From self.com
Living with a chronic condition like psoriasis affects your life in so many ways that go beyond your daily skin-care routine. Psoriasis is an autoimmune disease, meaning your immune system goes a bit haywire and mistakenly makes too many skin cells without shedding them as they pile up. As a result, psoriasis causes inflamed skin patches or plaques, which can be painful, itchy, flaky, and really frustrating to deal with.
Although there is absolutely no reason to feel bad about having a medical condition that can be so out of your control, some people may feel self-conscious about their psoriasis, since the plaques can appear in very visible areas, like the knees, elbows, and chest.
It’s common to encounter periods of worsening symptoms for days, weeks, or even months, which are called flare-ups. After your first psoriasis “outbreak,” there are a number of things that can trigger these flare-ups, which vary widely from person to person. This can include everything from stress to dry weather to an infection.
As with many other chronic conditions, there’s also the question of whether or not the foods you eat can play a role in triggering or easing psoriasis symptoms. Unfortunately, the answer isn’t so simple, but researchers are actively investigating the link between diet and psoriasis. There’s still a lot to learn, but here’s what experts know so far.
First, what are some common psoriasis triggers?
Psoriasis flare-ups are typically triggered by environmental or internal factors. It’s not clear why, but encountering one of your personal triggers can alert your immune system to kick off the early stages of the psoriasis process. According to the American Academy of Dermatology (AAD), this can include the following:
- Drinking at least two alcoholic beverages daily
- Smoking cigarettes
- Skin injuries, like a cut, bruise, or bug bite
- Infections, like strep throat or bronchitis
- Taking certain medications
- Having overly dry skin due to cold weather, a sunburn, or spending too much time in air conditioning
Since there are so many things that can trigger symptoms, it’s only natural to wonder whether there are any diets for psoriasis that can help with symptoms.
Can your diet affect psoriasis symptoms?
The causes of psoriasis might feel obscure, “so thinking that it might be something in the diet has some appeal," Steven Feldman, M.D., professor of dermatology at Wake Forest University School of Medicine in North Carolina, tells SELF. “There is also some scientific evidence that diet can affect inflammation in the body, and psoriasis is an inflammatory condition, so it makes sense to think the diet might have some effect.”
But science hasn’t solidified a connection yet. While there is some evidence exploring the link, there isn’t concrete data to support the theory that a person’s diet plays a role in their psoriasis, according to Dr. Feldman, who co-authored a 2019 review of 63 medical articles investigating diets for psoriasis.
In most research that has studied a person’s diet and its impact on psoriasis, he explains, the sample sizes tend to be small, so the data is limited. Further, many people who participated in these studies continued to take their prescribed psoriasis medication in addition to changing their diet as part of the research. For these types of experiments, people are asked to make detailed logs of their behaviours, which may encourage them to take their medications as prescribed without skipping doses, Dr. Feldman says—and when it feels like a researcher is “watching” you via your logs, you may be more inclined to take your meds consistently. “So while it might look like the dietary intervention was beneficial, it may have been beneficial only in that it caused people to take their other medicines better,” Dr. Feldman says.
Unfortunately, because of the way many of these studies have been designed, it’s really hard to conclude which changes, including diet changes, are responsible for certain outcomes, like worsened or improved symptoms. That doesn’t mean it’s out of the question that certain diet changes can have a beneficial impact on psoriasis—it just means that more research that addresses these issues needs to be done so scientists have more solid data to work with.
With that said, it’s really unlikely that there will ever be one “psoriasis diet” to help each person with the condition. “You’re not going to cure psoriasis with diet—this is a chronic disease,” Dr. Feldman says. “But if you find that when you eat certain things they seem to exacerbate your psoriasis, avoiding those things makes entirely good sense.”
So far, there are two main diet approaches for people with psoriasis: additive diets and subtractive diets. With an additive diet, you’d focus on consuming more of a specific food or nutrient. With a subtractive diet, you’d slowly remove certain foods or nutrients.
