Psoriasis is a chronic immune disease that presents as itchy red spots or red patches on the skin and is most commonly seen on the elbows, knees, scalp, lower back, face, palms and soles of the feet. The most common form is called plaque psoriasis.1 Psoriatic arthritis affects the joints causing pain, stiffness or swelling. The current treatment consists of topical ointments and creams such as steroids to reduce inflammation and aspirin containing products to induce sloughing off of the outer layer of skin that is affected by the psoriasis plaques. Oral and injectable medications such as steroids, methotrexate, and other immune suppressing drugs may be given. Phototherapy, or UV light may be given in conjunction with topical or oral medication.2
Omega-3 fatty acids are known for their anti-inflammatory effects and may be effective in people with psoriasis.3 It is thought that the anti-inflammatory action from the free fatty acids is due to competition with arachadonic acid formation.
The following study was a double blind randomized trial for 14 days administering IV lipids twice daily. the Control group received omega-6 fatty acid emulsion while the target group received omega-3 fatty acid emulsion. The results were scored by a Psoriasis Area and Severity Index(PASI). Both groups had an improvement in their PASI scores however there was a significantly lower score overall in the omega-3 group. This study shows that omega-3 administration is helpful in the management of the symptoms of plaque psoriasis to reduce the itchy red patches and plaques on the skin.4
- J Am Acad Dermatol. 1998 Apr;38(4):539-47.
Omega-3 fatty acid-based lipid infusion in patients with chronic plaque psoriasis: results of a double-blind, randomized, placebo-controlled, multicenter trial.
- J Am Acad Dermatol 1998 Sep;39(3):421.
Profound changes in the metabolism of eicosanoids with increased concentrations of free arachidonic acid (AA) and its proinflammatory metabolites have been observed in psoriatic lesions. Free eicosapentaenoic acid (EPA) may compete with liberated AA and result in an antiinflammatory effect.
Our purpose was to assess the efficacy and safety of intravenously administered fish-oil-derived lipid emulsion on chronic plaque-type psoriasis.
A double-blind, randomized, parallel group study was performed in eight European centers. Eighty-three patients hospitalized for chronic plaque-type psoriasis with a severity score of at least 15 according to the Psoriasis Area and Severity Index (PASI) participated in a 14-day trial. They were randomly allocated to receive daily infusions with either a omega-3 fatty acid-based lipid emulsion (Omegavenous; 200 ml/day with 4.2 gm of both EPA and docosahexaenoic acid (DHA); 43 patients) or a conventional omega-6-lipid emulsion (Lipovenous; EPA+DHA < 0.1 gm/100 ml; 40 patients). The groups were well matched with respect to demographic data and psoriasis-specific medical history. Efficacy of therapy was evaluated by changes in PASI, in an overall assessment of psoriasis by the investigator, and a self-assessment by the patient. In one center neutrophil 4- versus 5-series leukotriene (LT) generation and platelet 2- versus 3- thromboxane generation were investigated and plasma-free fatty acids were determined.
The total PASI score decreased by 11.2 +/- 9.8 in the omega-3 group and by 7.5 +/- 8.8 in the omega-6 group (p = 0.048). In addition, the omega-3 group was superior to the omega-6 group with respect to change in severity of psoriasis per body area, change in overall erythema, overall scaling and overall infiltration, as well as change in overall assessment by the investigator and self-assessment by the patient. Response (defined as decrease in total PASI of at least 50% between admission and last value) was seen in 16 of 43 patients (37%) receiving the omega-3 emulsion and 9 of 40 patients (23%) receiving omega-6 fatty acid-based lipid emulsion. No serious side effects were observed. Within the first few days of omega-3 lipid administration, but not in the omega-6 supplemented patients, a manifold increase in plasma-free EPA concentration, neutrophil leukotriene B5 and platelet thromboxane B3 generation occurred.
Intravenous omega-3-fatty acid administration is effective in the treatment of chronic plaque-type psoriasis. This effect may be related to changes in inflammatory eicosanoid generation.