Shah VK, Tran T, Chang SJ, Sadur A, Lio PA, Choudhary S. Role of dietary intervention in
the management of selected skin diseases: A systematic review. Journal of Integrative
Dermatology. Published online 2025.
Review Article
Role of dietary intervention in the management of selected skin
diseases: A systematic review
Vrusha K. Shah, MPH1, Theresa Tran, MD2, Selina J. Chang, BS1, Alana Sadur, BS3, Peter A. Lio, MD4,
Sonal Choudhary, MD5
1 Dermatology, University of Pittsburgh Medical Center, 2 Dermatology, Temple University Hospital, 3 Dermatology, George Washington University
School of Medicine and Health Sciences, 4 Dermatology, Northwestern University Feinberg School of Medicine, 5 Dermatology, University of
Pittsburgh Medical Cente
Keywords: diet, psoriasis, hidradenitis suppurativa, atopic dermatitis, acne
Journal of Integrative Dermatology
Relevance
Dietary intervention in the management of skin disease is underutilized in medical
practice and could be a means for patients to optimize skin health as well as overall
physical and mental well-being. Summarizing existing literature can serve as a catalyst to
increase research efforts focusing on dietary intervention and skin disease management
which may inform the way dermatologists provide care to their patients.
Objective
Dietary intervention is a commonly used option to improve physical and mental health
with many evidence-based associations in improving prognoses of diabetes, high
cholesterol, high blood pressure, depression, among many other conditions. The role of
dietary intervention in the management of skin disease remains limited. Understanding
its role may improve the options for care dermatologists may provide to their patients.
Methods
A systematic search of PubMed, EMBASE, and Cochrane Central Registrar between
January 1st, 1985 and December 31st, 2023 was conducted. Studies included were case
reports, clinical trials, controlled studies, comparative studies, systematic reviews, and
meta-analyses. Review papers were excluded.
Results
Results showed that dietary intervention improves symptom severity among atopic
dermatitis, acne, hidradenitis suppurativa, and psoriasis patients.
Conclusion
While data shows positive associations between use of dietary intervention and decrease
in symptom severity, future small and large-cohort randomized controlled trials with
placebo and intervention groups are warranted.
INTRODUCTION ated dietary interventions can influence the course of skin
diseases. In learning more about these nutritional recom-
Dietary choices have profound effects on overall health. Be- mendations, dermatologists can be more comprehensive in
yond supplying the body with nutrients including proteins, their treatment recommendations to better care for their
vitamins, and minerals, nutrition is now considered an im- patients.
portant factor for influencing disease risk, triggering health On the macro level, the GI tract absorbs nutrients from
conditions, and offering medicinal and protective quali- food, and the circulatory system passes them on to other
ties.1 In medicine, evidence-based nutritional advice is part parts of the body. On the micro level, the gut hosts micro-
of the gold standard for common diseases such as obesity, biota comprising prokaryotic and eukaryotic symbiotic mi-
diabetes mellitus, hyperlipidemia, and coronary heart dis- croorganisms which support the host in terms of metabolic
ease.2 However, the impact of nutrition on the progression and immune function. They can metabolize indigestible
of dermatological diseases is not similarly regarded as di- complex polysaccharides into essential nutrients, protect
etary modifications have been underappreciated in terms the host by maintaining the gut’s epithelial barrier in-
of dermatological disease therapy. Recent studies, however, tegrity, and influence immune system development.3‑6
have uncovered significant evidence that well-substanti- Communication between the microbiota and the host is im-
portant for preventing harm to the host, which includes
Role of dietary intervention in the management of selected skin diseases: A systematic review
- preventing tissue-damaging inflammatory responses and vention. Alpha-lipoic acid, found in certain meats and veg-
avoiding infection or uncontrolled growth.3 Communica- etables, can prevent glycation seen in the aging process,
tion is possible via hormone-like compounds produced by and a diet rich in fruits and vegetables can reduce the risk
the microbiota: short chain fatty acids (SCFAs), secondary of cancer.34
bile acids, cortisol, and neurotransmitters including In this article, we review common skin disorders and the
gamma-aminobutyric acid (GABA), serotonin, dopamine, current literature on the effect of different diets and offer
and tryptophan.7‑9 These compounds can locally affect the evidence-based nutritional guidance for the everyday prac-
intestinal mucosal barrier, enter the bloodstream, and thus ticing dermatologist. The reviewed skin disorders, includ-
can impose systemic effects at distant organs and systems ing acne, atopic dermatitis, hidradenitis suppurativa, and
as well. These compounds, interacting with skin receptors, psoriasis are the most common skin conditions clinicians
can consequently directly affect the skin or modify the treat.
skin’s commensal bacteria.7
The gut and skin are connected through the systemic METHODS
circulation, where these two systems can communicate via
the diet, microbial metabolites, the immune system, neu- A systematic search of PubMed, EMBASE, and Cochrane
roendocrine pathways, and the central nervous system. The Central Registrar was conducted between January 1st, 1985
skin-gut axis is termed from the gut and skin communi- and December 31st 2023 to identify studies to treat dietary
cating with one another via these gut microbiota metabo- intervention among different diseases. Search terms
lite products.10 Host lifestyle factors including diet and hy- broadly included the disease of interest (“acne,”
giene can impact the proportions of commensal microbiota “hidradenitis suppurativa,” “psoriasis,” “atopic dermatitis”
strains and disrupt mucosal immunological tolerance.10 If [OR] “eczema”) [AND] (“gut,” “diet,” “supplement,” “in-
the gut microbiota is perturbed, the quantity of microbial flammation”). Case reports, clinical trials, controlled stud-
products can change and impact the host accordingly.10‑12 ies, comparative studies, systematic reviews, and meta-
Therefore, an imbalance in gut microbiome, termed in- analyses were included. After abstract and title review
testinal dysbiosis, can affect skin function and integrity followed by full-text article review, 46, 9, 39, and 10 articles
through their metabolic activity and immunological im- in the English language were included for acne, hidradeni-
pact.13‑15 The dysbiotic state is characterized by an im- tis suppurativa, psoriasis, and atopic dermatitis respec-
paired gut barrier, including an imbalanced gut micro- tively. Systematic reviews and meta-analyses were included
biome, reduced mucus layer, intestinal permeation into the for reference review. PRISMA flow diagrams for acne,
bloodstream, and gut inflammation.8 Specifically, certain hidradenitis suppurativa, psoriasis, and atopic dermatitis
neurotransmitters such as GABA, dopamine, serotonin, can be seen in Figures 1-4. Level of evidence for included
acetylcholine, as well as short chain fatty acids such as bu- studies was defined as I: systematic reviews of randomized
tyrate have important effects such as creation of a robust controlled trials, II: RCTs or observational studies with dra-
intestinal barrier with decreased permeability. Absorption matic effect, III: non-randomized controlled cohort/follow-
of short chain fatty acids is dependent on intake of fiber, up studies, IV: case series, case-control studies, or his-
intestinal absorptive capacity, and fermentation rate of mi- torically controlled studies, and V: mechanism-based
crobes.10 Compromise of these factors can lead to de- reasoning. This systematic review did not require IRB ap-
creased short chain fatty acid absorption and decreased proval. The study is registered with PROSPERO and fol-
epithelial barrier strength. Molecules with potential modu- lowed PRISMA guidelines.
latory effect on the skin and gut are summarized in Table
- Additionally, dysbiosis leading to inflammatory skin dis- ease is seen in conditions such as acne vulgaris where a de- RESULTS & DISCUSSION crease in Firmicutes and an increase in Bacteroides bacteria is observed per literature.10 ACNE VULGARIS Dietary changes play a role in consequent modulation Acne vulgaris, a chronic inflammatory skin disease affect- of the gut microbiome, hormonal changes, and neurotrans- ing 85% of adolescent individuals globally is influenced by mitter activity which can lead to a wide variety of dermato- hormonal factors, genetics, diet, stress, and environmen- logical disorders, systemic disease, and health outcomes. In tal factors. Notably, the prevalence of this dermatological regard to alterations of gut microbiome, with nutrient de- disease can vary across different regions and populations ficiencies, dermatological manifestations are familiar. For with studies showing increased prevalence and incidence in example, inadequate protein intake can result in Kwash- westernized versus non-westernized societies.35,36 iorkor, an exfoliative erythroderma dermatitis, while vit- amin B3 deficiency, or Pellagra, can lead to a photo-dis- ROLE OF DYSBIOSIS WITHIN THIS DISEASE tributed dermatitis.32 Conversely, nutrient excess may also elicit dermatological manifestations. For example, hypervi- On the skin surface, disruption of the normal skin flora taminosis A can manifest with xerosis, cheilitis, and alope- can contribute to acne pathogenesis. However when look- cia while insulin resistance and hyperinsulinemia can pre- ing at the gut-skin axis, increased intestinal permeability sent as acanthosis nigricans and skin tags.33 In some cases, and disruptions in the gut microbiota can lead to acne dietary interventions may even serve as an aspect of pre- through systemic inflammation.37 Stress disturbs eubiosis,
Journal of Integrative Dermatology 2
Role of dietary intervention in the management of selected skin diseases: A systematic review
Table 1. Cutaneous Effects of Important Dietary Metabolites and Components
Molecule Source Documented/
Possible effect on
skin
Bacterial metabolites
SCFAs (short chain fatty acids) From fermentation of dietary Anti-inflammatory
complex carbohydrates by effects; promotes
colonic bacteria keratinocyte
differentiation14,16
Gamma-aminobutyric acid (GABA) Bacterial by-product Anti-itch, anti-
inflammatory, anti-
allergy11,12,17,18
Dopamine Bacterial by-product Inhibits human hair
growth12,19
Phenol and p-cresol Metabolites of aromatic amino Disrupts skin
acids produced by colonic barrier integrity
bacteria and epidermal
differentiation,
reduces skin
hydration, disrupts
keratinization20
Serotonin Anti-
inflammatory11
Dietary components
Catechins: a polyphenol compound Green tea Anti-inflammatory,
reductions in pro-
inflammatory
eicosanoids, novel
therapeutics for
treatment of
melanoma21‑24
Polyphenols: chemical compounds found naturally in plants. Protect Strawberries, blueberries, Anti-inflammation,
plants from damage caused by ultraviolet radiation from the sun. plums, cherries, apples, black anti-oxidant25,26
These are poorly absorbed from the small intestine, and therefore currants, black olives, dark
accumulate in the large intestine. Polyphenols then catalyze changes chocolate, black tea, coffee,
in the gut microbiome that lead to significantly lower levels of hazelnuts, pecans, turmeric,
inflammation. cloves, cinnamon, ginger, cumin
Lycopene Tomatoes Protection against
photodamage27,28
Alpha-lipoic acid Organ meat (liver, kidney), Antioxidant, Anti-
broccoli, spinach, tomatoes, aging29,30
brussels sprouts, rice bran
Prolamin Wheat, rye, barley Protection against
atopic dermatitis31
and bacteria Lactobacillus and Bifidobacterium are particu- ily history of acne, further research is needed to evaluate
larly sensitive to its effect.38 Notably, acne patients have the true impact of diet on acne.42,43 A systematic review
increased ratios of Firmicutes to Bacteroides, with overall consisting of 34 articles concluded that a high glycemic in-
decreased levels of Actinobacteria and Proteobacteria com- dex diet and high glycemic load was positively associated
pared to healthy individuals.38‑40 The gut microbiota can with increased acne severity.44 Diets rich in refined carbo-
affect the metabolism and regulation of hormones, includ- hydrates, saturated fat, and trans-fats stimulate the syn-
ing sex hormones that play a role in acne.40 There is also a thesis of sebum triglycerides, promoting the growth of C.
noted gender difference between male and female acne pa- acnes and cytokines and therefore promoting comedogen-
tients and their gut microbiota.41 esis.44 Milk consumption has also shown association with
The systematic review search revealed many cross-sec- acne onset and or aggravation likely attributable to either
tional studies which used questionnaires to assess diet and its high-glycemic index or high insulin index.45,46 Whey
its impact on acne in populations such as Turkey, China, protein has also been seen to worsen acne severity, and in-
Korea, Italy, India, USA, Pakistan, and Norway. A system- crease incidence.47‑49
atic review of diet and acne shows acne being linked to diet.
