Photo Credit: Tumeyes

Research shows lifestyle changes like diet, exercise, and smoking cessation can assist with improving psoriasis outcomes and managing metabolic comorbidities.

Patients with chronic plaque psoriasis face a higher risk for developing metabolic syndrome, a cluster of interrelated conditions characterized by central obesity, elevated blood lipid levels, high BP, and insulin resistance.

“Monitoring metabolic parameters, including blood glucose, glycated hemoglobin, lipid levels, creatinine, and liver enzymes is advisable in patients with psoriasis and metabolic comorbidities,” wrote Paolo Gisondi, MD, and colleagues in a review published in the American Journal of Clinical Dermatology.

The researchers described various lifestyle interventions that hold promise to address the severity of psoriasis and metabolic conditions.

“Pharmacological interventions targeting metabolic comorbidities should be integrated in the global management of patients with psoriasis with metabolic comorbidities,” the researchers wrote, adding that “non-pharmacological interventions such as diet and physical activity are also extremely beneficial to patients with psoriasis.”

Dietary Modifications

Recent research has highlighted the influence of diet on inflammation.

“Diets rich in proinflammatory bioactive compounds have been linked to an increased incidence and severity of inflammatory disorders such as rheumatoid diseases and inflammatory bowel diseases. Conversely, healthy diets have not only been associated with a reduction in metabolic syndrome and cardiovascular events but also to a reduction in chronic systemic inflammation,” the authors said.

Numerous trials have focused on low-calorie diets. One randomized trial found that patients with obesity on a low-calorie diet, alongside low-dose cyclosporine, exhibited a higher PASI 75 response compared with those receiving only low-dose cyclosporine. Other studies have shown similar results; however, the authors noted that not all studies have reported positive outcomes.

Recent studies have shown promise for very-low-calorie ketogenic diets and Mediterranean-like diets. Other diets have also been explored; a small trial evaluating the Ornish and South Beach diets among patients with obesity undergoing phototherapy revealed notable improvements in PASI, with no significant differences between the diets.

The researchers said that weight management through dietary interventions can significantly improve psoriasis severity, especially in patients with comorbid obesity.

“A recent multicenter survey showed that a significant percentage of obese patients with psoriasis are interested in participating in nutritional programs to reduce excess body weight,” the authors noted. “They are well aware of the negative effects of obesity on their health, whereas they are less informed of the impact of obesity on psoriasis.”

Alcohol Consumption

Research indicates that patients with psoriasis consume alcohol more frequently than the general population, which has been linked to exacerbated disease severity and compromised treatment efficacy.

Given alcohol’s detrimental effects on both psoriasis severity and treatment effectiveness, addressing alcohol consumption is essential in the management of psoriasis, according to the review authors. Screening tools such as AUDIT, AUDIT-Concise (AUDIT-C), and CAGE (Cut, Annoyed, Guilty, and Eye) have been validated in this patient population, offering simple yet effective means for assessing alcohol use.

Interventions aimed at reducing alcohol intake can lead to improvements in psoriasis severity and a reduction in cardiovascular risks. The authors advised clinicians to prioritize discussions about alcohol consumption in their treatment plans for patients with psoriasis, reinforcing the importance of lifestyle modifications alongside pharmacological therapies.

Physical Activity  

Several studies indicate that patients with psoriasis engage in physical activity at significantly lower rates than the general population. Despite limited clinical trials directly addressing the role of physical activity in psoriasis, the researchers believe there are compelling reasons to advocate for increased activity in these patients.

Physical activity can facilitate weight loss in patients with overweight and obesity. Additionally, exercise can reduce oxidative stress by enhancing the upregulation of antioxidant enzymes. Physical activity also may lower levels of inflammatory cytokines, further reducing inflammation.

“Ultimately, physical activity is associated with the improvement of comorbidities associated with psoriasis, particularly the cardiovascular, metabolic, and psychological comorbidities,” the authors said. “Physical activity has several favorable effects on psoriasis and thus represents a cornerstone of non-pharmacologic treatments of psoriasis.”

Smoking Cessation

Evidence suggests that smoking significantly exacerbates psoriasis and its complications. Most studies indicate that higher levels of smoking correlate with increased psoriasis severity. In addition, one meta-analysis suggested that smoking may hinder the effectiveness of certain therapeutic modalities for psoriasis.

“Smoking has a detrimental impact on patients with psoriasis as it not only worsens psoriasis severity but also its associated comorbidities, including cardiovascular diseases and inflammatory bowel diseases. Hence, smoking cessation should be strongly encouraged in patients with psoriasis who smoke,” the authors said.

Overall, Dr. Gisondi and colleagues cautioned clinicians that metabolic comorbidities influence therapy selection in patients with psoriasis, adding that non-pharmacological interventions can improve disease severity while mitigating comorbidities.

“Ultimately, non-pharmacological interventions, including diet, physical activity, alcohol abstinence, and smoking avoidance, may be very useful in the global management of patients with psoriasis with metabolic comorbidities,” the authors concluded.