Dietary and Nutritional Considerations for Metabolic Dysfunction-Associated Steatotic Liver Disease in Psoriasis and Hidradenitis Suppurativa: A Narrative Review.

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognised in patients with chronic inflammatory skin disease, particularly psoriasis, for which epidemiological evidence of increased MASLD prevalence is relatively strong; corresponding data in hidradenitis suppurativa (HS) remain more limited. This narrative review examines the epidemiological and biological links between psoriasis, HS and MASLD, and evaluates dietary and nutritional strategies relevant to their multidisciplinary management. Particular emphasis is placed on distinguishing direct evidence in patients with concomitant inflammatory skin disease and MASLD from evidence derived from dermatology cohorts without liver-specific outcomes and from general MASLD populations. Mediterranean-style dietary patterns, energy restriction and weight loss, improved diet quality, and reduced intake of ultra-processed foods and added sugars are supported principally by MASLD and cardiometabolic data, with more limited direct evidence in psoriasis or HS. The review also discusses nutritional considerations during incretin-based therapy, including reduced food intake, preservation of lean mass, micronutrient adequacy and gastrointestinal adverse effects, while highlighting areas in which recommendations remain extrapolated or expert-derived. For dermatologists, the practical emphasis is on recognition of metabolic risk, general dietary counselling and appropriate multidisciplinary referral. Overall, nutritional management is an important component of MASLD care, but dedicated intervention studies in patients with concomitant psoriasis or HS remain a major evidence gap.