NAFLD and Psoriasis: What’s the Connection?
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NAFLD is one of the least known acronyms for a common disease. It stands for Non-Alcoholic Fatty Liver Disease. NAFLD is the most common chronic liver disease and the most frequent liver condition in people who are obese.1 NAFLD represents a multitude of liver conditions that range from benign to cancerous. It is closely linked to both the cluster of conditions known as metabolic syndrome, and psoriasis.

Psoriasis is a chronic immune base inflammatory disorder, which affects about 3% of the population worldwide. Psoriasis is characterized as a surface skin condition where the dermis and epidermis grow and reproduce too quickly. Looking at psoriasis patches on the skin you can see irritated areas covered in scaly patches. Psoriasis most commonly appears on the elbows, knees, scalp and back.

Psoriasis has not typically been thought of as a life-threatening condition. Yet psoriasis is now known to be a systemic disorder. It is more than the topical plaques and red itchy areas. It can have a direct impact on quality of life because of chronic inflammation and metabolic function changes. Taking a multidisciplinary approach to treating psoriasis and other comorbid conditions from the onset may help limit the severity or onset of related medical conditions.

Liver function and psoriasis

The liver, one of the largest organs in the body, serves many metabolic functions. It produces bile, a digestive protein, and converts substances we ingest into usable components. The liver also helps eliminate toxins from the body.

NAFLD is the build-up of fat in the liver of people who drink little or no alcohol. It tends to develop in people who are overweight or obese, or have diabetes or high cholesterol. Symptoms include being tired, abdominal discomfort and elevated liver enzymes. The leading treatment for NAFLD on its own is diet.

The liver helps to metabolize lipids (fats). In NAFLD too much fat accumulates creating problems in metabolic processing. This can lead to insulin resistance, cardiovascular disease, skin cell dysfunction and obesity among other conditions.1 There is a strong association between psoriasis and NAFLD. It is unclear if one can cause the other, or if there is an association between changed lipid protein metabolism and high levels of cholesterol. Psoriasis can be a significant predictor of NAFLD. A liver ultrasound can be conducted to detect signs of NAFLD.3

What is Metabolic Syndrome?

Metabolic syndrome is a cluster of conditions, a group of cardiovascular risk factors such as high blood pressure, elevated blood sugar, obesity and other traits that when combined create significant cardiovascular risk.

Obesity, like psoriasis and NAFLD, is considered a persistent condition characterized by the inflammatory process.1 Leptin, a hormone made by fat cells, regulates appetite and body weight. Leptin resistance can contribute to heart problems and stroke brought on by metabolic syndrome. These conditions are closely associated, and can cause severe medical complications like high blood pressure, high cholesterol and excess abdominal fat.1

The link between NAFLD and psoriasis

Similar risk factors suggest a potential link between psoriasis, obesity and metabolic syndrome. The severity of psoriasis along with the presence of obesity and poor metabolic health has shown a relationship between the diseases. Metabolic syndrome can be present in NAFLD and psoriasis. There is also a correlation between having both conditions and developing psoriatic arthritis.

The relationship between psoriasis and NAFLD needs further study, especially because of its association with increased cardiovascular risk.

What’s the Treatment?

There is no cure for psoriasis or NAFLD. But taking medication if prescribed, and changing your lifestyle and diet can help improve liver function. Moreover, treating psoriatic symptoms can help alleviate physical and psychological distress.1 Topical therapies and light therapy are generally prescribed before systemic drug therapy.

Methotrexate (MTX) is one of the most common drugs used to treat psoriasis. It is a systemic agent that has been widely tested for safety and efficacy. But, like with other drugs, toxicity on the liver has to be closely monitored.

Diet can also play a role in metabolic complications of psoriasis. Weight loss can reduce the severity of the condition can lead to overall metabolic improvement and reduced inflammation.

NAFLD Diet

When you have fatty liver disease your liver is considered damaged and doesn’t work the usual way. Eating foods high in fiber, plants, and grains, fruits and vegetables are beneficial for everyone, especially those with NAFLD. Low-fat foods and a lower calorie intake can help you lose weight.
Similarly, there are foods you should avoid. Those with added sugar, salt and fried foods (some full of trans-fats), as well as red meat and alcohol, are not beneficial for someone with psoriasis and NAFLD.4

Doctors should conduct a routine workup for NAFLD in patients with psoriasis when considering hepatotoxic drug therapy, like methotrexate. Closely monitoring patient blood and lipid levels going forward can also help prevent or manage NAFLD.2

view references
  1. Ganzetti G, Campanati A, Non-alcoholic fatty liver disease and psoriasis: So far, so near. World J Hepatol. 2015 Mar 27; 7(3): 315–326. Published online March 27, 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381160/ Accessed online February 6, 2018
  2. Miele L, Vallone S. Prevalence, characteristics and severity of non-alcoholic fatty liver disease in patients with chronic plaque psoriasis. J Hepatol. 2009;51(4):778-86.Published October, 2009. http://www.journal-of-hepatology.eu/article/S0168-8278(09)00442-5/fulltext. Accessed online February 6, 2018
  3. Fernandes, J. Psoriasis may be associated with Liver Disease, research shows. Published January 12, 2017 https://psoriasisnewstoday.com/2017/01/12/psoriasis-may-be-linked-to-liver-disease/ Accessed online February 6, 2018
  4. Psoriasis and fatty liver are frequent companians(sic) - If you have psoriasis consider the NAFLD diet Posted April 25, 2017. http://www.fattyliverfoundation.org/psoriasis#gsc.tab=0. Accessed online February 5, 2018
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