Background
Methods
Database | Search strategy |
---|---|
Cochrane Central Register of Controlled Trials (CENTRAL) | #1 MeSH descriptor: [Psoriasis] explode all trees #2 Psoriasis:ti,ab,kw (Word variations have been searched) #3 #1 or #2 #4 MeSH descriptor: [Fish Oils] explode all trees #5 Fish Oil:ti,ab,kw (Word variations have been searched) #6 fish liver oil:ti,ab,kw (Word variations have been searched) #7 MeSH descriptor: [Cod Liver Oil] explode all trees #8 Cod Liver Oil:ti,ab,kw (Word variations have been searched) #9 MeSH descriptor: [Fatty Acids, Omega-3] explode all trees #10 Omega-3:ti,ab,kw (Word variations have been searched) #11 Omega3:ti,ab,kw (Word variations have been searched) #12 MeSH descriptor: [Eicosapentaenoic Acid] explode all trees #13 EPA:ti,ab,kw (Word variations have been searched) #14 eicosapentaenoic acid:ti,ab,kw (Word variations have been searched) #15 eicosapentaenoate:ti,ab,kw (Word variations have been searched) #16 icosapentaenoic acid:ti,ab,kw (Word variations have been searched) #17 MeSH descriptor: [Docosahexaenoic Acids] explode all trees #18 DHA:ti,ab,kw (Word variations have been searched) #19 docosahexaenoic acid:ti,ab,kw (Word variations have been searched) #20 docosahexaenoate:ti,ab,kw (Word variations have been searched) #21 #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15 or #16 or #17 or #18 or #19 or #20 #22 #3 and #21 |
Embase | #1 ‘psoriasis’/exp. OR ‘psoriasis’ #2 ‘fish oil’ #3 ‘fish liver oils’ #4 ‘cod liver oil’ #5 ‘omega 3 fatty acid’ #6 ‘eicosapentaenoic acid’ #7 ‘icosapentaenoic acid’ #8 eicosapentaenoate #9 ‘docosahexaenoic acid’ #10 docosahexaenoate #11 #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 #12 #1 AND #11 |
MEDLINE | 1 exp Psoriasis/ 2 psoriasis.mp. 3 1 or 2 4 exp. Fish Oils/ 5 fish oil.mp. 6 fish liver oil.mp. 7 exp. Cod Liver Oil/ 8 cod liver oil.mp. 9 exp. Fatty Acids, Omega-3/ 10 omega-3.mp. 11 omega3.mp. 12 exp. Eicosapentaenoic Acid/ 13 EPA.mp. 14 eicosapentaenoic acid.mp. 15 eicosapentaenoate.mp. 16 icosapentaenoic acid.mp. 17 exp. Docosahexaenoic Acids/ 18 DHA.mp. 19 docosahexaenoic acid.mp. 20 docosahexaenoate.mp. 21 or/4–20 22 3 and 21 |
Results
Characteristics of included studies
Study ID | Participants | Intervention | Control | Outcome of interest |
---|---|---|---|---|
Bittiner 1988 [12] | Chronic stable plaque psoriasis. | MaxEPA capsules 10# daily (containing 1.8 g EPA) for 12 weeks. | Capsules containing olive oil 10# daily for 12 weeks. | Erythema, scaling, BSA, itching. |
Bjørneboe 1988 [13] | Stable psoriasis vulgaris. | MaxEpa® capsules 10# daily (containing 1.8 g EPA and 1.2 g DHA) for 8 weeks. | Capsules containing olive oil 10# daily for 8 weeks. | Erythema, induration, desquamation, BSA, blood tests. |
Danno 1998 [14] | Moderately-involved, chronic plaque-type psoriasis vulgaris. | 20 mg etretinate combined with 1.8 g EPA /day for 12 weeks. | 20 mg etretinate for 12 weeks. | Clinical score (based on erythema, induration, and scaling of 3 selected plaque lesions), AEs, routine lab data. |
Grimminger 1993 [15] | Acute guttate psoriasis with BSA at least 10%. | 50 ml fish oil derived lipid emulsion twice daily via IV route for 10 days (containing 2.1 g EPA + 2.2 g DHA per day). | 50 ml soya oil derived lipid emulsion twice daily via IV route for 10 days. | Erythema, infiltration, desquamation, subjective score (based on appearance of lesions, impairment of daily life, pruritus, burn and pain), AEs, blood tests. |
Gupta 1989 [17] | Stable plaque psoriasis with total BSA 10–50%; skin type II or III. | Max-EPAR capsules 10# twice daily (daily total of 3.6 g EPA and 2.4 g DHA) for 15 weeks and UVB therapy for 8 weeks (weeks 3–11). | Olive oil capsules 10# twice daily for 15 weeks and UVB therapy for 8 weeks (weeks 3–11). | Erythema, thickness, scale, BSA, AEs. |
Gupta 1990 [16] | Stable plaque type psoriasis with BSA at least 10%. | Topical betamethasone diproprionate twice day (45 g/week) + Max-EPAR capsules 10# thrice daily (daily total of 5.4 g EPA and 3.6 g DHA) for 3 weeks then keep Max-EPAR capsules. | Topical betamethasone diproprionate twice day (45 g/week) + olive oil capsules 10# thrice daily for 3 weeks then keep olive oil capsules. | Global severity score (based on scale, erythema and thickness), BSA, AEs. |
Kristensen 2018 [18] | Psoriatic arthritis; adult above 18 years of age. | Daily intake of 6 capsules containing 3 g of n-3 PUFA (50% EPA + 50% DHA) for 24 weeks (1.5 g EPA + 1.5 g DHA per day). | Daily intake of 6 capsules containing 3 g of olive oil for 24 weeks. | VAS-pain, Health Assessment Questionnaire, Disease Activity Score based on CRP, tender joint count (68), swollen joint count (66), ASDAS, BASDAI, BASMI, LEI, SPARCC, PASI, NSAID (no. of tablets/week), Paracetamol (no. of tablets/week), lab tests, AEs. |
