In an RCT by Yoshida et al. 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. Harari A., Harats D., Marko D., Cohen H., Barshack I., Kamari Y., Gonen A., Gerber Y., Ben-Amotz A., Shaish A. 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.

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. Confusion in the nomenclature of ketogenic diets blurs evidence. Schwingshackl L., Hoffmann G. Mediterranean dietary pattern, inflammation and endothelial function: A systematic review and meta-analysis of intervention trials. Serwin A.B., Wasowicz W., Gromadzinska J., Chodynicka B. Selenium status in psoriasis and its relations to the duration and severity of the disease. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (, inflammation, immunity, nutrients, antioxidants, diet, obesity, psoriasis, arthritis, fatty acids.

In an RCT by Grimminger et al., 20 patients were hospitalized for acute guttate psoriasis (BSA > 10%) and randomly received either an n-3 lipid emulsion (2.1 g EPA, 2.1 g DHA) or a conventional n-6 lipid emulsion for 10 days. Careers. Similarly, in mice with flaky skin, treatment with water and green tea extracts led to delayed and milder onset of skin lesions compared to the animals treated with water only [250], and in another mouse model of psoriasis, treatment with a nanoparticle formulation of EGCG led to 20-fold stronger therapeutic effect compared to free EGCG in terms of erythema, scales, infiltratory immune cells and pro-inflammatory cytokines [251].

Increased consumption of virgin olive oil, nuts, legumes, whole grains, and fish promotes HDL functions in humans. Gupta A.K., Ellis C.N., Tellner D.C., Anderson T.F., Voorhees J.J. Double-blind, placebo-controlled study to evaluate the efficacy of fish oil and low-dose UVB in the treatment of psoriasis. [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].

Chitosan-based nanoformulated (-)-epigallocatechin-3-gallate (EGCG) modulates human keratinocyte-induced responses and alleviates imiquimod-induced murine psoriasiform dermatitis. In addition, bariatric surgery, particularly gastric bypass, reduces the risk of developing psoriasis (HR: 0.52) [155].

Retinoic acid promotes phagocytosis and activation of natural killer (NK) T-cells and, therefore, vitamin A deficiency has been associated with defective immune responses [101,102]. Effect of omega-three polyunsaturated fatty acids on inflammation, oxidative stress, and recurrence of atrial fibrillation. Lumeng C.N., Bodzin J.L., Saltiel A.R. Touvier M., Deschasaux M., Montourcy M., Sutton A., Charnaux N., Kesse-Guyot E., Assmann K.E., Fezeu L., Latino-Martel P., Druesne-Pecollo N., et al. The authors report no conflict of interest. Kratz M., Kuzma J.N., Hagman D.K., van Yserloo B., Matthys C.C., Callahan H.S., Weigle D.S. Herron M.D., Hinckley M., Hoffman M.S., Papenfuss J., Hansen C.B., Callis K.P., Krueger G.G. The In a study by Zhang et al. official website and that any information you provide is encrypted Nyirenda M.H., Sanvito L., Darlington P.J., OBrien K., Zhang G.X., Constantinescu C.S., Bar-Or A., Gran B. TLR2 stimulation drives human naive and effector regulatory T cells into a Th17-like phenotype with reduced suppressive function. showed that a 3-month gluten-free diet resulted in significant amelioration in PASI score in all patients; the improvement was sustained in 89% of patients after six months [166]. Ravn-Haren G., Dragsted L.O., Buch-Andersen T., Jensen E.N., Jensen R.I., Nemeth-Balogh M., Paulovicsova B., Bergstrom A., Wilcks A., Licht T.R., et al. For this reason, vitamin D and analogues have been proposed as possible treatments in psoriasis [190,195]. [117] showed that supplementation with 5 mg/d of folic acid and 1 mg/d of B12 (typical daily intake: about 500 mcg/day and 3.4 mcg/day, respectively) for eight weeks significantly improved endothelial dilatation, and a similar result was also demonstrated in a 7-year RCT where this combination along with high doses of B6 was provided [118]. Schwedhelm C., Pischon T., Rohrmann S., Himmerich H., Linseisen J., Nimptsch K. Plasma Inflammation Markers of the Tumor Necrosis Factor Pathway but Not C-Reactive Protein Are Associated with Processed Meat and Unprocessed Red Meat Consumption in Bavarian Adults.

