Interestingly, increased leptin levels have also been detected in patients with psoriasis independently of BMI. Gisondi P., Del Giglio M., Di Francesco V., Zamboni M., Girolomoni G. Weight loss improves the response of obese patients with moderate-to-severe chronic plaque psoriasis to low-dose cyclosporine therapy: A randomized, controlled, investigator-blinded clinical trial.

Moazen S., Amani R., Homayouni Rad A., Shahbazian H., Ahmadi K., Taha Jalali M. Effects of freeze-dried strawberry supplementation on metabolic biomarkers of atherosclerosis in subjects with type 2 diabetes: A randomized double-blind controlled trial. Received 2021 Jan 1; Accepted 2021 Jan 19. shark cartilage puritan In conclusion, according to The Medical Board of the National Psoriasis Foundation, vitamin D supplementation is not recommended in patients with psoriasis and normal serum Vitamin D levels. There is a high prevalence of gluten sensitivity and celiac disease (CD) among patients with psoriasis.

However, the lack of human studies prevents any recommendation for these polyphenols to be applied as adjuvant treatment for psoriasis. Meng Z., Yan C., Deng Q., Gao D.F., Niu X.L.

As they compete for the same enzymes, it is the n-6/n-3 ratio which seems to be more significant for the maintenance of a healthy metabolic milieu, with the ideal ratio reaching up to 4:1, contrary to the usual 10:1 ratio which applies for Western-type diets [30]. Skyvalidas et al. Central obesity is associated with increased visceral fat, where activated macrophages stimulate adipocytes to produce pro-inflammatory molecules such as TNF-, IL-1, IL-6 and IL-8 [140]. Chronic inflammation refers to a series of pathophysiological dysregulations which eventually result in a sustained, increased production of pro-inflammatory cytokines and oxidative stress.

After 8 weeks, the treatment group showed a significantly greater improvement in PASI score, in Nail Psoriasis Severity Index and in Dermatological Life Quality Index compared to controls [227]. Curcumin mediates attenuation of pro-inflammatory interferon and interleukin 17 cytokine responses in psoriatic disease, strengthening its role as a dietary immunosuppressant. Sanchez-Rodriguez E., Lima-Cabello E., Biel-Glesson S., Fernandez-Navarro J.R., Calleja M.A., Roca M., Espejo-Calvo J.A., Gil-Extremera B., Soria-Florido M., de la Torre R., et al. Four-weeks of VLCKD resulted in 10% weight loss, 50% reduction in PASI score, improvement of biochemical markers related to psoriasis (folic acid, vitamin B12, cortisol, bilirubin, calcium, LDL, cholesterol) and decreased IL-1 and IL-2 levels [189]. Antiga E., Bonciolini V., Volpi W., Del Bianco E., Caproni M. Oral Curcumin (Meriva) Is Effective as an Adjuvant Treatment and Is Able to Reduce IL-22 Serum Levels in Patients with Psoriasis Vulgaris. Trimboli P., Castellana M., Bellido D., Casanueva F.F.

Oh D.Y., Talukdar S., Bae E.J., Imamura T., Morinaga H., Fan W., Li P., Lu W.J., Watkins S.M., Olefsky J.M. Antioxidant Rich Potato Improves Arterial Stiffness in Healthy Adults. Since fruits are also rich in other components, such as vitamins and fiber, some studies in animal models have used purified polyphenol extracts to address their role more specifically. Despite the lack of large randomized clinical trials to confirm the effect of different diets in patients with psoriasis, an abundance of research data highlights diet as a potential therapeutic target. Fatty acids as macronutrients are key players for immunomodulation, with n-3 polyunsaturated fatty acids having the most beneficial effect, while polyphenols and carotenoids seem to be the most promising antioxidants. Takahashi H., Tsuji H., Takahashi I., Hashimoto Y., Ishida-Yamamoto A., Iizuka H. Plasma adiponectin and leptin levels in Japanese patients with psoriasis. Furthermore, curcumin may enhance the secretion of anti-inflammatory cytokines such as IL-10 [240].

