Dietary habits in Japanese patients with psoriasis and psoriatic arthritis: Low intake of meat in psoriasis and high intake of vitamin A in psoriatic arthritis

The role of diet in the management of psoriasis: a scoping review

Psoriasis is a chronic, systemic, immune-mediated, inflammatory skin disease associated with significant comorbidities. Globally, there are an estimated 60 million people living with psoriasis (PLwP). There is a growing body of evidence on the role of diet in psoriasis management, and demand for dietary advice is high. However, there are no specific, evidence-based dietary guidelines. This scoping review summarises the literature on use and effectiveness of diet in the management of psoriasis to improve understanding of the evidence and assist PLwP and healthcare professionals (HCPs) to discuss diet. The findings were categorised into three themes: (1) dietary intakes of PLwP, (2) the perceived role of diet in psoriasis management and (3) dietary approaches to manage psoriasis symptoms. In cross-sectional studies PLwP were reported to have higher fat and lower fibre intakes compared with controls, and lower psoriasis severity was associated with higher fibre intake. However, research is limited. PLwP perceive diet to have an impact on symptoms and make dietary modifications which are often restrictive. Systematic reviews and RCTs found certain dietary approaches improved symptoms, but only in specific populations (e.g. PLwP with obesity and PLwP with coeliac disease), and evidence for supplement use is inconclusive. The grey literature provides limited guidance to PLwP; focusing on weight loss and associated comorbidities. Larger, controlled trials are required to determine dietary approaches for psoriasis management, especially in PLwP without obesity and non-coeliac PLwP. Further understanding of diet modification, information acquisition and experiences among PLwP will enhance holistic care for psoriasis management.

Adherence to the Mediterranean diet in patients with psoriasis and its relationship with the severity of the disease: A case-control study

Background and Aim

Psoriasis is a prevalent chronic inflammatory skin condition, and the Mediterranean diet is often recommended for its health benefits, particularly its ability to mitigate chronic inflammation. This study sought to examine the extent to which psoriasis patients adhere to the Mediterranean diet and to explore its correlation with the severity of their condition.

Methods

Seventy-one psoriasis patients and 71 age- and sex-matched healthy controls were enrolled the study and filled a standard questionnaire of adherence to the Mediterranean diet. The relationship between disease severity and adherence to the diet was also dealt with.

Results

The Mediterranean diet adherence score in the psoriasis group (5.25 ± 1.64) was significantly lower than the control group (6.28 ± 2.10) (p = 0.004). In addition, the consumption of fruit and fish in psoriasis patients was significantly lower than the control group and the consumption of red meat was significantly higher in the patient group. No significant relationship was found between the severity of the disease and the score of adherence to the Mediterranean diet (p = 0.42).

Conclusion

A significant difference between the two groups of psoriasis and the control group following the Mediterranean diet might be indicative of the relationship between diet and psoriasis and the potential benefits of this type of diet due to its anti-inflammatory properties.

Oral Exposure to Low Concentration of Fumonisin B2, but Not Fumonisin B1, Significantly Exacerbates the Pathophysiology of Imiquimod-Induced Psoriasis in Mice

This study aimed to determine whether oral fumonisin exposure contributes to the development of psoriasis. Oral administration of fumonisin B1 (FB1, 0.1 mg/kg) or fumonisin B2 (FB2, 0.1 mg/kg) was conducted for 10 days, in addition to the induction of psoriatic symptoms through topical application of 5% imiquimod cream from day 6 to day 10 (5 days) in female BALB/c mice. The results demonstrated that oral administration of FB2 significantly exacerbated psoriatic symptoms, including skin thickness, itching behavior, transepidermal water loss, immune cell infiltration in the dermis, and proinflammatory cytokine production. However, no changes were observed following exposure to FB1. Our results confirm that oral exposure to FB2 adversely affects the pathogenesis of psoriasis by increasing skin thickness and impairing barrier function.

Psoriatic arthritis risk in psoriasis patients prescribed acitretin versus disease-modifying antirheumatic drugs: a nationwide cohort study

OBJECTIVES

To compare the risk of PsA in psoriasis (PsO) patients treated with acitretin vs DMARDs.

