Nutritional strategies for psoriasis: current scientific evidence in clinical trials.

European review for medical and pharmacological sciences. 2018;22(23):8537-8551

Plain language summary

Psoriasis is an inflammatory skin disease that results in patches of dry, scaly skin that can be itchy or sore. This review looked at the evidence for a variety of nutritional and herbal strategies for reducing the risk and severity of psoriasis. Obesity is associated with both an increased risk of psoriasis, and increased severity of the disease, with obese patients being twice as likely to suffer from psoriasis as people of normal weight. Abdominal obesity in particular is associated with chronic low-grade inflammation that contributes to immune dysregulation. In obese patients, weight reduction via a low-calorie diet has been shown to reduce the severity of psoriasis. A Mediterranean-style diet, rich in extra virgin olive oil, fish, fruit vegetables, legumes, nuts and seeds is associated with a lower incidence of psoriasis. In contrast, a diet high in simple carbohydrates, high in arachidonic acid, and a low omega 3: omega 6 ratio is likely to drive inflammation, worsening severity of the disease. The microbiota plays a role in the development of psoriasis, with disruption of the gut and skin microbiomes both associated with psoriasis. In particular, psoriasis patients have a reduced abundance of Akkermansia muciniphilia in their gut. Several Lactobacillus strains have demonstrated potential for therapeutic effects in psoriasis patients when taken as a supplement. Common nutritional supplements used by psoriasis patients are fish oil, selenium, and zinc. In a review of the efficacy of fish oil supplementation, 12 of 15 trials showed a benefit. The evidence for zinc supplementation is less robust. There is limited data on the effectiveness of selenium supplementation, however low serum selenium levels are associated with increased psoriasis severity. Vitamin D levels are lower in psoriasis patients and correlate with disease severity. In individuals who are deficient, supplementing with vitamin D may prevent psoriasis-related comorbidities. Amongst the herbal and botanical remedies studied, neem, turmeric, Tripterygium wilfordii (Thunder God Vine), and the carotenoid-rich alga Dunaliella bardawil may reduce the severity of psoriasis. The review authors concluded that an integrated multidisciplinary approach should be considered for the management of psoriasis patients. Education to modify lifestyle and environmental risk factors is important. A collaboration between nutritionists and medical specialists with a holistic approach may be useful for psoriasis patients.

Abstract

OBJECTIVE Several nutritional strategies for the management of psoriasis are promising. Even if recent data support that nutrition may play a pivotal role in prevention and co-treatment and despite patient's concerns regarding the best nutritional habits, the consensus regarding the nutritional strategies to be adopted lacks in clinical settings. In this manuscript, the effects of several nutritional strategies for psoriasis patients such as hypocaloric diet, vitamin D, fish oil, selenium, and zinc supplementation were systematically reviewed. Randomized controlled trials (RCTs) on beneficial botanical oral supplements were also included in the analysis. MATERIALS AND METHODS For each topic, a search was conducted in MEDLINE electronic databases for articles published in English between January 1, 1990 and September 2018. Two independent reviewers assessed and extracted the data. Only controlled clinical trials were selected. RESULTS The evidence regarding the current nutritional strategies for psoriasis patients were summarized and translated into a global, comprehensible recommendation. CONCLUSIONS Weight loss combined with a healthy lifestyle was shown to be very beneficial for patients with moderate to severe disease with a significant reduction of the Psoriasis Area and Severity Index (PASI) score. Currently, oral vitamin D supplementation for prevention or treatment of psoriasis in adults with normal vitamin D levels is not recommended; however, psoriasis patients with a deficit in plasma vitamin D levels are advised to complement with oral supplements to prevent psoriasis-related comorbidities. Instead of zinc, selenium, and omega 3 supplements have been proven beneficial for psoriasis patients. Among botanical species, Dunaliella bardawil (D. bardawil), Tripterygium wilfordii (T. wilfordii), Azadirachta indica (A. indica), Curcuma longa (C. longa), and HESA-A are the most beneficial. In conclusion, a close cooperation between nutritionists and dermatologists may be useful for the management of psoriasis.

Lifestyle medicine

Fundamental Clinical Imbalances : Immune and inflammation
Patient Centred Factors : Mediators/Inflammation
Environmental Inputs : Diet ; Nutrients
Personal Lifestyle Factors : Nutrition
Functional Laboratory Testing : Not applicable
Bioactive Substances : Fish oil ; Omega 3 ; Vitamin D ; Zinc ; Selenium ; Turmeric ; Neem ; EPA

Methodological quality

Jadad score : Not applicable
Allocation concealment : Not applicable

Metadata

Nutrition Evidence keywords : Inflammation ; Autoimmunity