{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T22:44:23Z","timestamp":1783464263696,"version":"3.55.0"},"reference-count":46,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2021,8,25]],"date-time":"2021-08-25T00:00:00Z","timestamp":1629849600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Vegans and vegetarians often consume foods containing photosensitizers capable of triggering phytophotodermatitis. The potential effect of vegan and vegetarian diets on the response of psoriatic patients undergoing phototherapy is not well characterized. We assessed clinical outcomes of vegan, vegetarian and omnivore adult psoriatic patients undergoing band ultraviolet B phototherapy (NB-UVB). In this multicenter prospective observational study, we enrolled 119 adult, psoriatic patients, of whom 40 were omnivores, 41 were vegetarians and 38 were vegans, with phototherapy indication. After determining the minimum erythemal dose (MED), we performed NB-UVB sessions for 8 weeks. The first irradiation dosage was 70.00% of the MED, then increased by 20.00% (no erythema) or by 10.00% (presence of erythema) until a maximum single dose of 3 J\/cm2 was reached and constantly maintained. All the enrolled patients completed the 8 weeks of therapy. Severe erythema was present in 16 (42.11%) vegans, 7 (17.07%) vegetarians and 4 (10.00%) omnivores (p &lt; 0.01). MED was lowest among vegans (21.18 \u00b1 4.85 J\/m2), followed by vegetarians (28.90 \u00b1 6.66 J\/m2) and omnivores (33.63 \u00b1 4.53 J\/m2, p &lt; 0.01). Patients with severe erythema were more likely to have a high furocumarin intake (OR 5.67, 95% CI 3.74\u20138.61, p &lt; 0.01). Vegans consumed the highest amount of furocumarin-rich foods. A model examining erythema, adjusted for gender, age, skin type, MED, phototherapy type, number of phototherapies and furocumarin intake, confirmed that vegans had a lower number of treatments. Vegans had more frequent severe erythema from NB-UVB, even after adjustment of the phototherapy protocol for their lower MED. Assessing diet information and adapting the protocol for vegan patients may be prudent.<\/jats:p>","DOI":"10.3390\/nu13092934","type":"journal-article","created":{"date-parts":[[2021,8,25]],"date-time":"2021-08-25T04:24:27Z","timestamp":1629865467000},"page":"2934","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Diet-Related Phototoxic Reactions in Psoriatic Patients Undergoing Phototherapy: Results from a Multicenter Prospective Study"],"prefix":"10.3390","volume":"13","author":[{"given":"Alessia","family":"Pacifico","sequence":"first","affiliation":[{"name":"Clinical Dermatology Department, San Gallicano Dermatological Institute, IRCCS, 00144 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9209-2883","authenticated-orcid":false,"given":"Rosalynn R. Z.","family":"Conic","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, Maryland University, Baltimore, MD 21201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Cristaudo","sequence":"additional","affiliation":[{"name":"Clinical Dermatology Department, San Gallicano Dermatological Institute, IRCCS, 00144 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8508-552X","authenticated-orcid":false,"given":"Sergio","family":"Garbarino","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal\/Child Sciences, Polyclinic Hospital San Martino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), University of Genoa, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Ardig\u00f2","sequence":"additional","affiliation":[{"name":"Clinical Dermatology Department, San Gallicano Dermatological Institute, IRCCS, 00144 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aldo","family":"Morrone","sequence":"additional","affiliation":[{"name":"Clinical Dermatology Department, San Gallicano Dermatological Institute, IRCCS, 00144 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Iacovelli","sequence":"additional","affiliation":[{"name":"Clinical Dermatology Department, San Gallicano Dermatological Institute, IRCCS, 00144 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"di Gregorio","sequence":"additional","affiliation":[{"name":"Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo Daniele Maria","family":"Pigatto","sequence":"additional","affiliation":[{"name":"Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy"},{"name":"Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5321-0584","authenticated-orcid":false,"given":"Ayman","family":"Grada","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Boston University School of Medicine, Boston, MA 02118, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0090-6289","authenticated-orcid":false,"given":"Steven Richard","family":"Feldman","sequence":"additional","affiliation":[{"name":"Wake Forest School of Medicine, Department of Dermatology, Winston-Salem, NC 27157, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2753-8487","authenticated-orcid":false,"given":"Egeria","family":"Scoditti","sequence":"additional","affiliation":[{"name":"Institute of Clinical Physiology, National Research Council (CNR), 73100 Lecce, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalaf","family":"Kridin","sequence":"additional","affiliation":[{"name":"L\u00fcbeck Institute of Experimental Dermatology, University of L\u00fcbeck, 23538 L\u00fcbeck, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2390-6505","authenticated-orcid":false,"given":"Giovanni","family":"Damiani","sequence":"additional","affiliation":[{"name":"Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy"},{"name":"Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy"},{"name":"PhD Degree Program in Pharmacological Sciences, Department of Pharmaceutical and Pharmacological Sciences, University of Padua, 35131 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,8,25]]},"reference":[{"key":"ref_1","first-page":"83","article-title":"Key Signaling Pathways in Psoriasis: Recent Insights from Antipsoriatic Therapeutics","volume":"11","author":"Johansen","year":"2021","journal-title":"Psoriasis (Auckland)"},{"key":"ref_2","first-page":"32","article-title":"A dermatologic perspective on autoinflammatory diseases","volume":"36","author":"Marzano","year":"2018","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"101694","DOI":"10.1016\/j.berh.2021.101694","article-title":"Pathogenesis of psoriatic arthritis","volume":"35","author":"Stober","year":"2021","journal-title":"Best Pract. Res. Clin. Rheumatol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Yan, D., Blauvelt, A., Dey, A.K., Golpanian, R.S., Hwang, S.T., Mehta, N.N., Myers, B., Shi, Z.