A double-blind, randomized, placebo-controlled trial of n-3 fatty acid based lipid infusion in acute, extended guttate psoriasis

Abstract

Twenty patients hospitalized for acute psoriasis guttata with a minimum 10% of body surface area involvement (range 10-90%) completed a 10-day trial in which they were randomly allocated to receive daily infusions with either an n-3 fatty acid based lipid emulsion [100 ml/day with 2.1 g eicosapentaenoic (EPA) and 21 g docosahexaenoic acid (DHA)] or a conventional n-6 lipid emulsion (EPA + DHA < 0.1 g/100 ml). The severity of disease was evaluated by scoring daily erythema, infiltration, and desquamation and by a subjective scoring of clinical manifestations offered by the patients. Leukotriene (LT) and platelet-activating factor (PAF) generation were investigated in ionophore-stimulated neutrophils obtained on days 0, 1, 3, 5, 10, and 40. Moderate improvement in clinical manifestations was noted in the n-6 group (changes in score systems between 16-25% from baseline within 10 days). In contrast, the severity of disease markedly decreased in all patients of the n-3 group, with improvements in all score systems ranging between 45% and 76% within 10 days (P < 0.05 for each variable). The difference in response to the two regimens was evident within 4-7 days after onset of lipid infusion. A more than ten fold increase in neutrophil EPA-derived 5-lipoxygenase product formation (LTB5, its omega-oxidation products, non-enzymatic degradation products of LTA5 and 5-hydroxyeicosapentaenoic acid) was noted in the n-3 group but not in the n-6 group. Neutrophil PAF generation increased in the n-6 group but decreased in the n-3 group. In conclusion, modulation of eicosanoid metabolism by intravenous n-3 fatty acid supplementation appears to exert a rapid beneficial effect on inflammatory skin lesions in acute guttate psoriasis.

Effect of omega‐3 fatty acids on disease severity in patients with psoriasis: A systematic review

“…Regardless of the contradictory effects of n-3 PUFA treatment for psoriasis, some studies did show an increase in 5-lipoxygenase metabolites (e.g., LTB5) 11 and a significant decrease in LTB4 production. 6 In a recent randomized controlled trial 23 involving 54 rheumatoid arthritis (RA) and six psoriatic arthritis patients who received 12 weeks treatment with n-3 PUFA, they analyzed the proportion of EPA and DHA being incorporated into the erythrocyte membranes.…”

“…A total of 720 articles were excluded because they were not randomized controlled trials or observational studies (427 articles), did not involve dietary or pharmacologic interventions with n-3 fatty acids (210 articles), did not perform a comparison (65 articles), or did not include the outcome of interest (18 articles). Eleven randomized controlled trials [4][5][6][11][12][13][14][15][16][17][18] and one open-label controlled observational study 19 were included, and the data of all 12 studies were extracted. The characteristics of the extracted studies are outlined in Table 1.…”

“…Six studies 4,[11][12][13]16,19 reported improvement in the patients' erythema, scaling, itching, area involved and infiltration. Gupta et al 4 reported 35-48% improvement of patients' scaling, erythema, area involved and thickness, especially during concurrent n-3 PUFA and ultraviolet B (UVB) treatment but not in the placebo group.…”

“…Gupta et al 4 reported 35-48% improvement of patients' scaling, erythema, area involved and thickness, especially during concurrent n-3 PUFA and ultraviolet B (UVB) treatment but not in the placebo group. Grimminger et al 11 is the only study that was conducted on hospitalized acute guttate psoriasis. They reported a significant improvement in all objective (erythema, infiltration, desquamation) and patients' subjective scoring system (appearance of lesions, impairment of daily life, pruritus, burn and pain) within 4-7 days after infusion of n-3 PUFA (P < 0.05); the exact numbers were not reported in the article.…”

Psoriasis and Nutrition Interactions

“…Guttat psoriasisli hastalara 10 gün boyunca günlük 2,1 g EPA ve 21 g DHA veya n-6 yağ asitleri içeren solüsyonları verildiği başka bir çalışma yapılmıştır. EPA ve DHA alan grubun klinik ve sübjektif skorları önemli derecede azalmıştır (16). Mayser ve ark.…”