Madland 2006 [19] | Polyarticular psoriatic arthritis. | 10 ml seal oil self administered orally before meals thrice daily for 14 days (2.4 g EPA, 1.1 g DPA, 2.6 g DHA per day). | 10 ml soy oil self administered orally before meals thrice daily for 14 days. | Joint pain intensity, patient’s global assessment, number of tender and swollen joints, PASI, lab tests. |
Mayser 1998 [20] | Inpatients between 18 and 80 years of age with chronic plaque psoriasis; PASI ≥15. | Infusions with a ω-3 fatty acid–based lipid emulsion (Omegavenous) 100 ml twice daily for 14 days (4.2 g of both EPA and DHA/day). | Infusions with a conventional ω-6-lipid emulsion (Lipovenous) 100 ml twice daily for 14 days. | PASI, PASI 50, intensity of psoriasis, self assessment (VAS), AEs, SAEs, lab tests. |
Oliwiecki 1994 [21] | Chronic stable plaque psoriasis; 16–70 years old. | Placebo capsules (500 mg liquid paraffin) 6# bid for 4 weeks then receiving active treatment (capsules containing 430 mg evening primrose oil + 107 mg fish oil + 10 mg vitamin E; 6# bid) for the next 24 weeks (1.284 g fish oil per day). | Placebo capsules (500 mg liquid paraffin) 6# bid for 28 weeks. | 10 cm linear analogue scale to measure erythema, scaling and overall severity; plaque thickness; patient self-assessment. |
Søyland 1993 [22] | Stable plaque psoriasis with BSA > 8%. | 6 capsules daily, each containing 1 g of highly concentrated ethyl esters of very-long-chain n-3 fatty acids (3.06 g EPA + 1.92 g DHA per day), for 4 months. | 6 capsules of corn oil daily, each containing 1 g, for 4 months. | PASI, erythema, infiltration, desquamation, subjective score based on degree of redness, scaling, itching and general effects of the disease on daily living. |
Strong 1993 [23] | Chronic stable plaque psoriasis of an extent sufficient to warrant inpatient admission. | Treated with conventional tar and dithranol during admission ➔ Efamol Marine capsules 500 mg 6# twice daily (containing 80% evening primrose oil and 20% fish oil; 216 mg EPA + 240 mg DHA per day) for up to 7 months after discharge. | Treated with conventional tar and dithranol during admission ➔ placebo capsules 600 mg 6# twice daily (containing liquid paraffin) for up to 7 months after discharge. | Rate of deterioration after discharge (global score, based on BSA, redness, scaling, overall impression, and itch), blood tests. |
Veale 1994 [24] | Chronic stable plaque psoriasis and psoriatic arthritis. | 12 Efamol Marine capsules daily (total daily dose of 480 mg GLA, 240 mg EPA and 132 mg DHA) for 9 months ➔ placebo capsules for 3 months. | 12 placebo capsules daily (containing liquid paraffin) for 12 months. | Chang/improvement in inflammatory joint disease, grip strength, number of active joint, Ritchie articular index, duration of morning stiffness, NASID intake, skin severity (VAS), BSA, itch (VAS), blood tests. |
Effects of fish oil in treating psoriasis
Psoriasis area and severity index score
Body surface area
Erythema, scaling, and induration
Pruritus
Adverse events
Study ID | Intervention | Adverse events |
---|---|---|
Bjørneboe 1988 [13] | Fish oil | Routine lab: none of the parameters changed significantly during the trial (CBC, ESR, creatinine, albumin, ALT, GGT, bleeding time, triglyceride, cholesterol). |
Danno 1998 [14] | Fish oil + Etretinate | Cheilitis, dry mouth, dry eyes, desquamation of palms, folliculitis, gastric symptoms, and increased liver enzymes. All were mild or tolerable. No significant difference in the incidence between intervention and control groups. |
Grimminger 1993 [15] | Fish oil (intravenous) | No obvious side effect except for rare irritations at the site of peripheral intravenous route; routine lab: not change substantially (ESR, CRP, cholesterol, triglyceride, BUN, ALT, GGT, amylase, lipase, coagulation variables). |
Gupta 1989 [17] | Fish oil + UVB phototherapy | No side effect was reported in either group. |
Gupta 1990 [16] | Fish oil + betamethasone diproprionate cream | An occasional fishy taste upon eructation in one patient on fish oil and one on olive oil therapy; transient diarrhea at beginning of therapy in 2 patients on fish oil |
Kristensen 2018 [18] | Fish oil | Mild gastrointestinal adverse effects (9 in intervention group and 6 in control group) |
Mayser 1998 [20] | Fish oil (intravenous) + 3% salicyclic acid | Most frequently reported in intervention group: superficial thrombophlebitis; most frequently reported in control group: superficial thrombophlebitis, pruritus, hypertriglyceridemia, and fever; no severe AEs; routine lab: not substantially change (AST, ALT, Alk-P, creatinine, blood glucose, CBC/DC, total cholesterol, triglyceride) |
Strong 1993 [23] | Fish oil + evening primrose oil | Blood test: remained unchanged throughout the trial (CBC, urea, creatinine, total lipids, HDL and LDL, cholesterol, triglyceride, electrolytes) |
Veale 1994 [24] | Fish oil + evening primrose oil | No significant differences in lab indices including ESR, CRP, hemoglobin, urea, electrolytes, liver enzymes |