The Impact of Ramadan Fasting on the Reduction of PASI Score, in Moderate-To-Severe Psoriatic Patients: A Real-Life Multicenter Study

Fasting during the month of Ramadan consists of alternate abstinence and re-feeding periods (circadian or intermittent fasting). Nothing is currently known on the impact of this kind of fasting on psoriasis. A sample of 108 moderate-to-severe plaque psoriasis patients (aged 42.84 ± 13.61 years, 62 males, 46 females) volunteered to take part in the study. A significant change in the "Psoriasis Area and Severity Index" (PASI) score before and after the Ramadan fasting (mean difference = -0.89 ± 1.21, p < 0.0001) was found. At the multivariate regression, the use of apremilast (p = 0.0009), cyclosporine (p = 0.0003), phototherapy (p = 0.0015), interleukin-17 or IL-17 blockers (p < 0.0001), and tumor necrosis factor or TNF blockers (p = 0.0107) predicted the PASI score before the Ramadan fasting. Disease duration (p = 0.0078), use of apremilast (p = 0.0005), and of mammalian target of rapamycin or mTOR inhibitors (p = 0.0034) resulted in independent predictors of the change in the PASI score before and after the Ramadan fasting. The consumption of cyclosporine (p < 0.0001), phototherapy (p = 0.0015), IL-17 blockers (p < 0.0001), mTOR inhibitors (p = 0.0081), and TNF blockers (p = 0.0017) predicted the PASI score after the Ramadan fasting. These findings reflect the influence of dieting strategy, the biological clock, and circadian rhythm on the treatment of plaque psoriasis.