Diet-related phototoxic reactions in psoriatic patients undergoing phototherapy: Results from a multicenter prospective study

Alessia Pacifico, Rosalynn R.Z. Conic, Antonio Cristaudo, Sergio Garbarino, Marco Ardigò, Aldo Morrone, Paolo Iacovelli, Sara Di Gregorio, Paolo Daniele Maria Pigatto, Ayman Grada, Steven Richard Feldman, Egeria Scoditti, Khalaf Kridin, Giovanni Damiani

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16 Scopus citations


Vegans and vegetarians often consume foods containing photosensitizers capable of triggering phytophotodermatitis. The potential effect of vegan and vegetarian diets on the response of psoriatic patients undergoing phototherapy is not well characterized. We assessed clinical outcomes of vegan, vegetarian and omnivore adult psoriatic patients undergoing band ultraviolet B phototherapy (NB-UVB). In this multicenter prospective observational study, we enrolled 119 adult, psoriatic patients, of whom 40 were omnivores, 41 were vegetarians and 38 were vegans, with phototherapy indication. After determining the minimum erythemal dose (MED), we performed NB-UVB sessions for 8 weeks. The first irradiation dosage was 70.00% of the MED, then increased by 20.00% (no erythema) or by 10.00% (presence of erythema) until a maximum single dose of 3 J/cm2 was reached and constantly maintained. All the enrolled patients completed the 8 weeks of therapy. Severe erythema was present in 16 (42.11%) vegans, 7 (17.07%) vegetarians and 4 (10.00%) omnivores (p < 0.01). MED was lowest among vegans (21.18 ± 4.85 J/m2), followed by vegetarians (28.90 ± 6.66 J/m2) and omnivores (33.63 ± 4.53 J/m2, p < 0.01). Patients with severe erythema were more likely to have a high furocumarin intake (OR 5.67, 95% CI 3.74–8.61, p < 0.01). Vegans consumed the highest amount of furocumarin-rich foods. A model examining erythema, adjusted for gender, age, skin type, MED, phototherapy type, number of phototherapies and furocumarin intake, confirmed that vegans had a lower number of treatments. Vegans had more frequent severe erythema from NB-UVB, even after adjustment of the phototherapy protocol for their lower MED. Assessing diet information and adapting the protocol for vegan patients may be prudent.

Original languageEnglish
Article number2934
Issue number9
StatePublished - 25 Aug 2021
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.


  • Diet
  • Efficacy
  • Exposome
  • Exposures
  • Inflammation
  • NB-UVB
  • Omnivores
  • Phototherapy
  • Precision medicine
  • Psoriasis
  • Vegans
  • Vegetarians


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