乾癬患者採地中海飲食，可有效減輕乾癬嚴重度，近半數可改善 75% 以上：JAMA Dermatology 研究
乾癬患者常問我：飲食上要注意什麼？
這篇西班牙的隨機試驗，找來 38 位輕中度、使用外用藥的乾癬患者，一半由營養師帶著吃 16 週的地中海飲食，另一半只給一般的低脂飲食建議。
結果地中海飲食組有 47.4% 的人乾癬嚴重度改善 75% 以上，對照組沒有任何人達到。這裡的嚴重度用的是乾癬面積與嚴重度指數（PASI），綜合病灶面積，以及紅、厚、脫屑的程度來計分。
地中海飲食組的糖化血色素也跟著下降。
地中海飲食的重點是多蔬菜、水果、豆類、全穀、魚，用橄欖油取代其他油脂，少吃紅肉與加工食品。
我也曾叮囑一位乾癬數年、外用超強類固醇的患者：健康飲食與減重可以有效改善乾癬；之後患者確實改變生活習慣，不吃垃圾食物，每天運動。
不過，就像我在《不「藥」而癒》書評寫的，當皮膚病況走在惡性循環中，若只是在家調整飲食，是遠遠不夠的，還是需要尋求醫療協助。
乾癬不只是皮膚問題，常合併代謝方面的問題，好好吃飯，對皮膚和身體都有幫助。
本篇研究，“Mediterranean Diet and Patients With Psoriasis: The MEDIPSO Randomized Clinical Trial”，期刊摘要如下：
Importance：
Despite growing interest on the role of diet in the prevention and treatment of psoriasis, randomized clinical trials are lacking. The Mediterranean diet is known for its anti-inflammatory and cardiometabolic benefits, which may be relevant to psoriasis pathophysiology.
Objective：
To assess whether a 16-week Mediterranean diet intervention would improve psoriasis severity in patients with mild to moderate disease.
Design, Setting, and Participants：
MEDIPSO (Impact of the Mediterranean Diet on Patients With Psoriasis), an open-label, single-center, single-blinded (evaluator) randomized clinical trial, was conducted from February 2024 to March 2025 at a dermatology referral clinic in Madrid, Spain. Participants were adults with mild to moderate psoriasis (Psoriasis Area and Severity Index [PASI] of 2-10, with higher scores indicating maximal disease) receiving stable topical therapy.
Interventions：
Participants were randomized 1:1 to the intervention or control group. The intervention group received a 16-week, dietitian-guided Mediterranean diet program, including nutritional counseling, educational materials, and weekly provision of extra virgin olive oil. The control group received standard low-fat dietary advice without dietitian supervision.
Main Outcomes and Measures：
The primary outcome was the change in the PASI from baseline to week 16. Secondary outcomes included changes in Mediterranean diet adherence, anthropometric and metabolic parameters, serum inflammatory cytokines, and patient-reported outcomes. Estimated marginal means (EMMs) at baseline and for the change from baseline to week 16 were reported, with the intervention effect presented as the between-group difference.
Results：
Among 45 individuals screened, 38 participants were enrolled and randomized (mean [SD] age, 46.4 [12.8] years; 25 males [65.8%]); 19 were randomized to the intervention group and 19 were randomized to the control group; 37 individuals (97.4%) completed the study. The EMM PASI change at week 16 was -3.4 (95% CI, -4.4 to -2.4) in the intervention group and 0.0 (95% CI, -1.0 to 1.0) in the control group; the between-group EMM difference was -3.4 (95% CI, -4.8 to -2.0; P < .001). Nine of 19 participants in the Mediterranean diet group (47.4%) achieved PASI 75 (a 75% reduction in PASI) compared with none in the control group. A significant reduction in EMM hemoglobin A1c (glycated hemoglobin) was observed in the intervention group as compared with the control group (between-group EMM difference, -4.1 mmol/mol [95% CI, -6.9 to -1.3 mmol/mol]; P = .01).
Conclusions and Relevance：
This randomized clinical trial found that a 16-week Mediterranean diet intervention significantly improved psoriasis severity in patients with mild to moderate disease receiving stable topical therapy. These findings suggest that incorporating dietary strategies may be beneficial as an adjunctive therapy in psoriasis management.
原始論文
Mediterranean Diet and Patients With Psoriasis: The MEDIPSO Randomized Clinical Trial（外部網站）
Perez-Bootello J, Berna-Rico E, Abbad-Jaime de Aragon C, et al. JAMA Dermatology. 2025;161(12):1215-1223. doi:10.1001/jamadermatol.2025.3410
論文摘要（中文翻譯）
以下為中文翻譯，僅供參考，內容以英文原文為準。
地中海飲食與乾癬患者：MEDIPSO 隨機臨床試驗
重要性：雖然飲食在預防與治療乾癬中的角色越來越受關注，但隨機臨床試驗仍然很少。地中海飲食以抗發炎與有益心血管代謝著稱，可能與乾癬的病理機轉有關。
目的：評估 16 週的地中海飲食介入，能否改善輕中度乾癬患者的嚴重度。
研究設計、場域與對象：MEDIPSO（地中海飲食對乾癬患者的影響）是開放標示、單一中心、評估者單盲的隨機臨床試驗，於 2024 年 2 月至 2025 年 3 月在西班牙馬德里一家皮膚科轉診門診進行。對象是正在使用穩定外用藥治療的輕中度乾癬成人（乾癬面積與嚴重度指數 PASI 2–10，分數越高越嚴重）。
介入方式：參與者以 1:1 隨機分配到介入組或對照組。介入組接受 16 週、由營養師指導的地中海飲食計畫，包括營養諮詢、衛教資料，以及每週提供特級初榨橄欖油。對照組只接受一般低脂飲食建議，沒有營養師指導。
主要結果與測量方式：主要結果是 PASI 從治療前到第 16 週的變化。次要結果包括地中海飲食遵從度、身體測量與代謝指標、血清發炎細胞激素，以及患者自評結果的變化。報告治療前與第 16 週變化的估計邊際平均值，介入效果以組間差異表示。
結果：篩選 45 人，納入並隨機分配 38 人（平均年齡 46.4 歲［標準差 12.8］；男性 25 人［65.8%］），介入組與對照組各 19 人；37 人（97.4%）完成研究。第 16 週時，介入組 PASI 變化的估計邊際平均值為 −3.4（95% CI −4.4 至 −2.4），對照組為 0.0（95% CI −1.0 至 1.0）；組間差異為 −3.4（95% CI −4.8 至 −2.0；P < .001）。地中海飲食組 19 人中有 9 人（47.4%）達到 PASI 75（PASI 改善 75%），對照組則沒有任何人達到。與對照組相比，介入組的糖化血色素也明顯下降（組間差異 −4.1 mmol/mol［95% CI −6.9 至 −1.3 mmol/mol］；P = .01）。
結論與意義：這項隨機臨床試驗發現，對於使用穩定外用藥治療的輕中度乾癬患者，16 週的地中海飲食介入能明顯改善乾癬嚴重度。結果顯示，將飲食策略納入乾癬照護，可能是有益的輔助治療。
