Effective Strategies for Managing Psoriasis and Liver Health

Connection Between Psoriasis and Liver Disorders

Psoriasis is not merely a skin condition; it is associated with a higher incidence of liver disorders, including metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), and alcoholic liver disease (ALD) (1). The prevalence of liver disorders among psoriasis patients can be attributed to several factors, including obesity and metabolic syndrome, which are common in this demographic (5, 6). Chronic inflammation plays a significant role in the development of liver conditions, as pro-inflammatory cytokines and adipokines contribute to insulin resistance and hepatic lipid accumulation (9, 10).

The spectrum of liver disorders ranges from simple steatosis to more severe forms like steatohepatitis, fibrosis, and cirrhosis (11, 12). The challenge lies in managing psoriasis while addressing these potential liver complications, particularly when considering the hepatotoxic effects of some systemic therapies used in psoriasis treatment, such as methotrexate (MTX) (13).

Breakthroughs in Biologic Treatments for Psoriasis

In recent years, significant advancements in the treatment of psoriasis have emerged, particularly with the introduction of biologic therapies. These biologics target specific pathways involved in the inflammatory process of psoriasis. Tumor necrosis factor (TNF)-α inhibitors were the first generation of biologics introduced, and while they are effective, they have been associated with potential liver enzyme elevation and drug-induced liver injury (14–16).

The introduction of monoclonal antibodies targeting interleukin (IL)-12 and IL-23, such as ustekinumab, has marked a turning point in psoriasis management. These therapies have demonstrated efficacy in reducing psoriasis symptoms while maintaining a better safety profile regarding liver health (1). Furthermore, the advent of IL-17 inhibitors, including secukinumab and ixekizumab, has shown promising results, with some studies suggesting potential beneficial effects on liver function (23–25).

The Impact of IL-17 Blockers on Liver Function

IL-17 blockers are a recent addition to the armamentarium against psoriasis. Emerging evidence indicates that these biologics may have a dual role in treating psoriasis and protecting liver function. IL-17 is known to play a significant role in various liver diseases, including chronic viral hepatitis and autoimmune liver diseases (23, 24). By inhibiting IL-17, these treatments may not only provide relief from psoriatic symptoms but also reduce inflammation and improve liver health.

In a study analyzing patients treated with IL-17 blockers, a notable reduction in liver enzyme levels was observed, suggesting a protective effect of these agents against liver damage (25). Consistently, patients receiving IL-17 inhibitors reported improved liver function tests compared to those treated with TNF-α inhibitors (19, 20). This finding highlights the importance of selecting the appropriate biologic therapy for psoriasis patients with underlying liver concerns.

Importance of Monitoring Liver Function in Psoriasis Patients

Given the increased risk of liver disorders in psoriasis patients, regular monitoring of liver function is paramount. Liver function tests (LFTs) should be conducted prior to initiating systemic therapies and periodically thereafter, especially for patients undergoing treatment with potentially hepatotoxic medications (19, 20). Elevated liver enzymes can serve as an early warning sign of liver distress, prompting timely intervention.

In a cohort study examining 276 psoriasis patients, half exhibited elevated LFTs at baseline. Notably, those with elevated liver enzymes were more likely to have significant comorbidities such as obesity, diabetes, and hypertension, underscoring the interplay between metabolic health and psoriasis (1).

Table 1: Baseline Characteristics of Psoriasis Patients

*PASI: Psoriasis Area and Severity Index (5).

Real-World Evidence on Systemic Treatments for Psoriasis

The effectiveness and safety of systemic treatments for psoriasis have been underscored by real-world evidence. A recent study assessed the potential liver toxicity of systemic treatments, including IL-17 blockers and TNF-α inhibitors. The findings indicated that IL-17 inhibitors, particularly secukinumab and ixekizumab, had significantly less impact on liver function compared to traditional therapies (1).

Among the 276 patients studied, those treated with IL-17 inhibitors experienced a notable decrease in liver enzyme levels over six months, reinforcing the need for personalized treatment approaches in psoriatic patients with comorbid liver conditions. This evidence supports the transition from older, hepatotoxic treatments to newer, safer biologic therapies that can improve both skin and liver health (12, 19).

FAQ

What is psoriasis, and how does it affect liver health?

Psoriasis is a chronic inflammatory skin condition that can lead to various comorbidities, including liver disorders like MASLD and drug-induced liver injury. Chronic inflammation associated with psoriasis may exacerbate liver conditions due to metabolic syndrome and obesity.

What are the latest treatments for psoriasis?

Recent treatments for psoriasis include biologics that target specific inflammatory pathways, such as IL-12, IL-23, and IL-17 inhibitors. These treatments have demonstrated improved safety profiles concerning liver function compared to older systemic therapies like methotrexate.

How often should liver function tests be conducted in psoriasis patients?

Liver function tests should be performed before initiating systemic therapies and periodically during treatment, particularly for patients receiving hepatotoxic medications or those with known liver disorders.

What lifestyle changes can help improve liver health in psoriasis patients?

Maintaining a healthy weight, following a balanced diet, minimizing alcohol intake, and engaging in regular physical activity can significantly improve liver health and overall well-being for psoriasis patients.

Are there any risks associated with biologic treatments for psoriasis?

While biologics generally have a better safety profile than traditional systemic therapies, they can still cause adverse effects, including injection site reactions. Regular monitoring and personalized treatment plans are essential to mitigate risks.

References

1. Baseline Pathological Liver Function Tests in Patients With Psoriasis Support the Indication for Systemic Therapy Rather Than Being a Reason Against It: A Real-World Analysis. Retrieved from https://doi.org/10.2147/PTT.S502296

2. The Role of Ubiquitin-Proteasome System (UPS) in Asthma Pathology. Retrieved from https://doi.org/10.2147/JAA.S490039

3. Localised Hypersensitivity Reaction to Polysorbate 80 During Secukinumab Treatment: A Case of Injection‐Site Contact Urticaria. Retrieved from https://pubmed.ncbi.nlm.nih.gov/11880874/

4. The neutrophil-to-C3 ratio: unveiling diagnostic efficacy for lupus nephritis and association with reduced retinal vascular density in systemic lupus erythematosus. Retrieved from https://doi.org/10.3389/fphar.2025.1484320

5. Advance in peptide-based drug development: delivery platforms, therapeutics and vaccines. Retrieved from https://doi.org/10.1038/s41392-024-02107-5

6. Old drugs, new challenges: reassigning drugs for cancer therapies. Retrieved from https://doi.org/10.1186/s11658-025-00710-0