This is tricky territory. Any time you make a diet change, especially if you have a chronic health condition, it’s best to talk to your doctor or a registered dietitian who is familiar with the disease, so they can guide you through the process and help you avoid risky side effects, like lower energy, unintended weight loss, or nutrient deficiencies.
Here’s a closer look at some popular diet changes people make when they have psoriasis—and what the science says about each one so far:
Anti-inflammatory diet
Psoriasis lesions are set off by inflammation in the body, so it makes sense to assume that “anti-inflammatory” foods could help tame that irregular immune response. Researchers believe that foods with certain nutrients may reduce oxidative stress in your body, a process that contributes to inflammation, but it’s an area of research that is still being explored. A typical list of “anti-inflammatory” foods is pretty expansive and diverse, including berries, green leafy vegetables, nuts, fatty fish, tomatoes, and so much more. The theory is that these foods may prevent inflammation from starting in the first place or reduce its impact.
For example, a fat called eicosapentaenoic acid (EPA) that is found in fatty fish like salmon is thought to help reduce the number of inflammatory chemicals in the body, according to Dermatology Online Journal. However, in the case of psoriasis, researchers are still unsure if consuming EPA has much of an effect on a person’s symptoms. Many studies looking at EPA and psoriasis specifically involve using fish oil supplements instead of whole fatty fish, which may not offer the same theorized benefit. Dr. Feldman’s team found that fish oil studies have really conflicting results: Some people saw no improvement, some said their psoriasis got better, and others said their psoriasis actually got worse.
There’s not much existing research on other proposed anti-inflammatory nutrients, which are thought to include vitamins A, C, D, and E, as well as monounsaturated fatty acids. A 2019 review of research on the link between psoriasis and diet published in Cutis, concluded that “foods with systemic anti-inflammatory effects may be worth testing and adding to the patient’s diet,” but also noted that “no single food, supplement, or diet has been shown to have a notable positive impact on all variations of psoriasis.”
Gluten-free diet
People who have psoriasis are two times more likely to have celiac disease compared to those without psoriasis, according to a 2020 study published in the Journal of the American Academy of Dermatology. Celiac disease is an autoimmune condition that causes intestinal damage from eating gluten, which is a protein found in wheat, rye, and barley.
Although multiple studies show a correlation between the two conditions, the relationship between psoriasis and celiac disease isn’t fully understood. However, people with psoriasis are more likely to have multiple autoimmune diseases, possibly due to —you guessed it—all that inflammation in the body. So, if you have celiac disease and psoriasis, eating a gluten-free diet may help you avoid very specific celiac-related skin rashes, according to the Cleveland Clinic.
But as for whether or not eating a gluten-free diet may help reduce your psoriasis skin symptoms, the results have been mixed so far. In Dr. Feldman’s aforementioned 2019 review, 30 people with psoriasis (a very small amount) in one study said their symptoms improved after following a gluten-free diet for three months. In the same review, a different (and again, very small) study of 16 people with psoriasis showed that only 9 of them experienced any kind of improvement after following a gluten-free diet. Both of the studies in the review aren’t recent, but there haven’t been clear answers from newer studies, either.
Of course, if you do have celiac disease, you’ll benefit from following a gluten-free diet that’s monitored by your doctor. But, as the current research is so inconclusive for psoriasis in particular, avoiding all gluten isn’t proven to positively affect your skin symptoms if you don’t have a sensitivity or intolerance to it.
Ketogenic diet
There is some research pointing to keto as a potential diet option for people with psoriasis, but it’s far from conclusive.
For example, a woman with moderate-to-severe plaque psoriasis experienced a psoriasis flare-up after her medication stopped working to improve her symptoms, according to a 2016 case study published in Obesity Research & Clinical Practice. She followed a four-week, low-calorie ketogenic diet, meaning she ate practically no carbs and lots of protein. When you eat a keto diet, the goal is to encourage your body to use fat as a primary source of energy, instead of glucose (which you get from carbs) as it normally would. After that four-week period, her medication effectively started treating her symptoms again.
With that said, one woman’s experience isn’t enough to say that a keto diet can help everyone with psoriasis. In fact, the study authors attribute her improvement in symptoms to losing weight, as there is an independent relationship between reducing body weight and improving psoriasis flares. (With that, weight is a complex topic, so it’s really best to talk to your doctor about how this specific factor relates to your condition.)
