Mindfulness and the Mediterranean diet as alternative therapies in ambulatory care of psoriasis
DOI:
https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20253404Keywords:
Psoriasis, Mediterranean diet, Mindfulness, InflammationAbstract
Psoriasis is a chronic disease marked by intense inflammatory processes and a significant emotional effect. The progression of long-term emotional stress and poor dietary intake is a crucial factor; therefore, it's vital to have whole-person care. In this context, mindfulness appears to be rising as a viable cooperative strategy with the potential to promote emotional stability and enhance patients' wellness. This study aimed to evaluate the outcomes of holistic therapy supported by the mediterranean diet and mindfulness (MBI) through a review of up-to-date scientific research. A methodical research was conducted in the PubMed database using the keywords: “psoriasis,” “types of psoriasis,” “factors and psoriasis,” “pathophysiology and psoriasis or inflammation,” “mindfulness and psoriasis,” “meditation and psoriasis,” “cytokines and psoriasis,” and “psoriasis diagnosis.” Articles published between 2020 and 2025, in English or Spanish, with full-text access and peer review, were included. A total of 57 articles were considered. Evidence compiled over the most recent 5 years supports that mindfulness and the Mediterranean diet are successful therapies in psoriasis disease and, together, can improve outpatient healing and time to treatment, particularly by modulating the expression and activity of cytokines, such as TNF-α, interleukins (IL-1β, IL -6, IL-8, IL-10, IL-17, IL-23), IFN-γ, and cortisol levels. The implementation of the Mediterranean diet and mindfulness represents an effective and viable alternative in the outpatient treatment of psoriasis, with a positive impact on physical and emotional health.
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References
Formisano E, Proietti E, Borgarelli C, Pisciotta L. Psoriasis and Vitamin D: A Systematic Review and Meta-Analysis. Nutrients. 2023;15(15). DOI: https://doi.org/10.3390/nu15153387
Sbidian E, Chaimani A, Guelimi R, Garcia-Doval I, Hua C, Hughes C, et al. Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis. Cochrane Database Syst Rev. 2023;7(7):CD011535. DOI: https://doi.org/10.1002/14651858.CD011535.pub6
Raharja A, Mahil SK, Barker JN. Psoriasis: a brief overview. Clin Med (Lond). 2021;21(3):170-3. DOI: https://doi.org/10.7861/clinmed.2021-0257
Nowowiejska J, Baran A, Grabowska P, Lewoc M, Kaminski TW, Flisiak I. Assessment of Life Quality, Stress and Physical Activity Among Patients with Psoriasis. Dermatol Ther (Heidelb). 2022;12(2):395-406. DOI: https://doi.org/10.1007/s13555-021-00662-1
Aryanian Z, Asghari M, Zanousi PP, Ghadimi R, Kebria AS, Hatami P. Adherence to the Mediterranean diet in patients with psoriasis and its relationship with the severity of the disease: A case-control study. Health Sci Rep. 2024;7(9):e70049. DOI: https://doi.org/10.1002/hsr2.70049
Bartholomew E, Chung M, Yeroushalmi S, Hakimi M, Bhutani T, Liao W. Mindfulness and Meditation for Psoriasis: A Systematic Review. Dermatol Ther (Heidelb). 2022;12(10):2273-83. DOI: https://doi.org/10.1007/s13555-022-00802-1
Zhou X, Chen Y, Cui L, Shi Y, Guo C. Advances in the pathogenesis of psoriasis: from keratinocyte perspective. Cell Death Dis. 2022;13(1):81. DOI: https://doi.org/10.1038/s41419-022-04523-3
Rajguru JP, Maya D, Kumar D, Suri P, Bhardwaj S, Patel ND. Update on psoriasis: A review. J Family Med Prim Care. 2020;9(1):20-4. DOI: https://doi.org/10.4103/jfmpc.jfmpc_689_19
O'Toole A, Gooderham M. Topical Roflumilast for Plaque Psoriasis. Skin Therapy Lett. 2023;28(5):1-4.