While overall positive associations exist between acne and
familial dysmetabolism, high body mass indices, and fam-
Journal of Integrative Dermatology 3
Role of dietary intervention in the management of selected skin diseases: A systematic review
Figure 1. PRISMA flow diagram for acne studies
DIETS amounts of fish and seafood, rich in omega-3 fatty acids,
had less oily skin and fewer acne lesions.35
LOW-GLYCEMIC INDEX DIET
SUPPLEMENTS
With the positive association of high glycemic index, diets
and acne, several studies have evaluated the impact of a OMEGA-3 FATTY ACIDS/FISH OIL
low-glycemic index diet on acne. These studies have shown
significant reductions in noninflammatory and inflamma- Based on how omega-3 fatty acids as a part of the Mediter-
tory lesion counts, smaller sebaceous glands, decreased in- ranean diet are associated with less acneiform lesions, it
flammation, and reduced acne severity grading.50‑54 can be theorized that fish oil supplements, rich in omega-3
fatty acids, may be beneficial for acne. However, only a few
studies have been conducted to evaluate this effect. Smaller
MEDITERRANEAN DIET
studies have concluded moderate improvement in acne le-
sions with supplementation, however the efficacy of fish oil
Diets such as the Mediterranean diet, emphasize consump-
supplementation may depend on the acne severity.59‑61
tion of components such as fish and olive oil which contain
omega-3 fatty acids, vegetables such as leafy greens, fruits,
nuts, whole grains with a moderate consumption of dairy PROBIOTICS
products as well as a decreased consumption of red meat
and processed foods. Omega-3 fatty acids show a protective In addition, when looking at the gut-skin axis, the use of
effect towards acne with an association with decreased se- probiotics as a potential therapy has been considered. The
bum production and inhibition of inflammatory cytokines, clinical trials completed with oral probiotics have shown
reducing inflammatory acne lesions.35,55‑58 An epidemio- positive results.38‑42,62 Oral probiotics are theorized to
logical study found that participants who consumed large modify the intestinal microbiota, generating an anti-in-
flammatory response and restoring intestinal integrity, or
Journal of Integrative Dermatology 4
Role of dietary intervention in the management of selected skin diseases: A systematic review
Figure 2. PRISMA flow diagram for hidradenitis suppurativa studies
through metabolic pathways involving insulin-like growth abscesses and sinus tracts in intertriginous regions and
factor I (IGF-1).63‑68 A few specific strains shown to be as- has a poorly understood mechanism. HS can cause signif-
sociated with improvement in acne symptom severity in- icant pain, disfigurement, and unpleasant odor, frequently
clude Lactobacillus rhamnosus, Lactobacillus plantarum, and resulting in social isolation and diminished quality of
Lactobacillus reuteri.64‑66,68 life.81‑84
OTHER SUPPLEMENTS HIDRADENITIS SUPPURATIVA AND DYSBIOSIS
Numerous research studies have sought to characterize the
There have also been several randomized controlled trials
cutaneous microbiome in individuals with HS. A systematic
which evaluate other supplements. Chan et al evaluates
review conducted in 2022 identified several studies reveal-
lactoferrin with vitamin E and zinc supplementation, which
ing common patterns, such as an overgrowth of anaerobic
was seen to reduce acneiform lesion counts.69 Tolino et
bacteria and a reduction in skin commensals, which typi-
al evaluated a combination of probiotics, vitamin E, zinc,
cally exhibit antimicrobial properties. Two prevalent bac-
and nicotinamide with either male or female formulations,
terial skin species, Staphylococcus aureus and Streptococcus
which also had significant response.70 Other supplements
pyogenes, did not seem to play a role in HS.85 The increased
studied include vitamin D, vitamin A, berberis vulgaris fruit
abundance of anaerobic species, such as Prevotella or Por-
extract, magnesium, phosphate, herbal syrups, coenzyme
phyromonas, has been suggested as a potential contributor
Q10, green tea extract, sunflower seeds, soy isoflavones,
to HS pathogenesis by promoting the upregulation of an-
and more.71‑80 (See Table 2)
timicrobial peptide secretion (AMP), inducing keratinocyte
proliferation and subsequent recruitment of neutrophils
HIDRADENITIS SUPPURATIVA
and macrophages. This sequence of events may lead to
Hidradenitis suppurativa (HS), also known as acne inversa, heightened follicular occlusion and increased levels of
is a chronic inflammatory skin disorder that causes skin TNFα.86
Journal of Integrative Dermatology 5
Role of dietary intervention in the management of selected skin diseases: A systematic review
Table 2. Acne Vulgaris Studies
Study Level of Design Intervention/exposure and comparison Main outcome measures Results/Data Discussion
Reference Evidence Description group (if applicable) pertaining to Acne
19 IV Case study of Daily dietary supplementation of 250 mg Total lesions count; Both average total and Dietary supplementation with
5 patients of EPA obtained from sardines and inflammatory lesions count inflammatory lesion PUFAs may improve acne lesion
with mild to anchovies, 3.75 mg of zinc gluconate, 50 counts decreased count
moderate mcg of selenium, 50 mcg of chromium significantly
acne vulgaris and 50 mg of EGCG from green tea
extract for 2 months
20 II Observational Acne incidence and Of the 1200 Kitavan The incidence of acne between
study of 1200 prevalence subjects, no cases of nonwesternized and westernized
Kitavan acne were observed. Of societies can have a genetic
patients 115 Aché subjects, over difference, however Ache and
843 days, no case of Kitavan diets also differ from typical
acne were observed Western high-glycemic diets in that
they are composed of minimally
processed plant and animal foods.
Low-glycemic load dietary
interventions may have therapeutic
potential in treating acne
21 IV Case-control Oral minocycline DNA extracted from stool After minocycline Minocycline induces gut and skin
study to samples and facial skin treatment, patients had microbiota derangements
assess gut swabs before and after a decreased Firmicutes
microbiota of minocycline treatment to Bacteroides ratio
8 acne
patients
22 IV Case-control Intestinal microbiota Acne patients have Acne patients have gut microbial
study on 43 lower Firmicutes and dysbiosis
acne patients higher Bacteroidiain
with matched microbials
controls
23 IV Case-control Minocycline Bacterial community A lower Firmicutes to Race and diet have a significant
study on 8 profiling Bacteroides ratio was impact on the Firmicutes to
acne patients associated with a Bacteroides ratio in acne patients
with 8 Western diet and with taking antibiotics
matched acne; the ratio was
controls significantly reduced
following antibiotics in
the Asian population
24 IV Case-control Gut microbiota evaluation In acne patients, Shows a link between gut microbiota
of 31 acne through 16S RNA Actinobacteria is changes and acne risk
patients with Sequencing decreased and
Journal of Integrative Dermatology 6
Role of dietary intervention in the management of selected skin diseases: A systematic review
31 controls Proteobacteria is
increased
25 IV Cross- Gut microbiota analysis of Men with acne had Gut dysbiosis in acne patients are
sectional, 16SrDNA and microbial lower abundance of 18 gender-specific
case-control metabolites types of microbes, and
study of 43 had disordered
acne patients metabolism of fatty
and 43 acids. Female acne
matched patients had increased
controls Clostridium and
declined Oscillibacter
and Odoribacterin, and
showed dysbiosis of
amino acid metabolism
26 I Systematic There is growing Further research is needed for a
review of 53 interest in acne and diet, more comprehensive outline of the
articles with acne-promoting effect of diet on acne
meeting factors to include high
eligibility glycemic index/load
criteria foods, dairy, fatty foods,
and chocolate
27 I Systematic Acne is associated with
review of pre-puberty, a positive
acne family history, and a
epidemiology, possible association
distribution, between dairy food
and causes on intake and diet
Medline and
Embase to the
end of
November
2011
28 I Of 410 High glycemic index and Increased carbohydrate intake and
articles in the load was positively higher glycemic load and index have
literature associated with increased acnegenic effect.
search, 34 increased acne severity
articles met
the inclusion
criteria in the
literature
search
29 II Randomized Daily whole milk or low-fat milk Plasma hormone levels Mongolian children had Milk intake may stimulate
cross-over higher growth hormone endogenous growth hormone
Journal of Integrative Dermatology 7
Role of dietary intervention in the management of selected skin diseases: A systematic review
study of 46 levels production
children in
Ulaanbaatar
and 28
children in
Boston
30 I Systematic Increased risk for acne Any dairy is associated with an
review, meta- was seen with full-fat increased odds ratio for acne
analysis of 14 dairy, any milk, whole
studies milk, low-fat/skim milk,
consisting of cheese, and yogurt
78,529 consumption
patients,
including
23,046 acne
patients and
55,483
controls
31 IV Case reports Stopping whey protein supplementation Total acneiform lesions Acneiform lesions Whey protein may promote acne
of 5 male cleared in 4 patients formation
patients after discontinuation of
whey protein
32 II Observational Protein calorie supplements Onset or exacerbation of Those consuming This type of supplementation may
study of 30 acneiform lesions protein calorie worsen acne
patients supplements,
specifically Whey
protein extract, had a
significant onset of
acneiform lesions
33 IV Case series of Whey protein exposure Acne lesion count These patients This trending supplement may be
6 patients developed truncal acne related to truncal acne
after consumption of
whey protein
34 II Randomized Low glycemic-index load diet Acneiform lesion count, Experimental diet A low-glycemic-load diet can
controlled insulin sensitivity, resulted in greater improve acne and insulin sensitivity
cohort study androgen and testosterone reduction in weight, less
of 43 male levels total acne lesion counts,
acne patients and improved insulin
sensitivity
35 II Randomized Low glycemic-index load diet with the Changes in lesion counts, Experimental diet Nutrition-related lifestyle factors
controlled control group having a high glycemic- sex hormone binding resulted in reduced help in acne pathogenesis
trial of 43 load diet globulin, free androgen weight, reduced free
male acne index, insulin-like growth androgen index, and
Journal of Integrative Dermatology 8
Role of dietary intervention in the management of selected skin diseases: A systematic review
patients factor-I, and insulin-like increased insulin-like
growth factor binding growth factor binding
proteins protein
36 II Randomized Histopathological examination of skin Experimental diet Reduction in glycemic load diet can
controlled samples showed significant lead to improvements in acne
trial of 32 improvement in the
mild to number of acne lesions,
moderate reduced inflammation,
acne patients and reduced sebaceous
with a low gland size
glycemic load
diet
37 II Observational 41-item, IRB-approved, Most patients noted The South Beach Diet could be an
study with anonymous, web-based improvements in their additional modality in which to treat
2,995 questionnaire to assess low acne condition within 3 acne
respondents glycemic South Beach, months of starting the
Florida diet low-glycemic South
Beach, Florida diet
38 II Randomized High or Low glycemic index diets. Severity of facial Differences between A longer time frame and or weight
trial of 58 inflammatory lesions, body the groups were not loss may be necessary to further
adolescent mass index significant during the evaluate acne among adolescent
males. 8-week period males
39 IV Case control Food-frequency Mediterranean diet Acne patients were more likely to
study of 93 questionnaire showed protective have familial dysmetabolism history.