In another 2021 study published in the Journal of Proteome Research, 30 people with psoriasis who weren’t taking medication for the condition followed a non-keto diet and then a keto diet to see how it impacted their symptoms. According to the limited data, everyone’s psoriasis felt less painful and covered fewer areas of their bodies. But this is such a small study—and the participants followed a very low-calorie meal plan that’s often unsustainable for most people. The study authors even mention that the diet is feasible “with high compliance,” meaning you’d have to stick to a very restrictive diet that omits many foods to see any potential benefit, which hasn’t yet been proven with more expansive research.
Mediterranean diet
The Mediterranean diet is pretty popular for good reason. This method of eating has tons of research to back up its overall health benefits, including a reduced risk of cardiovascular disease and other inflammatory conditions like rheumatoid arthritis.
The diet is often easier to follow than other restrictive plans because it includes a healthy mix of protein, fat, and carbs, such as fruits, vegetables, legumes, nuts, whole grains, olive oil, fish, a little bit of dairy, and the occasional glass of wine in moderation. Red meats and processed foods are typically avoided, though.
Because many of these foods are thought to have anti-inflammatory properties, especially when combined, there has been some interest in whether the diet is helpful for psoriasis. Again, the results are mixed. In the 2019 Cutis clinical review, two studies (one with 62 people and the other with 3,557) that examined the relationship between Mediterranean-style eating and psoriasis failed to show a beneficial relationship between the two. That said, the larger of those two studies found that people who didn’t adhere to the Mediterranean diet very closely had worse symptoms.
It’s hard to say that the diet itself helps with psoriasis flares, but out of all the eating plans mentioned above, this one comes with the least amount of risk overall—it’s often seen as a “gold standard” science-backed diet because it’s full of nutrient-rich, satisfying foods that have been shown to promote better health, so it won’t hurt to ask your doctor about it if you want to give it a try.
Which psoriasis treatments help with flares?
Even if you may or may not be able to manage your psoriasis symptoms with what you eat, there are many other proven treatments that “work phenomenally well,” Dr. Feldman says. Psoriasis medications are determined by the severity of your symptoms, where they’re located on your body, and how much your condition affects your ability to do everyday tasks.
There are some psoriasis treatments that may be worth asking your doctor about, according to the Mayo Clinic:
- Topical corticosteroids are one of the most common and effective treatments for psoriasis. They penetrate into the skin and reduce inflammation to help reduce the appearance of plaques. You can use them as creams, foams, gels, medicated shampoos, or sprays.
- Topical calcipotriene cream is a synthetic form of vitamin D that works to minimize redness and scaling of the skin.
- Coal tar is found in medicated shampoos. It’s not usually a popular treatment because it smells pretty unpleasant and can make your hair dry.
- Scale softeners are usually made with salicylic acid, a gentle exfoliator that helps soften psoriasis patches so other medicines can more easily sink in and work better.
- Light therapy uses targeted UVB rays to shrink psoriasis lesions. How exactly this works is “still the basis of a lot of research that’s going on right now," Tina Bhutani, M.D., an associate professor of dermatology and the co-director of the Psoriasis and Skin Treatment Centre at the University of California, San Francisco, tells SELF.
- Systemic therapies are commonly used to treat severe psoriasis. These include biologics, which help prevent your immune system from misfiring. These are available as injections or infusions, the latter of which may need to be given at your doctor’s office. Oral retinoids are another systemic therapy that can help by limiting your skin cell production and reducing inflammation.
Ultimately, working closely with a board-certified dermatologist will help you figure out the best course of action to manage your psoriasis symptoms. “You want to have a checklist when you go to the doctor, including all areas of the body affected by your psoriasis,” Dr. Feldman says.
Your treatment plan may include diet changes, but it’s important to remember that it’s just one (very small) piece of the puzzle. “We have to get to the underlying cause of the issue,” Dr. Feldman says—and that will likely require tackling the inflammation head-on with one of the medications above.
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