Leung AK, Barankin B, Lam JM, Leong KF. Childhood guttate psoriasis: an updated review. Drugs Context. 2023;12. DOI: https://doi.org/10.7573/dic.2023-8-2
Uppala R, Tsoi LC, Harms PW, Wang B, Billi AC, Maverakis E, et al. "Autoinflammatory psoriasis"-genetics and biology of pustular psoriasis. Cell Mol Immunol. 2021;18(2):307-17. DOI: https://doi.org/10.1038/s41423-020-0519-3
Battista T, Scalvenzi M, Martora F, Potestio L, Megna M. Nail Psoriasis: An Updated Review of Currently Available Systemic Treatments. Clin Cosmet Investig Dermatol. 2023;16:1899-932. DOI: https://doi.org/10.2147/CCID.S417679
Guglielmetti A, Conlledo R, Bedoya J, Ianiszewski F, Correa J. Inverse psoriasis involving genital skin folds: successful therapy with dapsone. Dermatol Ther (Heidelb). 2012;2(1):15. DOI: https://doi.org/10.1007/s13555-012-0015-5
Lo Y, Tsai TF. Updates on the Treatment of Erythrodermic Psoriasis. Psoriasis (Auckl). 2021;11:59-73. DOI: https://doi.org/10.2147/PTT.S288345
Galili E, Levy SR, Tzanani I, Segal O, Lyakhovitsky A, Barzilai A, et al. New-Onset Guttate Psoriasis: A Long-Term Follow-Up Study. Dermatol. 2023;239(2):188-94. DOI: https://doi.org/10.1159/000527737
Saleh D, Tanner LS. Guttate Psoriasis. StatPearls. Treasure Island (FL). 2025.
Genovese G, Moltrasio C, Cassano N, Maronese CA, Vena GA, Marzano AV. Pustular Psoriasis: From Pathophysiology to Treatment. Biomedicines. 2021;9(12). DOI: https://doi.org/10.3390/biomedicines9121746
Potestio L, Camela E, Cacciapuoti S, Fornaro L, Ruggiero A, Martora F, et al. Biologics for the Management of Erythrodermic Psoriasis: An Updated Review. Clin Cosmet Investig Dermatol. 2023;16:2045-59. DOI: https://doi.org/10.2147/CCID.S407813
Vicic M, Kastelan M, Brajac I, Sotosek V, Massari LP. Current Concepts of Psoriasis Immunopathogenesis. Int J Mol Sci. 2021;22:21. DOI: https://doi.org/10.3390/ijms222111574
Sieminska I, Pieniawska M, Grzywa TM. The Immunology of Psoriasis-Current Concepts in Pathogenesis. Clin Rev Allergy Immunol. 2024;66(2):164-91. DOI: https://doi.org/10.1007/s12016-024-08991-7
Griffiths CEM, Armstrong AW, Gudjonsson JE, Barker J. Psoriasis. Lancet. 2021;397(10281):1301-15. DOI: https://doi.org/10.1016/S0140-6736(20)32549-6
Kanda N, Hoashi T, Saeki H. Nutrition and Psoriasis. Int J Mol Sci. 2020;21:15. DOI: https://doi.org/10.3390/ijms21155405
Hwang J, Yoo JA, Yoon H, Han T, Yoon J, An S, et al. The Role of Leptin in the Association between Obesity and Psoriasis. Biomol Ther (Seoul). 2021;29(1):11-21. DOI: https://doi.org/10.4062/biomolther.2020.054
Rajasekharan A, Munisamy M, Menon V, Mohan Raj PS, Priyadarshini G, Rajappa M. Stress and psoriasis: Exploring the link through the prism of hypothalamo-pituitary-adrenal axis and inflammation. J Psychosom Res. 2023;170:111350. DOI: https://doi.org/10.1016/j.jpsychores.2023.111350
Petit RG, Cano A, Ortiz A, Espina M, Prat J, Munoz M, et al. Psoriasis: From Pathogenesis to Pharmacological and Nano-Technological-Based Therapeutics. Int J Mol Sci. 2021;22:9. DOI: https://doi.org/10.3390/ijms22094983
Anand S, Littler DR, Mobbs JI, Braun A, Baker DG, Tennant L, et al. Complimentary electrostatics dominate T-cell receptor binding to a psoriasis-associated peptide antigen presented by human leukocyte antigen C *06:02. J Biol Chem. 2023;299(7):104930. DOI: https://doi.org/10.1016/j.jbc.2023.104930
Singh S, Pradhan D, Puri P, Sharma S, Jain AK. Profiling CARD14 gene expression in Indian Psoriasis patients. Sci Rep. 2024;14(1):28798. DOI: https://doi.org/10.1038/s41598-024-78267-9