cases and 200 effects against acne; The Mediterranean diet may play a
controls familial role in the pathogenesis of acne
hypercholesterolemia,
diabetes, and
hypertension are strong
risk factors for acne
40 IV Case-control Adherence to the Mediterranean diet Global evaluation acne Significant negative It is important to consider a holistic
study of 40 severity score, and correlation between the approach for acne management
acne patients PREDIMED (Prevención severity of acne and the
and 40 con Dieta Mediterránea) adherence to
control questionnaire to assess Mediterranean diet
patients adherence to the
Mediterranean diet
41 IV Cross Adherence to the Mediterranean diet IGF-1 serum levels IGF-1 serum levels were The Mediterranean diet can have a
sectional, higher in the western protective role in acne pathogenesis
case control diet group compared to through IGF-1
study of 35 the Mediterranean
patients group
Journal of Integrative Dermatology 9
Role of dietary intervention in the management of selected skin diseases: A systematic review
42 IV Case-control Global acne grading system Higher percentage of Diet and body composition may be
study of 51 score, PREDIMED acne patients had lower useful in assessing clinical severity of
acne patients (Prevención con Dieta Mediterranean diet acne
and 51 Mediterránea) adherence scores and
matched questionnaire, and body higher values of fat
controls composition mass in their body
composition
43 IV Case-cohort Three capsules of fish oil daily for 12 Total inflammatory lesions Inconclusive results, as Fish oil supplementation to improve
study of 13 weeks, which contained a total of 930 counts and acne severity eight patients showed acne may be dependent on the initial
males with mg of EPA, 720 mg DHA, and 174 mg grades were determined improved acne, four acne severity
inflammatory DPA using the Allen and Smith patients showed
acne grading scale; skin redness worsened acne, and one
data obtained using a patient's acne remained
Konica Minolta CR-400 unchanged
colorimeter with the Lab*
color system as defined by
the Commission
Internationale de
L’Eclairage
44 II Randomized, Three groups, one which took 2000 mg Inflammatory lesion count Both treatment groups Moderate doses of omega-3
double-blind of EPA and DHA daily, the second group and non-inflammatory showed a significant polyunsaturated fatty acids or
prospective taking borage oil containing 400 mg GLA lesion count decrease in both gamma-linoleic acids could improve
study of 45 daily, and a control group not receiving inflammatory and non- acne lesions
patients with any treatment for 10 weeks inflammatory acne
mild to lesion count
moderate
acne
45 I Systematic Report benefits for Shows well-studied benefits of
review of 38 omega-3 fatty acid omega-3 fatty acid supplementation
studies supplementation in in dermatology
treatment of acne
among other
dermatologic disorders
46 II RCT of 18 Fermented milk with 200 mg of Acne lesion counts and The lactoferrin group Lactoferrin-enriched fermented milk
patients in the lactoferrin daily grade showed improvement may help treat acne vulgaris through
treatment with significant a mechanism of decreasing surface
group, 18 decreases in triacylglycerols
patients in the inflammatory lesion
placebo group count, decreased sebum
content specifically
surface triacylglycerols
47 II Prospective, Treatment group A receiving probiotic Clinical and subjective The treatment group Probiotics in adjunct with antibiotics
open-label supplementation, group B receiving assessments receiving both the may provide a synergistic anti-
Journal of Integrative Dermatology 10
Role of dietary intervention in the management of selected skin diseases: A systematic review
randomized minocycline, and group C receiving both probiotic and the inflammatory effect
study with 45 probiotic and minocycline antibiotic had a
female significant decrease in
participants total lesion counts
compared to the other
groups at 8 and 12
weeks
48 RCT of 20 Supplementation with the probiotic Paired skin biopsy analysis Patients who had taken Supplementation with probiotic
subjects with strain Lactobacillus rhamnosus SP1 for insulin-like growth the probiotic had strain may improve appearance of
acne compared with placebo group which factor 1, and forkhead box improved acneiform adult acne
received a liquid lacking probiotic protein O1 gene lesions compared to the
expression involved in placebo group, and had
insulin signaling reduced insulin
signaling expression
49 III Non- Supplement composed of biotin and 3 Photographic evaluation; Total reduction in the Probiotic supplementation in
randomized strains of lactic ferments in addition to a GAGS (Global Acne GAGS, SEBUTAPEtm, adjunction with topical therapy may
controlled topical gel composed of azelaic acid, Grading System) Score; and TEWL score help treat acne
cohort study hydroxy pinacolone retinoate, and α- SEBUTAPEtm score to
of 30 patients hydroxy acids assess seborrhea,
measurement of the trans
epidermal water loss
(TEWL), and TBlue test on
saliva to measure oxidative
stress
50 II Randomized Lactobacillus rhamnosus T12 dietary Dermatological visual The Lactobacillus Data supports the use of
clinical trial of supplement score of acne, and supplement group Lactobacillus containing
44 subjects instrumental evaluations showed a significant supplements in diseases such as
including hydration, pH, etc improvement in acne seborrheic dermatitis and acne
appearance and
instrumental skin
evaluations
51 I Systematic Further studies are needed to
review of 697 evaluate the full effects of probiotics
articles
52 II Randomized Lactobacillus plantarum CJLP55 Acne lesion count and Those who ingested the Dietary supplementation with this
control study ingestion or placebo grade, skin sebum, supplement had Lactobacillus strain was beneficial to
of 14 patients hydration, pH and surface improved acne lesion the skin and gut microbiomes of
per group lipid assessment; count and grade, and acne patients
Metagenomic DNA decreased sebum
analysis on urine triglycerides. The
extracellular vesicles supplement also
(reflecting systemic decreased the
bacterial flora) Bacteroides: Firmicutes
Journal of Integrative Dermatology 11
Role of dietary intervention in the management of selected skin diseases: A systematic review
ratio
53 II Randomized Lactoferrin with vitamin E and zinc Reduction in the number of The intervention group A twice daily supplement of
clinical trial acne lesions showed a significant lactoferrin with vitamin E and zinc
with 168 reduction in total lesion may reduce acne lesion count in
participants count acne patients
54 II Randomized Oral supplements contain biotin, Global acne Grading Most patients had An association of oral therapeutic
clinical trial probiotic, vitamin E, zinc, nicotinamide System (GAGs) significant therapeutic supplementation for mild to
with the male formulation containing response moderate acne
beta sitosterol and Boswellia serrata,
and females containing myo-inositol and
folic acid compared to topical cream
device containing active plant agents
(verbascoside, Ocimum gratissimum) and
keratolytic molecules (salicylic acid,
gluconolactone, complex alpha-hydroxy
acids)
55 I Randomized 0.25 micrograms of alfacalcidol daily Serum levels of Serum levels of Acne patients may have vitamin D
clinical trial 25-hydroxy-vitamin D 25-hydroxy-vitamin D deficiency, and alfacalcidol
with 100 acne were significantly lower supplementation may have a
patients and in acne patients and beneficial role in acne treatment
100 controls were inversely
correlated to acne
severity. After the
intervention, patients
had significantly higher
serum levels with
decreased inflammatory
markers IL6 and TNFα
56 I Meta analysis Of the 9 studies, 8 noted Oral vitamin A could serve as a
from 1931 to improvement in therapy for acne management;
2021 patients' acne with however side effects must be
regarding use vitamin A considered
of vitamin A supplementation
in acne
treatment,
resulting in 9
studies for
review
57 II Randomized 600 mg dried barberry Counts of acne lesions, At 4 weeks, acne lesion Barberry can be considered an
clinical trial of Michaelson's acne severity count and acne severity effective supplemental treatment
49 patients score score declined for acne patients
significantly in the
intervention group
Journal of Integrative Dermatology 12
Role of dietary intervention in the management of selected skin diseases: A systematic review
58 II Randomized Dietary supplementation with Acne resolution All patients who took The dietary supplementation can
control study magnesium, phosphate, omega 6 (linoleic the dietary supplement promote better regression and or
of 257 acid calcium salt - C18:2 fatty acid Ca reported complete cure of acne symptoms compared to
patients in the salt), and omega 7 (palmitoleic acid regression of symptoms drugs such as isotretinoin
treatment calcium salt - C16:1 fatty acid Ca salt) after 6 months of
arm, and 275 compared with controls who took treatment. In the
patients in the isotretinoin control group, 68%
control arm reported complete
resolution of symptoms
over the same period
59 II Randomized Herbal syrup consisting of Prunus Acne severity index and From 6 to 12 weeks, The herbal syrup could be an
clinical trial of domestica L., Tamarindus indica L., Cardiff acne disability there was a significant alternative treatment for acne
57 patients in Terminalia chebula L., Ziziphus jujube L., index reduction in the mean
each group and Cassia fistula (Plum, Jujube, Yellow number of comedones
Myrobalan, Golden Shower, Tamarind, in the herbal syrup
Honey) or placebo intervention group
60 II Randomized Treatment group received tretinoin Serum glutathione Administration of Coenzyme Q10 supplementation
trial of 36 0.025% cream and once-daily coenzyme peroxidase levels and coenzyme Q10 with may improve acne severity
patients with Q10 supplementation; placebo group severity of acne tretinoin cream
acne only received tretinoin cream treatment significantly improved
acne severity after 8
weeks compared to
tretinoin cream only.
Serum glutathione
peroxidase levels were
not significant
61 II Randomized 1500 mg of decaffeinated green tea Inflammatory lesion No significant Green tea extract may improve
clinical trial of extract, or placebo of cellulose daily counts, fasting glucose differences between the lesion counts in certain areas,
80 levels, and lipid profile groups for total lesion however more research is needed
participants counts, however for total benefit of green tea extract
improved acne lesion on acne
counts on the nose,
perioral area, and chin in
the treatment group
62 II Randomized Intervention group consumed 25 g 10% increase/decrease in Global acne grading Sunflower seed intake may worsen
controlled sunflower-containing food daily for 7 baseline acne severity score was not acne severity
trial of 40 days, control group were asked to stop index significantly different
acne patients eating sunflower seeds between groups. A
majority of those taking
the sunflower food
supplement had at least
a 10% increase in
baseline acne severity
Journal of Integrative Dermatology 13
Role of dietary intervention in the management of selected skin diseases: A systematic review
663 II Randomized 5 groups: isoflavones 40 mg, 80 mg, 120 Acne lesions There was significant Soy isoflavones supplementation
test of 25 mg, 160 mg and placebo, and treated for difference in acne can lower total acneiform lesions
patients 4 weeks lesions when comparing
pre and post-treatment
in groups receiving
isoflavone
supplementation
64 II Randomized 2 groups, placebo group and 160 mgs of Acne lesions There was significant Supplementation with 160 mg of
test of 40 isoflavone group difference after soybean isoflavone can reduce total
patients treatment with 160 mgs acneiform lesions
of isoflavone compared
to placebo
Journal of Integrative Dermatology 14
Role of dietary intervention in the management of selected skin diseases: A systematic review
Figure 3. PRISMA flow diagram for psoriasis studies
Changes in gut microbiomes may stimulate inflamma- ating a cycle wherein exacerbated symptoms may decrease
tion and modify immune responses in HS. HS has been cor- physical activity.
related with an elevated risk of inflammatory bowel dis- Interventions focused on weight loss have been demon-
ease.87 In a 2022 study, McCarthy et al reported an strated to alleviate HS disease flares. Documented in-
increased presence of Ruminococcus gnavus in the fecal mi- stances of reduced HS severity following weight loss have
crobiome of HS patients compared to controls. Notably, R. been observed post-bariatric surgery.89,92,93 Kroman et al
gnavus is also more prevalent in individuals with Crohn’s reported a 35% reduction in patients reporting HS symp-
disease, suggesting a potential link between the diseases toms after weight loss, a decrease in the mean number of
through shared alterations in microbiota.88 involved sites from 1.93 to 1.22, and a significant associa-
tion between weight loss exceeding 15% and reduced dis-
HIDRADENITIS SUPPURATIVA AND DIETS ease severity.89
Dietary modifications may play a role in managing HS.
