Psoriasis and Lifestyle Changes
Posted on 1st February 2021 by Tessa Li Chyin Lim
In this blog post, I will provide my own summary of a 2019 Cochrane systematic review “Lifestyle changes for treating psoriasis“.
Psoriasis is a chronic inflammatory dermatological condition where patients present with erythematous, silvery-white scaly plaques or papules. The diagnosis of psoriasis is a clinical diagnosis. Some other diagnostic factors include a family history of psoriasis. Patients with psoriasis can experience itching and irritation. The risk factors for psoriasis include genetic factors, infection, trauma and stress.
Management of Psoriasis
According to BMJ Best Practice, topical corticosteroids and/or vitamin D analogues are used to treat mild psoriasis. Phototherapy and systemic agents are used to treat moderate to severe psoriasis. Examples of systemic agents include methotrexate, oral retinoids or biologics.
Lifestyle changes vs no lifestyle changes or another active intervention
The systematic review aims to assess the effects of lifestyle changes on psoriasis. Some of the lifestyle changes include weight reduction, exercise, smoking cessation, and alcohol abstinence. The randomised controlled trials (RCTs) which were included compared lifestyle changes with no lifestyle changes or another active intervention. For all the trials, the treatment had to be given for a minimum of 3 months. ‘Adherence to the intervention’ and ‘Severity of psoriasis’ were the primary outcomes. Other outcomes were also included, for example, ‘Quality of life’, ‘Reduction in comorbidities’ and ‘Time to relapse’.
An analysis of 10 RCTs involving 656 men and 478 women with the mean age of 43 to 61 years old were included. Two of the trials which followed up the participants up to 6 months had high statistical heterogeneity. Sensitivity analysis was not carried out due to the number of trials with a high risk of bias. It was found that the Psoriasis Area and Severity Index (PASI) may be improved by 75% when there is strict caloric restriction (risk ratio (RR) 1.66, 95% confidence interval (CI) 1.07-2.58). Moderate-quality evidence has shown that dietary intervention probably achieves a higher score of dermatology quality-of-life index (DLQI) versus care as usual. In conclusion, lifestyle changes may reduce the severity of psoriasis in people who are obese. However, the quality of evidence which supported this is low.
Clinical Practice and Future Research
A number of key interventions (smoking cessation and alcohol abstinence) are not assessed by any of the trials. There is limited evidence which shows that lifestyle changes affect the treatment of psoriasis. Further trials and reviews comparing lifestyle changes with other pharmacological or non-pharmacological interventions would be a valuable guidance for clinical practice.