Liu S, He M, Jiang J, Duan X, Chai B, Zhang J, et al. Triggers for the onset and recurrence of psoriasis: a review and update. Cell Commun Signal. 2024;22(1):108. DOI: https://doi.org/10.1186/s12964-023-01381-0
Duchnik E, Kruk J, Tuchowska A, Marchlewicz M. The Impact of Diet and Physical Activity on Psoriasis: A Narrative Review of the Current Evidence. Nutrients. 2023;15:4. DOI: https://doi.org/10.3390/nu15040840
Medovic MV, Jakovljevic VL, Zivkovic VI, Jeremic NS, Jeremic JN, Bolevich SB, et al. Psoriasis between Autoimmunity and Oxidative Stress: Changes Induced by Different Therapeutic Approaches. Oxid Med Cell Longev. 2022;2022:2249834. DOI: https://doi.org/10.1155/2022/2249834
Laguardia F, Owczarczyk-Saczonek A, Maggi P. The role of smoking in psoriasis. Postepy Dermatol Alergol. 2024;41(2):143-8. DOI: https://doi.org/10.5114/ada.2023.133582
Potestio L, Lauletta G, Tommasino N, Portarapillo A, Salsano A, Battista T, et al. Risk Factors for Psoriasis Flares: A Narrative Review. Psoriasis (Auckl). 2024;14:39-50. DOI: https://doi.org/10.2147/PTT.S323281
Zhou S, Yao Z. Roles of Infection in Psoriasis. Int J Mol Sci. 2022;23(13). DOI: https://doi.org/10.3390/ijms23136955
Yeroushalmi S, Hakimi M, Chung M, Bartholomew E, Bhutani T, Liao W. Psoriasis and Exercise: A Review. Psoriasis (Auckl). 2022;12:189-97. DOI: https://doi.org/10.2147/PTT.S349791
Roszkiewicz M, Dopytalska K, Szymanska E, Jakimiuk A, Walecka I. Environmental risk factors and epigenetic alternations in psoriasis. Ann Agric Environ Med. 2020;27(3):335-42. DOI: https://doi.org/10.26444/aaem/112107
Marek-Jozefowicz L, Czajkowski R, Borkowska A, Nedoszytko B, Zmijewski MA, Cubala WJ, et al. The Brain-Skin Axis in Psoriasis-Psychological, Psychiatric, Hormonal, and Dermatological Aspects. Int J Mol Sci. 2022;23:2. DOI: https://doi.org/10.3390/ijms23020669
Gisondi P, Geat D, Bellinato F, Spiazzi L, Danese E, Montagnana M, et al. Psychological Stress and Salivary Cortisol Levels in Patients with Plaque Psoriasis. J Pers Med. 2021;11:11. DOI: https://doi.org/10.3390/jpm11111069
Alesci A, Lauriano ER, Fumia A, Irrera N, Mastrantonio E, Vaccaro M, et al. Relationship between Immune Cells, Depression, Stress, and Psoriasis: Could the Use of Natural Products Be Helpful? Molecules. 2022;27:6. DOI: https://doi.org/10.3390/molecules27061953
Plenkowska J, Gabig-Ciminska M, Mozolewski P. Oxidative Stress as an Important Contributor to the Pathogenesis of Psoriasis. Int J Mol Sci. 2020;21:17. DOI: https://doi.org/10.3390/ijms21176206
Reolid A, Servitje O, Ginarte M, Perez-Ferriols A, Velez A, Aragues M, et al. Validation of an Optical Pencil Method to Estimate the Affected Body Surface Area in Psoriasis. Actas Dermosifiliogr (Engl Ed). 2020;111(2):143-8. DOI: https://doi.org/10.1016/j.adengl.2020.01.001
Ogdie A, Shin DB, Love TJ, Gelfand JM. Body surface area affected by psoriasis and the risk for psoriatic arthritis: a prospective population-based cohort study. Rheumatology (Oxford). 2022;61(5):1877-84. DOI: https://doi.org/10.1093/rheumatology/keab622
Lin YL, Huang A, Yang CY, Chang WY. Measurement of Body Surface Area for Psoriasis Using U-net Models. Comput Math Methods Med. 2022;2022:7960151. DOI: https://doi.org/10.1155/2022/7960151
Papp KA, Lebwohl MG, Kircik LH, Pariser DM, Strober B, Krueger GG, et al. The Proposed PASI-HD Provides More Precise Assessment of Plaque Psoriasis Severity in Anatomical Regions with a Low Area Score. Dermatol Ther (Heidelb). 2021;11(4):1079-83. DOI: https://doi.org/10.1007/s13555-021-00572-2
Miceli A, Schmieder GJ. Palmoplantar Psoriasis. StatPearls. Treasure Island (FL). 2025.