reported that a 16-week low-energy diet (8001000 Kcal/day) resulted in significant weight loss (mean change 15.8 Kg compared to 0.4 Kg in control groups), improvements in PASI score (mean change 2.3 vs. 0.3 in control group) and statistically significant amelioration in Dermatology Life Quality Index (a ten-question questionnaire measuring the impact of skin disease on the quality of life) in patients with BMI > 27 compared to control group [153].

reported that selenium and Vitamin E supplementation for 8 weeks resulted in the increase of glutathione peroxidase in patients with psoriasis [232]. Western diet and inflammation. [25], where healthy adults consumed one of four types of isoenergetic meals, postprandial serum endotoxin concentration was increased after the SFA meal; similarly, in a study where healthy, lean and obese adults consumed high-PA (HPA) and low-PA/high-oleic-acid (HOA) diets for 3 weeks, lower secretion of interleukin (IL)-1, IL-18, and TNF- by peripheral blood mononuclear cells (PBMCs) was observed in the HOA group [26]. showed that 4.5 g/d of oral curcuminoid C3 complex as monotherapy had no effect on any of the disease parameters [245]. The https:// ensures that you are connecting to the In a study by Bardazzi et al., among 33 patients receiving biological agents, patients who put on weight during the 8-month follow-up did not achieve PASI 50, while patients who had a stable weight presented variable response to treatment and those who decreased their weight achieved PASI 90 or PASI 75, even when not responding initially [136]. According to another meta-analysis from 2014, patients with psoriasis have a 2.4-fold increased risk of seropositivity for antigliadin antibodies compared to healthy controls and, even more importantly, elevated antibody titers are associated with psoriasis severity.

Of all its components, extra virgin olive oil seems to play the most important role in its anti-inflammatory capacities [173]. Chambers J.C., Ueland P.M., Obeid O.A., Wrigley J., Refsum H., Kooner J.S.

According to recent data, patients with psoriasis have decreased vitamin D levels, and this possibly explains why the incidence of psoriatic disease is higher in locations less exposed to ultraviolet light, as this limited exposure leads to decreased vitamin D synthesis, together with the antiproliferative actions of ultraviolet radiation on keratinocytes [192,193]. Montonen J., Knekt P., Jrvinen R., Reunanen A. Dietary antioxidant intake and risk of type 2 diabetes. Selenoproteins: Antioxidant selenoenzymes and beyond.

Vitamins C and E are associated with a reduction in coronary artery disease, but their supplementation in high pharmacological doses seems to bear no additional benefit [107].

A diet enriched with 1% blueberry reduced aortic atherosclerotic lesions area in ApoE/ mice, with a concomitant increase in the antioxidant activity of superoxide dismutase (SOD) 1, SOD2 and GRx (enzymes which catalyze the dismutation of the superoxide radical) and reduced lipid peroxidation [64]. Farras M., Fernandez-Castillejo S., Rubio L., Arranz S., Catalan U., Subirana I., Romero M.P., Castaner O., Pedret A., Blanchart G., et al. Serum lipid profile and inflammatory markers in the aorta of cholesterol-fed rats supplemented with extra virgin olive oil, sunflower oils and oil-products. On the other hand, micronutrients such as polyphenols and carotenoids seem to possess potent antioxidant properties, however, the high pharmacological doses needed to exert their effects cast doubt on their significance for everyday clinical practice. Chitosan-based nanoformulated (-)-epigallocatechin-3-gallate (EGCG) modulates human keratinocyte-induced responses and alleviates imiquimod-induced murine psoriasiform dermatitis. In 80 patients with chronic, stable psoriasis, 34 of whom also had psoriatic arthritis, supplementation with high doses of EPA and DHA for 8 weeks led to decreases in PASI score and a subjective improvement in joint pain [213].

Carr A.C., Maggini S. Vitamin C and Immune Function. Cigarette smoking, body mass index, and stressful life events as risk factors for psoriasis: Results from an Italian case-control study. However, after 12 weeks, no significant differences between the two treatment regimens were demonstrated [208]. Carrion-Gutierrez M., Ramirez-Bosca A., Navarro-Lopez V., Martinez-Andres A., Asn-Llorca M., Bernd A., Horga de la Parte J.F.

