Diet, Exercise, and Mental Health May Help Complement Psoriasis Treatment

For people living with psoriasis, disease management has traditionally centered on pharmacological treatments, but growing evidence suggests that lifestyle changes and nutritional interventions may offer meaningful support alongside conventional care.¹

A narrative review published in Anais Brasileiros de Dermatologia synthesized current evidence on nonpharmacological strategies for people with psoriasis, including trace elements, vitamins, dietary patterns, aerobic exercise, and psychological interventions. Researchers searched PubMed, Scopus, Web of Science, and Google Scholar in early 2025, analyzing clinical trials, meta-analyses, and cohort studies.

The systemic burden of psoriasis—spanning individual health, quality of life, and broader health care economics—has been well documented in the literature. A 2023 comprehensive review published in Signal Transduction and Targeted Therapy characterized the condition as carrying substantial costs for patients, health systems, and society on a global scale, arising from a complex convergence of immune dysregulation, cytokine-mediated signaling cascades, and genetic susceptibility.² The review also surveyed an expanding armamentarium of targeted therapies, from conventional systemic agents to next-generation biologics, underscoring a growing clinical consensus that effective management of psoriasis must account for its full systemic dimensions rather than its skin manifestations alone.

Psoriasis Comorbidities Fuel the Need for Broader Management Strategies

Psoriasis is a chronic immune-mediated inflammatory disease driven by overactivation of the tumor necrosis factor-α/IL-23/IL-17 axis, resulting in hyperproliferation of epidermal keratinocytes. People with psoriasis carry an elevated burden of comorbidities, including obesity, type 2 diabetes, dyslipidemia, cardiovascular disease, and inflammatory bowel disease. The authors noted that this population tends to exhibit unbalanced dietary habits marked by high-fat, low-fiber intake—factors that may both reflect and amplify systemic inflammation.

Micronutrients Showed Associations With Disease Severity but Inconsistent Clinical Benefit

Alterations in trace element levels were consistently documented across included studies. A meta-analysis of research from 1988 to 2016 found elevated serum copper and reduced serum zinc levels in people with psoriasis relative to healthy controls. A 2021 case-control study of 72 people with psoriasis reported a significantly higher copper-to-zinc ratio in affected individuals, particularly among those with severe disease (Psoriasis Area and Severity Index [PASI] > 10).

Selenium data were similarly mixed. One double-blind, placebo-controlled trial reported significant improvements in PASI and severity scores when selenium aspartate was combined with coenzyme Q10 and vitamin E in people with erythrodermic or arthropathic psoriasis. However, other trials found no benefit from selenium supplementation added to narrowband UV-B phototherapy.

Vitamin D deficiency was common in people with psoriasis, yet oral supplementation alone did not consistently improve PASI scores across randomized trials. A cross-sectional analysis from the National Health and Nutrition Examination Survey found that higher dietary vitamin E intake was inversely associated with psoriasis risk. Regarding B vitamins, a study of 98 people with psoriasis and 98 controls found that 57% of those with psoriasis had elevated homocysteine levels—a marker linked to B12 and folate deficiency—compared with 25% of controls (P < .0001).

Aerobic Exercise Reduced PASI Scores by Nearly Half

Exercise offered some of the more clinically compelling evidence. In a randomized controlled trial, 303 people with obesity and psoriasis (PASI > 10) performed aerobic exercise for at least 40 minutes 3 times per week over 20 weeks, targeting a 5% weight reduction. That group experienced a 48% reduction in PASI scores, compared with a 25.5% reduction in the control group (P = .02).

Despite these benefits, physical activity remained markedly underutilized. A separate study found that 53% of people with psoriasis aged 18 to 65 years and 66% of those older than 65 failed to meet recommended cardiovascular physical activity guidelines. Disease-related barriers—including skin discomfort during exercise, embarrassment about skin appearance, and treatment-related constraints—contributed to lower activity levels, with reduced participation particularly noted in women aged 18 to 65.

Mental Health Screening Remains an Underrecognized Priority in Psoriasis Care

The psychological burden of psoriasis was substantial across included studies. Anxiety disorders affected 7% to 48% of people with psoriasis in a systematic review of observational studies, while depression prevalence was estimated at 20% to 30%. Suicidal ideation was reported in 12.7% of individuals with the condition. The authors recommended routine screening for depression, anxiety, and suicidality, noting that neuroinflammatory pathways may link psychiatric comorbidities to skin disease severity. Cognitive-behavioral therapy was identified as a potentially beneficial tool for improving adherence to dietary and exercise interventions.

Small Samples and Observational Designs Limit Clinical Translation

Several factors tempered confidence in the review's findings. The available evidence consisted largely of observational and cross-sectional studies, limiting causal inference. Sample sizes were frequently small, intervention protocols inconsistent, and patient populations heterogeneous in terms of age, body mass index, comorbidities, and baseline nutrient levels. Confounding factors such as medication use, dietary patterns, and lifestyle behaviors were often inadequately controlled.

"While non-pharmacological strategies show promise as complementary interventions in psoriasis management, they cannot replace conventional therapy," the authors wrote, emphasizing that individualized patient assessments and continuous follow-up are essential to optimize outcomes.

The investigators called for randomized controlled trials with standardized protocols for dietary, exercise, and psychological interventions and for greater integration of psychosocial support into psoriasis management.

References

1. Valenzuela F, Benavides E, Echeverry EV, Hartmann D, Bilicic D. Complementary strategies in psoriasis—non-pharmacological approaches for comprehensive management. An Bras Dermatol. 2026;101(3):501356. doi:10.1016/j.abd.2026.501356
2. Guo J, Zhang H, Lin W, Lu L, Su J, Chen X. Signaling pathways and targeted therapies for psoriasis. Signal Transduct Target Ther. 2023;8(1):437. doi:10.1038/s41392-023-01655-6