Clinical Implications of Interleukin-17 as a Hepato-Dermal Link in Patients With Psoriasis and Concomitant Steatotic Liver Disease

Psoriasis is increasingly recognized as a systemic inflammatory disease with impacts beyond the skin and joints. Metabolic dysfunction-associated steatotic liver disease (MASLD) and excessive alcohol consumption are common in the psoriasis population, affecting up to two-thirds of patients. Interleukin-17 (IL-17) has been identified as a potential key pro-inflammatory link between psoriasis and MASLD. IL-17 levels have been positively correlated with progression of MASLD to more advanced forms of liver disease, including steatohepatitis, cirrhosis and hepatocellular carcinoma. Given the high prevalence of concurrent psoriasis and liver disease, dermatologists should have an elevated index of suspicion of MASLD in patients with psoriasis, particularly those with concomitant metabolic risk factors and/or excessive alcohol consumption. Using 3 parameters, the Fibrosis-4 index is a validated, non-invasive screening tool that can be implemented in clinical practice. With the wide variety of therapeutics available to treat psoriasis, practitioners should be mindful of systemic agents carrying potential hepatotoxic adverse effects and could consider instead implementation of advanced therapies that have neutral or potentially beneficial effects on the liver. There is emerging data, pending larger prospective confirmatory studies, that support consideration of IL-17 inhibitors as a reasonable option in appropriate patients with or at risk of MASLD.