October 03, 2025
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Key takeaways:
Patients in a 16-week Mediterranean diet program saw improvements in their psoriasis compared with those on a standard low-fat diet.
Outcomes included decreased PASI scores, hemoglobin A1c levels and anxiety.
Adhering to a Mediterranean diet significantly improved disease severity among patients with psoriasis, independent of weight loss, according to a study published in JAMA Dermatology.
“Although there has been growing interest in diet and psoriasis, most of the evidence so far has been observational. Clinical guidelines only recommend weight loss for people with overweight or obesity and gluten-free diets for those with celiac disease, but they do not address the potential benefit of specific dietary patterns,” Javier Perez-Bootello, MD, a dermatologist at the Hospital Universitario Ramón y Cajal in Madrid, Spain told Healio. “The Mediterranean diet is well known for its anti-inflammatory and cardiometabolic properties, which are particularly relevant in psoriasis, a chronic immune-mediated inflammatory disease.”
There has never been a randomized clinical trial evaluating the benefit of a structured Mediterranean diet program on psoriasis outcomes independent of weight loss, according to Perez-Bootello.
For the Impact of the Mediterranean Diet on Patients with Psoriasis (MEDIPSO) trial, 38 participants (mean age, 46.4 years; 65.8% men) who were receiving topical therapy for mild to moderate psoriasis were randomly assigned to a high-intensity, dietitian-guided Mediterranean diet program for 16 weeks, or a control group, receiving standard low-fat dietary advice without the guidance of a dietitian. In addition to monthly 20-minute phone consultations with dietician-nutritionists, participants in the intervention group received weekly extra-virgin olive oil at no cost during clinic visits and were encouraged to consume at least 4 tablespoons daily.
“We found that a 16-week intensive Mediterranean diet intervention … led to a significant improvement in skin disease severity compared with standard low-fat dietary advice,” Perez-Bootello said.
Participants in the Mediterranean diet program had a 3.4 (95% CI, –4.4 to –2.4) decrease in their PASI score by week 16 compared with no change (95% CI, –1 to 1) in the control group. Nearly half (47.4%; P < .001) of the participants in the intervention group achieved PASI 75 and 26.3% reached PASI 90 (P = .046) vs. none in the control group.
“Importantly, these improvements occurred without significant weight loss,” Perez-Bootello said. “This highlights that the benefits were likely due to the anti-inflammatory and metabolic effects of the diet itself.”
Participants undergoing the Mediterranean diet saw greater reductions in their hemoglobin A1c levels compared with participants in the control group (difference = –4.1 mmol/mol; 95% CI, –6.9 to –1.3 mmol/mol; P < .001). They also experienced better sleep quality, decreased anxiety and an overall greater quality of life, “suggesting broader systemic benefits,” Perez-Bootello said.
“Our results support the idea that structured nutritional counseling should be considered as an adjunctive therapy in psoriasis management,” Perez-Bootello told Healio. “The Mediterranean diet is sustainable, culturally adaptable and has the added benefit of improving cardiometabolic health in a population at increased cardiovascular risk. While larger, multicenter and longer term trials are needed to confirm these findings, we believe this study is a strong step forward in integrating diet into the holistic management of psoriasis.”
For more information:
Javier Perez-Bootello, MD, can be reached at drperezbootello@gmail.com; Instagram: @javierbootelloder.
Perspective
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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 have a positive impact on psoriatic disease, as well as cardiovascular comorbidities.
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 there 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.
Veronica Richardson, MSN, ANP-BC, DCNP
Dermatology Nurse Practitioner, University of Pennsylvania.
Disclosures: Richardson reports no relevant financial disclosures.
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