Cndido F.G., Valente F.X., Silva L.E., Coelho O.G.L., Peluzio M.C.G., Alfenas R.C.G. 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. Kouli G.M., Panagiotakos D.B., Kyrou I., Magriplis E., Georgousopoulou E.N., Chrysohoou C., Tsigos C., Tousoulis D., Pitsavos C. Olive oil consumption and 10-year (20022012) cardiovascular disease incidence the ATTICA study. Obesity is a major risk factor for psoriasis, which leads to worse clinical outcomes.

A recent meta-analysis of 63 studies, including 2876 psoriasis patients and 2237 healthy controls, showed that patients with psoriasis have decreased levels of adiponectin; on the contrary, another meta-analysis with 521 cases and 482 controls indicated no statistically significant difference in the levels of adiponectin and high-molecular weight adiponectin levels between the two groups [141,147]. Renner S., Rath R., Rust P., Lehr S., Frischer T., Elmadfa I., Eichler I. Psoriasis is an immune-mediated disease where chronic inflammation plays a key role, a fact which has been consolidated through its established association with obesity, which negatively affects disease incidence, severity and response to treatment. A growing number of studies have highlighted the association between obesity and psoriasis [124,125,126,127,128,129,130,131,132,133]. Gammoh N.Z., Rink L. Zinc in Infection and Inflammation. The ketone metabolite -hydroxybutyrate blocks NLRP3 inflammasome-mediated inflammatory disease. Effects of dietary supplementation with polyunsaturated ethyl ester lipids (Angiosan) in patients with psoriasis and psoriatic arthritis. The amount, quality and dietary source of carbohydrates are the factors which determine their inflammatory capacity. 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]. Similar results were reproduced in studies regarding the association of olive oil with cardiovascular events [83,84,85,86], as well as in animal models [87,88]. Aleixandre A., Miguel M. Dietary fiber and blood pressure control. Western diet and inflammation. Naldi L., Conti A., Cazzaniga S., Patrizi A., Pazzaglia M., Lanzoni A., Veneziano L., Pellacani G. Psoriasis Emilia Romagna Study Group.

Muscogiuri G., Barrea L., Laudisio D., Pugliese G., Salzano C., Savastano S., Colao A. Resveratrol, a flavonoid mainly found in red wine, decreases the concentration of TNF- by activating SIRT-1 (promoting autophagy), eNOS (increasing NO production), and Nrf2 (inhibiting the NF-B pathway and proinflammatory cytokine production) pathways, decreases the expression of ICAM-1 and VCAM-1 via inhibition of the NF-B pathway activation and reduces the formation of foam cells via inhibition of NADPH oxidase-1 in mouse macrophages [65,66,67]. Instead, a diet rich in vegetables and fruits such as the Mediterranean diet seems to be the safest and most established pattern to prevent metabolic and immune derangement. Interestingly, increased leptin levels have also been detected in patients with psoriasis independently of BMI. 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. Adipocytokines, which are secreted not only by adipocytes but also by macrophages in adipose tissue, contribute equally to the inflammation process [141]. Indisputably, however, nutrition can be an additional therapeutic tool in psoriasis management, and this underlines the need for more, large-scale, randomized trials to confirm the beneficial effects of more dietary patterns and the underlying pathophysiological mechanisms, so as to understand which regimen fits each patient, and offer physicians and patients safe, feasible and individualized alternative approaches to alleviate the disease burden. Similarly, a more recent study by Kolchak et al. Furthermore, psoriasis severity (assessed by PASI score and CRP) was negatively associated with the intake of extra virgin oil, fruits, nuts, fish or seafood, vegetables and legumes, whereas it was positively correlated with red meat intake [175]. Loued S., Berrougui H., Componova P., Ikhlef S., Helal O., Khalil A. Extra-virgin olive oil consumption reduces the age-related decrease in HDL and paraoxonase 1 anti-inflammatory activities.

On the contrary, an open study including 26 patients with psoriasis showed that fish oil supplementation did not improve psoriasis outcomes in any of the patients with plaque-type psoriasis except for one, a fact which was attributed to low dosage of EPA and the absence of dietary fat restriction [216].

Kiecolt-Glaser J.K., Belury M.A., Andridge R., Malarkey W.B., Hwang B.S., Glaser R. Omega-3 supplementation lowers inflammation in healthy middle-aged and older adults: A randomized controlled trial. Elmadfa I., Rust P., Majchrzak D., Wagner K.H., Genser D., Lettner R., Pinter M. Effects of beta-carotene supplementation on free radical mechanism in healthy adult subjects.

