Der Hautarzt

, Volume 57, Issue 11, pp 999–1004

Die Bedeutung der Ernährung und begleitender Faktoren für die Psoriasis

Übersicht

Zusammenfassung

Psoriasis ist eine T-Lymphozyten-vermittelte Entzündung der Haut, die durch Hyperproliferation und verminderte Differenzierung epidermaler Keratinozyten gekennzeichnet ist. In schweren Fällen kommt es zu einer Beeinträchtigung des Ernährungsstatus, zusätzlich forciert durch Medikamenten-Nährstoff-Interaktionen bei systemischer Therapie. Die Art der Ernährung wie auch einzelne Nahrungsinhaltsstoffe werden als ätiologische und pathogenetische Faktoren diskutiert. Positive Effekte zeigten sich durch Fastenperioden, vegetarische Ernährung oder die erhöhte Zufuhr von Omega-3-Fettsäuren aus Fischöl. Die Verbesserung resultiert aus einer verminderten Arachidonsäure- bzw. einer erhöhten Eicosapentaensäurezufuhr. Als Konsequenz verändert sich das Eicosanoidprofil und damit die Konzentration der Entzündungsmediatoren. Allerdings konnte nur in einer von 4 randomisierten, kontrollierten Studien mit Omega-3-Fettsäuren ein Nutzen nachgewiesen werden. Einige Patienten weisen eine Glutensensitivität auf und könnten von einer glutenfreien Diät profitieren. Eine Verbesserung der Symptome lässt sich darüber hinaus durch Vitamin D erzielen, welches antiproliferative und immunregulatorische Effekte besitzt.

Schlüsselwörter

Psoriasis Ernährung Medikamenten-Nährstoff-Interaktionen Omega-3-Fettsäuren Gluten 

The significance of diet and associated factors in psoriasis

Abstract

Psoriasis is a T cell mediated inflammatory skin disease characterized by hyperproliferation and reduced differentiation of epidermal keratinocytes. In severe cases, the disease can result in an insufficient nutritional status which may even be promoted by nutrient-drug interactions. Both the general diet and single food components have been suggested to play a role in etiology and pathogenesis of psoriasis. Fasting periods, vegetarian diets, and diets rich in omega-3 polyunsaturated fatty acids from fish oil have all been associated with improvement in some studies. The most likely explanation is the reduced amounts of arachidonic acid and the increased eicosapentaenoic acid intake resulting in a modulated eicosanoid profile. However, only one of four controlled studies showed a benefit of omega-3 fatty acids compared to placebo. Some psoriasis patients are gluten-sensitive and may benefit from a gluten free diet. The active form of vitamin D exhibits anti-proliferative and immunoregulatory effects and has been shown to be useful in the treatment of psoriasis.