Rencz F, Gulacsi L, Pentek M, Szegedi A, Remenyik E, Bata-Csorgo Z, et al. DLQI-R scoring improves the discriminatory power of the Dermatology Life Quality Index in patients with psoriasis, pemphigus and morphea. Br J Dermatol. 2020;182(5):1167-75. DOI: https://doi.org/10.1111/bjd.18435
Schuman-Olivier Z, Trombka M, Lovas DA, Brewer JA, Vago DR, Gawande R, et al. Mindfulness and Behavior Change. Harv Rev Psychiatry. 2020;28(6):371-94. DOI: https://doi.org/10.1097/HRP.0000000000000277
de Aguiar KR, Bilhalva JB, Cabelleira MD, Guimaraes GO, Madureira T, Agako A, et al. The impact of mindfulness on suicidal behavior: a systematic review. Trends Psychiatry Psychother. 2022;44:e20210316. DOI: https://doi.org/10.47626/2237-6089-2021-0316
Gotink RA, Meijboom R, Vernooij MW, Smits M, Hunink MG. 8-week Mindfulness Based Stress Reduction induces brain changes similar to traditional long-term meditation practice - A systematic review. Brain Cogn. 2016;108:32-41. DOI: https://doi.org/10.1016/j.bandc.2016.07.001
Alrabadi LS, Dutton A, Rabiee A, Roberts SJ, Deng Y, Cusack L, et al. Mindfulness-based stress reduction may decrease stress, disease activity, and inflammatory cytokine levels in patients with autoimmune hepatitis. JHEP Rep. 2022;4(5):100450. DOI: https://doi.org/10.1016/j.jhepr.2022.100450
Diez GG, Anitua E, Castellanos N, Vazquez C, Galindo-Villardon P, Alkhraisat MH. The effect of mindfulness on the inflammatory, psychological and biomechanical domains of adult patients with low back pain: A randomized controlled clinical trial. PLoS One. 2022;17(11):e0276734. DOI: https://doi.org/10.1371/journal.pone.0276734
Garbicz J, Calyniuk B, Gorski M, Buczkowska M, Piecuch M, Kulik A, et al. Nutritional Therapy in Persons Suffering from Psoriasis. Nutrients. 2021;14(1). DOI: https://doi.org/10.3390/nu14010119
Borsini A, Nicolaou A, Camacho-Munoz D, Kendall AC, Di Benedetto MG, Giacobbe J, et al. Omega-3 polyunsaturated fatty acids protect against inflammation through production of LOX and CYP450 lipid mediators: relevance for major depression and for human hippocampal neurogenesis. Mol Psychiatry. 2021;26(11):6773-88. DOI: https://doi.org/10.1038/s41380-021-01160-8
Lombardo M, Feraco A, Camajani E, Caprio M, Armani A. Health Effects of Red Wine Consumption: A Narrative Review of an Issue That Still Deserves Debate. Nutrients. 2023;15:8. DOI: https://doi.org/10.3390/nu15081921
Lieffers JRL, Quintanilha M, Trottier CF, Johnson ST, Mota JF, Prado CM. Experiences with and Perception of a Web-Based Mindfulness, Nutrition, and Fitness Platform Reported by First-Year University Students: A Qualitative Study. J Acad Nutr Diet. 2021;121(12):2409-18e3. DOI: https://doi.org/10.1016/j.jand.2021.04.019
Crovetto F, Crispi F, Casas R, Martin-Asuero A, Borras R, Vieta E, et al. Effects of Mediterranean Diet or Mindfulness-Based Stress Reduction on Prevention of Small-for-Gestational Age Birth Weights in Newborns Born to At-Risk Pregnant Individuals: The IMPACT BCN Randomized Clinical Trial. JAMA. 2021;326(21):2150-60. DOI: https://doi.org/10.1001/jama.2021.20178
Crovetto F, Nakaki A, Arranz A, Borras R, Vellve K, Paules C, et al. Effect of a Mediterranean Diet or Mindfulness-Based Stress Reduction During Pregnancy on Child Neurodevelopment: A Prespecified Analysis of the IMPACT BCN Randomized Clinical Trial. JAMA Netw Open. 2023;6(8):e2330255. DOI: https://doi.org/10.1001/jamanetworkopen.2023.30255
Nakaki A, Crovetto F, Urru A, Piella G, Borras R, Comte V, et al. Effects of Mediterranean diet or mindfulness-based stress reduction on fetal and neonatal brain development: a secondary analysis of a randomized clinical trial. Am J Obstet Gynecol MFM. 2023;5(12):101188. DOI: https://doi.org/10.1016/j.ajogmf.2023.101188