Psoriasis and Your Risk of Metabolic Dysfunction–Associated Steatotic Liver Disease

Here’s what you should know about the connection between psoriasis and MASLD.

The Psoriasis-MASLD Link

When it comes to psoriasis and metabolic conditions like MASLD, it’s not as simple as one condition causing another. In fact, there may be underlying processes in your body — including the activity of immune system chemicals called cytokines — that increase the risk for both psoriasis and metabolic dysfunction.

“Ongoing inflammatory signals from cytokines, such as TNF-alpha and IL-17, can interfere with how the liver handles fat, making it more likely for fat to build up in liver cells,” says Meena B. Bansal, MD, a professor of medicine and the director of the MASLD/MASH Center of Excellence at the Icahn School of Medicine at Mount Sinai in New York City.

Dr. Bansal says that metabolic syndrome, particularly excess body weight and elevated blood sugar, can also independently raise the risk for MASLD. “So people with psoriasis often face a double hit — the shared inflammatory biology of the disease itself, plus a higher rate of the metabolic conditions that cause MASLD,” she says.

People with psoriasis can develop MASLD even if they have a normal body weight, says Joseph Lim, MD, a professor of medicine and the director of clinical hepatology at the Yale School of Medicine in New Haven, Connecticut. This “lean MASLD,” he says, may be more likely in people with psoriasis who also have diabetes.

In general, “The more severe the psoriasis, the greater the risk” for MASLD, says Bansal, due to greater inflammatory activity in the body.

MASLD Progression

While MASLD typically progresses in a series of stages, the timing of this progression will vary from person to person. In fact, Dr. Lim says, only a fraction of people with MASLD will experience progression to severe liver inflammation, or steatohepatitis.

MASLD may progress according to the following stages, Bansal says.

• Fatty Liver (Steatosis) Fat builds up in liver cells. “Most people have no symptoms at all here,” says Bansal.
• MASH (Metabolic Dysfunction–Associated Steatohepatitis) Fat buildup causes inflammation and injury to liver cells. At this stage, “It is still often silent, though some people notice fatigue or mild discomfort in the upper right abdomen,” says Bansal.
• Fibrosis Ongoing injury to liver cells causes the buildup of scar tissue. “Symptoms are usually still minimal or nonspecific,” says Bansal.
• Cirrhosis Severe scarring begins to impair liver function. “Early cirrhosis may still be asymptomatic but can then progress,” Bansal says, causing symptoms like fatigue, confusion, swelling in your legs or abdomen, or yellowing of your skin or eyes (jaundice).

Managing MASLD Risk When You Have Psoriasis

For people with psoriasis who are at greater risk for MASLD, lifestyle measures are critical to help prevent MASLD or its progression. Your doctor may recommend one or more of the following steps, according to Bansal.

• Lose excess body weight.
• Make dietary changes, including limiting refined carbohydrates.
• Get more physical activity, including aerobic and resistance training.
• Manage related conditions like high blood pressure, diabetes, or abnormal blood lipid levels (cholesterol and triglycerides).
• Limit alcohol consumption.

Weight loss may be the most important intervention for many people at high risk for MASLD. “Losing even 5 percent of body weight can meaningfully reduce liver fat, and 7 percent weight loss can improve inflammation,” says Bansal. But avoiding alcohol is also important for people at high risk for MASLD progression. “Even moderate alcohol use can add stress to an already vulnerable liver,” Bansal says.

It’s possible that biologic drugs used to treat psoriasis could help reduce the risk of MASLD progression, although the evidence on this is limited, says Lim. These treatments “appear to be neutral with regard to liver fat, but appear to have meaningful benefit in reducing liver inflammation and biomarkers of liver fibrosis,” he says.

Beyond taking steps to reduce your risk for MASLD and its progression, it’s important for people at high risk to undergo periodic monitoring with blood tests, imaging scans, or both. “Patients can advocate for themselves by speaking with their treating physician about the potential role of regular liver monitoring,” says Lim.