OBESITY AND METABOLIC SYNDROME Barrea et al found that HS patients displayed poorer body
composition and lower adherence to Mediterranean diets
Elevated rates of obesity and metabolic syndrome are re- compared to healthy controls. In their cross-sectional,
ported among HS patients, with higher BMI correlated with case-controlled observational study, HS patients consumed
more severe disease activity.82,89,90 The connection be- higher quantities of simple carbohydrates, total fat, and
tween obesity and HS is attributed to increased mechanical foods with a higher n-6/n-3 PUFA ratio. The severity of
friction, the development of humid microenvironments in HS, assessed through the Sartorius score, showed an in-
skin folds fostering bacterial growth, and systemic low- verse correlation with adherence to the MedD.94 Although
grade inflammation.83,91 Despite these associations, en- Lorite-Fuentes et al found a similar correlation of greater
gaging in exercise can be challenging and painful, perpetu- MedD adherence with lower HS severity,95 Velluzzi et al did
not observe a significant association.96
Journal of Integrative Dermatology 15
Role of dietary intervention in the management of selected skin diseases: A systematic review
Figure 4. PRISMA flow diagram for atopic dermatitis studies
LOW CARBOHYDRATE/LOW DAIRY to the blockage of follicles by inducing cytokeratin overex-
pression, keratinocyte hyperproliferation, and heightened
Reducing carbohydrate and dairy consumption has been as- follicular wall cornification, leading to the leakage and rup-
sociated with improved HS symptoms. In an online anony- ture of pilosebaceous units. Moreover, androgen hormones
mous survey study from 2020, 237/728 patients identified are hypothesized to play a role in activating HS.100 Casein
HS symptom-exacerbating foods, which included sweets activates insulin-like growth factor 1 (IGF-1), and whey in-
(67.9%), bread/pasta/rice (51.1%), dairy (50.6%), and high- creases insulin levels; hyperinsulinemia and high IGF-1 can
fat foods (44.2%).97 In an online survey study from 2022, amplify androgen receptor activation.99,101
individuals reported significant improvements in symptoms
when adhering to Paleo and anti-inflammatory diets, which WHEAT AND BREWER’S YEAST
are characterized by reduced emphasis on dairy and grains
and increased fruit and vegetable consumption. Reductions Evidence suggests that brewer’s yeast and wheat may exac-
in sugar and dairy consumption were noted to lead to erbate HS symptoms. Anti-Saccharomyces cerevisiae anti-
greater self-reported symptom improvement.98 In a small bodies (ASCA), traditionally considered specific for Crohn’s
uncontrolled study, Danby reported that 39 out of 47 pa- disease, have been found in elevated levels in patients with
tients (83%) showed improvement under dairy-free diets, other autoimmune conditions such as type 1 diabetes and
with none experiencing worsening symptoms. However, systemic lupus erythematosus.102 Assan et al reported that
Danby’s study has faced criticism for lacking specificity in ASCA is associated with systemic inflammation and ad-
self-reported improvements regarding symptoms, potential vanced HS disease.103
response bias, and lack of formal or validated assessment Elimination diets targeting wheat and brewer’s yeast
methods.99 have demonstrated effectiveness in stabilizing HS. In a
High intake of simple carbohydrates and dairy is the- study involving 12 patients with ASCA antibodies, a
orized to increase follicular obstruction in HS.99 Casein, 12-month brewer’s yeast-free diet combined with surgical
whey, natural androgens, and their precursors contribute excision resulted in symptom stabilization, regression of
Journal of Integrative Dermatology 16
Role of dietary intervention in the management of selected skin diseases: A systematic review
skin lesions, and improvements in quality of life. Recur- PSORIASIS AND DYSBIOSIS
rence was observed upon accidental or intentional inges-
tion of beer or other foods containing wheat or brewer’s The gut and skin immune systems are interconnected. Re-
yeast.104 A 6-year follow-up study at the same center found search has shown an increased prevalence of intestinal in-
that 26/37 (70%) patients reported improvement in HS flammation in individuals with psoriatic arthritis, with gut
symptoms with a brewer’s and baker’s yeast-free diet and inflammatory lesions occurring in 16% of psoriasis patients
operative intervention. Similarly, 32/37 (82%) patients ex- which were identified via ileocolonoscopy.117,118 Although
perienced symptom recurrence after reintroducing re- the exact underlying mechanisms remain unclear, there is
stricted foods. 10% of these patients completed serological a mutual relationship between psoriasis and inflammatory
testing by measuring immunoglobulin G (IgG) antibodies, bowel diseases, including Crohn’s disease (CD). People with
which identified yeast intolerance in 20%, wheat intoler- CD are five times more likely to develop psoriasis compared
ance in 29%, and cow’s milk intolerance in 23%.105 Both to those without CD, and individuals with psoriasis have an
studies, with small sample sizes and lacking control groups, elevated risk of developing CD.119
were confounded by the inclusion of surgical excisions per- Studies on the gut microbiome consistently report im-
formed on all patients. Moreover, it remains unclear balances in individuals with psoriasis, although the specific
whether a similar diet would benefit patients without com- compositions of intestinal microbiota may vary among pso-
parable dietary intolerances. riasis patients.120,121 The gut microbiota are known to play
a vital role in maintaining host equilibrium and regulating
HIDRADENITIS SUPPURATIVA AND SUPPLEMENTS inflammation in the gut and skin, particularly in the con-
text of Th17, a cytokine associated with CD.122 Th17 cells
Zinc supplementation has been associated with improved govern the IL-17A and IL-17F production, which modulates
HS symptoms. A 2018 case control study highlighted a gut inflammation.123
higher prevalence of low serum zinc levels among HS pa- A randomized controlled trial (RCTs) demonstrated that
tients compared to controls. Moreover, low zinc levels were dietary interventions can have specific effects on gut mi-
found to be correlated with more severe Hurley staging, in- crobiota diversity and inflammatory markers. For example,
creased DLQI scores, and heightened symptom severity.106 the consumption of fermented foods has been found to re-
In cases where traditional treatments like systemic antibi- duce IL-6, a mediator of chronic inflammation that is ele-
otics, isotretinoin, surgery, or antiandrogens proved inef- vated in chronic inflammatory diseases such as rheumatoid
fective, Brocard et al revealed that administering 90 mg of arthritis and type 2 diabetes.124,125 Notably, elevated IL-6
zinc gluconate daily resulted in complete remission for 8/22 expression has been linked to psoriatic skin lesions and in-
(36%) and partial remission for 14/22 (63.6%) patients.107 creased keratinocyte proliferation.126,127
Similarly, Molinelli et al and Hessam et al found that zinc
supplementation was associated with significant reductions PSORIASIS AND DIETS
in acute flares, disease severity, and longer disease-free
survival.108,109 Psoriasis can profoundly impact quality of life. and many
HS patients exhibit a higher prevalence of vitamin D patients seek information regarding lifestyle changes that
deficiency compared with controls,110,111 and vitamin D may help with disease management. Studies indicate that
serum levels are inversely correlated with HS disease sever- individuals suffering from psoriasis display strong motiva-
ity.112 In HS patients with low vitamin D, Guillet et al re- tion to modify their diets, as they view these interventions
vealed that vitamin D supplementation significantly de- as natural, safe, and self-empowering.128,129 While there
creased the number of nodules at 6-month follow up, are numerous dietary suggestions for psoriasis in popular
noting a correlation between response to HS therapies and literature, the scientific literature, particularly randomized
an increased vitamin D levels following supplementa- controlled trials (RCTs), is notably lacking. There is a dearth
tion.113 (See Table 3) of studies examining the impacts of widely recommended
dietary approaches, such as the Paleolithic or vegetarian di-
PSORIASIS ets. This limited body of research on the relationship be-
tween diet and psoriasis highlights a significant knowledge
Psoriasis is a chronic inflammatory skin disorder with nu- gap, making it challenging for both patients and clinicians
merous subtypes,114 most commonly plaque psoriasis to engage in informed discussions on this subject.128 Below
which is characterized by well-demarcated erythematous are the top dietary interventions and supplements reported
plaques with silvery scaling on extensor surfaces, trunk, in literature.
and the scalp. Psoriasis appears with a similar frequency
in both men and women with a mean onset age of 33
HYPOCALORIC DIETS
years, although studies indicate that it may present earlier
in women.115 As there is no known cure for psoriasis and
The association between obesity and psoriasis is well-doc-
given the complex nature with a multifaceted origin that
umented. Studies have found a correlation between ele-
is influenced by both genetic and environmental factors,114
vated levels of obesity-related adipokines, such as leptin,
dietary intervention may be a potential therapeutic option
and a higher risk of developing psoriasis. Moreover, indi-
to explore to alleviate symptoms.116
viduals with psoriasis are more likely to be obese compared
Journal of Integrative Dermatology 17
Role of dietary intervention in the management of selected skin diseases: A systematic review
Table 3. Hidradenitis Suppurativa Studies
Study Level of Design Description Intervention/ Main outcome Results/Data pertaining to HS Discussion
Reference Evidence exposure and measures
comparison
group (if
applicable)
79 IV Cross-sectional study Disease severity, Higher adherence to a Mediterranean diet was associated with lower The MD could be
with 221 patients with Hurley, and IHS4 disease activity, lower self-reported Hurley and lower IHS4 an appropriate
HS, explored potential (International (International Hidradenitis Suppurativa Severity Score System) dietary pattern for
association between Hidradenitis patients with HS
adherence to a Suppurativa due to its anti-
Mediterranean diet, Severity Score inflammatory
physical activity and HS System) properties, and
severity combining this
with increased
levels of physical
activity could have
additional benefits
80 IV Case-control with 35 35 patients Disease severity HS patients showed a significantly lower adherence to the Although
patients with HS, 35 with HS, 35 (via Hurley stage Mediterranean diet than that of controls. Hidradenitis patients nutritional factors
healthy subjects, healthy system or showed significantly higher values of body mass index, waist and lifestyle can be
evaluated several subjects Sartorius score) circumference, body composition, fat mass, and lower values of important and
anthropometric physical and mental health status compared to controls, while both modifiable factors
measures, lifestyle groups showed a similar moderate physical activity level which can be in the hidradenitis
(Mediterranean diet assumed to counteract the negative effects of obesity or poor suppurativa
adherence, and physical nutritional pattern in hidradenitis patients. However, none of the course, the
activity level) and the evaluated variables were correlated with the severity of the disease, detrimental effect
perceived physical and assessed by means of the Hurley stage system or the Sartorius score. of chronic
mental health status Instead, the Sartorius score showed a positive correlation with the inflammation and
were evaluated duration of hidradenitis, mainly imputable to the diagnostic delay and delayed
the consequent long lasting inflammatory status management are
clearly prevalent
and heavily
influence the
disease burden
88 IV Studied 12 patients who Clinical Diet demonstrated stabilization of clinical symptoms; skin lesions Surgery followed
underwent surgical symptoms, skin regressed over the 12-month treatment period. Similarly, all the by the elimination
excision or localized lesion patients demonstrated an immediate recurrence of skin lesions of the foods
treatments followed by regression or following accidental or voluntary consumption of beer or other foods containing or made
diet modification recurrence containing brewer’s yeast or wheat with the yeast
(controlled brewer's resulted in a rapid
yeast-free diet for 12 stabilization of the
months) dermatologic
manifestation and
Journal of Integrative Dermatology 18
Role of dietary intervention in the management of selected skin diseases: A systematic review
a slow, but
complete,
regression of the
skin lesions within
a year
89 IV 185 patients with a self- Yeast- HS In the diet group, 70% had an improvement of HS symptomatology. Stabilization and
evaluative exclusion diet symptomatology 87% of patients demonstrated an immediate recurrence of skin regression of
questionnaire; 37 followed by lesions less than a week after consuming a food containing the yeast hidradenitis
treated following a operative suppurativa with
protocol (yeast- intervention protocol diet,
exclusion diet followed compared presumably by
by operative with decreasing the
intervention) and 148 members of a local and systemic
were members of a support inflammation,
support group for group for leading to a less
patients with HS treated patients with invasive operative
by other centers HS treatment. These
new findings seem
to link hidradenitis
suppurativa to
food intolerance
and gut dysbiosis
90 IV Multicenter, 122 patients Disease severity, Low serum zinc levels were associated with Hurley III, Dermatology Low serum zinc
prospective clinical and with HS Dermatology Life Quality Index ≥ 9, number of affected sites ≥ 3, genital location, levels are more
analytical case–control compared to Life Quality and perineal location prevalent in HS
study with 122 patients 122 control Index, affected than in a healthy
with HS and 122 control subjects sites population, an
subjects was designed indicator that may
to assess the possible also be associated
association between HS with disease
and serum zinc levels severity
91 IV 22 patients treated with Clinical There was a clinical response with zinc gluconate in all patients, with Zinc salts could
90 mg of zinc gluconate response 8 complete remissions (CR) and 14 partial remissions (PR) provide a new
per day therapeutic
alternative for the
treatment of
hidradenitis
suppurativa
92 IV 92 patients with Hurley 47 patients Number and There was a significant reduction in the number and mean duration of Zinc and
stage I and III HS were treated with duration of acute flares in the treated versus control groups. Patients of the nicotinamide
evaluated, divided into 2 oral zinc acute flares, treated group correspondingly reported a marked reduction in mean supplementation in
groups according to gluconate VAS, Visual Analogue Scale, Dermatology Life Quality Index, and patients who have
treatment received or and Dermatology International HS Severity Score System scores compared with the previously been
not received. 47 nicotinamide Life Quality control group at 12 and 24 weeks. Disease-free survival was treated with
Journal of Integrative Dermatology 19
Role of dietary intervention in the management of selected skin diseases: A systematic review
patients started oral compared to Index, significantly longer in the treated group, and it showed sustained tetracyclines
therapy with capsules a control International HS improvement even after discontinuation of oral supplementation. (minocycline) may
containing 90 mg of zinc group of 45 Severity Score Slightly decreased or stable International HS Severity Score System be a valuable and a
gluconate and 30 mg of patients who System score and pain Visual Analogue Score during the maintenance well-tolerated
nicotinamide once daily did not treatment was collaterally observed in the treated group with no maintenance
for 90 days, compared receive any statistically significant difference at 24 weeks approach for mild
to a control group of 45 treatment to moderate HS,
patients who did not extending the
receive any treatment disease-free
survival reducing
the rate and
duration of flares
93 IV To evaluate the efficacy Modified HS After 3 months of combination therapy, The combination
of anti-inflammatory score and The modified HS Score and the Dermatology Life Quality Index therapy of zinc
oral zinc gluconate, 90 Dermatology improved significantly. The number of inflammatory nodules, new gluconate and
mg/day, combined with Life Quality boils or flare-ups, and erythema scores decreased significantly. Fistula topical triclosan
topical triclosan, 2% Index, Number count and the visual analogue scale score showed no significant can be considered
twice daily in 60 of inflammatory difference as an anti-
patients with HS lesions, fistulas, inflammatory
visual analogue treatment for HS
scale patients in Hurley
stage I and initial
Hurley stage II
97 IV 14 patients Number of Supplementation significantly decreased the number of nodules at 6 Disease is
supplemented with nodules and months and the endpoints (20% decrease in number of nodules and associated with a
vitamin D evaluated for frequency of frequency of flare-ups) were achieved in 79% of patients major vitamin D
number of nodules and flare-ups deficiency,
frequency of flare-ups correlated with the
at 6 months disease severity. It
suggests that
vitamin D could
significantly
improve the
inflammatory
nodules, probably
by stimulating the
skin innate
immunity
Journal of Integrative Dermatology 20
Role of dietary intervention in the management of selected skin diseases: A systematic review
to those without the condition,130 and a higher body mass substantial reductions in their PASI scores when they main-
index (BMI) is associated with more severe psoriasis symp- tained a gluten-free diet for one year.149
toms.131,132 Importantly, obesity has been found to dimin- Psoriasis patients without serological markers for gluten
ish the effectiveness of psoriasis treatments by as much as sensitivity serum markers do not benefit from gluten-free
50%.133 These associations may be due to increased adi- diets.148
posity leading to heightened inflammation from overpro-
duction of proinflammatory cytokines such as TNF-α, IL-1, MEDITERRANEAN DIET
IL-6, and IL-8.134
Numerous RCTs have indicated that weight loss through The Mediterranean diet (MedD) promotes the consumption
hypocaloric diets is beneficial for individuals with psoriasis of healthy fats and plant-based foods, proving beneficial
who are classified as overweight or obese, which is defined for weight reduction.150 While there is no conclusive evi-
as BMI ≥ 25.0. When caloric restriction is implemented dence establishing a causal link between MedD and psoria-
in conjunction with pharmacologic therapies, these diets sis severity, numerous observational studies suggest a con-
lead to significant improvements in dermatology life qual- nection between poor adherence to MedD and increased
ity index (DLQI),135,136 psoriasis area and severity index PsO severity.151 Korovesi et al revealed that MedD adher-
(PASI),136‑138 body surface area (BSA),138 and weight loss ence is inversely associated with psoriasis risk, severity, and
compared to controls. Serum markers such as triglyc- quality of life,152 and Barrea et al’s case control study re-
erides,135,139 total cholesterol,135 plasma glucose, and gly- vealed that higher percentages of psoriatic patients had
cated hemoglobin also significantly decrease.140 Jensen et lower PREDIMED scores compared to control groups.153
al showed that the positive effects on PASI and BSA can last Similarly, the 2018 NutriNet-Santé Cohort study showed an
for one year.140 inverse relationship between MEDI-LITE score and severe
Dietary weight loss has been demonstrated to be bene- psoriasis.
