Abstract
Fasting during the month of Ramadan consists of alternate abstinence and re-feeding periods (circadian or intermittent fasting). Nothing is currently known on the impact of this kind of fasting on psoriasis. A sample of 108 moderate-to-severe plaque psoriasis patients (aged 42.84 ± 13.61 years, 62 males, 46 females) volunteered to take part in the study. A significant decrease in the “Psoriasis Area and Severity Index” (PASI) score after the Ramadan fasting (mean difference = −0.89 ± 1.21, p < 0.0001) was found. At the multivariate regression, the use of cyclosporine (p = 0.0003), interleukin-17 or IL-17 blockers (p < 0.0001), and tumor necrosis factor or TNF blockers (p = 0.0107) was independently associated with a low PASI score, while the use of apremilast (p = 0.0009), and phototherapy (p = 0.0015) was associated with a high PASI score before the Ramadan fasting. Similarly, the consumption of cyclosporine (p < 0.0001), IL-17 blockers (p < 0.0001), mammalian target of rapamycin or mTOR inhibitors (p = 0.0081), and TNF blockers (p = 0.0017) predicted a low PASI score after the Ramadan fasting. By contrast, narrow band ultraviolet light B or NB-UVB (p = 0.0015) was associated with a high PASI score after Ramadan fasting. Disease duration (p = 0.0078), use of apremilast (p = 0.0005), and of mTOR inhibitors (p = 0.0034) were independent predictors of the reduction in the PASI score after the Ramadan fasting. These findings reflect the influence of dieting strategy, the biological clock, and circadian rhythm on the treatment of plaque psoriasis.
Highlights
Psoriasis is a chronic, systemic, inflammatory, recurrent disease affecting approximately 2%of the population worldwide, with prevalence rates differing according to the ethnicity
Inclusion criteria were the following: (i) patients aged greater than 18 years; (ii) suffering from plaque psoriasis, with pharmacologically stable disease; (iii) willing to fast during the month of Ramadan; iv) not pregnant; (v) human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) negative; and (vi) without any medical contraindication to follow the fasting
The change in the Psoriasis Area and Severity Index” (PASI) score before and after the Ramadan fasting correlated, instead, with body mass index (BMI)
Summary
Systemic, inflammatory, recurrent disease affecting approximately 2%. Of the population worldwide, with prevalence rates differing according to the ethnicity. It is an immune-mediated inflammatory disorder, which imposes a relevant burden, in terms of costs and health-related perceived quality of life. Pharmacological treatment relies on several options, including topical therapy for mild to moderate psoriasis, and systemic agents such as small molecules and biological drugs for more severe or extensive disease [3]. Phototherapy, including both narrow band ultraviolet light B (NB-UVB)
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