Año 2019 / Volumen 111 / Número 4
Revisión
Psoriasis e hígado graso: una sinergia perjudicial

314-319

DOI: 10.17235/reed.2019.6263/2019

Antonio Olveira, Pedro Herranz, María Luisa Montes,

Resumen
Numerosos estudios epidemiológicos confirman la mayor prevalencia de la enfermedad hepática grasa no alcohólica en la psoriasis grave, con un riesgo de más del doble respecto a la población sin psoriasis (odds ratio [OR] 2,15). En estos pacientes, la enfermedad hepática es más grave que en controles sin psoriasis, guardando, a su vez, relación con la gravedad de la psoriasis. De forma recíproca, los pacientes con hígado graso presentan una mayor gravedad de la psoriasis. Esta perjudicial sinergia tiene un origen patogénico común, resultado de la frecuente asociación de las dos enfermedades a resistencia insulínica y síndrome metabólico, el cual se manifiesta con mayor intensidad cuando coexisten ambas que si lo hacen por separado. Como segundo factor, psoriasis e hígado graso comparten un trasfondo inflamatorio crónico mediado por citoquinas, con desequilibrio entre las proinflamatorias y las antiinflamatorias, del que se retroalimentan mutuamente. El dermatólogo debe ser el principal detector de la hepatopatía, valorando de forma específica a sus pacientes que presenten factores de síndrome metabólico. El hepatólogo debe ser consciente de la mayor gravedad de estos pacientes. Diversos medicamentos, como acitretino, ciclosporina y metotrexato, pueden resultar perjudiciales para la hepatopatía. Los medicamentos biológicos resultan seguros en el paciente con enfermedad hepática crónica. Hepatólogos y dermatólogos, de forma conjunta, deben valorar cuidadosamente la mejor opción terapéutica en cada paciente dependiendo de la gravedad de ambas enfermedades, evitando en lo posible medicamentos hepatotóxicos y optando por opciones que, incluso, pudieran tener un beneficio compartido en ambas enfermedades.
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Olveira A, Herranz P, Montes M. Psoriasis e hígado graso: una sinergia perjudicial. 6263/2019


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Recibido: 04/03/2019

Aceptado: 06/03/2019

Prepublicado: 03/04/2019

Publicado: 04/04/2019

Tiempo de prepublicación: 30 días

Tiempo de edición del artículo: 31 días


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