After three months, there was no significant difference in PASI score between the two groups [201].

Effect of omega-three polyunsaturated fatty acids on inflammation, oxidative stress, and recurrence of atrial fibrillation. Similarly, in a 12-week study, subjects who received n-3 supplementation showed a 14% decrease in lipopolysaccharide (LPS) stimulated interleukin 6 (IL-6) production, while a decrease in the n-6:n-3 ratio led to reductions in stimulated IL-6 and TNF- production [32]. Castaldo G., Pagano I., Grimaldi M., Marino C., Molettieri P., Santoro A., Stillitano I., Romano R., Montoro P., DUrsi A.M., et al. Kiecolt-Glaser J.K., Belury M.A., Andridge R., Malarkey W.B., Glaser R. Omega-3 supplementation lowers inflammation and anxiety in medical students: A randomized controlled trial. Nicklas B.J., Ambrosius W., Messier S.P., Miller G.D., Penninx B.W., Loeser R.F., Palla S., Bleecker E., Pahor M. Diet-induced weight loss, exercise, and chronic inflammation in older, obese adults: A randomized controlled clinical trial.

observed marked improvement of itching, erythema and scaling after 8 weeks of treatment with 3 g of n-3 fatty acids supplementation compared to olive oil supplementation [217]. Acharya P., Mathur M. Association between psoriasis and celiac disease: A systematic review and meta-analysis. Decreased selenium levels along with the concomitant depressed selenium-dependent enzymatic activity have been observed in patients with psoriasis. A prospective study by Merola et al., including 70,743 female nurses who completed semi-quantitative food frequency questionnaires in 1994, 1998, 2004 and 2006, showed no association between vitamin D intake and the development of psoriasis [199].

showed that overweight and obese patients have an odds ratio (OR) of 1.6 and 1.9, respectively, for psoriasis compared to controls [128].

A 9-cis b-Carotene-enriched diet inhibits atherogenesis and fatty liver formation in LDL-R knockout mice. Kharaeva et al. Interestingly, the improvement of psoriasis severity in intervention group was achieved with only a slight weight loss [154]. Maurice P.D., Allen B.R., Barkley A.S., Cockbill S.R., Stammers J., Bather P.C. showed that 0.5 g/day Vitamin D supplementation had significant immunomodulatory effect in patients with polyarticular psoriasis [203]. Isocaloric diets high in animal or plant protein reduce liver fat and inflammation in individuals with type 2 diabetes. The classic ketogenic diet, very-low-carbohydrate ketogenic diet, Atkins diet, high-fat ketogenic diet and very low-calorie ketogenic diet (VLCKD) are different forms of KD. A diet rich in antioxidants can also be considered a substantial part of a comprehensive treatment regimen along with pharmacotherapy. Oliveira A., Monteiro V., Navegantes-Lima K.C., Reis J.F., Gomes R.S., Rodrigues D., Gaspar S., Monteiro M.C. Micronutrients are essential elements which are found in very small quantities in the human body and include vitamins, minerals and trace elements. A Critically Appraised Topic. For this reason, vitamin D and analogues have been proposed as possible treatments in psoriasis [190,195]. The authors reported that despite the complete remission of skin lesions in both groups, the PASI score was higher in the treatment group, where the increased levels of TNF-R1 were also maintained [235]. Jarrett P., Camargo C.A., Jr., Coomarasamy C., Scragg R. A randomized, double-blind, placebo-controlled trial of the effect of monthly vitamin D supplementation in mild psoriasis. and V.L., structuring of the review, writing, and literature review; I.I., E.T., D.V., E.P., A.R., assistance with writing. Similarly, a more recent study by Ingram et al. Dietary Recommendations for Adults With Psoriasis or Psoriatic Arthritis From the Medical Board of the National Psoriasis Foundation: A Systematic Review. Effect of virgin olive oil and thyme phenolic compounds on blood lipid profile: Implications of human gut microbiota. Topical therapy with vitamin D as an ointment or cream has been investigated thoroughly and the results indicate that vitamin D and analogues can be utilized either as monotherapy or in combination with a topical corticosteroid, methotrexate or cyclosporine [196,197,198]. Based on the available studies, the Medical Board of the National Psoriasis Foundation recommends a trial of MD with the intake of extra virgin oil as a main lipid, 3 and 2 daily servings of fruits and vegetables respectively, 3 servings of fish/seafood, nuts, legumes weekly and 2 servings of sofrito sauce weekly in patients with psoriasis [167].

