Maybury CM, Porter HF, Kloczko E, et al. - Via the Severe Psoriasis study, a prospective observational cohort study of 333 patients with severe psoriasis, experts illustrated the prevalence of and assessed the clinical factors related to advanced liver fibrosis in people with severe psoriasis. A total of 333 of 400 patients enrolled, had a successful transient elastography scan and were involved in the final analysis. As diagnosed by transient elastography, advanced liver fibrosis was noted in 47 patients. The clinical factors that created the best-fit model for advanced fibrosis were central obesity (waist circumference), insulin resistance, aspartate aminotransferase level, platelet count, psoriasis disease severity, and decreased alcohol use. In conclusion, findings from this study imply that advanced fibrosis is prevalent in severe psoriasis. Abdominal obesity (by waist circumference) and insulin resistance were related to the presence of advanced fibrosis. Longitudinal work to identify the hepatic sequelae of central obesity, insulin resistance, and inflammation, as well as the influence of systemic drugs (methotrexate and biologics), will notify prospective personalized therapeutic decision-making.