Behavioral modifications may reduce psoriasis severity

Behavioral modifications such as weight reduction and exercise could possibly impact psoriasis severity.(©Sweetheart/Shutterstock.com)

Can behavioural modifications impact patients with psoriasis? Researchers in Taiwan explored this question by performing a systematic cochran review, in which they compared behavioural modifications such as weight reduction, alcohol abstinence, smoking cessation and exercise to usual care.

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Dr. Chi from the Department of Dermatology and Centre for Evidence-Based Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan and colleagues included 10 randomized controlled trials (RCT) in the review, including:

• 6 dietary interventions

• 1 dietary intervention and exercise

• 1 exercise and health education

• 2 health education

• 0 trials investigating smoking cessation

• 0 trials investigating alcohol abstinence

When combined, these trials were composed of 1163 participants. The mean age of participants was 43 to 61, where 656 were men and 278 were women. The outcomes were measured at 24 weeks to 6 months.

Results showed that dietary intervention may lead to a PASI 75 (risk ratio (RR) 1.66, 95% confidence interval (CI) 1.07 to 2.58). However, the authors consider this low quality evidence. Adherence may have been greater in patients receiving dietary interventions adding bias. The authors found that dietary intervention improved DLQI compared to usual care (MD -12.20, 95% CI -13.92 to -10.48), though this was based on only one trial. BMI was also reduced in the dietary intervention group (MD -4.65, 95% CI -5.93 to -3.36).

In summary, this review suggests that dietary intervention may reduce the severity of psoriasis, probably improves quality of life and likely reduces BMI. Diet combined with exercise also may reduces psoriasis severity.

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The authors note, however, that no trials assessed the time to relapse. Furthermore the trials reviewed were limited in that they included unblinded participants and had a high dropout rate. They suggest that to improve future studies, efforts should be made to reduce dropout rates, include comprehensive outcome measures and evaluate time to relapse.

Given the association with cardiovascular morbidity and psoriasis it is important to reduce the usual cardiovascular risk factors. Therefore exercise and diet should be included in the counselling in patients with psoriasis. Future studies must measure the impact of these interventions so that dermatologists may better understand the influence of diet and exercise on psoriasis severity.