Edrisi F., Salehi M., Ahmadi A., Fararoei M., Rusta F., Mahmoodianfard S. Effects of supplementation with rice husk powder and rice bran on inflammatory factors in overweight and obese adults following an energyrestricted diet: A randomized controlled trial. A retrospective observational study including 98 patients with psoriasis and 98 healthy individuals demonstrated that patients with psoriasis had increased homocysteine levels and lower serum levels of vitamin B12 and folic acid compared to healthy individuals [207]. More specifically, the study included 18 patients who were advised to initially consume 170 g of white fish daily for 4 weeks and then they were randomized to consume either 170 g of white fish or 170 g of oily fish daily for six weeks; at the end of this second period, the diets were reversed for a further 6 weeks. with nonobese humans [91], supplementation of astaxanthin (a xanthophyll found mainly in seafood) for 12 weeks improved HDL-C, TG, and adiponectin levels.

prospectively examined the association between development of psoriasis and BMI, waist circumference, waist-to-hip ratio and 10-year weight gain. Juhlin et al. The biological role of inflammation in atherosclerosis. In general, fibers slow down carbohydrate uptake and hamper the absorption of dietary lipids [52]. Recently, a single-arm, open-label clinical trial by Castaldo et al. Chiricozzi A., Raimondo A., Lembo S., Fausti F., Dini V., Costanzo A., Monfrecola G., Balato N., Ayala F., Romanelli M., et al.

Effect of Combined Treatment With Folic Acid, Vitamin B6, and Vitamin B12 on Plasma Biomarkers of Inflammation and Endothelial Dysfunction in Women. Maced. Verdile G., Keane K.N., Cruzat V.F., Medic S., Sabale M., Rowles J., Wijesekara N., Martins R.N., Fraser P.E., Newsholme P. Inflammation and Oxidative Stress: The Molecular Connectivity between Insulin Resistance, Obesity, and Alzheimers Disease. However, such high doses which cannot readily be implemented in everyday practice doubt the clinical significance of these results.

Ggebakan O., Kohl A., Osterhoff M.A., van Baak M.A., Jebb S.A., Papadaki A., Martinez J.A., Handjieva-Darlenska T., Hlavaty P., Weickert M.O., et al. Resveratrol ameliorates imiquimod-induced psoriasis-like skin inflammation in mice. A cohort study from Italy including patients who received systemic treatment for plaque psoriasis for the first time showed that the percentage of patients achieving reduction of PASI score >75% was 30% lower in obese patients compared to individuals with normal BMI [134]. 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. Armstrong A.W., Harskamp C.T., Armstrong E.J. showed that low-calorie diet improves response to cyclosporin treatment in obese patients with moderate-to-severe psoriasis [159]. conducted an RCT including 40 patients with moderate-to-severe psoriasis, who were randomized to receive either turmeric tonic twice daily for nine weeks or placebo. Serwin A.B., Wasowicz W., Chodynicka B. Selenium supplementation, soluble tumor necrosis factor-alpha receptor type 1, and C-reactive protein during psoriasis therapy with narrowband ultraviolet B. Serwin A.B., Mysliwiec H., Hukalowicz K., Porebski P., Borawska M., Chodynicka B. Soluble tumor necrosis factor-alpha receptor type 1 during selenium supplementation in psoriasis patients. 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. Association between coeliac disease and psoriasis: Italian primary care multicentre study. A diet with a fiber content of 30 g/d led to a significant reduction in hsCRP [50].

In this notion, a significant number of studies have been conducted to investigate the effect of low-calorie diet on psoriasis severity and progression.

Manson J.E., Cook N.R., Lee I.M., Christen W., Bassuk S.S., Mora S., Gibson H., Albert C.M., Gordon D., Copeland T., et al. Overall, available studies suggest that gluten-free diet results in clinical improvement of psoriasis in patients with positive serum markers, with or without celiac disease; however, large randomized controlled trials have not yet been conducted. Treatment of psoriasis with large doses of vitamin B12, 1,100 micrograms per cubic centimeter; preliminary clinical report. In accordance with these results, another RCT with 23 patients who received supplementation with 100.000 IU Vitamin D/month and 42 controls showed that there was no significant difference in any of psoriasis outcome measures (PASI, PGA, PDI) after 12 months [202]. 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]. showed that obesity is associated with a two-fold increased risk of psoriasis compared to individuals with normal body weight. Adiponectin as a biomarker linking obesity and adiposopathy to hematologic malignancies.