Keywords

Psoriasis Nutrition Drug-nutrient interactions Omega-3 fatty acids Gluten 

Literatur

  1. 1.
    Allain TJ, Dhesi J (2003) Hypovitaminosis D in older adults. Gerontology 49: 273–278CrossRefPubMedGoogle Scholar
  2. 2.
    Behnam SM, Behnam SE, Koo JY (2005). Alcohol as a risk factor for plaque-type psoriasis. Cutis 76(3): 181–185PubMedGoogle Scholar
  3. 3.
    Bittiner SB, Tucker WF, Cartwright I et al. (1988) A double-blind, randomised, placebo-controlled trial of fish oil in psoriasis. Lancet 1(8582): 378–380CrossRefPubMedGoogle Scholar
  4. 4.
    Bjorneboe A, Smith AK, Bjorneboe GE et al. (1988) Effect of dietary supplementation with n-3 fatty acids on clinical manifestations of psoriasis. Br J Dermatol 118: 77–83PubMedGoogle Scholar
  5. 5.
    Briganti S, Picardo M (2003) Antioxidant activity, lipid peroxidation and skin disease. What’s new. J Eur Acad Dermatol Venereol 17:663–669CrossRefPubMedGoogle Scholar
  6. 6.
    Chalmers RJG, Kirby B (2000) Editorial comments: Gluten and psoriasis. Br J Dermatol 142: 5–7CrossRefPubMedGoogle Scholar
  7. 7.
    Chalmers RJG, O’Sullivan T, Owen CM et al. (2001) A systematic review of treatments for guttate psoriasis (Cochrane Review). Br J Dermatol 145: 891–894CrossRefPubMedGoogle Scholar
  8. 8.
    Collier PM, Ursell A, Zaremba K et al. (1993) Effect of regular consumption of oily fish compared with white fish on chronic plaque psoriasis. Eur J Clin Nutr 47: 251–254PubMedGoogle Scholar
  9. 9.
    Collin P, Reunala T (2003) Recognition and management of the cutaneous manifestations of celiac disease: a guide for dermatologists. Am J Clin Dermatol 4: 13–20CrossRefPubMedGoogle Scholar
  10. 10.
    Grimminger F, Mayser P, Papavassilis C et al. (1993) A double-blind, randomized, placebo-controlled trial of n-3 fatty acid based lipid infusion in acute, extended guttate psoriasis. Rapid improvement of clinical manifestations and changes in neutrophil leukotriene profile. Clin Investig 71: 634–643CrossRefPubMedGoogle Scholar
  11. 11.
    Gupta AK, Ellis CN, Goldfarb MT et al. (1990) The role of fish oil in psoriasis. A randomized, double-blind, placebo-controlled study to evaluate the effect of fish oil and topical corticosteroid therapy in psoriasis. Int J Dermatol 29: 591–595PubMedGoogle Scholar
  12. 12.
    Hahn A, Wolters M (2002) Lebensmittel-Medikamenten-Interaktionen. In: Lexikon der Ernährung. Band 2. Spektrum Akademischer Verlag, Heidelberg, S 298–306Google Scholar
  13. 13.
    Holick MF (2003) Vitamin D: a millenium perspective. J Cell Biochem 88: 296–307CrossRefPubMedGoogle Scholar
  14. 14.
    Hsieh EA, Chai CM, De Lumen BO et al. (2004) Dynamics of keratinocytes in vivo using HO labeling: a sensitive marker of epidermal proliferation state. J Invest Dermatol 123: 530–536CrossRefPubMedGoogle Scholar
  15. 15.
    Mayer K, Seeger W, Grimminger F (1998) Clinical use of lipids to control inflammatory disease. Curr Opin Clin Nutr Metab Care 1: 179–184CrossRefPubMedGoogle Scholar
  16. 16.
    Mayser P, Mrowietz U, Arenberger P et al. (1998) Omega-3 fatty acid-based lipid infusion in patients with chronic plaque psoriasis: results of a double-blind, randomized, placebo-controlled, multicenter trial. J Am Acad Dermatol 38: 539–547CrossRefPubMedGoogle Scholar
  17. 17.
    Michaelsson G, Gerdén B, Hagforsen E et al. (2000) Psoriasis patients with antibodies to gliadin can be improved by a gluten-free diet. Br J Dermatol 142: 44–51CrossRefPubMedGoogle Scholar
  18. 18.
    Michaelsson G, Gerdén B, Ottosson M et al. (1993) Patients with psoriasis often have increased serum levels of IgA antibodies to gliadin. Br J Dermatol 129: 667–673PubMedGoogle Scholar
  19. 19.
    Michaelsson G, Kraaz W, Gerdén B et al. (1995) Increased lymphocytic infiltration in duodenal mucosa from patients with psoriasis and serum IgA antibodies to gliadin. Br J Dermatol 133: 896–904PubMedGoogle Scholar
  20. 20.
    Muller H, de Toledo FW, Resch KL (2001) Fasting followed by vegetarian diet in patients with rheumatoid arthritis: a systematic review. Scand J Rheumatol 30: 1–10PubMedGoogle Scholar
  21. 21.
    Naldi L, Parazzini F, Peli L et al. (1996) Dietary factors and the risk of psoriasis. Results of an Italian case-control study. Br J Dermatol 134: 101–106CrossRefPubMedGoogle Scholar
  22. 22.
    Naldi L, Svensson A, Diepgen T et al. (2003) Randomized clinical trials for psoriasis 1977–2000: the EDEN survey. J Invest Dermatol 120: 738–741CrossRefPubMedGoogle Scholar
  23. 23.
    Pinette KV, Yee YK, Amegadzie BY, Nagpal S (2003) Vitamin D receptor as a drug discovery target. Mini Rev Med Chem 3: 193–204CrossRefPubMedGoogle Scholar
  24. 24.
    Prinz JC (2003) Neueste Aspekte in der Pathogenese der Psoriasis. Hautarzt 54: 209–214PubMedGoogle Scholar
  25. 25.
    Prystowsky JH, Orologa A, Taylor S (1993) Update on nutrition and psoriasis. Int J Dermatol 32: 582–586PubMedGoogle Scholar
  26. 26.
    Rucevic I, Perl A, Barisic-Drusko V et al. (2003) The role of the low energy diet in psoriasis vulgaris treatment. Coll Antropol 27 [Suppl 1]: 41–48Google Scholar
  27. 27.
    Soyland E, Funk J, Rajka G et al. (1993) Effect of dietary supplementation with very-long-chain n-3 fatty acids in patients with psoriasis. N Engl J Med 328: 1812–1816CrossRefPubMedGoogle Scholar
  28. 28.
    van der Wielen RP, Lowik MR, van den Berg H et al. (1995) Serum vitamin D concentrations among elderly people in Europe. Lancet 346: 207–210CrossRefPubMedGoogle Scholar
  29. 29.
    Whittle SL, Hughes RA (2004) Folate supplementation and methotrexate treatment in rheumatoid arthritis: a review. Rheumatology (Oxford) 43: 267–271Google Scholar
  30. 30.
    Wolters M (2005) Diet and psoriasis – experimental data and clinical evidence. Br J Dermatol 153: 706–714CrossRefPubMedGoogle Scholar
  31. 31.
    Wolters M, Ströhle A, Hahn A (2004) Altersassoziierte Veränderungen im Vitamin-B12- und Folsäurestoffwechsel: Prävalenz, Ätiopathogenese und pathophysiologische Konsequenzen. Z Gerontol Geriatr 37: 109–135CrossRefPubMedGoogle Scholar
  32. 32.
    Wolters M, Ströhle A, Hahn A (2005) Neue Erkenntnisse zu Vitamin D und Vitamin B12. Dtsch Apothek Z 145: 221–228Google Scholar

Copyright information

© Springer Medizin Verlag 2006

Authors and Affiliations

  1. 1.Abteilung Ernährungsphysiologie und Humanernährung, Institut für Lebensmittelwissenschaft, Zentrum Angewandte ChemieUniversität HannoverHannover

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