Complementary strategies in psoriasis - Non-pharmacological approaches for comprehensive management

Psoriasis is a chronic immune-mediated inflammatory disease linked to systemic comorbidities such as obesity, diabetes, cardiovascular disease, and inflammatory bowel disease. Non-pharmacological interventions, such as dietary modifications, nutritional supplementation, exercise, and psychological interventions, have emerged as complementary therapies in the management of psoriasis.

Review the current and recent evidence and the role of trace elements, vitamins, diet, exercise, and psychological interventions as complementary approaches in the management of patients with psoriasis.

A narrative review was conducted, analyzing clinical trials, meta-analyses, and cohort studies from major databases.

Trace elements such as zinc, copper, and selenium, and vitamins including D, E, B-complex, and A, play roles in oxidative stress modulation, immune regulation, and keratinocyte biology. However, the clinical efficacy of micronutrient supplementation remains uncertain due to inconsistent and conflicting findings. Dietary interventions, particularly Mediterranean diet adherence and weight loss through caloric restriction or bariatric surgery, have been associated with reductions in psoriasis severity, although clear clinical protocols are lacking. Aerobic exercise appears beneficial but is underutilized, partially due to psychological and disease-related barriers. Furthermore, psoriasis is associated with a high prevalence of psychological disorders, with the necessity to integrate psychological interventions to optimize disease management.

The available evidence is limited and with heterogeneity in study design, with small sample sizes, observational methodologies, and inconsistent intervention protocols, restricting causal inference and generalizability.

While non-pharmacological strategies show promise as complementary interventions in psoriasis management, they cannot replace conventional therapy. Further studies are required to confirm their clinical impact. These approaches should be considered as complementary strategies, with individualized patient assessments and continuous follow-up being essential.