Ruedemann R., Jr. Habitual dietary intake of n-3 and n-6 fatty acids in relation to inflammatory markers among US men and women. The ketogenic diet improves oxidative stress via the activation of nuclear factor erythroid-derived 2 (NF-E2)related factor 2 (Nrf2); its anti-inflammatory role is based on the activation of the peroxisome proliferator-activated receptor-gamma (PPAR-) and hydroxy-carboxylic acid receptor 2 (HCA2) [183,184,185]. Al-Mutairi N., Nour T. The effect of weight reduction on treatment outcomes in obese patients with psoriasis on biologic therapy: A randomized controlled prospective trial. Kolchak N.A., Tetarnikova M.K., Theodoropoulou M.S., Michalopoulou A.P., Theodoropoulos D.S. Gupta A.K., Ellis C.N., Goldfarb M.T., Hamilton T.A., Voorhees J.J. Treatment of psoriasis with large doses of vitamin B12, 1,100 micrograms per cubic centimeter; preliminary clinical report. As inflammation is modulated by nutrition, it comes as no surprise that the impact of diet on the incidence and severity of the disease as well as on treatment response has been a matter of extensive research [13]. In individuals with impaired fasting glucose receiving a daily meal containing 10 g EVOO, postprandial circulating LPS stabilized, along with the oxidation of LDL and NADPH oxidase 2 (Nox2) [81]. The application of calcitriol ointment for eight weeks resulted in improvement of psoriatic lesions in approximately 34% of patients, compared with 12% to 22.5% of controls [197]. In the study by Clemmensen et al.

Adiponectin levels in patients with psoriasis: A meta-analysis. Once again, however, it should be noted that the doses administered were extremely higher than the usual daily intake.

