The effects of Modified Intermittent Fasting in Psoriasis (MANGO) : preliminary results of a pilot crossover study

Abstract

Psoriasis is a chronic skin disease, characterized by systemic inflammation. Many comorbidities are associated with psoriasis, including obesity and gastrointestinal issues. Dietary lifestyle interventions have been reported to affect the disease in terms of lesional severity. Modified intermittent fasting (MIF) is known for its beneficial metabolic and gastrointestinal effects, and its effects on skin were investigated. Patients with mild psoriasis were recruited and randomized into a two-armpilot crossover controlled trial. The intervention arm included two nonconsecutive fasting days during 12 weeks. Data were collected on demographics, disease phenotype and activity (including transepidermal water loss), and visual analogue scaleon itch, diet and exercise, and quality of life (QoL). A total of 24 patients were enrolled; 21 completed the study. No significant differences were found between the intervention and control arms in terms of disease activity and metabolic parameters. Time-dependent differences were significant within groups: the first fasting group showed a reduction in PASI (P=0.025) after 12 weeks vs. baseline. A significant increase in PASI was noted when patients returned to their regular diet after 6 weeks (P=0.018). No differences were observed for body surface area (BSA). The same group reported improve-ment in their skin symptoms, including itch (P=0.014),scaling and thickening, upon fasting. Fasting patients also reported an improvement in their QoL, assessed by Dermatology Life Quality Index after 6 but not 12 weeks of fasting (P=0.024). Weight and BMI were significantly reduced in both fasting groups (at least P<0.05). A decrease in waist circumference was noted in both groups (P=0.008 for fasting group 2). Twelve weeks of MIF in patients with psoriasis shows a mild improvement in psoriatic symptoms such as scaling and plaque thickness, as well as itch. However, this benefit was transient and lost after 6 weeks of a regular diet. Currently, additional data are being collected and analysed. Although this was a pilot study, it would be of great interest to identify the patients who would benefit most from MIF as an add-on treatment for mild psoriasis. Its effect in moderate-to-severe psoriasis remains to be investigated.