Psoriasis, which affects approximately 7.5 million people in the United States, is a chronic, immune-mediated dermatological disorder characterized by keratinocyte hyperproliferation, often presenting as erythematous, scaly plaques on the skin. In some cases, it is accompanied by psoriatic arthritis (PsA), a seronegative oligoarthritis marked by progressive joint pain and destruction.
While pharmacologic interventions, including biologic and immunomodulatory therapies, are central to disease management, nonpharmacologic approaches play a critical adjunctive role. Here are five things to know about non-pharmacologic therapies in psoriasis and PsA.
1. Emerging evidence underscores the significant role of diet and gut microbiota modulation in mitigating inflammation and decreasing the severity of psoriasis symptoms.
An anti-inflammatory dietary pattern, particularly one aligned with the Mediterranean diet, is associated with a decreased severity of psoriasis symptoms. Additionally, a meta-analysis of 22 studies demonstrated that adherence to the Mediterranean diet significantly reduced multiple inflammatory biomarkers, including IL-6, IL-1β, CRP, IL-8, and TNF-α, key mediators implicated in the chronic inflammatory response characteristic of psoriasis. Conversely, a diet high in processed foods, red meat, and refined sugars, all of which are characteristics of the typical Western dietary pattern, may exacerbate inflammatory pathways.
Recent research has shifted its focus toward leveraging nutrition to modulate gut microbiota, with the aim of enhancing immune regulation and improving disease management. New evidence links intestinal dysbiosis to psoriasis, identifying potential therapeutic targets for clinical intervention. Preliminary research suggests that probiotic and prebiotic supplementation may provide benefits for individuals with psoriasis. Additionally, a two-sample bidirectional Mendelian randomization analysis has implicated gut microbiota in PsA, suggesting that probiotics could serve as a potential therapeutic option. However, the limited scope of existing studies highlights the need for more extensive research to validate these findings.
2. Emerging research highlights therapeutic textiles as a potential non-pharmacologic intervention for managing psoriasis.
Therapeutic textiles have garnered attention as a potential non-pharmacologic approach in the management of psoriasis. These innovative fabrics are engineered with bioactive compounds such as silver, silk, or chitosan, which possess antimicrobial, antioxidant, and anti-inflammatory properties. A systematic review encompassing 18 studies revealed that these textiles may enhance skin barrier function and exhibit efficacy in alleviating common psoriasis symptoms, including pruritus, irritation, and inflammation. Notably, most of the studies included in the review were conducted on individuals with atopic dermatitis rather than psoriasis specifically; however, the two conditions share many clinical characteristics. While early clinical evidence indicates potential benefits, further investigation is warranted to establish their long-term impact and determine their role as an adjunctive therapy option in psoriasis care.
3. Regular physical exercise has anti-inflammatory and antioxidative benefits that may help reduce psoriasis and PsA risk.
The HUNT study, a prospective population-based investigation, explored the relationship between adiposity, physical activity, and the risk of developing PsA. Findings suggested that higher BMI and increased waist circumference are associated with an elevated risk of PsA. While higher levels of physical activity did not significantly alter this risk, individuals who were more active exhibited a modestly reduced likelihood of developing the condition.
A recent comprehensive systematic review encompassing 319 studies suggested benefits of regular exercise, showing improvement in disease symptoms and quality of life among individuals with PsA. Specifically, a randomized controlled trial evaluated the efficacy of functional training versus resistance exercise in patients with PsA and found that both interventions significantly enhanced functional capacity, increased muscle strength, and improved quality of life.
Despite growing evidence showing the benefits of regular exercise, many patients with psoriasis and PsA fail to engage in adequate physical activity. Many patients with psoriasis report condition-specific barriers such as soreness, pruritus, and discomfort wearing certain clothing, which hinder their participation in regular exercise. A cross-sectional study of 232 patients with PsA found that 25.9% led a sedentary lifestyle, which was inversely related to disease impact. This points to the importance of tailored strategies to support physical activity as part of psoriasis and PsA management.
4. Cognitive behavioral therapies used as an adjunct to conventional treatments may improve quality of life in patients with psoriasis and PsA.
Patients with psoriasis are known to experience higher rates of depression and anxiety, with psychological stress playing a significant role in exacerbating disease severity and diminishing quality of life. Emerging evidence suggests that cognitive behavioral therapy (CBT) may serve as a potential adjunctive treatment for addressing the psychological symptoms associated with psoriasis.
A systematic review that included 30 studies demonstrated that the integration of internet-based CBT with standard medical treatment significantly enhances physical functioning in individuals with psoriasis. Additionally, a separate systematic review analyzing nine randomized controlled trials revealed that CBT interventions led to improvements in psoriasis severity in half of the included studies, with several also reporting reductions in anxiety, depression, and stress.
While the COMPASS study did not focus specifically on psoriasis, this two-armed randomized controlled trial examined digital CBT interventions in individuals with other chronic health conditions. The study demonstrated significant improvements in depression, anxiety, and illness-related distress within the experimental group, underscoring the potential for these findings to be applied to patients with psoriasis.
5. Telemedicine models improve access to specialized dermatologic and rheumatologic care.
Access to specialized dermatologic and rheumatologic care remains a significant barrier for many individuals managing psoriasis and PsA. The National Psoriasis Foundation’s Telemedicine Task Force underscores the role of teledermatology and virtual rheumatology consultations in mitigating these challenges. By leveraging high-quality patient-provided images, video assessments, and standardized disease severity tools, telemedicine aims to facilitate early diagnosis, expedite treatment decisions, and enhance long-term disease monitoring.
For PsA, validated screening instruments such as the Psoriasis Epidemiology Screening Tool can be integrated into telehealth visits, enabling clinicians to identify early joint involvement and initiate timely interventions to prevent irreversible damage. While telemedicine is not a substitute for in-person examinations in complex cases, it serves as a strategic alternative, optimizing access to care and reducing unnecessary delays.
While pharmacologic therapies remain central to managing psoriasis and PsA, non-pharmacologic interventions also play a crucial role in enhancing treatment outcomes and improving patients' quality of life. Evidence highlights the potential benefits of dietary modifications, therapeutic textiles, physical activity, CBT, and telemedicine in supporting disease management. These strategies not only address the multifaceted nature of psoriasis and PsA but also provide patients with additional tools to mitigate symptom severity, reduce psychological distress, and improve overall well-being. As research in these areas continues to evolve, integrating evidence-based non-pharmacologic approaches alongside conventional treatments can foster a more comprehensive and patient-centered model of care.