METHODS

This retrospective study used Taiwan's National Health Insurance Research Database from 1997 to 2013. Adult PsO patients without PsA prescribed acitretin or DMARDs for ≥30 days within a year were assigned to the acitretin cohort or DMARDs cohort, respectively. Patients in the acitretin cohort prescribed DMARDs for >7 days, or in the DMARDs cohort prescribed acitretin for >7 days, were excluded. Cumulative incidence of PsA were determined within both cohorts using the Kaplan-Meier method. The hazard ratio (HR) comparing acitretin to DMARDs was calculated with Cox regression models, adjusting for demographic and clinical covariates including the use of NSAIDs and comorbidities.

RESULTS

The study included 1948 patients in each cohort. The 5-year cumulative incidence of PsA in the acitretin cohort was lower than that in the reference cohort (7.52% vs 9.93%; P = 0.005), with a more pronounced difference in the subpopulation receiving NSAIDs treatment. However, in subpopulations without NSAIDs treatment, the 5-year cumulative incidence of PsA in the acitretin cohort was comparable to the DMARDs cohort (5.26% vs 6.98%; P = 0.106). Acitretin was not associated with PsA development in PsO (HR 0.83, 95% confidence interval 0.65-1.05). This risk remained consistent regardless of adjustments for NSAID treatment and comorbidities. Other independent risk factors for PsA included female and NSAIDs treatment.

CONCLUSION

Compared with DMARDs, acitretin was not associated with increased PsA risk in PsO patients.

Increased dental comorbidities in patients with psoriasis: a nationwide population-based cohort study in Korea

BACKGROUND

Limited data are available regarding the association between psoriasis and common dental conditions.

OBJECTIVES

To investigate the risk of potential dental comorbidities in patients with psoriasis.

METHODS

We conducted a nationwide population-based cohort study to analyse the claims data of patients with psoriasis (n = 15 165) and age- and sex-matched controls (n = 75 825). The incidence risk of the following potential dental conditions was analysed: dental caries, pulp and periapical disease, periodontal disease, gingival changes and tooth loss.

RESULTS

After adjusting for potential cofactors, the adjusted hazard ratios (aHRs) of dental caries [1.105; 95% confidence interval (CI) 1.078-1.132], pulp and periapical disease (1.07; 95% CI 1.044-1.096) and periodontal disease (1.108; 95% CI 1.088-1.129) were significantly higher than those in the control cohort (P < 0.001). However, among the subset of patients with psoriasis who received systemic antipsoriatic treatment (n = 4275), the aHR risk of all potential dental comorbidities was not significantly higher from that of the control cohort.

CONCLUSIONS

Patients with psoriasis have an increased risk of dental comorbidities, and systemic antipsoriatic treatment may help mitigate this increased risk.

Oral exposure to citrinin significantly exacerbates the pathophysiology of a mouse model of imiquimod-induced psoriasis via direct activation of dendritic cell

Citrinin, a mycotoxin produced by Penicillium citrinum and Penicillium verrucosum, mainly contaminates cereals. The aim of study was to investigate the novel immunoreactive effect of citrinin using a mouse model of psoriasis. A mouse model of psoriasis was generated by topical application of 5% imiquimod in female BALB/c mice. Standard rodent diet and rice samples with 3 ppm of citrinin were mixed to obtain a final citrinin concentration of 0.3 ppm, and a citrinin-contaminated diet was fed to mice daily. Skin thickness, scratching behavior, and trans epidermal water loss (TEWL) were monitored continuously during the imiquimod application. Immediately after the final imiquimod application, ear skin and auricular lymph node (LN) were sampled for further analysis. Only a slight increase was observed in skin thickness in the citrinin exposure group; however, citrinin exposure significantly exacerbated hyperkeratinization and inflammatory cell infiltration in histological evaluation. TEWL, which is representative of cutaneous barrier function, was significantly increased by citrinin exposure. In terms of immune function, the number of immune cells in LN (T cells and dendritic cells) and gene expression of interleukin (IL)-17 in skin tissue were significantly increased by citrinin exposure. Direct interaction of dendritic cells (DCs) in citrinin-induced psoriasis development was further examined by proinflammatory cytokine determination in THP-1 cells and murine bone marrow derived DCs. IL-6 and/or tumor necrosis factor α were significantly increased by citrinin exposure. Taken together, our results imply that oral exposure to citrinin exacerbates the symptoms of a mouse model of psoriasis via direct activation of DCs.

The association of psoriasis and psoriatic arthritis with periodontitis: A hospital-based case-control study

Background

Periodontitis can trigger and perpetuate inflammation in several chronic inflammatory diseases. The association of periodontitis with psoriasis has been investigated earlier, but data are incomplete and the influence of confounders has not been fully evaluated.

