Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany.
Division of Hepatology, Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany.
J Dtsch Dermatol Ges. 2021 Apr;19(4):517-528. doi: 10.1111/ddg.14425. Epub 2021 Mar 25.
Psoriasis is an immune-mediated systemic inflammatory disease that is not limited to the skin but may be associated with arthritis, cardiovascular diseases, metabolic syndrome including diabetes and obesity and, as identified more recently, non-alcoholic fatty liver disease (NAFLD) that occurs in approximately 50 % of all patients with psoriasis. NAFLD is characterized by accumulation of fat in hepatocytes in the absence of excessive alcohol consumption. Over the last two decades, NAFLD has developed to the most common chronic liver disease with an estimated prevalence of 25 % in the Western population. NAFLD ranges from non-inflammatory or bland hepatic steatosis to inflammation of hepatic tissue (non-alcoholic steatohepatitis, NASH) and consecutive liver fibrosis. It is controversial whether the underlying systemic inflammation of psoriasis is contributing to development of NAFLD or if comorbid diseases such as obesity enhance NAFLD development. Recent findings indicate that cytokine-mediated inflammation through TNFα, interleukin (IL)-6 and IL-17 might be the common link between psoriasis and NAFLD. Considering the shared inflammatory pathways, IL-17 pharmacological blockade, which is already well-established for psoriasis, may be a promising strategy to treat both psoriasis and NAFLD. Therefore, early detection of NAFLD and a better understanding of its pathophysiology in the context of the systemic inflammation in psoriasis is important with regard to individualized treatment approaches.
银屑病是一种免疫介导的系统性炎症性疾病，不仅局限于皮肤，还可能与关节炎、心血管疾病、代谢综合征（包括糖尿病和肥胖症）有关，最近还发现与非酒精性脂肪性肝病（NAFLD）有关，大约 50%的银屑病患者都患有这种疾病。NAFLD 的特征是肝细胞内脂肪堆积，而不存在过量饮酒。在过去的二十年中，NAFLD 已发展成为最常见的慢性肝病，在西方人群中的患病率估计为 25%。NAFLD 从轻度非炎症性或单纯性肝脂肪变性到肝组织炎症（非酒精性脂肪性肝炎，NASH）和随后的肝纤维化不等。银屑病的潜在系统性炎症是否会导致 NAFLD 的发展，或者肥胖等合并症是否会增强 NAFLD 的发展，这一点存在争议。最近的研究结果表明，通过 TNFα、白细胞介素（IL）-6 和 IL-17 介导的细胞因子炎症可能是银屑病和 NAFLD 之间的共同联系。鉴于其共同的炎症途径，已经在银屑病中得到充分验证的 IL-17 药物阻断可能是治疗银屑病和 NAFLD 的一种有前途的策略。因此，早期发现 NAFLD 并更好地了解其在银屑病系统性炎症中的病理生理学对于个体化治疗方法非常重要。
