Omega-3, an aid to fight psoriasis and dermatitis

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

Topical treatments often used to manage these conditions do not target the systemic inflammation that characterizes them, which prevents true control; therefore, new treatment opportunities are highly desirable. Omega 3s, long-chain fatty acids that can be taken with fatty fish and marine-derived oils (from fish, cod liver, krill and microalgae), could represent an innovative approach to their management precisely because of their ability to counteract inflammatory phenomena.

Omega 3 and the skin

The importance of food-derived fats for skin health has been known for almost a century now. It was, in fact, 1929 when a syndrome caused by a very low-fat diet was first described in the scientific literature; its predominantly cutaneous manifestations 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 state that, among the various fats that can be taken in with the diet, adequate doses of long-chain polyunsaturated ones, such as Omega 3, must not be missing at all. In fact, the epidermis is capable of producing only minute amounts of them; supplying it with them through the diet is therefore indispensable.

Once in the skin, Omega 3s support its barrier function, promote the maturation and differentiation of the stratum corneum and the formation of lamellar bodies, and attenuate skin inflammation by competing with arachidonic acid (ARA, a derivative of Omega 6 linoleic acid with strongly inflammatory properties) and inhibiting the production of eicosanoids with pro-inflammatory properties. In addition, several of their derivatives suppress the migration of immune cells and promote their apoptosis, while promoting 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 the production of anti-inflammatory molecules from food-derived fats appears to be reduced. Not only that: among the mechanisms underlying it, which are complex and multifactorial, a significant role is played by an alteration of immune defenses characterized by elevated levels of pro-inflammatory molecules, also promoted by a diet characterized by a ratio of Omega 6 to Omega 3 fats strongly unbalanced toward the former.

Several studies suggest that fish oil, a source of the 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. Not only that, DHA's ability to promote normal keratinocyte differentiation and support the structural integrity of the different layers of the epidermis by improving its barrier function could also play a role in the management and prevention of atopic dermatitis.

Adequate Omega 3 intake would help counteract 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 that's not all: breast milk high in saturated fat and low in Omega 3 has been associated with increased incidence, and taking Omega 3 supplements has also been associated with beneficial effects in older children. Specifically, a study published in Nutrients in 2024 showed how combined intake of EPA, DHA, GLA (gamma-linolenic acid, an Omega 6 with anti-inflammatory properties known to have 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 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 pages of 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, encoding for a protein belonging to the Tumor Necrosis Factor (TNF) superfamily involved in the regulation of immune response and inflammation.

Elevated levels of TNFSF14, a marker of the body's general inflammatory state, are associated with an increased risk of atopic dermatitis. According to Huang and colleagues, DHA could reduce the risk of developing this skin condition by reducing its expression and thereby inhibiting the inflammatory response. Further studies will allow this hypothesis to be tested.

Omega 3 and psoriasis

Psoriasis is also a dermatologic condition with a strong inflammatory component. Sufferers face the consequences of chronic skin inflammation associated with increased release of proinflammatory cytokines and damage to various organs and tissues.

Underlying the excessive proliferation of keratinocytes that characterizes it seems to be precisely the activation of the immune system, leading to increased production of ARA and the production of pro-inflammatory mediators. EPA and DHA might regulate the immune response at the level of the epidermis, just as they seem to be able to do in the case of atopic dermatitis.

In fact, the low prevalence of psoriasis among Eskimos has been attributed precisely to the high consumption of foods rich in Omega 3. Conversely, significantly reduced levels of Omega 3 in red blood cell membranes (considered good indicators of the levels of these fats in the body) were found in patients with severe forms of psoriasis. Finally, even in the case of psoriasis, the role of Omega 3 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 pages of the Journal of Cosmetology and Dermatology, only Omega 3, and not other fats, would be associated with a lower risk of psoriasis.

Given the absence of therapies that can completely cure the disease, the possibility of adjuncting currently available treatments with natural remedies such as Omega 3 supplements is particularly intriguing. To date, it is known that the production of increased proinflammatory cytokines in psoriasis is suppressed by Omega 3, which, after the intake of fish oil, inserts itself into cell membranes. In addition, animal model experiments suggest that derivatives of Omega 3 that can resolve inflammation (resolvins) suppress immune cell infiltration and hyperplasia in psoriatic skin.

Good news is also coming from clinical trials, from which it appears that Omega 3 supplements can be used to improve erythema, itching, and skin thickening due to psoriasis. In particular, adding fish oil (or, more generally, Omega 3) to conventional treatments can significantly reduce PASI (Psoriasis Area and Severity Index, a parameter by which disease severity is assessed) and lesion size.

Omega 3 supplements: a valuable aid with no serious side effects 

Given the strong consequences of inflammatory skin diseases on the quality of life of sufferers, being able to improve the effects of available treatments with natural remedies such as Omega 3, which, except for specific cases such as fish allergy, are free of serious side effects, is a highly desirable outcome. In addition, the improvements that can be achieved by Omega 3s could also make it possible to reduce the dosages of drugs and, consequently, the risk of their possible adverse effects.

New studies will help confirm the benefits of this complementary approach and give more precise guidance on the dosages of Omega 3 to take in the management of psoriasis and dermatitis. Read the Omegor Blog to find out all the news in the field!

Bibliographic references:

Abdelnour AM, Shareef SJ, Kreuser K, Ashack K. 319 Effects of omega-3 fatty acid supplementation on atopic dermatitis, British Journal of Dermatology, Volume 188, Issue Supplement_2, February 2023, ljac140.015. doi: 10.1093/bjd/ljac140.015

Balić A, Vlašić D, Žužul K, Marinović B, Bukvić Mokos Z. Omega-3 Versus Omega-6 Polyunsaturated Fatty Acids in the Prevention and Treatment of Inflammatory Skin Diseases. Int J Mol Sci. 2020 Jan 23;21(3):741. doi: 10.3390/ijms21030741

Cespedes Zablah A, Lio P. Oral Lipids/Fatty Acids Supplements and Eczema: What Is Known? Dermatitis. 2025 Jan 8. doi: 10.1089/derm.2024.0317

Chen X, Hong S, Sun X, Xu W, Li H, Ma T, Zheng Q, Zhao H, Zhou Y, Qiang Y, Li B, Li X. Efficacy of fish oil and its components in the management of psoriasis: a systematic review of 18 randomized controlled trials. Nutr Rev. 2020 Oct 1;78(10):827-840. doi: 10.1093/nutrit/nuz098

Clark CCT, Taghizadeh M, Nahavandi M, Jafarnejad S. Efficacy of ω-3 supplementation in patients with psoriasis: a meta-analysis of randomized controlled trials. Clin Rheumatol. 2019 Apr;38(4):977-988. doi: 10.1007/s10067-019-04456-x

Huang Y, Chen Z, Wu X, Chen C, Cai L. The effects of fatty acids on psoriasis: A two-sample Mendelian randomization study. J Cosmet Dermatol. 2024 Aug;23(8):2716-2725. doi: 10.1111/jocd.16313

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.

Radu A, Tit DM, Endres LM, Radu AF, Vesa CM, Bungau SG. Naturally derived bioactive compounds as precision modulators of immune and inflammatory mechanisms in psoriatic conditions. Inflammopharmacology. 2024 Nov 22. doi: 10.1007/s10787-024-01602-z

Sawada Y, Saito-Sasaki N, Nakamura M. Omega 3 Fatty Acid and Skin Diseases. Front Immunol. 2021 Feb 5;11: 623052. doi: 10.3389/fimmu.2020.623052