Some evidence suggests a higher risk of liver disease with psoriasis. Certain psoriasis treatments can cause liver toxicity, but the two conditions also share common risk factors, which may explain the connection.
Researchers don’t know the exact reason why psoriasis seems to affect liver function for some people.
Higher liver enzymes may be a side effect of drugs used to manage psoriasis. Certain liver diseases may also have the same inflammatory pathways in the body as psoriasis.
While psoriasis often has visible symptoms, liver disease can be harder to detect without blood tests and imaging. If you have a diagnosis of psoriasis, your doctor may want to monitor your liver function closely after prescribing certain medications.
People with psoriasis might be more likely to experience many liver conditions, including:
- nonalcoholic fatty liver disease (NAFLD)
- cirrhosis
- autoimmune hepatitis
- cholangitis (bile duct inflammation)
In one large 2017 study, researchers found that the risk for any liver disease was 37% higher for someone with psoriasis compared with someone who didn’t have the condition. That risk increased to 97% higher for people using systemic treatment.
Cirrhosis and NAFLD had the strongest associations with psoriasis.
These findings are consistent with those from a
Why are they related?
The reasons behind the connection are not fully understood, but there are a few possibilities:
- Psoriasis may release inflammatory proteins into your body, which causes insulin resistance in the liver. This also causes your liver to become inflamed, which in turn causes skin inflammation.
- Certain medications used to treat psoriasis may cause liver problems because they increase liver enzyme levels. These include methotrexate, cyclosporine, and acitretin.
- A person with psoriasis may have risk factors that also raise their risk for liver disease, such as genetic risks, higher alcohol intake, obesity, and metabolic syndrome.
Although you may first discuss symptoms with a family doctor, they’ll likely refer you to one or more specialists for the diagnosis and treatment of psoriasis and liver disease.
Liver disease
Hepatologists or gastroenterologists are the types of specialists who may diagnose liver disease. In many types of liver disease, such as NAFLD, you may not feel any symptoms. If you do, they may include:
- fatigue
- discomfort or pain in the abdomen, particularly the upper right side
To diagnose liver disease, your doctor will perform a physical exam and run a few tests. According to the American Liver Foundation, these may include:
- Liver enzyme tests: These blood tests measure various enzyme levels, which can tell doctors if you have any liver damage. Some common liver enzymes include alanine transaminase (ALT), aspartate transaminase (AST), and gamma-glutamyl transpeptidase (GGT).
- Liver protein tests: These blood tests measure certain proteins made in the liver, including albumin and globulin. The tests can show how well the liver is functioning.
- Bilirubin tests: These blood tests measure bilirubin, an enzyme that’s processed in the liver. High levels of it in the blood can mean the liver is damaged.
- Transient elastography: This is a special ultrasound test that measures liver stiffness, which indicates scarring (fibrosis).
- Magnetic resonance elastography (MRE): This imaging test combines ultrasound or MRI with a device that sends pulses of waves through your liver to measure stiffness.
Your doctor may also cut a tiny sample from your liver for further testing. This is called a biopsy. Usually, a biopsy is only recommended if other tests indicate advanced liver disease or if it’s necessary to rule out cancer or other conditions.
Psoriasis
If you haven’t received an official diagnosis for your skin condition, a dermatologist is usually the type of doctor who will diagnose psoriasis. They’ll examine your skin for symptoms including:
- patches of thick, itchy skin
- skin with silvery, gray-white scales
- skin that is itchy, dry, cracked, or bleeding
- thickening, pits, or ridges in your nails
Your doctor will also ask about your medical history and other symptoms, such as:
- pain, swelling, or stiffness in the joints
- close relatives with psoriasis
- recent illnesses or stressful life events
In some cases, they may do a biopsy of the skin. This can confirm whether you have psoriasis and not another skin condition.
Treatment depends on the type of liver disease you have and the severity of your psoriasis symptoms.
For NAFLD, the primary treatment is weight management. If you have cirrhosis, your doctor may recommend medicines or surgery to treat complications. In the case of liver failure, you may benefit from a liver transplant.
Psoriasis is often treated with topical and systemic medications, as well as light therapy.
Medical guidelines for psoriasis management recommend close monitoring if you take systemic drugs, such as methotrexate, as this may mean you’re at higher risk for liver toxicity.
If your psoriasis treatment affects liver function, your doctor may recommend a different therapy.
Both conditions are known to benefit from the following:
- maintaining a weight that’s healthy for you
- avoiding smoking
- avoiding consumption of alcohol
- having a nutritious diet that’s low in saturated fats and added sugars
- keeping physically active
People with psoriasis may be at a higher risk of developing liver disease. The two conditions can have similar causes, such as systemic inflammation.
Liver disease is also a potential side effect of some psoriasis medications.
Your healthcare team may monitor you for changes in liver function after prescribing certain treatments for psoriasis if they put you at higher risk for liver toxicity.