Addressing skin disease with medications alone is ‘not enough,’ diet also brings benefits

Key takeaways:

• Patients with psoriasis treated with tumor necrosis factor inhibitors should adhere to a Mediterranean diet.
• Patients with melanoma treated with immune checkpoint inhibitors should increase their fiber intake.

ORLANDO — Patients with skin disease adhering to a proper diet may experience better treatment responses and a reduced risk of adverse events, according to a speaker at the American Academy of Dermatology Annual Meeting.

Following the 2025 AAD Annual Meeting, the academy published a press release stating presentations on diet and lifestyle took center stage during the event. According to Steve Daveluy, MD, a professor at Wayne State Dermatology, this surge of interest in nutrition among health care professionals, including dermatologists, is due to a growing awareness of the impact of the gut microbiome on the immune system.

“We are learning more and coming to appreciate the amazing intricacies of our body,” Daveluy told Healio. “Microbiome research is highlighting the amazing impact that our gut bacteria, or gut microbiome, has on the function of our immune system.”

According to Daveluy, patients’ dietary choices impact their microbiome, which, in turn, can work with the immune system to prevent skin disease and inflammation.

“It’s important to talk to patients about their diet, since it can impact their response to therapy and risk of side effects,” he told Healio. “Equipping yourself with some simple and practical dietary recommendations is a huge asset for your patients and will take your care to a new level of excellence.”

In his presentation at the AAD Annual Meeting, Daveluy offered tips for managing dermatologic conditions, including psoriasis and melanoma through the lens of nutrition.

Psoriasis

“Spoiler alert, what you eat influences how well drugs are going to work for you,” Daveluy said in his presentation, placing a particular emphasis on patients with psoriasis who are being treated with tumor necrosis factor (TNF)-alpha inhibitors.

According Daveluy, patients with psoriasis tend to see a slight increase in weight gain following treatment with TNF-alpha inhibitors.

“This makes sense mechanistically because our body uses TNF-alpha to metabolize adipose tissue and muscle, so by inhibiting it we are probably inhibiting people’s ability to lose weight slightly. It also antagonizes insulin,” Daveluy said in his presentation, “This is something we don’t want in our psoriasis patients, so what can you do when you are starting someone on a TNF inhibitor for psoriasis?”

According to Daveluy, the answer is to help them with their diet. Daveluy highlighted a 2017 study that evaluated the treatment responses of patients with psoriasis treated with a TNF inhibitor alone compared with those treated with a TNF inhibitor plus the Mediterranean diet.

Results showed patients treated with the TNF inhibitor alone saw an improvement in PASI 75 but reduced outcomes in their BMI and truncal fat percentage compared with baseline. In contrast, the TNF inhibitor plus diet treatment group saw an even higher improvement in PASI 75 than those treated with the TNF inhibitor alone. They also saw an improvement in their BMI, truncal fat, visceral adipose tissue and cholesterol compared with baseline.

“The Mediterranean diet is a great recommendation for about every patient but particularly patients with psoriasis starting a TNF-alpha inhibitor,” Daveluy told Healio. “The diet can prevent the weight gain we see when initiating a TNF inhibitor and help it work more effectively, demonstrating better skin clearance.”

Melanoma

Immune checkpoint inhibitors (ICIs) are a treatment option for melanoma that rely on an immune system that is healthy enough to target and kill the cancer, according to Daveluy. Although the studies are largely mixed as to which bacteria promote an optimally functioning immune system in this population, Daveluy argues that an increase in fiber is a great starting point.

“For melanoma patients undergoing immunotherapy with an ICI, the amount of fiber in the diet is directly correlated with treatment response, with each 5 g of fiber per day conferring a 30% lower risk of progression or death,” he told Healio. “This benefit is lost if a patient takes probiotics, so recommend a high-fiber diet and avoiding probiotic supplements.”

Similarly to patients with psoriasis on TNF inhibitors, patients with melanoma on ICIs may also benefit from the Mediterranean diet because adhering to this diet may improve their treatment response and reduce the risk of adverse events that commonly lead to treatment discontinuation, according to Daveluy.

Conclusion

As the treatment landscape continues to expand with growing technology, Daveluy encourages dermatologists to remember that taking a “holistic approach” remains important for both the overall health and skin health of patients.

“We are fortunate to live in an era of highly effective medications for many of our severe skin diseases, but addressing treatment with medications alone is not enough,” he told Healio. “Talking to our patients about optimizing their diet helps not only their health in general but also helps these medications to work their best and prevents side effects of therapy.”

References:

• Campanati A, et al. J Dermatolog Treat. 2017;doi: 10.1080/09546634.2016.1214666.
• Transform your skin health: diet and lifestyle take center stage at 2025 AAD Annual Meeting. https://www.aad.org/news/diet-lifestyle-2025-aad-annual-meeting. Published March 7, 2025. Accessed March 18, 2025.