ficial in conjunction with multiple systemic treatments, in- Furthermore, psoriatic arthritis has been inversely
cluding biologic therapies,138 cyclosporine,141 methotrex- linked to MedD adherence. A 2020 multicenter cross-sec-
ate,137 and psoralen ultraviolet A therapy (PUVA). This is tional study found a negative association between DAPSA
particularly important for individuals who have both obe- and MedD adherence154; Molina-Leyva et al reported that
sity and psoriasis, as they face an elevated risk of experi- the proportion of patients with PsA was lower in people
encing adverse effects from systemic medications. Weight with greater adherence to MedD.151 Randomized clinical
reduction not only enhances the treatment effectiveness trials are needed to establish the role of MedD in psoriasis.
but also reduces the likelihood of drug toxicity.142
However, weight reduction alone may not be sufficient PSORIASIS AND SUPPLEMENTS
to maintain psoriasis remission. In one RCT, patients in re-
mission for 12+ weeks on methotrexate therapy were ran- In the era of biologics, there is an increasing prevalence of
domly assigned to receive a hypocaloric diet or free diet af- complementary and alternative medicine (CAM) use among
ter discontinuing their methotrexate. The outcome of this psoriatic patients,155 and CAM use is high compared to
study revealed no significant difference between these two controls.156 Common dietary supplements include fish oils,
groups in terms of maintaining psoriasis remission.143 vitamin D, vitamin B12, and selenium.157
Although many patients believe that fish oil is helpful
GLUTEN-FREE DIET to improve their skin health,128 the results from double-
blinded RCT are mixed.158‑167 Many of the RCTs were con-
Gluten-free diets have gained popularity in recent decades, ducted in the 1980s-1990s and utilized less objective mea-
and evidence suggests that this may benefit some psoriasis sures or controls. Meta-analyses of RCTs yield similarly
patients. Celiac disease (CD) and psoriasis are hypothesized controversial findings.168‑170 Additional well-controlled
to have a bidirectional relationship, where people with pso- and randomized studies are needed to confirm the relation-
riasis have a higher odd of CD and vice versa.144,145 Psori- ship between fish oil and psoriasis.
asis patients were observed to have elevated levels of IgA Vitamin D is a popular supplement among patients.128
antigliadin antibodies (AGA), which are frequently utilized There is an increased prevalence of vitamin D deficiency in
in diagnosing celiac disease, and increased antibody levels psoriatic patients compared to the general population,171
are linked to more severe psoriasis.146 and vitamin D deficiency has been correlated with worse
Studies indicate that gluten-free diets may be helpful for psoriasis severity.172 Topical vitamin D is a well-established
patients with CD or serologic markers of gluten sensitivity. component of psoriasis treatment, but the benefit of oral
Adopting a gluten-free diet not only leads to a reduction vitamin D is unclear.173 RCT results are mixed, but open-
in the severity of psoriasis but also alleviates gastrointesti- label trials have shown beneficial results.174‑177 A 2021
nal symptoms.147 In psoriasis patients with AGA antibod- meta-analysis reports a lack of significant evidence for oral
ies, a 3-month adherence to a gluten-free diet resulted in vitamin D supplementation and concludes that additional
significant improvements in PASI scores, and symptoms re- RCTs with larger sample sizes are needed to yield more con-
bounded to pre-diet scores in 60% of patients after re- clusive data.178
suming a normal diet.148 Kolchak et al demonstrated that Vitamin B12 deficiency has been reported in psoriasis
individuals with higher AGA antibodies experienced more patients.179,180 However, limited studies have investigated
Journal of Integrative Dermatology 21
Role of dietary intervention in the management of selected skin diseases: A systematic review
the efficacy of intramuscular B12 injections in psoriasis duced protection.200 A compromised gut barrier is believed
treatment. A 2001 intra-individual trial suggested that B12 to permit the increased passage of antigens from ingested
and avocado oil may be beneficial for long-term therapy.181 contents and lead to an inflammatory response.201 Elevated
In contrast, Baker and Comaish’s double-blinded RCT re- intestinal permeability has been linked to more severe
vealed no statistically significant benefit of vitamin B12 in- cases of atopic dermatitis (AD).202,203
jections compared to placebo.182 Microbiota alterations have been associated with AD.
Selenium has been found to prevent ROS damage, reduce Skin dysbiosis is mediated through increased concentra-
cell proliferation, and catalyze apoptosis in ker- tions of Staphylococcus aureus during flares, which disrupts
atinocytes.183 Decreased selenium levels have been re- normal microbiota and reduces commensal bacteria.204,205
ported in psoriatic patients,184‑186 and selenium supple- While the association between gut microbiome diversity
mentation appears to yield varying results in patients with and the onset of AD is inconclusive, individuals with AD
different psoriasis subtypes. Kharaeva et al’s double- tend to exhibit higher proportions of Clostridium difficile,
blinded RCT reported that coenzyme Q(10) 50 mg/d, vit- Escherichia coli, and Staphylococcus aureus in the gut micro-
amin E 50 mg/d, and selenium 48 mug/d dissolved in soy biome compared to healthy controls. Conversely, there is a
lecithin for 30-35 days resulted in significantly decreased decrease in Bacteroides, Bacteroidetes, and Bifidobacteria.206
psoriasis severity compared to soy lecithin controls.187
However, selenium did not demonstrate benefit in plaque ATOPIC DERMATITIS AND DIETS
psoriasis management when used as monotherapy or adju-
vant therapy with 5% salicylic acid ointment or photother- ELIMINATION DIETS
apy.184,187‑189 (See Table 4).
In recent decades, there have been ongoing discussions re-
ATOPIC DERMATITIS volving around the influence of food triggers and elimina-
tion diets on AD. The prevalence of food allergies in pa-
Atopic dermatitis (AD), commonly referred to as eczema,
tients with AD has been reported to be as high as 50.7%.207
is a persistent and recurring inflammatory skin condition
A significant portion of atopic dermatitis (AD) patients re-
that constitutes part of the “atopic triad” (atopic dermati-
port restricting specific foods they suspect might be causing
tis, asthma, and allergies). Globally, it is estimated that AD
reactions, hoping that modifying their diet will alleviate
impacts approximately 3.4-33.7% of the population, with a
symptoms. Up to 75% of AD patients have tried dietary
higher prevalence among women.190 The increasing preva-
modifications to manage their disease, with only half seek-
lence over the past decades suggests a potential connection
ing prior consultation from a healthcare professional or di-
to environmental factors triggering the condition in predis-
etitian.208,209
posed individuals.191‑194 Diet is proposed as a significant
Numerous studies have explored potential food-related
factor in triggering AD, alongside other environmental ex-
risk factors for the development of atopic dermatitis (AD)
posures like pollution, UV radiation, and climate.193,195 In
or triggers for its symptoms. In a study using the Korean
addition, diet modifications have been proposed as strate-
National Health and Nutrition Examination Survey, Park
gies to ameliorate flares or prevent disease. Here, we exam-
et al reported that the consumption of meat, instant noo-
ine the existing literature regarding the impact of diet on
dles, and processed foods was linked to an increased preva-
AD.
lence of AD.210 Similarly, Lim et al found a strong associ-
ation between a high intake of burgers and fast food and
EPITHELIAL DYSFUNCTION AND DYSBIOSIS
an elevated risk of chronic and severe AD, while an in-
AD pathogenesis is associated with a dysfunctional skin creased consumption of fruits and vegetables was asso-
barrier. Loss-of-function mutations in the FLG gene result ciated with a reduced risk.211 In a 2017 survey focusing
in impaired filaggrin, a crucial protein that links keratin on patient-reported outcomes in dietary modifications, the
filaments and interacts with lamellar bodies, consequently most commonly trialed dietary modifications included junk
compromising the skin barrier function.196 Filaggrin-poor foods (68%), dairy (49.7%), and gluten (49%). Notably, the
skin is believed to facilitate greater allergen penetration, most significant skin improvement occurred when remov-
thereby heightening allergen sensitivity.197 Various case- ing white flour products (53.6%), gluten (51.4%), and night-
control studies have indicated that mutations in filaggrin shades (51.4%).212
are linked to an elevated risk of developing egg or peanut Studies on gluten intolerance and gluten-free diets in
allergies.198,199 Eczematous skin lesions additionally dis- AD have yielded inconsistent results. A cross-sectional
play increased dendritic cells, which express high-affinity study found that AD was associated with a significantly
receptors for IgE that facilitate allergen uptake. Increased higher prevalence of celiac disease on multi-variate analy-
receptor expression has been associated with greater lesion sis.213 However, a cohort study did not find a significant
severity.196 association between amount of dietary gluten intake and
Similar to the skin, the intestinal epithelium is integral atopic dermatitis in adult women.214 Similarly, in a ques-
to the innate immune system, safeguarding the body tionnaire study between celiac and non-celiac controls,
against environmental threats. The gastrointestinal tract there was no significantly increased risk of AD among celiac
can share analogous “leaky” characteristics with skin ep- patients. However, celiac patients with AD most frequently
ithelium, characterized by heightened permeability and re- reported positive responses from gluten-free diets.215 Ap-
Journal of Integrative Dermatology 22
Role of dietary intervention in the management of selected skin diseases: A systematic review
Table 4. Psoriasis Studies
Study Level of Design Intervention/exposure Main outcome Results/Data pertaining to Psoriasis Discussion
Reference Evidence Description and comparison group (if measures
applicable)
117 I Systematic review N/A Weight loss Weight loss following lifestyle interventions improves Weight loss can improve
and meta-analysis interventions, psoriasis compared with controls (p < 0.001). 3 studies pre-existing PsO and
of 6 RCTs PsO/PsA in obese on pharmacologic interventions yielded conflicting PsA, as well as prevent
patients results. 2 cohort studies suggested that gastric bypass the development of PsO
reduces the risk of developing psoriasis (p < 0.01) in individuals with
obesity
119 II RCT of 44 obese Energy-restricted diet (20 PASI, DLQI, body Data was measured at baseline, 3 months, and 6 In PsO patients with
patients with kcal/kg/ideal body weight/ weight, WC, months. PASI, itch scores, and DLQI decreased obesity, an energy-
plaque PsO day) with n-3 PUFAS (2.6 laboratory results significantly compared with baseline (p < 0.05). Among restricted diet with
g/day) or usual diet. All (serum patients with an energy-restricted diet, a significant immuno-modulating
patients continued their triglycerides, decrease in body weight, waist circumference, serum therapy improved
immuno-modulating serum total triglycerides, serum total cholesterol, and n-6/n-3 clinical outcomes and
therapy throughout the cholesterol, n-6/ ratio intake occurred (p < 0.05). No significant changes improved metabolic
duration of the RCT n-3 ratio) were observed among controls. profiles
120 II RCT of 60 Intervention group PASI, DLQI At week 16, mean weight loss was greater in In PsO patients who are
overweight/obese completed energy- intervention group compared with controls (p < overweight, an energy-
patients with restricted diet (800-1000 0.001). Mean differences in PASI (p = 0.06) and DLQR restricted diet improved
psoriasis kcal/day) for 8 weeks, (0.02) were greater in energy-restricted diet group PASI scores and reduced
followed by 8 weeks of compared with controls DLQI.
