Omega-3, a help to fight psoriasis and dermatitis

The skin is the body's first line of defense. The protection it offers is not only physical; rather, it is a true stage for the performance of numerous inflammatory processes that safeguard health from external threats. Sometimes, however, excessive inflammation can damage the skin itself; this is what happens in conditions such as psoriasis and atopic dermatitis, in which strong activation of the immune defenses triggers symptoms that significantly compromise the patient's quality of life.

Topical treatments often used to manage these conditions do not target the systemic inflammation that characterizes them, preventing true control; for this reason, new treatment opportunities are highly desirable. Omega-3s, long-chain fatty acids that can be consumed through fatty fish and marine oils (fish, cod liver, krill, and microalgae), could represent an innovative approach to managing them thanks to their ability to counteract inflammatory phenomena.

Omega-3s and the skin

The importance of dietary fats for skin health has been known for nearly a century. In fact, it was in 1929 that a syndrome caused by a very low-fat diet was first described in the scientific literature; its manifestations, primarily cutaneous, included erythema, skin thickening, and itching – all problems well known to those dealing with psoriasis and dermatitis.

After years of studies, it is now possible to affirm that among the various fats that can be consumed through diet, adequate doses of long-chain polyunsaturated fats, such as Omega-3s, must not be lacking. The epidermis is, in fact, capable of producing only minimal quantities of them; therefore, providing them through diet is essential.

Once in the skin, Omega-3s support its barrier function, promote maturation and differentiation of the stratum corneum and formation of lamellar bodies, and reduce skin inflammation by competing with arachidonic acid (ARA, a derivative of the Omega-6 linoleic acid with strongly inflammatory properties) and inhibiting the production of pro-inflammatory eicosanoids. Moreover, several of their derivatives suppress immune cell migration and promote their apoptosis, while supporting the survival of epithelial cells.

Omega-3 and atopic dermatitis

In the specific case of atopic dermatitis (the most common inflammatory skin disease), the activity of the enzyme responsible for producing anti-inflammatory molecules from dietary fats appears to be reduced. Not only that: among its complex and multifactorial underlying mechanisms, a significant role is played by an altered immune defense response characterized by elevated levels of pro-inflammatory molecules, also promoted by a diet with a strongly unbalanced ratio of Omega-6 to Omega-3 fats in favor of the former.

Several studies suggest that fish oil, a source of biologically active Omega-3s EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), may improve the symptoms of this condition and help prevent it through the anti-inflammatory effects of these polyunsaturated fats. Furthermore, the ability of DHA to promote normal keratinocyte differentiation and support the structural integrity of the different layers of the epidermis, improving its barrier function, could play a role in the management and prevention of atopic dermatitis.

An adequate intake of Omega-3 may help counter the onset of the disease from gestation; in fact, fish oil intake during pregnancy has been associated with improvements in the severity of the disease in the first year of life. But not only that: breast milk rich in saturated fats and low in Omega-3 has been associated with increased incidence, and Omega-3 supplementation has shown beneficial effects even in older children. In particular, a study published in Nutrients in 2024 demonstrated that the combined intake of EPA, DHA, GLA (gamma-linolenic acid, an Omega-6 with anti-inflammatory properties known for its beneficial effects on the skin), and vitamin D3 for 4 months significantly reduced the SCORAD index (SCORing Atopic Dermatitis, used to assess disease severity) and the topical application of corticosteroids, and significantly improved itching, sleep quality, and quality of life in atopic children.

The hypothesis that DHA, in particular, may reduce the risk of atopic dermatitis is further supported by a recent Mendelian randomization analysis published by Huang et al. in the European Review for Medical and Pharmacological Sciences. The same analysis suggests that the effect of this Omega-3 fat is mediated by the TNFSF14 gene, which encodes a protein belonging to the Tumor Necrosis Factor (TNF) superfamily involved in the regulation of immune response and inflammation.

High levels of TNFSF14, a marker of the body's general inflammatory state, are associated with a greater risk of atopic dermatitis. According to Huang and colleagues, DHA may reduce the risk of developing this skin condition by reducing its expression and thus inhibiting the inflammatory response. Further studies will allow this hypothesis to be verified.

Omega-3 and psoriasis

Psoriasis is also a dermatological condition with a strong inflammatory component. Those who suffer from it must face the consequences of chronic skin inflammation associated with increased release of pro-inflammatory cytokines and damage to various organs and tissues.

At the root of the excessive proliferation of keratinocytes that characterizes it seems to be the activation of the immune system, which leads to increased ARA production and the production of pro-inflammatory mediators. EPA and DHA could regulate the immune response at the epidermal level, just as they appear to do in the case of atopic dermatitis.

In fact, the low prevalence of psoriasis among the Eskimos has been attributed precisely to the high consumption of Omega-3-rich foods. Conversely, significantly reduced levels of Omega-3s have been found in red blood cell membranes (considered reliable indicators of the body's Omega-3 levels) in patients with severe forms of psoriasis. Finally, even in the case of psoriasis, the role of Omega-3s in the genesis of the disease is supported by a recent Mendelian randomization analysis. As reported by Huang et al., authors of the analysis, in the Journal of Cosmetology and Dermatology, only Omega-3s, and not other fats, were associated with a lower risk of psoriasis.

Given the absence of therapies capable of completely curing the disease, the possibility of supporting currently available treatments with natural remedies such as Omega-3 supplements is particularly intriguing. To date, it is known that the production of pro-inflammatory cytokines increased in cases of psoriasis is suppressed by Omega-3s, which, after fish oil intake, are incorporated into cell membranes. Furthermore, experiments in animal models suggest that Omega-3-derived inflammation-resolving molecules (resolvins) suppress immune cell infiltration and hyperplasia in psoriatic skin.

Good news also comes from clinical studies, which reveal the possibility of using Omega-3 supplements to improve erythema, itching, and skin thickening caused by psoriasis. In particular, adding fish oil (or, more generally, Omega-3s) to conventional treatments significantly reduces the PASI index (Psoriasis Area and Severity Index, a parameter used to assess the severity of the disease) and lesion size.

Omega-3 supplements: a valuable aid without serious side effects 

Given the severe impact of inflammatory skin conditions on the quality of life of those affected, being able to enhance the effects of available treatments with natural remedies such as Omega-3s, which, except in specific cases like fish allergy, are free from serious side effects, is a highly desirable outcome. Furthermore, the improvements made possible by Omega-3s could also allow for a reduction in drug dosages and, consequently, the risk of their potential adverse effects.

New studies will help confirm the benefits of this complementary approach and provide more precise recommendations on Omega-3 dosages to be taken in managing psoriasis and dermatitis. Read the Omegor Blog to discover all the latest updates in the field!

Bibliographic references:

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Huang XW, Pang SW, Yang LZ, Han T, Chen JM, Huang CW, Liao L, Xie PJ. TNFSF14 mediates the impact of docosahexaenoic acid on atopic dermatitis: a Mendelian randomization study. Eur Rev Med Pharmacol Sci. 2024 Jan;28(1):107-117. doi: 10.26355/eurrev_202401_34896

Marchlewicz M, Polakowska Z, Maciejewska-Markiewicz D, Stachowska E, Jakubiak N, Kiedrowicz M, Rak-Załuska A, Duchnik M, Wajs-Syrenicz A, Duchnik E. Fatty Acid Profile of Erythrocyte Membranes in Patients with Psoriasis. Nutrients. 2024 Jun 7;16(12):1799. doi: 10.3390/nu16121799

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