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Dietary Recommendations for Adults With Psoriasis or Psoriatic Arthritis From the Medical Board of the National Psoriasis Foundation: A Systematic Review

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Ford AR1, Siegel M2, Bagel J3, Cordoro KM4,5, Garg A6, Gottlieb A7,8, Green LJ9, Gudjonsson JE10, Koo J4, Lebwohl M11, Liao W4, Mandelin AM 2nd12, Markenson JA13, Mehta N14, Merola JF15, Prussick R9, Ryan C16, Schwartzman S13, Siegel EL17,18, Van Voorhees AS19, Wu JJ20, Armstrong AW1. JAMA Dermatol. 2018 Jun 20. doi: 10.1001/jamadermatol.2018.1412. [Epub ahead of print]

Abstract

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1 Keck School of Medicine, University of Southern California, Los Angeles.

2 National Psoriasis Foundation, Portland, Oregon.

3 Psoriasis Treatment Center of Central New Jersey, East Windsor.

4 Department of Dermatology, University of California San Francisco.

5 Department of Pediatrics, University of California San Francisco.

6 Department of Dermatology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.

7 New York Medical College at Metropolitan Hospital, New York.

8 Hudson Dermatology, Somers, New York.

9 Department of Dermatology, George Washington University School of Medicine, Washington, DC.

10 Department of Dermatology, University of Michigan, Ann Arbor.

11 Icahn School of Medicine at Mount Sinai, New York, New York.

12 Northwestern University Feinberg School of Medicine, Chicago, Illinois.

13 Hospital for Special Surgery, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York.

14 National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.

15 Brigham and Women's Hospital, Harvard University, Boston, Massachusetts.

16 Blackrock Clinic, Dublin, Ireland.

17 Arthritis and Rheumatism Associates, PC, Rockville, Maryland.

18 Georgetown University School of Medicine, Washington, DC.

19 Department of Dermatology, Eastern Virginia Medical School, Norfolk.

20 Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California.

Abstract

IMPORTANCE: Psoriasis is a chronic, inflammatory skin disease and has significant associated morbidity and effect on quality of life. It is important to determine whether dietary interventions help reduce disease severity in patients with psoriatic diseases.

OBJECTIVE: To make evidence-based dietary recommendations for adults with psoriasis and/or psoriatic arthritis from the Medical Board of the National Psoriasis Foundation.

EVIDENCE REVIEW: We used literature from prior systematic reviews as well as additional primary literature from the MEDLINE database from January 1, 2014, to August 31, 2017, that evaluated the impact of diet on psoriasis. We included observational and interventional studies of patients with psoriasis or psoriatic arthritis. The quality of included studies was assessed using the Newcastle-Ottawa scale for observational studies and the Cochrane Risk of Bias Tool for interventional studies. We made evidence-based dietary recommendations, which were voted on by the National Psoriasis Foundation Medical Board.

FINDINGS: We identified 55 studies meeting the inclusion criteria for this review. These studies represent 77 557 unique participants of which 4534 have psoriasis. Based on the literature, we strongly recommend dietary weight reduction with a hypocaloric diet in overweight and obese patients with psoriasis. We weakly recommend a gluten-free diet only in patients who test positive for serologic markers of gluten sensitivity. Based on low-quality data, select foods, nutrients, and dietary patterns may affect psoriasis. For patients with psoriatic arthritis, we weakly recommend vitamin D supplementation and dietary weight reduction with a hypocaloric diet in overweight and obese patients. Dietary interventions should always be used in conjunction with standard medical therapies for psoriasis and psoriatic arthritis.

CONCLUSIONS AND RELEVANCE: Adults with psoriasis and/or psoriatic arthritis can supplement their standard medical therapies with dietary interventions to reduce disease severity. These dietary recommendations from the National Psoriasis Foundation Medical Board will help guide clinicians regarding the utility of dietary interventions in adults with psoriatic diseases.