1200 kcal/day. Control
group continued ordinary
healthy foods
121 II RCT of 303 20-week dietary plan + PASI Mean PASI reduction was greater in dietary In systemically treated
overweight/obese physical exercise for intervention arm than information-only arm (p = 0.02), PsO patients who are
patients with weight loss, or simple and PASI scores reduction ≥ 50% was more frequent overweight/obese, a
plaque psoriasis counseling about utility of in the intervention group (p = 0.006). Weight-loss 20-week dietetic
who did not weight loss for controlling target (≥ 5% from baseline) was achieved more intervention with
achieve clearance psoriatic disease frequently in the dietary intervention arm (p = 0.001). increased physical
after 4 weeks of exercise reduced PsO
systemic therapy severity
122 II RCT of 262 Low-calorie (≤ 1000 kcal/ PASI Mean weight loss and PASI score improvement was Weight reduction in
overweight/obese day) or normal diet for 24 greater in dietary intervention arm than controls. PASI obese PsO patients on
patients with weeks 75 was achieved more frequently in the diet group (p < biologic therapy may
psoriasis on 0.001), and mean BSA was lower in the diet group increase drug efficacy
biologic therapy compared with controls
123 II RCT of 60 men Low calorie diet + exercise PASI, weight, BMI, Low calorie diet group had significant improvement in For male patients with
with class I + immunosuppressive WC, laboratory all measured variables, including: BMI, waist chronic plaque psoriasis
obesity, chronic drugs or results circumference, AST, ALT, triglycerides, PASI, and and non-alcoholic fatty
Journal of Integrative Dermatology 23
Role of dietary intervention in the management of selected skin diseases: A systematic review
plaque psoriasis, immunosuppressive drugs (triglycerides, liver DLQI). No significant improvements were achieved in liver disease, dietary
and non-alcoholic only for 12 weeks enzymes), DLQI control group interventions control
fatty liver disease BMI, increase psoriasis
responsiveness to
immunosuppressive
therapy, improves
quality of life, controls
hepatic enzymes, and
reduces triglycerides.
124 II RCT of 32 Two phases: low-energy PASI, DLQI PASI, DLQI, and weight were reduced after the Long-term weight loss in
patients with diet or control phase for 16-week low energy diet period. At week 64, there patients with psoriasis
psoriasis 16 weeks, followed by was an average regain in weight compared with week reduced psoriasis
weight maintenance for 48 16, but PASI and DLQI were maintained severity
weeks
125 II RCT of 61 obese Cyclosporine + low-calorie PASI At week 24, the mean body weight reduction and PASI For obese patients with
patients with diet or cyclosporine alone) 75 response was greater in the intervention group moderate-to-severe
chronic plaque for 24 weeks compared with controls (p < 0.001). More patients psoriasis, response to
psoriasis from the control group withdrew from the study low-dose cyclosporine
compared with the intervention group (p < 0.001) was increased if low-
calorie diet is included in
the treatment regimen
127 II Questionnaire to Hypocaloric diet or free Questionnaire, Most patients believed that a dietary modification can Weight reduction only
200 patients with diet for 24 weeks, with body weight, PASI influence psoriasis. Obese patients in psoriasis may be insufficient for
moderate-to- subsequent follow-up for remission had significant body weight reduction after maintaining remission
severe chronic 12 weeks 12 weeks, which was maintained at 24 weeks. No for moderate-to-severe
plaque psoriasis significant differences in maintenance of psoriasis psoriasis in obese
about perception remission were observed patients
of diet on
psoriasis severity.
RCT of 42 obese
patients with PASI
75 ≥ 12 weeks
after
methotrexate
therapy
131 IV Multicenter N/A Celiac screening; More PsO patients had positive anti-tissue There is a high
cross-sectional positive celiac transglutaminase antibodies compared with controls prevalence of CD in
study of 218 PsO serology prompted (p < 0.05). CD diagnosis was confirmed histologically psoriasis, and GFD can
patients and 264 histologic in all patients with positive antibodies. A 6-month improve skin lesions in
controls evaluation GFD was associated with significantly improved skin CD and psoriasis
lesions in the patients with celiac and psoriasis
132 III Cohort study of 3-month GFD + 3 months PASI, duodenal AGA-positive PsO patients had significantly decreased AGA-positive PsO
33 AGA-positive of ordinary diet biopsy histology mean PASI following GFD, whereas AGA-negative patients may improve on
Journal of Integrative Dermatology 24
Role of dietary intervention in the management of selected skin diseases: A systematic review
and 6 AGA- patients did not improve. When ordinary diet a GFD
negative PsO resumed, PsO symptoms resumed in 18/30 patients
patients with AGA who had completed the GFD
133 III Cohort study of Strict GFD for 2 years Gliadin IgA Patients who had high gliadin IgA antibodies were AGA positivity is
97 PsO patients + antibodies, PASI placed on a GFD without change to ongoing psoriasis significant among
91 healthy treatment. Psoriasis lesions improved in all patients, psoriatic patients who
controls with the most significant decline in PASI and reduction are not diagnosed with
in pharmacologic treatment in patients with strongly celiac disease or gluten
positive gliadin IgA sensitivity, and AGA
testing can identify
patients who may
benefit from GFD
135 IV Cross-sectional N/A PREDIMED Higher adherence to MedD is asssociated with Mediterranean diet
study of 89 compared with reduced psoriasis severity. Higher frequency of should be implemented
psoriasis patients severity of hypertension, diabetes, and large waist were observed for PsO patients as part
psoriasis, in patients with greater adherence to MedD of their ongoing
cardiovascular treatment
profile, and CRP
136 IV Cross-sectional N/A Med Diet Score, MedD diet was inversely associated with risk of There is an inverse
study of 69 mild- PASI, and DLQI psoriasis, PASI, and DLQI. PASI was inversely association between
to-severe correlated with fish, extra virgin olive oil, and legumes MeD dietary adherence
psoriasis and 69 while positively correlated with dairy products and psoriasis severity,
healthy matched occurance, and quality of
controls life
137 IV Cross-sectional N/A PREDIMED More psoriatic patients had lower PREDIMED scores There is an inverse
case-control compared with compared to controls. PASI score was positively association between
study of 62 mild- PASI, CRP, and associated with fat mass percentage and CRP, and MeD dietary adherence
to-severe PsO bioelectrical PASI and CRP were associated with PREDIMED and psoriasis severity.
patients and 62 impedance analysis scores. Extra virgin olive oil and fish consumption had Psoriatic patients had
matched controls for body inverse relationship with PASI and CRP levels significant differences in
composition body composition
compared with BMI-
matched controls, and
MedD dietary
interventions may be a
safe adjuvant treatment
138 IV Cross-sectional N/A DAPSA, CPDAI, DAPSA was negatively correlated with Mediterranean Since higher disease
study of 211 PsA BMI, and diet adherence and positively associated with BMI activity (DAPSA) is
patients PREDIMED correlated with MedD
dietary adherence, the
MedD diet may have a
potential anti-
inflammatory benefit
Journal of Integrative Dermatology 25
Role of dietary intervention in the management of selected skin diseases: A systematic review
142 II RCT of 20 Daily infusions with n-3 FA Clinical disease Disease severity significantly improved in all patients IV n-3 FA
hospitalized acute lipid emulsion (100 mL/day characteristics, of the n-3 group (p < 0.05), whereas moderate supplementation can
guttate PsO of 2.1 g eicosapentanenoic leukotrienes, and improvement was observed in the n-6 group. A ten- modulate eicosanoid
patients [EPA] and 21 g platelet-activating fold increase in 5-lipoxygenase products was observed metabolism and appears
docosahexaenoic acid factors in the n-3 group but not the n-6 group, whereas to rapidly benefit
[DPA]) or n-6 lipid emusion platelet activating factor generation decreased in the inflammatory skin
(EPA + DHA < 0.1 g/100 n-3 group but increased in the n-6 group lesions in acute guttate
mL) psoriasis
143 II RCT of 83 Daily infusions of n-3 FA Changes in PASI PASI score reduced more in the u-3 group than u-6 IV n-3 FA
hospitalized lipid emulsion and self- group (p < 0.05), as well as severity of psoriasis, supplementation can
chronic plaque- (omegavenous; 200 mL/ assessments by reduction in erythema, and scaling. Response was effectively treat chronic
type PsO patients day with 4.2 g of EPA and patient observed more frequently in u-3 than u-6 group. An plaque-type psoriasis
DHA)) or n-6 lipid increase in EPA concentration, leukotriene B5, and
emulsion (lipovenous; EPA thromboxane B3 generation occurred in the u-3 group
+ DHA < 0.1 gm/100 mL) but not then u-6 group
for 14 days
144 II RCT of 18 plaque Fish oil or placebo olive oil BSA, scaling, After phototherapy and 4 weeks later, the fish oil Given its safety and
PsO patients capsules for 15 weeks, erythema, group had a greater decrease in total BSA and greater health-promoting
with UVB in weeks 3-11 thickness improvement compared with patients in the olive oil features, fish oil could
for both groups group serve as an ideal
adjunctive therapy for
psoriasis treatment
145 II RCT of 28 PsO 10 fish oil or placebo olive BSA, scaling, In the fish oil group, there were significant reductions Fish oil may serve as a
patients oil capsules daily for 8 erythema, pruritus in itching, erythema, and scaling. No significant change treatment for psoriasis
weeks was observed in the placebo group
146 II RCT of 145 PsO 3 g n-3 PUFA/day or 3 g Disease activity, Compared with controls, the n-3 PUFA group had non- The n-3 PUFA group
patients olive oil/day for 24 weeks analgesic use, significant reductions Disease Activity Score showed improvement in
leukotriene (DAS28-CRP), 68 tender joint count, enthesitis score, outcome measures for
formation and PASI. There was significantly reduced NSAID and disease activity,
paracetamol usage compared with controls, and the although not statistically
n-3 PUFA group had reduced formation of leukotriene significant
B4 and higher formation of leukotriene B5 compared
with controls
147 II RCT of 38 PsA 12 Efamol Marine (evening Skin disease Skin disease activity measures were unchanged by the Efamol Marine may
patients primrose oil + fish oil) or activity (BSA, Efamol Marine, and NSAID requirements remained modify prostaglandin
placebo capsules daily for severity, pruritus), the same for both treatment and control groups. No metabolism in PsA
9 months, followed by NSAID usage, changes were observed in arthritis activity. In the patients, although it did
placebo capsules for 3 arthritis disease treatment group, a decrease in leukotriene B4 was not provide clinical
months. At month 3, activity (morning observed in the active phase, followed by a rise in benefit or reductions in
patients were instructed stiffness duration, serum leukotriene B4 and TXB2 during the placebo NSAIDs. A larger dose of
to reduce NSAID intake Ritchie articular phase essential FA may be
index, number of required
active joints, ESR,
Journal of Integrative Dermatology 26
Role of dietary intervention in the management of selected skin diseases: A systematic review
CRP)
148 II RCT of 145 6 g fish oil/day with 5 g of PASI; patient's In the fish oil group, serum phospholipids had an There was no significant
moderate-to- eicosapentaenoic and subjective increase in n-3 FA, decrease in arachidonic acid to difference between n-3
severe PsO docosahexaenoic acid or assessment of eicosapentaenoic acid, and decrease in n-6 FA. PASI FA and corn oil
patients corn oil with mostly n-6 erythema, iscaling, did not significantly change in both groups, although supplementation in PsO
FA. All patients were pruritus, and effect scaling was reduced in both. For the fish oil group, treatment. Increase in
instructed to reduce on daily living; there was no correlation between clinical serum n-3 FA was not
saturated FA intake selected 10-cm2 improvement and increased serum n-3 FA. For the correlated with clinical
area representing corn oil group, there was a correlation between improvement
moderate-to- clinical improvement and increase in eicosapentaenoic
severe psoriasis acid and total n-3 FA
evaluated for
erythema, scaling,
and cellular
infiltration
149 II RCT of 25 plaque 10 fish or olive oil capsules Total BSA, scaling, Most patients worsened after discontinuing steroids. Fish oil is minimally
PsO patients 3x daily for the whole erythema, There was no significant difference found between effective as a
study, in addition to thickness fish and olive oil groups through survival analysis monotherapy when used
betamethasone in high doses with
diproprioinate to their dietary control
psoriatic plaques for the
first 3 weeks. Study was
completed after 9 weeks
of capsules, or when global
severity score had
worsened to pre-
treatment level
150 II RCT of 145 10 g fish oil daily with 1.8 g PASI; patient's There were no significant differences in clinical Increased n-3 FA was
plaque PsO eicosapentaenoic acid or subjective manifestations in either group. For the fish oil group, not correlated with
patients isoenergetic amount of assessment of the amount of n-3 FA in serum phospholipids was clinical improvement in
olive oil for 8 weeks erythema, scaling, significantly increased at the end of the trial plaque psoriasis
pruritus, and effect
on daily living;
selected 10-cm2
area representing
moderate-to-
severe psoriasis
evaluated for
erythema, scaling,
and cellular
infiltration
151 II RCT of 43 PsA Seal or soy oil for 2 weeks. Joint pain intensity, The seal oil group had a significant improvement in Seal oil treatment was
patients Patients continued patient's global patient's global disease assessment 4 weeks post- followed by improved
NSAIDs and DMARDs assessment of treatment. Both groups had improved tender joint global assessment of
Journal of Integrative Dermatology 27
Role of dietary intervention in the management of selected skin diseases: A systematic review
during the study period disease, PASI, counts but the differences between groups was not disease. Serum FA
laboratory significant. The n-6 : n-3 FA ratio, arachidonic acid, and composition shifted
assessments eicosapentaenoic acid reduced after seal oil towards an anti-
inflammatory profile
152 I Systematic review PASI, erythema, u-3 FA had a significant reduction in PASI score, Current evidence
and meta-analysis scaling, pruritus erythema, scaling and correlated with higher dosage indicates that u-3 PUFA
of 10 u-3 PUFA of u-3 supplementation. Changes in itching and supplementation can
RCTs percentage of total body surface area were not improve PASI, erythema,
significant and scaling for psoriasis
patients
153 I Systematic review PASI 3 RCTs had usable data for meta-analysis. Fish oil Current evidence
and meta-analysis supplementation did not significantly reduce PUFA indicates that fish oil
of 13 u-3 PUFA supplements are not
RCTs beneficial for psoriasis
154 I Systematic review PASI, lesion, Fish oil monotherapy did not significantly change PASI, Current evidence
and meta-analysis pruritus pruritus, or lesion area. Fish oil/u-3 PUFAS in indicates that fish oil
of 18 u-3 PUFA combination with conventional treatments resulted in may have benefits on
RCTs reduced PASI and lesion area. Fish oil reduced risk psoriasis and its
factors for metabolic disease, cardiovascular disease, comorbidities when
and obesity while regulating inflammatory mediators combined with
conventional treatments
158 III Open-label study 3 groups: 1 alpha, Improvement was observed in all groups. The most Active vitamin D3
of 40 PsO hydroxyvitamin D3 orally rapid response was observed in Group 3, with metabolites may treat
patients 1.0 μgs/day for 6 months; improvement noted in 84% patients when applied for psoriasis lesions.
