Psoriasis

Lifestyle modifications

NUTRITION

  • Obesity tends to worsen the condition. A hypocaloric diet may improve symptoms in overweight and obese individuals (BMI > 25)  (1). Compared to usual care, dietary intervention (strict caloric restriction) may lead to 75% or greater improvement from baseline (large uncertainty) in the Psoriasis Area and Severity Index (PASI 75) (2).
  • Alcohol: There is some/mixed evidence that alcohol may increase symptoms of psoriasis, but more studies are needed to determine whether alcohol can induce or worsen psoriasis (7,6,5,4,3)
  • Omega 3: Some evidence that it may improve symptoms alone, or in combination with standard treatment (10)

PHYSICAL ACTIVITY

  • Vigorous physical activity is associated with reduced risk of psoriasis (12)
  • More research is needed to determine whether physical activity may reduce symptoms (13)

SMOKING

  • Smoking is a risk factor for psoriasis (3, 4)

STRESS

  • There is mixed/weak evidence that preceding psychological stress is associated with psoriasis exacerbation/onset (8,9)

SUNLIGHT

  • Exposure to natural sunlight and salt water bath improve the condition (1)

LIFESTYLE PREVENTION OF COMORBIDITIES

  • Psoriasis increases the risk of cardiovascular disease and diabetes type 2. Discuss cardiovascular risk factors with psoriasis patients, including hyperlipidemia, hypertension, smoking, alcohol use disorder, physical activity and diabetes type 2 prevention (11).

References

  1. https://www.uptodate.com/contents/treatment-of-psoriasis-in-adults
  2. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011972.pub2/full
  3. https://academic.oup.com/bjd/article/187/5/684/6966369
  4. https://www.sciencedirect.com/science/article/abs/pii/S0190962218329049
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6709030/
  6. https://onlinelibrary.wiley.com/doi/full/10.1111/jdv.12164
  7. https://pubmed.ncbi.nlm.nih.gov/22568495/
  8. https://onlinelibrary.wiley.com/doi/full/10.1111/bjd.16116
  9. https://onlinelibrary.wiley.com/doi/abs/10.1111/ijd.14032
  10. https://www.jaad.org/article/S0190-9622(20)32288-X/fulltext#secsectitle0270
  11. https://www.nice.org.uk/guidance/cg153/chapter/1-Recommendations
  12. https://jamanetwork.com/journals/jamadermatology/article-abstract/1158558
  13. https://www.tandfonline.com/doi/full/10.2147/PTT.S349791

Resources

EXPLANATION TO EVIDENCE PRESENTATION

Figure: Evidence pyramid

Evidence based on guidelines and evidence based Clinical Decision Systems is written in BOLD font

Evidence based on meta analysis or systematic reviews is written in BOLD and CURSIVE font

​Evidence based on randomized controlled trials is written in PLAIN font

Evidence based on observational / cohort studies is written in CURSIVE font