond nonalcoholic fatty liver disease

J Am Acad Dermatol. 2022 Apr;86(4):883-885

Key messages

  • Il presente studio ha dimostrato che la psoriasi si può associare a varie patologie epatiche oltre alla nonalcoholic fatty liver disease (NAFLD). La NAFLD e la malattia epatica associata all’alcol (ALD) sembrano mostrare la più forte associazione.
  • I risultati suggeriscono che potrebbero esserci fattori patogenetici comuni tra la malattia epatica e quella cutanea, oltre a quelli connessi allo stile di vita.
  • Anche l’epatite autoimmune è risultata significativamente associata alla psoriasi, con un effect size maggiore rispetto alla colangite biliare primitiva.


Studies have often found a strong association between psoriasis and nonalcoholic fatty liver disease (NAFLD), which is a manifestation of abnormal hepatic lipid accumulation where inflammatory adipokines and skin-derived cytokines lead to insulin resistance and metabolic syndrome. Psoriasis increases the risk of developing NAFLD and predicts liver disease progression to cirrhosis, while NAFLD predicts more severe psoriasis. Psoriasis may also be associated with hepatitis C but associations with other hepatic pathologies are unclear. Although studies have found that patients with alcoholic liver disease (ALD), primary biliary cholangitis (PBC), and autoimmune hepatitis (AIH) have higher chances of developing psoriasis compared with the general population, they have also emphasized a need for further confirmatory studies. We used a large-scale, nationally representative database to investigate whether inpatients with psoriasis have higher odds of developing various hepatic pathologies.

This study demonstrated that psoriasis may be associated with various hepatic pathologies outside NAFLD. NAFLD and ALD seem to have the strongest association, even after controlling for potential confounders. Although NAFLD/ALD and severe psoriasis have similar risk factors and psoriasis therapies (ie, methotrexate) can induce liver dysfunction, these findings suggest that there may be mechanisms outside lifestyle factors common to both hepatic and cutaneous diseases. For example, mouse models of imiquimod-induced psoriasis frequently developed hepatitis and subsequent liver fibrosis. Moreover, the overproduction of tumor necrosis factor-α in hepatitis C may drive the progression to cirrhosis and potentially its association with psoriasis as well. Interestingly, AIH was also significantly associated with psoriasis with a higher effect size than that of PBC. AIH is more consistently associated with psoriasis than PBC; however, our results cannot clarify whether this is a true pathophysiological association or a complication of tumor necrosis factor-α inhibitor treatment.

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