We examined the relationship of dental and periodontal health parameters in patients with psoriasis and/or psoriatic arthritis.

Methods

This hospital-based cross-sectional analytical study was conducted in patients with chronic plaque psoriasis, psoriatic arthritis or both, and compared with controls. Dental and periodontal health parameters were assessed based on the WHO oral health assessment method. Multivariate logistic regression was done on variables with significant or near-significant values to find the association between periodontitis and psoriasis and/or psoriatic arthritis after adjusting for confounders.

Results

Psoriasis and/or psoriatic arthritis were independently and significantly associated with periodontal pockets ≥4 mm in depth.

Limitations

Causality and temporal relationship cannot be established as this was a cross-sectional study. As in all observational studies, the possibility of unmeasured or unknown confounders exists. Psoriatic arthritis was present only in a small subset of patients.

Conclusion

Patients with psoriasis and/or psoriatic arthritis have significant periodontal inflammation. This needs to be addressed by dental examination and intervention.

Environmental Risks for Spondyloarthropathies

Spondyloarthropathies, also known as spondyloarthritis, encompasses a spectrum of diseases classified by it's axial and peripheral musculoskeletal manifestations. Extra-articular features are common in SpA making these systemic rheumatologic diseases involve the skin, eye, gut, and other organ systems.Research has identified risk factors for the development of spondyloarthritis, particularly regarding genetic susceptibility and the strong association with HLA-B27. Multiple studies have elucidated clinical risk factors associated with SpA disease activity and severity. In this review, we aim to explore the environmental risk factors for spondyloarthritis.

Dietary Intervention and Supplements in the Management of Psoriasis: Current Perspectives

Nutrition is a complex topic encompassing diet and a variety of supplements including vitamins, fish oil, herbal products, and probiotics. Patients with psoriasis display high interest in understanding the potential impact of nutritional modifications on their psoriasis. In this review, we examine the evidence for nutritional interventions in psoriasis and summarize important concepts. We found that certain diets, such as low-calorie diets for obese patients, gluten-free diets for patients with comorbid celiac disease, and the Mediterranean diet, may have benefits for psoriasis patients. Supplements in general do not show strong evidence of benefit, though more studies are required given the heterogeneity of these trials. Finally, the gut microbiome has drawn considerable interest in recent years, with specific probiotics showing promising results for psoriasis patients and warranting further exploration.

Dietary habits and perceptions of psoriatic patients: Mediterranean versus Asian diets

BACKGROUND

Mediterranean diets have been reported to improve psoriasis. Asian food has a unique character and differs from Mediterranean diets.

METHODS

This study compared the dietary intake of psoriatic patients and individuals without psoriasis, and investigated the association between diet and psoriasis severity. Data were collected on the frequency of consumption of Mediterranean and Asian diets.

RESULTS

One-hundred psoriatic patients and 100 individuals (age- and sex-matched controls) was conducted. In the case of the anti-inflammatory diets, the psoriatic patients consumed significantly less olive oil, berry fruits, fish, seafood, tree nuts, and eggs than the controls. As to the pro-inflammatory diets, greater quantities of dairy products and soft drinks were consumed by the psoriatic patients than the controls. Regarding Asian food, the patients consumed significantly less pickled foods and brown rice/Riceberry (a rice variety), but more coconut milk, than the controls. In terms of psoriasis severity, the patients with lower severities consumed significantly more vegetables; in contrast, a higher consumption of red meat, belly meat, and instant noodles was associated with greater psoriasis severities.

CONCLUSIONS

Our study adds further information on the role of diets-especially Asian diets-and psoriasis. These data should help patients and clinicians to focus more clearly on diet management.