Omega-3 FAs include -linolenic acid (ALA) which is mainly found in plants, and eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) found mainly in fish and seafood sources. On the other hand, two RCTs showed that 1.8 g of EPA for 8 weeks or 10 capsules of fish oil three times daily for three weeks did not achieve clinical improvement compared to olive oil supplementation [218,219]. Azadbakht L., Esmaillzadeh A. Vitamin A is present both in plants (carrots and red peppers) as carotenoids and in eggs, liver and milk as retinol, with both forms being processed to its active form, which is retinoic acid. Another polyphenol with remarkable effects on psoriasis is epigallocatechin-3-gallate (EGCG), which is the most abundant catechin in green tea and is known to possess anti-inflammatory, antioxidant and antiproliferative properties [248]. Zunino S.J., Peerson J.M., Freytag T.L., Breksa A.P., Bonnel E.L., Woodhouse L.R., Storms D.H. Dietary grape powder increases IL-1beta and IL-6 production by lipopolysaccharide-activated monocytes and reduces plasma concentrations of large LDL and large LDL-cholesterol particles in obese humans. Katsarou A.I., Kaliora A.C., Papalois A., Chiou A., Kalogeropoulos N., Agrogiannis G., Andrikopoulos N.K. Anti-inflammatory effects of sodium butyrate on human monocytes: Potent inhibition of IL-12 and up-regulation of IL-10 production. Skyvalidas D.., Mavropoulos A., Tsiogkas S., Dardiotis E., Liaskos C., Mamuris Z., Roussaki-Schulze A., Sakkas L.I., Zafiriou E., Bogdanos D.P. suggested curcumin as a dietary immunosuppressant in patients with psoriasis due to in vitro inhibition of pro-inflammatory IFN- and IL-17 [239]. Ruedemann et al. In vitro studies supported that Vitamin B12 regulates T-lymphocytes activation and cytokine secretion [204,205]. According to an observational cohort study based on Danish and Icelandic registries, BMI > 30 is associated with higher psoriasis activity at baseline and reduced drug response and treatment adherence (HR:1.85) [135]. FAs can be divided in two separate groups [21]. Finally, regarding the B-complex vitamins, a high B6 intake was reversely associated with plasma CRP [115]. Carotenoids serve primarily as potent antioxidants, being able to quench radicals and singlet oxygen, interact with nuclear receptors RAR/RXR (retinoic acid receptor/retinoid X receptor) to enhance immune pathways, and inhibit the pro-inflammatory NF-B pathway [90]. Resveratrol Role in Autoimmune Disease-A Mini-Review. A double-blind, randomized, placebo-controlled trial of n-3 fatty acid based lipid infusion in acute, extended guttate psoriasis. Licensee MDPI, Basel, Switzerland. Siddiqui M.A., Al-Khawajah M.M. An RCT including 18 patients with severe stable plaque psoriasis showed that fish oil supplementation in combination with UVB has beneficial effects on the clinical manifestations of psoriasis compared to the combination of olive oil with UVB [226]. investigated the impact of a nutritional supplement rich in n-3 fatty acids (560 mg EPA, 80 mg DHA, Ovarex) in thirty patients with psoriasis, who received either 2 capsules of Ovarex daily as add-on treatment to topical tacalcitol or only topical treatment with tacalcitol (control group). Polyphenols are the most abundant antioxidants in diet, with their main sources being fruits, vegetables, red wine, nuts, green tea, and olive oil. Kragballe K., Fogh K. A low-fat diet supplemented with dietary fish oil (Max-EPA) results in improvement of psoriasis and in formation of leukotriene B5. Again, the unfavorable results can be possible explained by the low doses of EPA (1.8 g and 5.4 g daily) administered, together with the unrestricted dietary fat content, which leads to a lower concentration of EPA in cell membranes due to the competitive action of n-6 PUFAs. A similar anti-inflammatory effect was shown in a study where 105 individuals were assigned to one of the three energy-restricted diet groups receiving rice bran, rice husk powder and control (low-calorie only) diet for 12 weeks, with the intervention groups demonstrating decreases in hsCRP and IL-6 compared to controls [51]. Even more interestingly, vitamin D and analogues have the same efficacy as topical corticosteroids without the adverse effect of skin atrophy, and they are thus suitable for long-term treatment. Siddiqui et al. Jaudszus A., Gruen M., Watzl B., Ness C., Roth A., Lochner A., Barz D., Gabriel H., Rothe M., Jahreis G. Evaluation of suppressive and pro-resolving effects of EPA and DHA in human primary monocytes and T-helper cells. Omentin-1 is another adiponectin with anti-inflammatory properties by inhibiting TNF-. Mayser P., Mrowietz U., Arenberger P., Bartak P., Buchvald J., Christophers E., Jablonska S., Salmhofer W., Schill W.B., Krmer H.J., et al. Effect of probiotic (VSL#3) and omega-3 on lipid profile, insulin sensitivity, inflammatory markers, and gut colonization in overweight adults: A randomized, controlled trial. According to recent studies, the ketogenic diet has been considered as an alternative therapeutic strategy with beneficial results for many diseases such as obesity, type 2 diabetes, cardiovascular disease, neurological diseases and polycystic ovary syndrome [179,180,181,182,183]. Frasheri L., Schielein M.C., Tizek L., Mikschl P., Biedermann T., Zink A. Retinoic acid modulates interferon-gamma production by hepatic natural killer T cells via phosphatase 2A and the extracellular signal-regulated kinase pathway. primrose soulful Correlation between BMI and PASI in patients affected by moderate to severe psoriasis undergoing biological therapy. Venturini D., Simo A.N.C., Urbano M.R., Dichi I. Similarly, a more recent study by Kolchak et al. Despite being best renowned for its role in calcium homeostasis, vitamin D also has immunomodulatory effects, with calcitriol being necessary for T-cells function [108]. However, such high doses which cannot readily be implemented in everyday practice doubt the clinical significance of these results. The impact of 1,25(OH)2D3 on keratinocytes by inhibiting proliferation of hyperproliferative cells and increasing differentiation, together with its actions on T-cell activation, has rendered it a possible treatment option for patients with psoriasis [190,191]. In particular, a lower percentage of patients with psoriasis consumed extra virgin oil (as main lipid), fruits (3 portions/day), nuts (3 servings/week), fish or seafood (3 portions/week). Clemmensen O.J., Siggaard-Andersen J., Worm A.M., Stahl D., Frost F., Bloch I. Psoriatic arthritis treated with oral zinc sulphate. However, the results regarding the efficacy of oral vitamin D supplementation are inconsistent. Elder J.T., Bruce A.T., Gudjonsson J.E., Johnston A., Stuart P.E., Tejasvi T., Voorhees J.J., Abecasis G.R., Nair R.P. The intervention consisted of a 4-week VLCKD (<500 Kcal/d; 1.2 g of protein/Kg of ideal body weight/d) and a 6-week hypocaloric, low glycemic index, Mediterranean-like diet. Fogh K., Kragballe K. New vitamin D analogs in psoriasis.

