Upon encountering the word psoriasis, clinicians typically first think “skin,” and might next reflect on “joints,” and perhaps even “nails,” but rarely does the internal intellectual discussion go any further. It is only in the last decade that an immunologically related disorder — rheumatoid arthritis — has been recognized to be associated with marked increase for cardiovascular (CV) disease. More recently, an association between psoriasis and CV disease has also been confirmed, and although the mechanism by which either of these inflammatory disorders induces vasculopathy is unclear, their common immunologic underpinnings suggest shared pathology.

According to a report by van der Voort et al, we should consider adding nonalcoholic fatty liver disease (NAFLD) to the list of comorbidities related to psoriasis. Reflecting on earlier case-control studies that indicated an increased prevalence of NAFLD among psoriasis patients, the authors studied a large population of persons enrolled in the Rotterdam Study (n = 2292) who underwent hepatic ultrasound. The prevalence of NAFLD was more than 30% greater in psoriasis subjects than controls (46.2% vs 33%).

The mechanism by which NAFLD is induced by psoriasis is unclear, although specific culprit genes are suspected. Because most of these patients did not have severe psoriasis, clinicians should be vigilant for the potential development of NAFLD, even in psoriatic patients with mild-moderate disease.