on July 15, 2026
Psoriasis is a chronic, relapsing inflammatory disease of immunological pathogenesis, characterized by a marked acceleration of epidermal mitotic activity. In patients with psoriasis, the replication and differentiation cycle of keratinocytes is completed in just 2–4 days, compared to the normal 28–30 days in healthy individuals. This pathological turnover manifests clinically as typical erythematous plaques with well-defined margins, covered by piles of white-silvery, friable scales.
From an etiopathogenetic standpoint, the disease has a strong multifactorial component involving genetic susceptibility loci (PSORS loci), immunological alterations mediated by the activation and migration of T lymphocytes from the dermis to the epidermis, and environmental triggers such as stress, physical trauma (Koebner phenomenon), infections, and medications (including beta-blockers, lithium salts, antimalarials, and NSAIDs). The persistent inflammatory state is not limited to the skin barrier: approximately one-third of patients develop psoriatic arthritis (PsA) 8–10 years after the onset of skin symptoms, and the disease is frequently associated with systemic comorbidities of cardiovascular nature (heart attack, stroke), metabolic syndrome, and type 2 diabetes, the incidence of which increases in parallel with body mass index (BMI).
Epidemiological and clinical research has consolidated the close link between dietary habits and the severity of psoriasis symptoms. A major observational study conducted in France by the Henri Mondor University Hospital in Créteil on over 3,500 patients, published in JAMA Dermatology, highlighted how strong adherence to a healthy, anti-inflammatory diet significantly reduces the severity of skin lesions. Patients who consumed high amounts of fruit, vegetables, whole grains, fish, nuts, and extra virgin olive oil, while limiting red meat, dairy, and alcohol, had decidedly more favorable clinical outcomes. Researchers hypothesize that this hypotoxic nutritional approach acts by directly modulating the innate immune system and the composition of the intestinal microbiota.
On a biochemical level, the diet for patients with psoriasis should aim to balance the ratio between omega-3 and omega-6 fatty acids, reducing the precursors of pro-inflammatory mediators such as arachidonic acid, leukotriene B4, and prostaglandin E2. It is therefore recommended to limit foods high in animal fats, refined sugars, salt, coffee, cocoa, and taurine. Particular attention should be paid to solanaceous plants (potatoes, eggplant, tomatoes, and peppers, especially when raw) and histamine-containing or histamine-releasing foods (bananas, strawberries, legumes), which can exacerbate itching and skin inflammation. Furthermore, given the frequent correlation with gluten sensitivity and celiac disease—highlighted by higher average levels of anti-gliadin antibodies in patients with psoriasis—many patients benefit from a temporary gluten-free diet.
Immunomodulating micronutrients play a crucial therapeutic role. A case-control study conducted in the Mediterranean population by Suarez-Varela et al. (2014) on 50 patients with psoriasis and 200 controls confirmed widespread vitamin D deficiency, which is correlated with more severe forms of psoriasis and greater comorbidity. Vitamin D supplementation (capable of regulating epidermal differentiation) and polyunsaturated fatty acids (PUFAs) through traditional remedies such as cod liver oil act synergistically with protective antioxidants such as zinc, selenium, coenzyme Q10, vitamin C, vitamin E, and beta-carotene, reducing systemic oxidative stress.
Alongside diet, the study of the microbiota represents one of the most promising frontiers for understanding disease progression and the development of psoriatic arthritis. The dysbiosis of the skin microbiota in patients with psoriasis is characterized by a marked decrease in the Firmicutes phylum and an increase in Proteobacteria, with a specific enrichment of strains belonging to Streptococcaceae, Rhodobacteraceae, Campylobacteraceae, and Moraxellaceae. In contrast, the microbiota of patients with atopic dermatitis shows a predominance of Staphylococcus aureus.
Psoriatic lesions also show a marked overexpression of endogenous antimicrobial peptides, including cathelicidins and human beta-2 defensin (HBD-2). The latter, also found at high levels in patients' serum, possesses immunomodulatory and chemotactic properties that fuel the inflammatory loop. Since psoriatic arthritis shares a synovial fluid histopathological pattern much more similar to seronegative spondyloarthropathies than to rheumatoid arthritis, longitudinal analysis of the skin and intestinal microbiota in patients with psoriasis could allow for the early identification of individuals biologically predisposed to developing joint involvement.
