28231 The use of lifestyle medicine in dermatology: Level of evidence in intervention studies

Abstract

Lifestyle medicine promotes healthy, evidence-based interventions in diet, exercise, sleep, stress reduction, and social support, to treat and prevent chronic disease. In dermatology, lifestyle medicine is emerging yet often underused. The aim of this study is to 1) identify all relevant studies examining lifestyle interventions in dermatologic disease, 2) narrow this group to prospective interventional studies, and 3) further stratify only prospective interventional studies based on the level of evidence, identifying which lifestyle interventions have the strongest evidence for their use in dermatology. We reviewed the existing PubMed literature through September 2020 with predefined criteria to assess studies with lifestyle interventions in acne, psoriasis, atopic dermatitis, hidradenitis suppurativa, rosacea, vitiligo, skin aging, and skin cancer. A total of 89 studies were found, of which 28 were prospective interventional studies examining lifestyle for a specific dermatologic disease. We categorized these 28 studies based on the level of evidence and identified the following: 5 investigator-blinded randomized clinical trials 13 randomized clinical trials; 6 pilot studies, 2 prospective case series, and 2 case reports. The use of diet, exercise, and stress reduction for the treatment of psoriasis had the most evidence. Acne presented as the second most studied skin condition, particularly the use of a low-glycemic, dairy-free diet. Our study underscores the need for more lifestyle-based interventional studies in order to confidently use lifestyle changes for the treatment of dermatologic diseases.