One of the most common questions I get when talking with my patients living with psoriasis is, “Are there any foods I should avoid?” This question often comes from the patients' desire to have an active role in their disease management. I use this as an opportunity to open a dialogue about food choices and psoriasis, and how incorporating healthy food choices can positively impact psoriatic disease and cardiovascular comorbidities.
The MEDIPSO trial was a randomized clinical trial that sought to evaluate the impact that adoption of a Mediterranean diet would have on psoriasis severity. This 16-week trial included 38 patients with mild to moderate psoriasis at a single center in Spain. The intervention group was randomized to receive a 16-week dietitian-guided Mediterranean diet program while the control group received standard low-fat dietary advice, without a dietitian's support. The study found that the Estimated Marginal Mean (EMM) change in PASI in the intervention group was -3.4 and 0 in the control group. There was also a significant EMM change in hemoglobin A1c in the intervention group compared to the control group. One limitation of the study was the small sample size and short duration, limiting the study’s generalizability and sustainability. Another consideration is the possible introduction of the Hawthorne effect, where participants in a clinical trial change their behavior because they know they are frequently being observed. Additionally, one should consider that the study took place in a Mediterranean country where cultural norms around food choices vary significantly from those in the United States. Nonetheless, this study was interesting and helpful to refer to when patients inevitably ask about diet and psoriasis.
For some patients, dietary choices are something they have a strong knowledge of and significant control over from both a knowledge and resource perspective. However, we have a significant cohort of patients for whom nutritional knowledge and food choices are limited due to various socioeconomic factors. It is incredibly important that we meet our patients where they are, no matter where they fall on this spectrum. Therefore, we should be mindful of the interventions we are suggesting and provide tailored support and education to all our patients.
Although not a panacea, diet is an incredibly important adjunct to psoriatic disease management. Engaging our patients in an educational discussion about its importance is a key part of providing comprehensive care and empowering our patients. Just as we have clinical trials to refer to when talking to patients about pharmacologic interventions and their respective efficacy, it is great to have this trial to refer to when talking to patients about meaningful dietary interventions that can positively impact their psoriasis disease severity.
Reference:
Perez-Bootello J, Berna-Rico E, Abbad-Jaime de Aragon C, Goni L, Vazquez-Ruiz Z, Neria F, Cova-Martin R, Naharro-Rodriguez J, Ballester-Martinez A, Pindado-Ortega C, Monge D, Blauvelt A, Jaen P, Mehta N, Gelfand JM, Martinez-Gonzalez MA, Gonzalez-Cantero Á. Mediterranean Diet and Patients With Psoriasis: The MEDIPSO Randomized Clinical Trial. JAMA Dermatol. 2025 Sep 24:e253410. doi: 10.1001/jamadermatol.2025.3410. Epub ahead of print. PMID: 40991259; PMCID: PMC12461594.
Veronica Richardson, ANP-BC, DCNP, is a dermatology-certified nurse practitioner at the Perelman Center for Advanced Medicine at the University of Pennsylvania in Philadelphia, PA. She sees general dermatology patients and has a passion for NP/PA education. Outside of work, she enjoys trying out new restaurants in Philly and paddleboarding in the Poconos. She and her husband love to spoil their doggies, Georgia & Tika.