Apart from genetic and environmental factors, nutrition has emerged as a potential modulator of immunological and inflammatory responses [2]. evaluated the efficacy of a weight loss program with ketogenic diet as a first-line strategy in drug-naive patients with psoriasis. In a subgroup analysis, higher dosages of >1800 mg/day and <8 weeks in duration were associated with more beneficial outcomes [222]. Psoriasis is one of the most prevalent autoinflammatory diseases worldwide, with an incidence of 23% in Europe and North America [5]. Ruedemann R., Jr.

SFAs activate dendritic cells, which results in the endocytosis of Toll-like receptor (TLR)-4 and the secretion of pro-inflammatory cytokines such as IL-1 and reactive oxygen species (ROS) [27]. In patients with peripheral artery disease, supplementation with orange and blackcurrant juice for 4 weeks led to a reduction in CRP and plasma fibrinogen [92]; similarly, MDA and 8,12-isoprostane F2a-VI levels were inversely associated with concentrations of individual carotenoids [93]. Upala S., Yong W.C., Theparee T., Sanguankeo A.

[236], including 34 patients with psoriatic arthritis, a 24-week zinc supplementation improved joint pain and mobility and alleviated joint swelling. Yamashiki M., Nishimura A., Koska Y. 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. Naldi L., Chatenoud L., Linder D., Belloni Fortina A., Peserico A., Virgili A.R., Bruni P.L., Ingordo V., Lo Scocco G., Solaroli C., et al. Research data regarding the effect of n-3 polyunsaturated fatty acids on the treatment of psoriasis are inconsistent. showed that three months of gluten-free diet improves skin biopsy anomalies (reduction in Ki67 positive cells and tissue transglutaminase-tTG expression in dermis) and psoriasis severity (reduction of psoriasis area and PASI score from 5.5 4.5 to 3.6 3) in patients with psoriasis and positive IgA-AGA or IgG-AGA antibodies [163,164]. Kolchak N.A., Tetarnikova M.K., Theodoropoulou M.S., Michalopoulou A.P., Theodoropoulos D.S. Accessibility All authors have read and agreed to the published version of the manuscript.

