Psoriasis and liver disease share certain risk factors, including metabolic syndrome, smoking, and alcohol consumption. Some psoriasis medications may also cause liver toxicity.

Psoriasis is a systemic, inflammatory condition that can cause scaly and inflamed lesions on the skin. This condition may occur alongside other health conditions, such as liver disease.

Doctors may suggest lifestyle changes, such as eating a balanced diet and regular exercise, when treating people with psoriasis and liver disease.

This article examines the link between psoriasis and liver disease, how doctors diagnose and treat these conditions, and the outlook for people with both conditions.

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According to a 2022 study, people with psoriasis may have a higher rate of non-alcohol-related fatty liver disease (NAFLD).

The study noted that, out of 5,672 adults in the United States, 32.7% of people with psoriasis also had NAFLD, compared with 26.6% of participants without psoriasis.

The researchers suggest that certain inflammatory proteins present in the development of psoriasis may play a role in insulin resistance, which they associate with the development of NAFLD.

According to a 2022 review, psoriasis doubles the risk of developing NAFLD and increases the risk of NAFLD developing into a more severe form of liver disease.

Risk factors

NAFLD is a type of liver disease that occurs due to inflammation and excessive fat in the liver. Both psoriasis and NAFLD share certain risk factors, including:

Both psoriasis and NAFLD have a link to chronic inflammation, increased oxidative stress, and insulin resistance.

Psoriasis treatments

Some psoriasis treatments may be toxic to the liver and increase the risk of liver disease. This includes:

  • Methotrexate: Doctors may prescribe methotrexate for severe psoriasis. This medication may negatively affect liver function and increase liver enzyme levels.
  • Cyclosporin: A 2018 mini-review associates cyclosporine with potential direct liver damage.
  • Dimethyl fumarate (DMF): This may cause liver toxicity in rare cases and may increase liver enzyme levels in some circumstances.
  • Acitretin: This may temporarily increase liver enzymes and cause high levels of fat in the blood, which is a risk factor for NAFLD.
  • TNF inhibitors: Drugs such as adalimumab, infliximab, and etanercept may have some risk of liver toxicity.

The process for diagnosing psoriasis and liver disease differs. People may expect the following when speaking with a doctor about these conditions.

Liver disease

In most cases, NAFLD does not cause any symptoms, but people may experience fatigue or abdominal pain.

To diagnose liver disease, doctors may use liver function tests to check liver enzyme levels and any signs of liver damage. These include:

  • tests to measure liver enzyme levels in the blood, as high levels of liver enzymes may be a sign of liver or bile duct damage
  • liver protein tests, which show how well the liver is producing the proteins the body requires and can help indicate liver damage
  • tests to measure bilirubin, a yellow substance that can occur in the blood or urine if there is liver damage, causing jaundice

If a person receives irregular liver function results, doctors may use a liver biopsy, the removal of a small section of liver tissue, to help determine the underlying cause. Doctors may also use liver imaging tests to help make a diagnosis.


Psoriasis may cause symptoms such as:

  • plaques — patches of thick, scaly skin that may itch or burn
  • dry skin, which may crack, itch, or bleed
  • thick, pitted nails with ridges

To diagnose psoriasis, doctors may examine the skin, as well as the scalp and nails. They will take a medical history and assess symptoms, potential triggers, and any family history of psoriasis.

They may also take a small sample of skin tissue for examination under a microscope to eliminate any other skin conditions.

Treatment for NAFLD typically involves lifestyle modifications, such as losing 7–10% of body weight through diet and exercise. Doctors will also treat any co-existing conditions, such as type 2 diabetes or high cholesterol.

The presence of liver disease may limit treatment options for psoriasis. For instance, people with a higher risk of liver disease may need to avoid certain medications with a higher risk of liver toxicity, such as methotrexate.

Doctors may consider the following alternative treatments, which may be necessary to help a person manage psoriasis flares:

NAFLD is reversible, and weight loss and increasing physical activity can help:

  • normalize liver enzymes
  • improve insulin resistance
  • reduce liver inflammation

Without treatment, asymptomatic liver disease may progress to more severe, irreversible forms of liver disease, including liver failure.

There is currently no cure for psoriasis, but treatments can help symptoms and help a person manage the condition.

People can also attend screenings for conditions known to occur alongside psoriasis. Early diagnosis may increase the chances of curing or successfully managing the condition.

People can talk with a healthcare professional about reducing their risk of liver damage if they have psoriasis. They can also discuss the potential risks and side effects of psoriasis medications prior to any treatment.

Before taking immunosuppressive medications for psoriasis, doctors may screen people for viral hepatitis, as these treatments may reactivate the infection.

If people have any symptoms of liver disease with psoriasis, including fatigue and abdominal discomfort, they should contact a doctor as soon as possible.

People with psoriasis may have an increased risk of liver disease due to inflammation, insulin resistance, and some psoriasis medications.

Maintaining a moderate weight and reducing other risk factors, such as alcohol consumption, may help lower the risk of liver disease with psoriasis.

If people with psoriasis experience symptoms of liver disease, including abdominal pain and fatigue, they should speak with a doctor as soon as possible.