Changes in diet and caloric intake, as well as engagement in regular physical exercise, may reduce the severity of psoriasis while improving quality of life in patients with obesity, a Cochrane Database Systematic Review reports.

The Cochrane Skin Specialized Register, CENTRAL, MEDLINE, Embase, and LILACS databases were searched for randomized controlled trials reporting on lifestyle changes alone or in combination with other interventions for treating psoriasis. Only studies that included interventions of 12 weeks or longer were included in the review. No lifestyle changes or other active interventions were compared with dietary intervention. Severity of psoriasis and adherence to intervention were the primary outcome measures. Secondary outcomes included quality of life, time to relapse, and comorbidity reduction.

A total of 10 randomized controlled trials were included in the final review analysis (n=1163; mean age, 43 to 61 years). In two trials that compared dietary intervention with usual care, strict caloric restriction was associated with a 75% greater improvement from baseline in psoriasis severity compared with usual care (risk ratio [RR], 1.66; 95% CI, 1.07-2.58; low-quality evidence).

Changes to diet were associated with a greater improvement in the Dermatology Life Quality Index score vs usual care in one trial (mean difference [MD], −12.20; 95% CI, −13.92 to −10.48); moderate-quality evidence). In addition, dietary intervention reduced body mass index to a greater degree than usual care (MD, −4.65; 95% CI, −5.93 to −3.36), according to two trials with moderate-quality evidence.

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Finally, the researchers found that a combined dietary intervention and exercise program was associated with improvements in psoriasis severity, despite it possibly making little or no difference from a statistical standpoint (RR, 1.28; 95% CI, 0.83-1.98).

Limitations of the trials included the unblinding of the patients, as well as the high dropout rate among cohorts.

“When compared with information only,” the researchers added, “combined dietary intervention and exercise probably leads to a greater reduction in BMI, but with no difference in treatment adherence.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Reference

Ko SH, Chi CC, Yeh ML, et al. Lifestyle changes for treating psoriasis. Cochrane Database Syst Rev. 2019;7:CD011972.