Nutrition for Psoriasis: A Case Study Exploring the Gut-Skin Axis
Many people living with psoriasis wonder whether nutrition can genuinely influence inflammatory skin symptoms. This case study explores how addressing gut health, histamine load and lifestyle factors contributed to significant improvements in one client’s chronic inflammatory skin condition.
The Client Presentation: Psoriasis, Allergies and Digestive Symptoms
R was a 31 year old female working freelance in the television industry, a role with irregular hours, frequent travel and sustained occupational stress. She had been diagnosed with flexural psoriasis in her mid-twenties and continued to experience persistent inflammatory skin symptoms despite intermittent topical treatment.
Alongside her skin presentation, she reported seasonal allergic rhinitis (requiring a daily antihistamine to manage symptoms from May through to September), recurrent digestive issues, and anxiety. Her sleep was disrupted and energy fluctuated, and she described reduced confidence linked to the visibility and discomfort of her skin.
R sought personalised nutritional support primarily to improve her skin, with secondary goals of stabilising digestion, reducing antihistamine use, improving mood and energy, and building greater resilience to work-related stress.
Key presenting symptoms
At the initial consultation, R reported:
Chronic flexural inflammatory skin lesions with intense itching
Sleep disturbance secondary to skin discomfort
Seasonal allergic rhinitis requiring daily antihistamines
Frequent loose stools and intermittent diarrhoea
Post-prandial fatigue and suspected food sensitivities
Anxiety, low mood, and reduced confidence
These symptoms were affecting her quality of life and personal relationships.
Exploring the Root Causes of Inflammatory Skin
Antecedents
The family health history included autoimmune and inflammatory conditions; thyroid disease, coeliac disease,and psoriasis. Her skin symptoms first developed in her mid-twenties following a prolonged ear and sinus infection, after which inflammatory and allergic features appeared to persist.
Triggers
In the present day, symptoms tended to flare during periods of stress and travel, along with her irregular routines. Eating out frequently, late nights and social alcohol use were common. Seasonal pollen exposure predictably aggravated her rhinitis.
Mediators
In practice, three interconnected systems seemed to be driving her symptoms: immune dysregulation driving inflammatory skin activity; gastrointestinal dysfunction contributing to loose stools and possible barrier impairment; and reduced tolerance to histamine from dietary and environmental sources. Ongoing stress and poor sleep were likely amplifying factors across all systems.
Practitioner assessment
At assessment, it became clear that R’s diet was not inherently poor in quality. Rather, her symptoms appeared to reflect cumulative physiological load and inconsistent routines. Although she consumed a wide variety of whole foods, irregular meal timing, frequent reliance on restaurant meals and regular caffeine and alcohol intake were notable features of her diet.
Taken together, her history and presentation pointed towards three priorities for intervention: immune regulation, gastrointestinal support and reduction of lifestyle and histamine burden. These formed the basis of a pragmatic and food-first approach before considering more complex investigations.
Diagnostic testing
R had previously tested negative for coeliac disease. In the absence of red flags and given several clear modifiable drivers identified during case taking, further functional laboratory testing was deferred. Clinically, there appeared to be sufficient ‘low hanging fruit’ to address through dietary and lifestyle intervention alone.
Progress was monitored using the Measure Yourself Medical Outcomes Profile (MYMOP®)(1), a validated patient-reported tool capturing key symptoms and overall wellbeing. This allowed structured tracking of change over time and informed pragmatic adjustments to the intervention.
Intervention strategy
Interventions were delivered in three phases. We first focused on reducing overall inflammatory and histamine load, then supporting gastrointestinal function, and finally consolidating lifestyle and stress regulation.
Phase 1 – Reducing Inflammatory and Histamine Load
The initial emphasis was on calming immune activity and lowering cumulative histamine exposure. Omega-3 fatty acids were introduced to support inflammatory regulation (2,3), alongside practical dietary swaps to reduce high-histamine foods rather than strict elimination. Alcohol intake was reviewed given its impact on histamine metabolism, sleep quality and systemic inflammation. (4)
A temporary six week gluten-free trial was also used to explore possible effects on intestinal permeability, digestive symptoms and skin. (5,6) Meals were structured using the British Association for Nutrition and Lifestyle Medicine (BANT) plate model (7) to improve protein intake, fibre diversity and blood glucose stability, particularly during travel and restaurant meals.
Phase 2 – Supporting Gut Health
Given the ongoing loose stools and suspected barrier dysfunction, we introduced a 30-day course of gastrointestinal support using a combination of probiotic strains, prebiotic fibres, and nutrients supportive of mucosal integrity. The aim was to also modulate the gut–skin axis indirectly by stabilising stool consistency, supporting microbial balance, and calming immune and histamine activity.
Phase 3 – Stress, Lifestyle and Immune Regulation
Lifestyle change was treated as central rather than adjunctive. We discussed implementing regular moderate exercise and daily breathwork, while structured stress management was encouraged to support sleep and autonomic balance. (8,9) Short coaching calls between consultations helped troubleshoot barriers, reinforce progress and support reductions in alcohol use. The goal was to create sustainable habits that would maintain improvements long term.
Results After Six Weeks
At the six week review, improvements were already evident. Digestive symptoms shifted first, with normalisation of stool consistency and complete resolution of weekly diarrhoea. Energy stabilised and post-prandial fatigue reduced. Shortly afterwards, allergic symptoms eased and she no longer required daily antihistamines during her usual hay fever season, a significant change for her.
