Fasting and Its Impact on Skin Anatomy, Physiology, and Physiopathology: A Comprehensive Review of the Literature

Abstract

Skin serves as the first protective line and barrier of the body. Like many other organs, skin can be affected by several disorders in response to external factors such as pathogens, ultraviolet light, and pollution, as well as endogenous alterations related to aging and/or oxidative stress disturbance. Researchers have reported new insights into how skin cells are altered in response to caloric restriction diets in mammals. One of the most well-known caloric restriction diets is the Ramadan intermittent fasting, which is a radical change in the diet plan of practitioners for the period of one lunar month. Ramadan fasting represents the fourth of the five pillars of the Islamic creed. Even though infirm individuals are waived to take part in this religious duty, patients with various health problems, including those with different skin disorders, might choose to share this event with peers and family members. No standardized protocols or guidelines exist, however, to advise their physicians on the proper management of their patients’ condition during fasting. With an increasing Muslim population living in Western countries, this topic has started to draw substantial attention, not only of Middle-Eastern physicians, but also of clinicians in the West. For this purpose, we carried out a comprehensive overview on the topic. Our main findings are that: (1) there is a strong need for evidence-based suggestions and guidance. Literature on the impact of the Ramadan fasting, as well as of other kinds of fasting, on skin diseases is scarce and of poor quality, as well as the information available from the Internet; (2) patients willing to fast should be advised about the importance of taking proper treatments or consider alternative options including administration of trans-dermal/topical drugs, as they are permitted during daylight hours. Further, non-compliance has important, clinical and economic implications for an effective patient management.

Untitled

“…Moreover, fasting treats diabetes (Ku, Ramos & Fung, 2017), treats skin diseases (Bragazzi et al, 2019), reduce obesity, hypertension, asthma, and arthritis, potentially prevent and treat diseases (Longo & Mattson, 2014), reduce inflammation, improve circadian rhythm, improve autophagy, resilience against stress, and modulation of intestinal mirobiota (Paoli, Tinsley, Bianco & Moro, 2019), improve metabolism, slow aging, and slow the spread of disease (Anton et al, 2018).…”

Skin Aging & Modern Age Anti-aging Strategies

“…National Health and Nutrition Examination Surveys (NHANES) 2007-2010 indicate that among US population 75% consumed less fruit and 87% consumed fewer vegetables than recommended [30]. The accumulation of glycoxidation products such as carboxymethyl lysine (CML) and pentosidine in cutaneous collagen promotes skin aging.Bragazzi et.al, 2019 reported that chronic caloric restriction decreased the glycation rate of skin proteins, resulting in the reduction of age-related accumulation of these metabolites in cutaneous collagen [31]. Mekić et.al, 2019 reported that better adherence to the Dutch Healthy Diet Index (DHDI) was significantly associated with less wrinkles among women but not in men.…”

Intermittent Fasting and Adding More days to Life

“…In another study, fasting was found to modulate the IGF-1 receptor (IGF-1R)/epithelial growth factor (EGF) receptor (EGFR) and the Akt/mTOR pathways, which are dysregulated in obesity and may lead to skin cancer [44] . However, Bragazzi et al, 2019 concluded that physicians should be instructed in recognizing rare dermatological disorders associated with fasting, such as Prurigo pigmentosa (PP) [45] . Damiani et al, 2019 reported significant decrease in the "Psoriasis Area and Severity Index" (PASI) score after the Ramadan fasting [38] .…”