1 3.3 ± 1.2 weeks. No side effects were observed in any Psoriasis pathogenesis
alpha,25-dihydroxyvitamin groups may involve
D3 orally 0.5 μg/day for 6 abnormalities in vitamin
D metabolism or
months; or 1
response
alpha,25-dihydroxyvitamin
D3 topically 0.5 μg/g for 8
weeks
159 III Non-randomized Both patient groups PASI, Though all patients presented with low baseline High-dose vitamin D3
trial of 25 (psoriasis and vitiligo) repigmentation, 25(OH)D3, 25(OH)D3 levels increased significantly may be an effective
patients with received 35,000 IU laboratory after 6 months of treatment. PTH levels significantly therapy for psoriasis and
psoriasis or vitamin D3 daily with low- assessments decreased in both groups. PASI score improved vitiligo
vitiligo calcium diet for 6 months significantly in all 9 patients with psoriasis, and 14/16
vitiligo patients experienced 25-75% repigmentation
160 II RCT of 65 PsO 23 vitamin D3 100,000 IU PASI, Physicians There were no significant differences between the Vitamin D3
patients monthly or placebo for 12 Global Assessment intervention and control for all outcome measures supplementation at
months (PGA), DLQI, and 100,000 IU/month is not
PsO Disability an effective treatment
Index (PDI) for psoriasis
Journal of Integrative Dermatology 28
Role of dietary intervention in the management of selected skin diseases: A systematic review
161 II RCT of 41 PsO Vitamin D3 1 μg/day or Improvement was observed in both intervention (45% Vitamin D3
patients placebo patients) and control (38%) patients supplementation at 1
μg/day is not an
effective treatment for
psoriasis
162 I Systematic review PASI Vitamin D supplementation for 6 months was Vitamin D
and meta-analysis effective for reducing PASI. However, results became supplementation could
of 7 RCTs (4 non-significant after the Hartung-Knapp adjustment not be verified as a
qualitative treatment for psoriasis
analysis, 3
quantitative
analysis)
165 II RCT of 13 chronic Vitamin D3 analog PASI score, Both PASI and 20-MHz showed no significant Vitamin B12 cream with
plaque PsO calcipotriol or vitamin B12 subjective differences between treatments. Effects of avocado oil has potential
patients cream with avocado oil in evaluation of calcipotriol peaked within first 4 weeks and subsided. as a long-term and well-
intraindividual R/L- patient & Effects of B12 cream with avocado oil remained at tolerated topic therapy
comparison for 12 weeks investigator, and constant level throughout observation period, and for psoriasis
20-MHz patients & investigators assessed B12 cream with
sonography avocado oil as significantly better tolerated than
calcipotriol
168 II RCT of 69 PsO 600 μgs of selenium- Laboratory At baseline, psoriasis patients' mean concentrations of Psoriasis lesions may not
patients enriched yeast, 600 μgs of evaluations selenium were reduced compared to matched healthy experience any
(selenium controls, but red cell glutathione peroxidase (GSH-Px) improvement with
selenium-enriched yeast +
concentrations in activity was normal. After 12 weeks, the patients' selenium-enriched
600 IU vitamin E, or
whole blood and mean whole blood, plasma, and platelet selenium yeast, with or without
placebo for 12 weeks
plasma, red cell concentrations, platelet GSH-Px activity, and plasma vitamin E. This absence
glutathione vitamin E levels increased significantly. However, of improvement may be
peroxidase activity, mean skin selenium concentration and red cell GSH- attributed to the lack of
plasma vitamin E), Px activity were unchanged. Neither supplementation increased selenium
skin selenium group reduced the severity of psoriasis content in the skin
concentration, despite supplementation
psoriasis severity
171 II RCT of 58 PsO Groups EP1 and PsA1 Oxidative stress At baseline, patients had increased superoxide release Antioxidant
patients received coenzyme Q, markers, PASI, from granulocytes, increased copper/zinc-superoxide supplementation with
vitamin E, selenium with Severity Score (SS) dismutase and catalase activity in granulocytes in EP coenzyme Q, selenium,
soy lecithin for 30-35 days. patients and decreased in PsA patients, decreased and vitamin E may be
Groups EP2 and PsA2 copper/zinc-superoxide dismutase activity, and useful for managing
(placebo) received soy altered catalase activity in the psoriatic epidermis. severe psoriasis
lecithin Dietary supplementation resulted in improvement of
clinical conditions and faster normalization of
oxidative stress markers compared with controls
172 II RCT of 37 PsO Narrowband UVB 5x PASI, selenium, Baseline sTNF-R1 was correlated to PASI (p < 0.05). In active psoriasis
patients and 20 weekly and 200 mug sTNF-R1, and CRP Treatment resulted in nearly parallel decreases in PASI patients, levels of sTNF-
Journal of Integrative Dermatology 29
Role of dietary intervention in the management of selected skin diseases: A systematic review
healthy controls selenium daily or placebo in both groups R1 and CRP and
for 4 weeks increased.
Selenomethionine
supplementation for 4
weeks is ineffective for
psoriasis
173 II RCT of 22 Topical 5% salicylic acid PASI, selenium, There was a positive correlation between PASI and Increased sTNF-R1 may
inpatient plaque ointment, 0.1-0.3% sTNF-R1 sTNF-R1. Nearly complete remission of skin lesions indicate active psoriasis.
PsO patients and dithranol ointment, and was achieved in both psoriasis groups after 4 weeks, Selenomethionine
10 healthy 200 μgs daily of but PASI score was higher in the intervention group (p supplementation was
controls selenomethionine or < 0.05). Correlation between PASI score and TNF-R1 ineffective for plaque
placebo for 4 weeks reversed psoriasis and may
contribute to high TNF-
R1 despite skin lesion
remission
Journal of Integrative Dermatology 30
Role of dietary intervention in the management of selected skin diseases: A systematic review
propriate testing for adverse food reactions is important, changes were accompanied by visible improvements in skin
albeit challenging. Despite the frequent implementation of lesions.227
dietary changes, research indicates that 50-90% of patient-
perceived food reactions are not allergies.216 To minimize VEGETARIAN DIET
subjective influences on observed outcomes, double-blind
placebo-controlled oral food challenges are the gold stan- Research evaluating the impact of vegetarian diets on AD
dard for diagnosing food allergies.216 Patients are recom- has yielded conflicting results. A 2023 questionnaire study
mended to avoid food triggers if true IgE-mediated allergies involving young adults from Singapore and Malaysia (aged
are found.217 19-22, n = 13,561) found a negative association between
Historically, empiric elimination diets were proposed as moderate-to-high intake of plant-based foods with chronic
a beneficial approach to diminish AD flare-ups. However, or moderate-to-severe AD.228 Conversely, a 2022 Dutch
more recent studies and guidance documents have increas- questionnaire study (n = 56,896) found no associations be-
ingly discouraged the use of elimination diets. A 2008 tween AD and physical activity, diet quality, and vegetarian
Cochrane review noted some benefits in employing an egg- or vegan diets. Interestingly, the Dutch study reported a
free diet for infants with suspected egg allergies and pos- positive association between moderate-to-severe AD and
itive IgEs to eggs. Nevertheless, limited evidence supports Class I obesity, a condition linked with dietary factors.229
the use of exclusion diets in individuals with atopic eczema, In 2001, Tanaka et al conducted an open-trial study on
possibly due to the absence of true food allergies to the the effects of a standardized vegetarian diet on AD im-
excluded foods.218 Excessively restrictive diets have led to provement, utilizing the SCORAD method for symptomatic
nutritional deficiencies and malnutrition.219 Unnecessary changes while measuring serologic and immunologic para-
food elimination diets may lead to iatrogenic food allergies, meters (n = 20). Following a two-month treatment period,
causing the emergence of new IgE-mediated sensitivities to significant reductions were observed in the SCORAD index,
previously tolerated foods and posing the risk of anaphy- LDH5 activity, and peripheral eosinophils. Moreover, there
laxis.220 was a significant decrease in PGE2 production from
mononuclear cells, although serum IgE levels remained un-
OBESITY AND WEIGHT REDUCTION changed.230
In 2017, Nosrati et al conducted a cross-sectional survey
There is a growing body of literature suggesting a reciprocal investigating dietary modifications, perceptions, and pa-
relationship between obesity and AD. Both conditions ex- tient-reported outcomes among individuals with AD. The
hibit common pathologic features, including inflammation, findings revealed that 79.9% of patients incorporated new
insulin resistance, and leptin resistance.221 Obesity has foods into their diets. Of the 63 respondents (37.3%) who
been shown to predispose individuals to AD development reported trialing a specific diet, the most implemented di-
and worsen AD symptoms, whereas AD is associated with ets were a gluten-free diet (n = 25, 39.7%), vegetarian diet
an increased risk of obesity.221‑224 Furthermore, obesity is (n = 17, 27%), and Paleo diet (n = 11, 17.5%). The most
linked to heightened resistance to anti-inflammatory treat- frequently added items were vegetables (62.2%) and fruits
ments.225 (57.8%), and the greatest improvement in skin occurred
Existing literature indicates that weight reduction can when adding vegetables (40/84, 47.6%) and organic foods
alleviate AD symptoms. In 2020, Jung et al conducted a (17/43, 39.5%).212
prospective randomized controlled study focusing on the Intrauterine sensitization and exposure during preg-
therapeutic effects of weight loss and serum adipokine lev- nancy has been suggested to influence the early develop-
els in AD. Obese patients (BMI > 25 kg/m2, n = 20) were ran- ment of immune systems in infants, thereby playing a role
domly assigned to either weight maintenance and weight in the etiology of childhood allergic diseases.231,232 Con-
reduction groups, while non-obese (n = 20) AD patients sequently, studies have been conducted to evaluate the ef-
served as controls. Significantly different serum adipokine fects of maternal diets on the development of AD during
levels were observed between obese and non-obese pa- childhood. In 2023, Su et al reported that children of moth-
tients, and there was a positive correlation between AD ers who adhered to a vegetarian diet during pregnancy ex-
severity (EASI score) and pruritus visual analog score (VAS). hibited a reduced risk of developing AD before reaching 18
BMI and EASI also exhibited a positive correlation, and months of age (OR 0.65, 95% CI 0.45-0.93, p = 0.018).233
weight reduction decreased EASI scores among obese AD Long-term follow-up studies are needed to better charac-
patients.226 terize the impact of a mother’s diet on allergic conditions.