Mood and anxiety improved in parallel with better sleep and reduced alcohol intake. R described feeling calmer, more resilient and better able to cope with work demands.
Skin changes were more gradual but meaningful. Itching reduced, sensitivity settled and overall severity improved. Using MYMOP® to track progress, scores improved from 5 to 1 for skin symptoms, 4 to 1 for mood and anxiety, 4 to 1 for impact on relationships, and overall wellbeing from 1 to 0.
Behavioural change was arguably the most significant outcome. R substantially reduced alcohol intake, managed stress differently and described the process as ‘transformational’, feeling more confident and in control of her health.
Long-Term Maintenance
At the follow up consultation, omega-3 fatty acids were continued and digestive support was repeated. With autumn approaching, a maintenance dose of vitamin D was introduced in line with seasonal guidance from the National Health Service (NHS). (10)
Gluten was reintroduced without adverse effects and her dietary pattern shifted towards a Mediterranean-style template emphasising plants, fibre, fish and minimally processed foods. (11) The focus moved away from restriction and towards consistency and self-monitoring.
No further follow up was required, and she reported sustained improvements in skin comfort, energy and overall wellbeing.
What This Case Reinforced About Psoriasis and Nutrition
This case reinforced the idea that inflammatory skin conditions rarely sit in isolation. Addressing immune, gastrointestinal and lifestyle factors together proved more effective than focusing on the skin alone.
Relatively modest changes to stress, sleep, alcohol intake and digestion appeared to deliver benefits comparable to targeted nutrients. It also highlighted that extensive testing is not always necessary at the outset, particularly when clear lifestyle drivers are present.
This case was managed relatively early in my clinical practice, and with greater experience I would now approach some of the nutritional support differently. However, the central role of lifestyle change, stress regulation, alcohol reduction and coaching support has remained a consistent and foundational part of my work.
Finally, outcomes were closely linked to engagement. Collaborative goal setting and ongoing coaching were central to the client’s adherence and long-term change.
You can find this client’s testimonial, among others here.
Looking for Personalised Support for Your Skin?
If you’re struggling with psoriasis, eczema or persistent inflammatory skin symptoms, this case highlights how small, targeted changes to gut health, histamine load, alcohol intake and stress regulation can create meaningful change. Personalised nutrition is not about restriction — it is about understanding your unique drivers and supporting the body’s capacity to regulate inflammation.
If you’re experiencing psoriasis, eczema or inflammatory skin symptoms and would like personalised support, I can help! You can book a discovery call with me here, or contact me here.
References
Meaningful Measures, 2021. The home of MYCaW® and MYMOP®. [online] Available at: <https://www.meaningfulmeasures.co.uk/mymop> [Accessed 3 February 2026].
Balić, A., Vlašić, D., Žužul, K., Marinović, B. and Bukvić Mokos, Z., 2020. Omega-3 Versus Omega-6 Polyunsaturated Fatty Acids in the Prevention and Treatment of Inflammatory Skin Diseases. International Journal of Molecular Sciences, 21(3), p.741. https://doi.org/10.3390/ijms21030741.
Gutiérrez, S., Svahn, S.L. and Johansson, M.E., 2019. Effects of Omega-3 Fatty Acids on Immune Cells. International Journal of Molecular Sciences, 20(20), p.5028. https://doi.org/10.3390/ijms20205028.
Song, F. and Walker, M.P., 2023. Sleep, alcohol, and caffeine in financial traders. PLOS ONE, 18(11), p.e0291675. https://doi.org/10.1371/journal.pone.0291675.
Bell, K.A., Pourang, A., Mesinkovska, N.A. and Cardis, M.A., 2021. The effect of gluten on skin and hair: a systematic review. Dermatology Online Journal, [online] 27(4). https://doi.org/10.5070/D3274053148.
Vazquez-Roque, M.I., Camilleri, M., Smyrk, T., Murray, J.A., Marietta, E., O’Neill, J., Carlson, P., Lamsam, J., Janzow, D., Eckert, D., Burton, D. and Zinsmeister, A.R., 2013. A Controlled Trial of Gluten-Free Diet in Patients with Irritable Bowel Syndrome-Diarrhea: Effects on Bowel Frequency and Intestinal Function. Gastroenterology, 144(5), pp.903-911.e3. https://doi.org/10.1053/j.gastro.2013.01.049.
BANT, 2024. BANT Wellbeing Guidelines [online] Available at: <https://bant.org.uk/bant-wellbeing-guidelines/> [Accessed 3 February 2026].
van der Zwan, J.E., de Vente, W., Huizink, A.C., Bögels, S.M. and de Bruin, E.I., 2015. Physical Activity, Mindfulness Meditation, or Heart Rate Variability Biofeedback for Stress Reduction: A Randomized Controlled Trial. Applied Psychophysiology and Biofeedback, 40(4), pp.257–268.
Fincham, G.W., Strauss, C., Montero-Marin, J. and Cavanagh, K., 2023. Effect of breathwork on
stress and mental health: A meta-analysis of randomised-controlled trials. Scientific Reports, 13,
NHS, 2020. Vitamins and minerals - Vitamin D. [online] Available at:
<https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/> [Accessed 3 February 2026].
Mirabelli, M., Chiefari, E., Arcidiacono, B., Corigliano, D.M., Brunetti, F.S., Maggisano, V., Russo, D., Foti, D.P. and Brunetti, A., 2020. Mediterranean Diet Nutrients to Turn the Tide against Insulin Resistance and Related Diseases. Nutrients, 12(4), p.1066. https://doi.org/10.3390/nu12041066.