In the field of phytotherapy and complementary interventions, the use of standardized extracts with anti-inflammatory and antiproliferative action provides valuable support for conventional topical and oral treatments. Among the most studied phytocomplexes is curcumin, the active principle of Curcuma longa. A systematic review of scientific literature conducted on international databases (Embase and PubMed) analyzed 18 clinical studies related to the oral and topical use of curcumin-based preparations in dermatological diseases. The results indicate that the intake of curcumin (up to doses of 1–6 g/day, depending on severity) or the topical application of 1% curcumin gel induces a statistically significant clinical improvement in psoriatic lesions and itching, thanks to the molecule's ability to inhibit pro-inflammatory transcription factors such as NF-kappa.
Another alkaloid of extraordinary therapeutic interest is berberine, which actively acts at the nuclear level by interacting with cellular DNA, reducing the synthesis of inflammatory prostaglandins, and slowing the proliferation of keratinocytes. Through topical and internal administration, Mediterranean herbal tradition and clinical research recognize Helichrysum italicum (particularly the microphyllum subspecies) as a remedy of choice for psoriasis. The synergistic use of a concentrated oral infusion of flowering tops, combined with the topical application of a 10% Helichrysum oleorubrum and balneotherapy, has been shown to induce, in just three weeks, a progressive reduction in erythema, the scaly parakeratotic component, and itching, with minor recurrences that are easily managed upon restarting treatment.
Finally, the phytotherapeutic arsenal is completed by the application of anthraquinones contained in Aloe vera gel (rich in immunomodulating acemannan), capsaicin (which desensitizes sensory nerve fibers, reducing itching), Nigella sativa, and the synergistic oral use of extracts of Fumaria officinalis, Boswellia serrata (a leukotriene inhibitor), Curcuma, Viola tricolor, and silymarin, which ensures deep skin penetration, optimizing dermal repair processes.
The personalized integration of these natural and nutritional aids represents an effective strategy for reducing the clinical severity of psoriasis and improving the patient's quality of life by acting synergistically on the various branches of the systemic inflammatory network.
Reference Bibliography
1. Barrea L, Nappi F, Di Somma C, et al. Environmental Risk Factors in Psoriasis: The Role of Nutrition and Diet. Reviews in Endocrine and Metabolic Disorders. 2016;17(3):343-353.
2. Campanini E. Dizionario di fitoterapia e piante medicinali. Tecniche Nuove. Ed. III. (Clinical references on the combined oral/topical use of Helichrysum italicum in psoriasis).
3. Ellertsen LK, et al. The skin microbiota in psoriasis and its relationship to systemic inflammation and psoriatic arthritis. Journal of Dermatological Science. 2009.
4. Gupta P. Herbal Treatment for Psoriasis: A Review of Clinical Evidence. Journal of Traditional Medicine & Clinical Naturopathy. 2015;4(2). (Analytical study on capsaicin, Aloe vera anthraquinones, Silybum marianum, Curcuma longa, and Nigella sativa).
5. Hsu CH, et al. The effects of curcumin on skin health and inflammatory dermatoses: A systematic review of clinical trials. Phytomedicine. 2008.
6. Kahan V, et al. Systematic review of curcumin/turmeric clinical trials for skin diseases. (Systematic analysis of 18 clinical trials conducted on Embase and PubMed databases, including the effects of 1% gel on psoriasis and oral use at doses between 1,500 mg and 6,000 mg/day for itching and lichen planus).
7. Phan CW, et al. The role of skin microbiome dysbiosis in the pathogenesis of psoriasis and psoriatic arthritis. Clinical Microbiology Reviews. 2015.
8. Santini L. Contribution to the therapeutic activity of Helichrysum italicum (ssp. microphyllum) in dermatoses and psoriasis. Archivio Italiano di Dermatologia, Sifilografia e Venereologia. 1950–1960. (Historical pioneering studies on infusion, 5% decoction, and topical application).
9. Suarez-Varela MM, Reguera-Leal E, et al. Vitamin D levels and dietary intake in Mediterranean patients with psoriasis: A case-control study. JAMA Dermatology (or related journals / Nutrition Journal). 2014;13:108. (Case-control study on 50 patients with psoriasis and 200 controls).
10. Phan, et al. French NutriNet-Santé Cohort Study: Association between Mediterranean diet adherence and psoriasis severity. JAMA Dermatology. 2018;154(9):1017-1024. (The major French study cited, conducted on over 3,500 patients by the Henri Mondor University Hospital in Créteil).