Similarly, a 2018 case report highlighted how dietary
control and exercise contributed to symptomatic improve- ATOPIC DERMATITIS AND SUPPLEMENTS
ment in a patient with refractory symptoms despite one-
year treatment with antihistamines, topical steroid, and Probiotics have been suggested for AD management based
cyclosporine. After 12 weeks, the patient’s BMI reduced on observations of distinct differences in the intestinal mi-
from 26.81 kg/cm2 to 20.64 kg/cm2, waist circumference de- crobiota between individuals with and without AD. How-
creased from 82 cm to 65 cm, EASI score decreased from ever, studies have found mixed evidence to support their
16.8 to 6.6, and VAS score decreased from 7 to 4. These use as a treatment. Recently, a 2022 meta-analysis sug-
gested that use of probiotics decreased Scoring Atopic Der-
Journal of Integrative Dermatology 31
Role of dietary intervention in the management of selected skin diseases: A systematic review
matitis scores significantly in adults with atopic dermati- etary intervention as a potential adjunct treatment, it is im-
tis.234,235 portant to first ask patients about their individual needs as
Fish oil has additionally been suggested for AD manage- well as their attitudes/perceptions towards use of dietary
ment, as essential fatty acid deficiencies were postulated to intervention in the management of their skin disease. Der-
be a factor involved in AD pathogenesis.236 Mendelian ran- matologists should recommend evidence-based dietary reg-
domization studies have indicated an association between imens and take an interdisciplinary approach, involving a
lower levels of n-3 fatty acids and a reduced risk of AD.237 dietician if deemed necessary along with setting realistic
Nevertheless, randomized controlled trials have produced expectations for patients.
varying outcomes, underscoring the need for larger and
more robust studies on the role of oral fatty acid supple-
mentation in AD.238
Hempseed oil, recognized as a source for omega-6 and ACKNOWLEDGEMENT
omega-3 PUFAs, has been evaluated for possible benefits
in AD. In a randomized single-blinded crossover study, 20 None.
adults (aged 25-60 years) were allocated to either the
DISCLOSURES
hempseed oil or olive oil (placebo) groups. Results revealed
improvements in skin dryness and itchiness, reduced usage
Ms. Shah, Ms. Chang, Ms. Tran, and Ms. Sadur have no
of dermatologic medications, and decreased skin transepi-
conflicts of interest. Dr. Choudhary is a speaker at Regen-
dermal water loss in the hempseed oil group. Furthermore,
eron Sanofi speaker bureau. Dr. Lio reports being on the
essential fatty acids such as linoleic acid, alpha-linolenic
speaker’s bureau for AbbVie, Arcutis, Eli Lilly, Galderma,
acid, and gamma-linolenic acid increased in the hempseed
Hyphens Pharma, Incyte, La Roche-Posay/L’Oréal, Pfizer,
oil group, without a corresponding increase in arachidonic
Pierre-Fabre Dermatologie, Regeneron/Sanofi Genzyme,
acid.239 Larger randomized controlled trials are needed to
Verrica; reports consulting/advisory boards for Alphyn Bi-
evaluate the potential benefits of hempseed oil in treating
ologics (stock options), AbbVie, Almirall, Amyris, Arcutis,
AD. (See Table 5).
ASLAN, Bristol-Myers Squibb, Burt’s Bees, Castle Bio-
sciences, Codex Labs (stock options), Concerto Biosci (stock
CONCLUSION options), Dermavant, Eli Lilly, Galderma, Janssen, LEO
Pharma, Lipidor, L’Oréal, Merck, Micreos, MyOR Diagnos-
Overall, the promising yet limited body of literature regard- tics, Regeneron/Sanofi Genzyme, Sibel Health, Skinfix,
ing dietary intervention and its effects on symptom severity Suneco Technologies (stock options), Theraplex, UCB,
and management of inflammatory skin diseases including Unilever, Verdant Scientific (stock options), Verrica, Yobee
psoriasis, atopic dermatitis, hidradenitis suppurativa, and Care (stock options). In addition, Dr. Lio has a patent pend-
acne vulgaris suggests a positive outlook for its use as a pri- ing for a Theraplex product with royalties paid and is a
mary or adjuvant treatment modality for these selected skin Board member and Scientific Advisory Committee Member
diseases. We conclude that dietary intervention may be an emeritus of the National Eczema Association. This study
effective treatment for reducing symptom severity related received no funding.
to skin disease. Future studies should compare dietary in-
tervention versus placebo for selected skin diseases to es- CONTRIBUTION STATEMENT
tablish more robust associations.
This paper highlights an exciting topic of research with V.K.S contributed to idea curation, data curation, data
further prospective research necessitated by both commu- analysis, manuscript writing and reviewing. S.J.C. con-
nity and academic dermatologists. As such, small and tributed to data curation, data analysis, manuscript writing.
large-cohort randomized controlled trials are warranted in T.T. contributed to data curation, data analysis, manuscript
order to establish dietary intervention as a treatment op- writing. A.S. contributed to data curation, data analysis,
tion for dermatologists caring for patients with psoriasis, manuscript writing. P.A.L. contributed to manuscript re-
atopic dermatitis, hidradenitis suppurativa, and acne vul- viewing. S.C. contributed to idea curation and manuscript
garis. Subsequent research may focus on a personalized ap- reviewing.
proach to dietary intervention. Currently, use of Mediter-
ranean diet is one of the most evidence-based diets used as Submitted: April 25, 2025 PDT. Accepted: May 09, 2025 PDT.
an adjunct to medical therapy for management of inflam-
matory dermatoses. For dermatologists recommending di-
Journal of Integrative Dermatology 32
Role of dietary intervention in the management of selected skin diseases: A systematic review
Table 5. Atopic Dermatitis Studies
Study Level of Design Description Intervention/ Main Results/Data pertaining to Atopic Dermatitis Discussion
Reference Evidence exposure and outcome
comparison measures
group (if
applicable)
194 III Investigated association Atopic The meat and processed food pattern was associated Consuming instant
between dietary habits and AD dermatitis with a significantly higher OR for atopic dermatitis than noodles, meat and
in 17,497 adults in the the low consumption group. Increased atopic dermatitis processed foods was
2009-2011 Korean National was most closely associated with instant noodles, associated with increased
Health and Nutrition whereas the groups with high intake of rice and kimchi prevalence of atopic
Examination Survey (KNHANES) exhibited lower ORs compared to the low intake group dermatitis, whereas
consuming rice and
kimchi, and coffee was
associated with
decreased prevalence of
atopic dermatitis
195 III Association between the dietary Severity of A moderate Quality of Diet based on Glycaemic Index While genetic
intake of 16 food types and AD atopic Score (QDGIS) class was significantly associated with a components are well-
manifestations using Singapore/ dermatitis lower odd of AD and moderate-to-severe AD. A good established in their risks
Malaysia Cross-sectional QDGIS class was only significantly associated with a associated with increased
Genetics Epidemiology Study lower odds of chronic AD. Among high GI foods, frequent AD prevalence, there is
(SMCGES) population. Dietary consumption of burgers/fast food was strongly still a lack of a focus
habits profiles of 11,494 young associated with an increased risk of chronic and epidemiology study
Chinese adults were assessed by moderate-to-severe AD. Among low GI foods, increased associating dietary
an investigator-administered intake frequencies of fruits, vegetables, and pulses influence with AD
questionnaire decreased the odds of AD. Also identified significant
associations between frequent seafood, margarine,
butter, and pasta consumption with an increased odds of
AD despite them having little GI values
196 IV 169 AD patients were surveyed Skin Eighty seven percent of participants reported a trial of Since dietary
with a 61-question survey about improvement dietary exclusion. The most common were junk foods modifications are
dietary modifications, (68%), dairy (49.7%) and gluten (49%). The best extremely common, the
perceptions, and outcomes improvement in skin was reported when removing white role of diet in AD and
flour products (53.6%), gluten (51.4%) and nightshades potential nutritional
(51.4%). 79.9% of participants reported adding items to benefits and risks need to
their diet. The most common were vegetables (62.2%), be properly discussed
fish oil (59.3%) and fruits (57.8%). The best improvement with patients
in skin was noted when adding vegetables (47.6%),
organic foods (39.5%), and fish oil (35%)
198 III 63,443 participants, food Risk of atopic Increased gluten intake was not associated with Findings do not support
frequency questionnaires were dermatitis increased risk of AD the amount of dietary
used to calculate gluten content gluten intake as a risk
Journal of Integrative Dermatology 33
Role of dietary intervention in the management of selected skin diseases: A systematic review
of participants' diet every 4 factor for atopic
years (1995-2013) dermatitis in adult
women
210 IV 40 AD outpatients, obese Eczema Area In the weight reduction group, there was a significant Weight reduction was
patients divided into a weight and Severity improvement in the EASI score, however, no significant associated with
maintenance and weight Index (EASI) improvement was determined in the weight maintenance significant improvement
reduction group, collected data and visual group. BMI and EASI showed positive correlation of AD symptoms
including BMI, Eczema Area and analogue
Severity Index (EASI), and visual scale for
analogue scale for pruritus. pruritus
211 IV 20-year-old obese F with AD EASI, visual At first visit, body mass index (BMI) was 26.81 kg/cm2 Weight loss decreased
prescribed Lorcaserin 10 mg BID analogue (73 kg, 165 cm), waist circumstance was 82 cm, Eczema severity of AD
and exercise and followed for 12 scale for Area and Severity Index (EASI) score was 16.8, and visual
weeks recording BMI, waist pruritus, skin analogue scale (VAS) for pruritus was ‘7.’ After 12 weeks,
circumference, EASI, VAS for lesions on BMI was 20.64 kg/cm2 (56.2 kg), waist circumstance was
pruritus, and physical exam physical 65 cm, and symptoms had improved. EASI score was 6.6,
exam VAS was ‘4,’ and skin lesions improved
212 III Standardized questionnaire Atopic Moderate-to-high intake of plant-based foods conferred Frequent adherence to
following the International dermatitis a negative association for chronic and moderate-to- plant-based foods was
Study of Asthma and Allergies in exacerbation severe AD. Meat and rice and probiotics, milk and eggs associated with reduced
Childhood (ISAAC) guidelines were not significantly associated with AD exacerbation. risks for AD exacerbation
was investigator-administered While frequent adherence to high-calorie foods in young Chinese adults
to a clinically and epidemiology increased the associated risks for moderate-to-severe from Singapore/Malaysia.
well-defined allergic cohort AD, having a higher adherence to plant-based foods This provides the initial
of 13,561 young Chinese adults diminished the overall associated risks evidence to support the
aged 19–22. Four corresponding association between
dietary scores were derived to dietary factors and AD.
examine the association of Further research is
identified dietary patterns with needed to better
allergic sensitization and AD understand the
exacerbations mechanisms underlying
diet and AD
exacerbations
214 IV 20 patients with AD, evaluated Severity of After a 2-month treatment, the severity of dermatitis This treatment may be
SCORAD index and serological dermatitis was inhibited, as assessed by SCORAD index and useful for treatment of
and immunological parameters serological parameters including LDH5 activity and a adult patients with severe
after 2 months of treatment number of peripheral eosinophils. A sharp reduction in AD
with a certain vegetarian diet eosinophils and neutrophils was observed prior to
improvement in the skin inflammation. In addition, PGE2
production by peripheral blood mononuclear cells was
reduced by this treatment. In contrast, serum IgE levels
did not change during the same period
217 IV Case control using Taiwan Birth 408 mothers Risk of 292 (1.8%) mothers who adhered to lacto-ovo A vegetarian diet during
Journal of Integrative Dermatology 34
Role of dietary intervention in the management of selected skin diseases: A systematic review
Cohort Study database with following a developing vegetarianism and 116 (0.7%) mothers who adhered to pregnancy may lower the
4,200 mother–child pairs in the vegetarian AD veganism, totaling 408 (2.4%) vegetarians during risk of AD in children
database, 20,172 completed diet during pregnancy. Compared to children of nonvegetarian
face-to-face interviews at 6 and pregnancy mothers, children of mothers who followed a vegetarian
18 months. Employing a 1:10 compared to diet during pregnancy showed a lower risk of developing
matching strategy based on 4080 AD before 18 months of age
maternal age, education level, nonvegetarian
and child sex, 408 mothers who mothers
followed a vegetarian diet
during pregnancy were matched
with 4080 nonvegetarian
mothers. This resulted in a final
dataset of 4488 subjects.
223 II 20-week randomized single Fatty acid levels of both essential fatty acids (EFAs), linoleic acid Dietary hempseed oil
blind crossover study with profiles, skin and alpha-linolenic acid, and gamma-linolenic acid caused significant
atopic patients comparing dryness, increased in all lipid fractions after hempseed oil, with no changes in plasma fatty
dietary hempseed oil and olive itchiness, use significant increases of arachidonic acid in any lipid acid profiles and
oil, measuring fatty acid profiles of dermal fractions after either oil. Intra-group TEWL values improved clinical
and skin dryness, itchiness, medications, decreased, qualities of both skin dryness and itchiness symptoms of atopic
usage of dermal medications, TEWL improved and dermal medication usage decreased after dermatitis
and TEWL hempseed oil intervention
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Journal of Integrative Dermatology 35
Role of dietary intervention in the management of selected skin diseases: A systematic review
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