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Psoriasis and NAFLD — SCE Dermatology MCQ

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ModerateInflammatory DermatosesPsoriasis and NAFLDSCE Dermatology

A 50-year-old man with psoriasis has developed non-alcoholic fatty liver disease (NAFLD). His dermatologist explains the relationship. What is the prevalence of NAFLD in psoriasis patients compared to the general population?

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Correct answer: D — NAFLD is approximately 2-3 times more prevalent in psoriasis patients (estimated 45-65% vs 20-30% in general population), likely driven by shared inflammatory pathways and metabolic syndrome

NAFLD is significantly more prevalent in psoriasis patients than the general population, estimated at 45-65% versus 20-30%. The association is driven by shared pathogenic pathways: systemic inflammation (TNF-alpha, IL-6), insulin resistance, metabolic syndrome, and genetic susceptibility. This has important implications: (1) Methotrexate hepatotoxicity risk may be amplified by pre-existing NAFLD; (2) PIIINP monitoring may be less reliable in NAFLD (elevated baseline); (3) FibroScan/transient elastography may be needed for baseline liver assessment; (4) weight loss improves both psoriasis and NAFLD. BAD comorbidity guidelines recommend liver assessment including liver stiffness measurement before starting hepatotoxic systemic therapy.

Reference: BAD 2020 Psoriasis Comorbidities; NICE