After 12 weeks, the intervention group showed a greater improvement in median PASI score, along with a significant reduction in IL-22 serum concentration compared to the placebo group [241]. Ketogenic diet-induced peroxisome proliferator-activated receptor- activation decreases neuroinflammation in the mouse hippocampus after kainic acid-induced seizures. In addition, in some studies where no correlation between vitamin D and PASI was found, analysis was limited to only one measurement per person and not on repeated measurements over a follow-up period, while the relationship between PASI and 25(OH)D has not been shown to be linear, either. This review aims to present the effect of strictly structured dietary nutrients, that are known to affect glucose/lipid metabolism and insulin responses, on chronic inflammation and immunity, and to discuss the utility of nutritional regimens as possible therapeutic tools for psoriasis and psoriatic arthritis. and transmitted securely. Moreover, subjects with a body weight increase >10 kg had an RR of 1.72 [129]. Supplementation with orange and blackcurrant juice, but not vitamin E, improves inflammatory markers in patients with peripheral arterial disease. Spah F. Inflammation in atherosclerosis and psoriasis: Common pathogenic mechanisms and the potential for an integrated treatment approach. The outcomes of randomized controlled trials are less encouraging [217,218,219,220]. The main characteristic of KD is the low carbohydrate intake (less than 3050 g/day) along with an increase in protein and fat [179]. 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]. Moghadam A.M., Saedisomeolia A., Djalali M., Djazayery A., Pooya S., Sojoudi F. Efficacy of omega-3 fatty acid supplementation on serum levels of tumour necrosis factor-alpha, C-reactive protein and interleukin-2 in type 2 diabetes mellitus patients. Meng Z., Yan C., Deng Q., Gao D.F., Niu X.L. Vitamin C is a potent ROS scavenger and stimulates neutrophil apoptosis and T-cell maturation, and its increased dietary intake has been associated with lower levels of CRP and PAI-1 [103,104,105]. Hroussalas G., Kassi E., Dalamaga M., Delimaris I., Zachari A., Dionyssiou-Asteriou A. Leptin, soluble leptin receptor, adiponectin and resistin in relation to OGTT in overweight/obese postmenopausal women. North C.J., Venter C.S., Jerling J.C. Selenium, ultraviolet radiation and the skin. Based on this data, ketogenic diet is a promising prospect in psoriasis management, but large studies are needed for safe conclusions. Fairris G.M., Lloyd B., Hinks L., Perkins P.J., Clayton B.E. Schena D., Chieregato G.C., de Gironcoli M., Schena D., Chieregato G.C., de Gironcoli M., Girelli D., Olivieri O., Stanzial A.M., Corrocher R., et al. The consumption of EPA (180 mg/d) and DHA (120 mg/d) for six weeks was associated with a reduction in CRP in overweight patients [34], and a similar anti-inflammatory pattern was observed in a study with patients with T2DM, where the supplementation of high doses of n-3 PUFAs led to lower concentrations of IL-2 and TNF- [35]. 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. This dietary intervention led to a body weight reduction of 12% and in a significant reduction of PASI score (mean change of 10.6) [188]. Hsu S., Dickinson D., Borke J., Walsh D.S., Wood J., Qin H., Winger J., Pearl H., Schuster G., Bollag W.B. Oral curcumin in the treatment of moderate to severe psoriasis vulgaris: A prospective clinical trial. National Library of Medicine about navigating our updated article layout. Omentin-1 is another adiponectin with anti-inflammatory properties by inhibiting TNF-. A 24-week randomized controlled trial by Gisondi et al. suggested curcumin as a dietary immunosuppressant in patients with psoriasis due to in vitro inhibition of pro-inflammatory IFN- and IL-17 [239]. Interventional randomized clinical trials to confirm these results are still lacking. Dangardt F., Osika W., Chen Y., Nilsson U., Gan L.-M., Gronowitz E., Strandvik B., Friberg P. Omega-3 fatty acid supplementation improves vascular function and reduces inflammation in obese adolescents. Hussain T.A., Mathew T.C., Dashti A.A., Asfar S., Al-Zaid N., Dashti H.M. Effect of low-calorie versus low-carbohydrate 1016. ketogenic diet in type 2 diabetes. Vitamin D intake and season modify the effects of the GC and CYP2R1 genes on 25-hydroxyvitamin D concentrations. Huang H., Shen E., Tang S., Tan X., Guo X., Wang Q., Ding H. Increased serum resistin levels correlate with psoriasis: A meta-analysis. Similarly, a more recent study by Ingram et al. In conclusion, evidence from large-scale trials about the clinical significance of carotenoids remains contradicting.

[49], where the low-GL diet reduced CRP compared to the high-GL diet in 80 participants, despite the fact that the diets were isocaloric. Only two RCTs have been conducted to investigate the efficacy of oral zinc supplementation in patients with psoriasis. Does weight loss reduce the severity and incidence of psoriasis or psoriatic arthritis? Mobarhan S., Bowen P., Andersen B., Evans M., Stacewicz-Sapuntzakis M., Sugerman S., Simms P., Lucchesi D., Friedman H. Effects of beta-carotene repletion on beta-carotene absorption, lipid peroxidation, and neutrophil superoxide formation in young men. Habitual dietary intake of n-3 and n-6 fatty acids in relation to inflammatory markers among US men and women. Update of the LIPID MAPS comprehensive classification system for lipids. The effects of dietary fibre on C-reactive protein, an inflammation marker predicting cardiovascular disease. Fogh K., Kragballe K. New vitamin D analogs in psoriasis.

