The Impact of Nutrition on IMID

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Although immune-mediated and inflammatory diseases (IMID) such as psoriasis, atopic dermatitis, hidradenitis suppurativa, bullous diseases, vitiligo, and alopecia areata are clinically different from one another, they all share a chronic inflammatory background of the skin.

The majority of patients with IMID believe their dietary habits play an important role in the disease, and as such, often have conversations with their dermatologists about the role of diet in inducing, exacerbating, or managing skin disorders. Many also turn to alternative sources—usually not reliable—for additional information.

It’s vital that dermatologists stay up to date on the latest literature in regard to the link between nutrition and IMID so that their patients are appropriately informed about the potential benefits of specific dietary interventions.

The correlation remains an open debate in the literature, therefore a group of researchers in Italy studied the role nutrition plays in IMID¹, looking at the complexity of immune-mediated skin disease’s clinical course, breadth, and variability of human nutrition.

The authors noted that previous studies have demonstrated the potential role of diet on the risk of exacerbating IMID, while several epidemiological studies point out some dietary factors as possible inducers of IMID. Still, it has never been made apparent whether and how diet could influence IMID development, and which foods may have a crucial role in disease progression and flares.

According to the authors, previous studies have demonstrated that several components of foodstuff have been indicated as potential triggers, including processed foods and their additives, and low levels of nutrients have also been associated with increased inflammation, such as vitamin D serum levels.

The authors also looked at whether specific dietary modifications could provide meaningful implementation in planning a therapeutic strategy for patients in accordance with regenerative medicine precepts, a healing-oriented medicine that considers the whole person, including all aspects of the lifestyle.

To collect data for their review, the researchers performed a worldwide review of studies reporting nutrition in IMID using three electronic medical databases—PubMed, EMBASE, and Web of Science over the past decade.

Additionally, the researchers searched the reference lists of other relevant articles on nutrition involvement in IMID, as well as government reports and gray literature available on the topic.

The first phase of the study identified 181 distinct records. From there, 6 researchers made independent selections of articles based on title, they evaluated the abstracts, with 100 assessed for full-text analysis and selected for the next phase, where further analysis resulted in 45 studies being included in the qualitative synthesis.

The data from this literature revealed that nutrition has a conditioning role in many inflammatory and immune-mediated diseases of the skin, namely, in psoriasis, atopic dermatitis, hidradenitis suppurativa, bullous diseases, vitiligo, and alopecia areata.

As it relates to vitiligo, the authors noted a growing pool of data supports the idea of immune dysregulation triggered by oxidative stress in patients with a genetic predisposition.

“Vitiligo therapies traditionally consist of corticosteroids, immunomodulators, and phototherapy, which can be effective in controlling the disease, but they do not always prove to be satisfactory for the patient,” the authors wrote. “Nutrition could be useful in bridging this gap—making traditional therapy more effective, safe, and satisfactory.”

They found several studies conducted in recent years that investigated nutrition’s role in vitiligo, with some showing some degree of repigmentation after a gluten-free diet, leading the study authors to conclude gluten elimination might be useful in patients with both vitiligo and celiac disease.

Several dietary approaches, including the addition of specific nutrients, have been proposed to play a role in the pathogenesis, management, and/or therapy of all of these conditions. The researchers concluded that in some cases, avoiding established triggers would be helpful, while in other cases, supplements and dietary alterations were recommended.

While the conclusion answered their original thesis, the authors believe that further studies regarding dietary manipulation and the effect of dietary components on these skin diseases are needed to better understand and treat patients.

Reference

1. Diotallevi, Federico et al. “The Role of Nutrition in Immune-Mediated, Inflammatory Skin Disease: A Narrative Review.” Nutrients vol. 14,3 591. 29 Jan. 2022, doi:10.3390/nu14030591