Tsang C., Smail N.F., Almoosawi S., McDougall G.J.M., Al-Dujaili E.A.S. In patients with B12 deficiency, methylcobalamin administration improved the CD4/CD8 ratio and suppressed NK cell activity [116]. Pischon T., Hankinson S.E., Hotamisligil G.S., Rifai N., Willett W.C., Rimm E.B. Results demonstrated that turmeric tonic significantly improved erythema, scaling and induration of lesions compared to controls [242]. In general, curcumin has shown promising results which, however, need to be confirmed by large-scale studies. The outcomes of randomized controlled trials are less encouraging [217,218,219,220]. The effect of dietary fish oil supplementation on psoriasis. primrose soulful Kyriakou A., Patsatsi A., Sotiriadis D., Goulis D.G.

Currently, low-calorie diets are the only dietary pattern with a proven benefit in all aspects of the disease and are practically considered to be a kind of adjuvant therapy to the conventional pharmacologic treatment. Hernez ., Sanllorente A., Castaer O., Martnez-Gonzlez M.., Ros E., Pint X., Estruch R., Salas-Salvad J., Corella D., Alonso-Gmez .M., et al. The first publication was a case report by Castaldo et al. They are scavengers of ROS and they can limit the generation of free radicals and inflammatory molecules, serving as potent antioxidants [4]. The management of very low-calorie ketogenic diet in obesity outpatient clinic: A practical guide. In 62 patients with at least one cardiovascular disease (CVD) factor, consumption of 330 mL/day bilberry juice resulted in a reduction in CRP, IL-6 and IL-15 levels [61].

