Psoriasis is a chronic inflammatory skin condition characterized by red, itchy, and scaly patches. While primarily affecting the skin, it is a systemic disease that can influence other parts of the body, including the liver. This article explores the relationship between psoriasis and liver health and steps to protect the liver.
Psoriasis and Liver Health
Psoriasis does not directly cause liver damage in the same way a viral infection or excessive alcohol consumption might. The connection is complex, often involving underlying systemic inflammation. Psoriasis is associated with increased inflammation throughout the body, driven by various inflammatory molecules. This chronic inflammation can indirectly contribute to liver concerns.
Individuals with psoriasis have a higher prevalence of non-alcoholic fatty liver disease (NAFLD) compared to the general population. While NAFLD affects about 30% of the general population, it may be present in up to half of all people with psoriasis. The severity of psoriasis can correlate with the severity of NAFLD, suggesting a link between the inflammatory processes of both conditions.
Medications and Liver Risk
Certain medications used to manage moderate to severe psoriasis can affect liver function. Methotrexate, a common systemic agent, can lead to elevated liver enzymes; long-term use is associated with fatty liver, fibrosis, and rarely, cirrhosis, with risk monitored through regular blood tests.
Acitretin, another oral retinoid, can also increase liver enzyme levels and cause acute liver injury, though often mild and reversible. Cyclosporine, an immunosuppressant, is linked to liver damage. Some biologics, while generally lower risk, still require monitoring for liver enzyme impact. Doctors monitor liver health throughout treatment.
Co-occurring Conditions and Liver Health
Individuals with psoriasis are more likely to experience health conditions that independently contribute to liver damage. Metabolic syndrome, a cluster of conditions including obesity, type 2 diabetes, high blood pressure, and elevated cholesterol, frequently co-occurs with psoriasis. Each component increases the risk of non-alcoholic fatty liver disease (NAFLD). NAFLD involves fat accumulation in the liver and can progress to more severe forms like non-alcoholic steatohepatitis (NASH), fibrosis, and cirrhosis.
Alcohol consumption further exacerbates liver issues. Both heavy drinking and psoriasis are risk factors for fatty liver disease. Limiting or avoiding alcohol can reduce liver damage risk and improve psoriasis treatment effectiveness.
Monitoring and Protecting Your Liver
Regular monitoring of liver health is important for managing psoriasis, especially for those on systemic medications. Liver function tests (LFTs) are commonly performed, including measurements of enzymes like alanine transaminase (ALT) and aspartate transaminase (AST), bilirubin, and albumin levels. These tests help detect potential liver problems early. For patients on methotrexate, additional monitoring may include serum PIIINP levels.
Lifestyle measures can help maintain liver health. A balanced diet, regular exercise, maintaining a healthy weight, and limiting alcohol intake are recommended. These adjustments can reduce liver fat, improve overall health, and may lessen the need for some psoriasis medications. Open communication with healthcare providers about all medications, supplements, and lifestyle habits is important for liver protection.