Zhang S., Zou J., Li P., Zheng X., Feng D. Curcumin attenuates atherosclerosis in apolipoprotein-E knockout mice by inhibiting Toll-like receptor 4 expression. Bohn T. Carotenoids and Markers of Oxidative Stress in Human Observational Studies and Intervention Trials: Implications for Chronic Diseases. Polyphenols are the most abundant antioxidants in diet, with their main sources being fruits, vegetables, red wine, nuts, green tea, and olive oil. Takeshita J., Grewal S., Langan S.M., Mehta N.N., Ogdie A., Van Voorhees A.S., Gelfand J.M. In accordance with these results, a more recent cross-sectional observational study with a larger sample (n = 35.735 patients) by Phan et al. Effects of a Mediterranean-style diet on cardiovascular risk factorsA randomized trial. Leptin levels in patients with psoriasis: A meta-analysis. Dalamaga M., Papadavid E. Metabolic co-morbidities and psoriasis: The chicken or the egg? Frasheri L., Schielein M.C., Tizek L., Mikschl P., Biedermann T., Zink A. However, some other studies have failed to support any beneficial effect of n-3 supplementation on inflammatory biomarkers, with this discrepancy being attributed to the relatively low supplemented daily dose, which did not exceed 6.6 g/d [36,37,38]. Apart from low-calorie diets, a number of nutrition strategies and dietary patterns such as gluten-free diet, Mediterranean diet and very-low-carb ketogenic diet have been proposed for weight loss achievement in patients with psoriasis. Rochette-Egly C., Germain P. Dynamic and combinatorial control of gene expression by nuclear retinoic acid receptors (RARs). Moreover, for each 10 cm increase in waist circumference and 0.1 unit increase in waist-to-hip ratio, the relative risk for psoriasis rose by 24% and 37%, respectively [132]. The effects of protein intake on metabolic derangement and inflammation are rather conflictive, and large-scale studies on the association between long-term habitual protein intake and circulating inflammatory biomarkers are lacking.

According to a recent review form Upala et al., including 12 studies, the results regarding the efficacy of n-3 PUFAs supplementation in the severity of psoriasis are still uncertain [221]. 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]. Furthermore, curcumin may enhance the secretion of anti-inflammatory cytokines such as IL-10 [240]. 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. Studies by Michalsson et al. However, the results regarding the efficacy of oral vitamin D supplementation are inconsistent. 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. Federal government websites often end in .gov or .mil. Is vitamin B12 of value in psoriasis? Ni Y.F., Wang J., Yan X.L., Tian F., Zhao J.B., Wang Y.J., Jiang T. Histone deacetylase inhibitor, butyrate, attenuates lipopolysaccharide-induced acute lung injury in mice. Since the report by Sph [9], where the idea of a potential common inflammatory pathway between psoriasis and atherosclerosis was first introduced, the link between psoriasis and chronic inflammation has been highlighted in many studies [10,11,12].

Jensen P., Zachariae C., Christensen R., Geiker N.R., Schaadt B.K., Stender S., Hansen P.R., Astrup A., Skov L. Effect of weight loss on the severity of psoriasis: A randomized clinical study. Barrea L., Megna M., Cacciapuoti S., Frias-Toral E., Fabbrocini G., Savastano S., Colao A., Muscogiuri G. Very low-calorie ketogenic diet (VLCKD) in patients with psoriasis and obesity: An update for dermatologists and nutritionists. Paoli A., Mancin L., Giacona M.C., Bianco A., Caprio M. Effects of a ketogenic diet in overweight women with polycystic ovary syndrome. Tamura J., Kubota K., Murakami H., Sawamura M., Matsushima T., Tamura T., Saitoh T., Kurabayshi H., Naruse T. Immunomodulation by vitamin B12: Augmentation of CD8+ T lymphocytes and natural killer (NK) cell activity in vitamin B12-deficient patients by methyl-B12 treatment. Mahil S.K., McSweeney S.M., Kloczko E., McGowan B., Barker J.N., Smith C.H. Consumption of extra virgin olive oil improves body composition and blood pressure in women with excess body fat: A randomized, double-blinded, placebo-controlled clinical trial.

Bach-Faig A., Berry E.M., Lairon D., Reguant J., Trichopoulou A., Dernini S., Medina F.X., Battino M., Belahsen R., Miranda G., et al. Vitamin C is also indispensable for the antioxidant actions of vitamin E, which contributes to T-cell and NK cells activity. Apart from their actions on innate immunity, n-3 PUFAs are crucial in the function of adaptive immunity as well, acting on T cells by regulating the janus kinasessignal transducer and activator of transcription proteins (JAK-STAT) pathway by decreasing JAK1 and JAK3 phosphorylation and, thus, leading to inhibition of STAT5 phosphorylation [42]. with the supplementation of apple or apple pomace [59]. Such results by single studies have been confirmed in a large meta-analysis including 54 studies and 19.372 patients, which showed that obesity is associated with 60% higher odds of inadequate response to anti-TNF treatment as compared to normal BMI; for each unit increment of BMI, there is an augmentation in odds of failure by 6.5% [137]. Increased erythrocyte membrane arachidonate and platelet malondialdehyde (MDA) production in psoriasis: Normalization after fish-oil. Di Minno M.N., Peluso R., Iervolino S., Russolillo A., Lupoli R., Scarpa R. CaRRDs Study Group. 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.

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