Effect of dietary supplementation with n-3 fatty acids on clinical manifestations of psoriasis. In the n-3 treatment group, a greater improvement in all clinical manifestations (erythema, infiltration, desquamation) was noted [224]. Gaal et al. However, data about more sophisticated nutritional patterns, such as ketogenic, very low-carb or specific macro- and micro-nutrient substitution, are scarce. Yang F., Suo Y., Chen D., Tong L. Protection against vascular endothelial dysfunction by polyphenols in sea buckthorn berries in rats with hyperlipidemia. Immune modulation by curcumin: The role of interleukin-10. However, according to an older study in 69 patients, selenium and Vitamin E supplementation for 12 weeks did not reduce psoriasis severity [233]. highlighted the inverse association between adherence to Mediterranean diet (assessed by MED-LITE) and psoriasis severity [176]. In general, vitamin B12 is not suggested as a treatment option for psoriasis. Clark C.C.T., Taghizadeh M., Nahavandi M., Jafarnejad S. E_cacy of -3 supplementation in patients with psoriasis: A meta-analysis of randomized controlled trials. Effect of dietary supplementation with very-long-chain n-3 fatty acids in patients with psoriasis. Juhlin L., Edqvist L.E., Ekman L.G., Ljunghall K., Olsson M. Blood glutathione-peroxidase levels in skin diseases: Effect of selenium and vitamin E treatment. The same factors were examined in a recent meta-analysis, including 7 prospective studies and 17.637 patients; for each 5 units increase in BMI and for each 5 kg of weight gain, the relative risk of psoriasis increased by 19% and 11%, respectively. Peripheral blood regulatory T cell measurements correlate with serum vitamin D level in patients with psoriasis. Michalsson G., Gerdn B., Hagforsen E., Nilsson B., Pihl-Lundin I., Kraaz W., Hjelmquist G., Lf L. Psoriasis patients with antibodies to gliadin can be improved by a gluten-free diet. Suwannalert P., Boonsiri P., Khampitak T., Khampitak K., Sriboonlue P., Yongvanit P. The levels of lycopene, alpha-tocopherol and a marker of oxidative stress in healthy northeast Thai elderly. ); rg.aou.dem@sitparta (A.R. Jin X.H., Ohgami K., Shiratori K., Suzuki Y., Hirano T., Koyama Y., Yoshida K., Ilieva I., Iseki K., Ohno S. Inhibitory effects of lutein on endo toxin-induced uveitis in Lewis rats. However, patients with Vitamin D deficiency should receive Vitamin D oral supplements for prevention of psoriasis-related comorbidities [167].

A recent meta-analysis of six RCTs confirmed that weight loss following lifestyle interventions improves psoriasis compared with controls, with a mean change in PASI score of 2.59. Saemann M.D., Bohmig G.A., Osterreicher C.H., Burtscher H., Parolini O., Diakos C., Stockl J., Horl W.H., Zlabinger G.J.

These actions have a favorable effect on psoriatic lesions. Evidence from the Psocare project.

In a sub-study associated with the Prevencin con Dieta Mediterrnea (PREDIMED) trial, individuals receiving Mediterranean diet plus EVOO showed a reduction in IL-6, VCAM-1, ICAM-1 and LDL, and an increase in HDL [82]. Kettler A.H., Baughn R.E., Orengo I.F., Black H., Wolf J.E., Jr. The beneficial effect of olive oil and, especially, extra virgin olive oil (EVOO) has been demonstrated in a number of studies [72,73,74,75,76,77]. Rochette-Egly C., Germain P. Dynamic and combinatorial control of gene expression by nuclear retinoic acid receptors (RARs). Chang H.K., Hou W.S. Molina-Leyva A., Cuenca-Barrales C., Vega-Castillo J.J., Ruiz-Carrascosa J.C., Ruiz-Villaverde R. Adherence to Mediterranean diet in Spanish patients with psoriasis: Cardiovascular benefits? Prevalence of Obesity in Patients with Psoriasis: Results of the National Study PsoHealth3. supported that patients with psoriasis and particularly women are more likely to have increased BMI compared to same-gender full siblings, and a positive correlation was demonstrated between obesity and disease severity as determined by body surface area (BSA) and the Physicians Global Assessment (PGA) [127]. Higher amounts of sun exposure have been associated with a lower risk of vitamin D deficiency; on the other hand, excessive sun exposure is the primary risk factor for skin cancer and generally seems to have a detrimental effect on many cutaneous diseases such as psoriasis [111,112]. Vitamin D3 and psoriasis: A randomized double-blind placebo- controlled study. In humans, vitamin E supplementation has been shown to reduce pro-inflammatory cytokines IL-1, IL-6 and TNF- by stimulating the production of cyclic adenosine monophosphate (cAMP) [106]. Carotenoids are mainly found in plants, bacteria and fungi, with the most important being carotenes and xanthophylls [89]. Psoriasis is a chronic, immune-mediated inflammatory disease with multifactorial etiology.

Another prospective study showed that a weight loss >5% is significantly associated with the achievement of minimal disease activity as a response to anti-TNF treatment in obese patients with psoriatic arthritis [158]. creams



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