Psoriasis is often associated with nonalcoholic fatty liver disease (NAFLD), but the skin condition may also be highly linked with alcoholic liver disease and autoimmune liver diseases, according to new research. Healthcare providers and patients should be aware of the associations and how that could influence treatments, researchers write in the Journal of the American Academy of Dermatology. "Studies have shown that patients with psoriasis are at higher risk of severe liver fibrosis from NAFLD and that patients with NALFD tend to have more advanced psoriasis, but the association between psoriasis and other hepatic pathologies is less clear," said first author Jason Yang of the David Geffen School of Medicine at the University of California at Los Angeles. NAFLD covers a range of liver conditions that affect people who drink little to no alcohol, where extra fat is stored in liver cells. The condition often leads to insulin resistance and metabolic syndrome. "Understanding how hepatic inflammation can perpetuate psoriasis (and vice versa) can help physicians advise and treat their patients more effectively," Yang told Reuters Health by email. He and his colleagues analyzed data from the 2000-2014 National Inpatient Sample to understand whether patients with psoriasis have higher odds of developing several liver diseases. They looked for primary or secondary psoriasis diagnoses and controlled for several factors, including socioeconomic status, tobacco and alcohol use, type 2 diabetes, HIV/AIDs and obesity or metabolic syndrome. The team found that, among 124 million hospital discharges between 2000-2014, nearly 250,000 patients had a psoriasis diagnosis. After adjusting for multiple comparisons, the skin condition was significantly associated with several liver conditions when all inpatients were used as control, including NAFLD (odds ratio, 1.92), alcoholic liver disease (OR, 1.76), primary biliary cholangitis (OR, 2.49), autoimmune hepatitis (2.79), hepatitis C (OR, 1.54), hepatitis B (OR, 1.34) and end-stage liver disease (OR, 1.81). Psoriasis was not associated with chronic kidney disease (OR, 0.98) or congestive heart failure (OR, 0.89). Patients with end-stage liver disease associated with nonalcoholic fatty liver disease, alcoholic liver disease or autoimmune hepatitis all had significantly higher odds of psoriasis as compared with other hospitalizations for end-stage liver disease. "The associations themselves aren't too surprising because systemic inflammation is present in all of these conditions, and the medications used to treat psoriasis can damage the liver," Yang said. "However, I personally did not expect the magnitude of the association between psoriasis and alcoholic or autoimmune liver disease to rival that of nonalcoholic fatty liver disease." Future research may indicate whether certain underlying mechanisms could be related to both liver and skin diseases, the researchers note. "Psoriatic inflammation may be associated with specific liver injury," said Dr. Philippe Vasseur of North Deux-Sevres Hospital Center in Bressuire, France. Dr. Vasseur, who wasn't involved in the study, has researched the links between liver fibrosis, psoriasis and alcohol consumption. "Psoriasis exhibits several extracutaneous manifestations," he said. "This should sensitize dermatologists to the screening and the management of fatty liver in psoriatic patients." —Carolyn Crist Source
