Department of Dermatology

Research Initiatives

Holistic approach to treatment of psoriasis: the role of diet modification and exercise

Now understood as more than a skin disease, psoriasis can increase the risk of psoriatic arthritis, major cardiovascular events, diabetes, and chronic kidney disease. Impacting 3-4% of the US population and 125 million individuals worldwide, with associated cost of > $135 billion annually, we need to focus our attention to therapies that improve the skin as well as the related comorbidities of psoriasis.

Here at the UH Department of Dermatology in conjunction with Case Western Reserve University, we are interested in a more holistic approach to treating psoriasis. What we know is that a diet high in total and simple carbohydrates, omega-6/omega-3 fatty acid ratio, cholesterol, total fat and low in fiber, complex carbohydrates, protein, and omega-3 fatty acid may lead to psoriasis flares and obesity. The majority of patients with psoriasis are obese with a BMI >30 kg/m2 and a waist circumference >100 cm2. This brings us to ask: what is the role of diet modification and exercise?

Previously, diet modification +/- exercise concomitantly with systemic treatments resulted in greater reduction in psoriasis severity and weight loss. Furthermore, increased compliance with a Mediterranean diet, an anti-inflammatory diet characterized by high omega-3 fatty acid, antioxidants and polyphenols, has shown to lessen psoriasis severity. As the majority of psoriasis patients report modifying their diet to improve their disease, we hope to provide the evidence on whether diet modification and exercise in the context of oral therapy leads to better outcomes.

To this end, we will conduct a study comparing patients on a regimen of a calorie-restricted Mediterranean diet and exercise plus apremilast or methotrexate (FDA-approved oral psoriasis medications) versus patients on a standard diet and apremilast or methotrexate. We will also determine whether diet modification and exercise leads to improvement of biomarkers of systemic inflammation.

If you have further questions, please contact Dr. Kevin Cooper at or Dr. Hope Barkoukis at

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