Steatotic liver disease (SLD), including metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH), is a prevalent chronic liver condition affecting over 25% of the global population. This review discusses the pathophysiology, diagnosis, and management of SLD, along with emerging pharmacotherapies. SLD is a complex disease with multiple subtypes, including those related to genetics, endocrine disorders, and metabolic dysfunction. The pathophysiology involves metabolic dysregulation, oxidative stress, inflammation, and fibrosis, which contribute to the progression of the disease. The current therapeutic landscape includes various pharmacological interventions, some of which are in phase 2 or 3 clinical trials. These include agents targeting metabolism, inflammation, cell death, and fibrosis. Despite the challenges in developing effective treatments, repurposing existing drugs is an attractive option due to available safety and tolerability data. The review highlights the importance of personalized medicine and interdisciplinary approaches in managing SLD. Non-invasive diagnostic tools are being explored to improve the detection and monitoring of SLD. The review also discusses the impact of comorbidities and the need for accurate, non-invasive diagnostic methods to replace invasive liver biopsies. The field of SLD is rapidly evolving, with a growing number of clinical trials and a focus on improving cardiometabolic outcomes. The review emphasizes the need for further research and the development of novel therapeutic strategies to address the significant burden of SLD.Steatotic liver disease (SLD), including metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH), is a prevalent chronic liver condition affecting over 25% of the global population. This review discusses the pathophysiology, diagnosis, and management of SLD, along with emerging pharmacotherapies. SLD is a complex disease with multiple subtypes, including those related to genetics, endocrine disorders, and metabolic dysfunction. The pathophysiology involves metabolic dysregulation, oxidative stress, inflammation, and fibrosis, which contribute to the progression of the disease. The current therapeutic landscape includes various pharmacological interventions, some of which are in phase 2 or 3 clinical trials. These include agents targeting metabolism, inflammation, cell death, and fibrosis. Despite the challenges in developing effective treatments, repurposing existing drugs is an attractive option due to available safety and tolerability data. The review highlights the importance of personalized medicine and interdisciplinary approaches in managing SLD. Non-invasive diagnostic tools are being explored to improve the detection and monitoring of SLD. The review also discusses the impact of comorbidities and the need for accurate, non-invasive diagnostic methods to replace invasive liver biopsies. The field of SLD is rapidly evolving, with a growing number of clinical trials and a focus on improving cardiometabolic outcomes. The review emphasizes the need for further research and the development of novel therapeutic strategies to address the significant burden of SLD.