Dietary Inflammatory Index in Relation to Psoriasis Risk, Cardiovascular Risk Factors and Clinical Outcomes; A Result from Case-Control Study in Psoriasis Patients

Psoriasis is an inflammatory skin disease. Despite the understanding of the disease pathogenesis, the link between diet-induced inflammation and the risk of psoriasis remains underexplored. Therefore, we have examined the capability of literature-derived Energy-adjusted Dietary Inflammatory Index (E-DII) as a predictive tool for inflammation, incidence, and severity of psoriasis (as indexed by The Psoriasis Area Severity Index (PASI)). We have conducted a case-control study consisting of 149 adults (n = 75 cases and n = 74 controls). The E-DII score was calculated based on the dietary intake that was evaluated by a validated 168 item quantity food-frequency questionnaire. The E-DII tertile cut-offs were categorized based on the following cut points: tertiles 1 ≤ -1.99; tertiles 2 = -2.00 - 0.60; tertile 3 ≥ 0.61. Logistic regression models were applied to estimate the multivariable odds ratio (OR) that was adjusted for confounders. Patients with higher pro-inflammatory E-DII had a 3.60-times increased risk of psoriasis relative to patients in tertiles 1 (E-DIIT3 vs E-DIIT1: OR = 3.64; 95% CI 1.51, 8.79, P = 0.005). The severity of disease as indexed by PASI remained associated with E-DII (E-DIIT3 vs E-DIIT1: OR = 3.64; 95% CI 1.74, 7.57, P = 0.015). For each unit increase in E-DII, the odds of disease severity increased by 3-times. Patients consuming a more pro-inflammatory diet were at greater risk of psoriasis. These patients also demonstrate increased disease severity relative to individuals consuming a more anti-inflammatory diet. • A pro-inflammatory diet is associated with higher psoriasis incidence • Subjects with higher DII scores, had higher inflammatory markers levels.

Dietary habits in Japanese patients with palmoplantar pustulosis

Palmoplantar pustulosis (PPP) is a chronic dermatitis characterized by sterile intra-epidermal pustules associated with erythema and scales on the palms and soles. Tumor necrosis factor (TNF)-α/interleukin (IL)-23/IL-17 inflammatory pathway may be involved in the pathogenesis of PPP, and the skin lesions manifest the enhanced expression of IL-8 in keratinocytes and increased levels of antimicrobial peptide cathelicidin, leucine leucine-37 in vesicles/pustules. Some PPP patients are associated with arthro-osteitis, called pustulotic arthro-osteitis (PAO). Dietary habits may modulate the pathogenesis of PPP, however, have not been investigated in PPP patients. We evaluated dietary habits in adult Japanese PPP patients, using a validated, brief-type self-administered diet history questionnaire, and compared their results to those of age- and sex-matched healthy controls. The results in PPP patients with PAO were compared to those in the patients without. Japanese PPP patients showed higher body mass indices (BMIs), higher intakes of pulses and sugar/sweeteners, and lower intake of vitamin A, compared to those of healthy controls. The bivariate and multivariable logistic regression analysis showed that PPP was associated with high BMI, high intake of pulses, and low intake of vitamin A. The sodium intake and BMI were positively correlated with palmoplantar pustulosis area and severity index (PPPASI). The linear multivariate regression analysis revealed that sodium intake and BMI were predictors of PPPASI. The age and sodium intake in the patients with PAO were lower than those in the patients without. The bivariate and multivariable logistic regression analysis showed that PAO was negatively associated with age and sodium intake. This is the first study showing the dietary habits in patients with PPP. Further studies should clarify if the dietary intervention to correct the BMI and sodium intake will alter the progress of PPP.

Myron Gordon Award paper: Microbes, T-cell diversity and pigmentation

Melanocytes are static, minimally proliferative cells. This leaves them vulnerable in vitiligo. Yet upon malignant transformation, they form vicious tumors. This profound switch in physiology is accompanied by genetic change and is driven by environmental factors. If UV exposure in younger years supports malignant transformation and melanoma formation, it can likewise impart mutations on melanocytes that reduce their viability, to initiate vitiligo. A wide variety of microbes can influence these diametrically opposed outcomes before either disease takes hold. These microbes are vehicles of change that we are only beginning to study. Once a genetic modification occurs, there is a wide variety of immune cells ready to respond. Though it does not act alone, the T cell is among the most decisive responders in this process. The same biochemical process that offered the skin protection by producing melanin can become an Achilles heel for the cell when the T cells target melanosomal enzymes or, on occasion, neoantigens. T cells are precise, determined, and consequential when they strike. Here, we probe the relationship between the microbiome and its metabolites, epithelial integrity, and the activation of T cells that target benign and malignant melanocytes in vitiligo and melanoma.

Nutrition and Psoriasis

Psoriasis is a chronic inflammatory skin disease characterized by accelerated tumor necrosis factor-α/interleukin-23/interleukin-17 axis, hyperproliferation and abnormal differentiation of epidermal keratinocytes. Psoriasis patients are frequently associated with obesity, diabetes, dyslipidemia, cardiovascular diseases, or inflammatory bowel diseases. Psoriasis patients often show unbalanced dietary habits such as higher intake of fat and lower intake of fish or dietary fibers, compared to controls. Such dietary habits might be related to the incidence and severity of psoriasis. Nutrition influences the development and progress of psoriasis and its comorbidities. Saturated fatty acids, simple sugars, red meat, or alcohol exacerbate psoriasis via the activation of nucleotide-binding domain, leucine-rich repeats containing family, pyrin domain-containing-3 inflammasome, tumor necrosis factor-α/interleukin-23/interleukin-17 pathway, reactive oxygen species, prostanoids/leukotrienes, gut dysbiosis or suppression of regulatory T cells, while n-3 polyunsaturated fatty acids, vitamin D, vitamin B12, short chain fatty acids, selenium, genistein, dietary fibers or probiotics ameliorate psoriasis via the suppression of inflammatory pathways above or induction of regulatory T cells. Psoriasis patients are associated with dysbiosis of gut microbiota and the deficiency of vitamin D or selenium. We herein present the update information regarding the stimulatory or regulatory effects of nutrients or food on psoriasis and the possible alleviation of psoriasis by nutritional strategies.

Importance of Redox Equilibrium in the Pathogenesis of Psoriasis-Impact of Antioxidant-Rich Diet

Psoriasis is a common, chronic, hyperproliferative, inflammatory skin disease occurring in most ethnic groups in the world. The disease is hereditary but the process of its inheritance is complex and still not fully understood. At the same time, it has been observed that psoriatic lesions may be triggered by certain prooxidative external factors: using narcotics, smoking, drinking alcohol, physical and mental stress, as well as bacterial infections and injury. Since the main physiological marker of psoriasis relates to disorders in the organism's antioxidative system, it is necessary to develop a well-balanced combination of pharmaceuticals and dietary antioxidants to facilitate the effective treatment and/or prevention of the disease. The dietary sources of antioxidants must be adequate for chronic use regardless of the patient's age and be easily available, e.g., as ingredients of regular food or dietary supplements. Diet manipulation is a promising therapeutic approach in the context of modulating the incidence of chronic diseases. Another potentially viable method entails the use of nutrigenomics, which guarantees a multiaspectual approach to the problem, including, in particular, analyses of the genetic profiles of psoriasis patients with the view to more accurately targeting key problems. The present paper pertains to the significance of redox equilibrium in the context of psoriasis. Based on information published in worldwide literature over the last decade, the impact of dietary exogenous antioxidants on the course of this chronic disease was analysed.

Estrogen receptor α activation aggravates imiquimod-induced psoriasis-like dermatitis in mice by enhancing dendritic cell interleukin-23 secretion

Our recent study has reported that estrogen receptors (ERs) are involved in several types of allergy development. This study aims to investigate the possible relationship between ER activation and development of imiquimod-induced psoriasis-like dermatitis. A mouse model of imiquimod-induced psoriasis-like dermatitis was generated by 5 days of topical application of 5% of imiquimod cream on the back of the ear and the shaved back skin of male BALB/c mice. From the second day of applying 5% imiquimod cream, either ERα selective agonist (propylpyrazoletriol [PPT] 2.5 mg/kg) or ERβ selective agonist (diarylpropionitrile, DPN; 2.5 mg/kg) was administered orally for four consecutive days. Immediately after the final imiquimod cream application, scratching behavior was video monitored for 2 hours. The ear-swelling response was determined by comparing ear thickness before and after the final application of imiquimod cream. Twenty-four hours after the final imiquimod application, back skin tissue and auricular lymph nodes were isolated under isoflurane anesthesia. Oral administration of PPT significantly induced itch behavior and proinflammatory responses, including the levels of interleukin (IL)-17 and IL-22, whereas DPN treatment did not influence either pruritic or proinflammatory responses. In addition, IL-23 contribution by dendritic cells was identified using ER agonists on pretreated lipopolysaccharide (LPS)-stimulated murine bone marrow derived dendritic cells (BMDCs). PPT also significantly enhanced IL-23 secretion by LPS-stimulated BMDCs. Our findings indicate that the activation of ERα, but not ERβ, is directly associated with inflammatory and pruritic responses in a mouse model of the imiquimod-induced psoriasis by enhancing the secretion of IL-23 by dendritic cells.