-R., Yosipovitch, G., and Bell, S. (2021). New Frontiers in Psoriatic Disease Research, Part II: Comorbidities and Targeted Therapies. J. Investig. Dermatol.","DOI":"10.1016\/j.jid.2021.02.743"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3140682","DOI":"10.1155\/2018\/3140682","article-title":"Psoriasis and Respiratory Comorbidities: The Added Value of Fraction of Exhaled Nitric Oxide as a New Method to Detect, Evaluate, and Monitor Psoriatic Systemic Involvement and Therapeutic Efficacy","volume":"2018","author":"Santus","year":"2018","journal-title":"Biomed Res. Int."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2981","DOI":"10.1007\/s10067-020-05050-2","article-title":"Patients with psoriatic arthritis have higher levels of FeNO than those with only psoriasis, which may reflect a higher prevalence of a subclinical respiratory involvement","volume":"39","author":"Damiani","year":"2020","journal-title":"Clin. Rheumatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1111\/bjd.14546","article-title":"Increased airway inflammation in patients with psoriasis","volume":"175","author":"Damiani","year":"2016","journal-title":"Br. J. Dermatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1544","DOI":"10.1111\/bjd.13988","article-title":"Narrowband ultraviolet B phototherapy in psoriasis reduces proinflammatory cytokine levels and improves vitiligo and neutrophilic asthma","volume":"173","author":"Malerba","year":"2015","journal-title":"Br. J. Dermatol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Conic, R.R., Damiani, G., Schrom, K.P., Ramser, A.E., Zheng, C., Xu, R., McCormick, T.S., and Cooper, K.D. (2020). Psoriasis and Psoriatic Arthritis Cardiovascular Disease Endotypes Identified by Red Blood Cell Distribution Width and Mean Platelet Volume. J. Clin. Med., 9.","DOI":"10.3390\/jcm9010186"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1016\/j.jid.2019.07.727","article-title":"Interaction of Resistin and Systolic Blood Pressure in Psoriasis Severity","volume":"140","author":"Seth","year":"2020","journal-title":"J. Investig. Dermatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s12967-014-0372-1","article-title":"Nutrition and psoriasis: Is there any association between the severity of the disease and adherence to the Mediterranean diet?","volume":"13","author":"Barrea","year":"2015","journal-title":"J. Transl. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1001\/jamadermatol.2018.1412","article-title":"Dietary Recommendations for Adults with Psoriasis or Psoriatic Arthritis from the Medical Board of the National Psoriasis Foundation: A Systematic Review","volume":"154","author":"Ford","year":"2018","journal-title":"JAMA Dermatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1001\/jamadermatol.2018.2127","article-title":"Association between Mediterranean Anti-inflammatory Dietary Profile and Severity of Psoriasis: Results from the NutriNet-Sant\u00e9 Cohort","volume":"154","author":"Phan","year":"2018","journal-title":"JAMA Dermatol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Adawi, M., Damiani, G., Bragazzi, N.L., Bridgewood, C., Pacifico, A., Conic, R.R., Morrone, A., Malagoli, P., Pigatto, P.D.M., and Amital, H. (2019). The Impact of Intermittent Fasting (Ramadan Fasting) on Psoriatic Arthritis Disease Activity, Enthesitis, and Dactylitis: A Multicentre Study. Nutrients, 11.","DOI":"10.3390\/nu11030601"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Damiani, G., Watad, A., Bridgewood, C., Pigatto, P.D.M., Pacifico, A., Malagoli, P., Bragazzi, N.L., and Adawi, M. (2019). The Impact of Ramadan Fasting on the Reduction of PASI Score, in Moderate-To-Severe Psoriatic Patients: A Real-Life Multicenter Study. Nutrients, 11.","DOI":"10.3390\/nu11020277"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2040622319864805","DOI":"10.1177\/2040622319864805","article-title":"Dietary compounds as potential modulators of microRNA expression in psoriasis","volume":"10","author":"Kocic","year":"2019","journal-title":"Ther. Adv. Chronic Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.12998\/wjcc.v8.i6.1002","article-title":"Gut microbiota and nutrient interactions with skin in psoriasis: A comprehensive review of animal and human studies","volume":"8","author":"Damiani","year":"2020","journal-title":"World J. Clin. Cases"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.fct.2018.10.027","article-title":"Dietary furocoumarins and skin cancer: A review of current biological evidence","volume":"122","author":"Melough","year":"2018","journal-title":"Food Chem. Toxicol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.fct.2018.01.030","article-title":"Furocoumarins: A review of biochemical activities, dietary sources and intake, and potential health risks","volume":"113","author":"Melough","year":"2018","journal-title":"Food Chem. Toxicol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1111\/j.1365-2133.1996.tb01182.x","article-title":"Celery soup causing severe phototoxicity during PUVAtherapy","volume":"135","author":"Boffa","year":"1996","journal-title":"Br. J. Dermatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1750","DOI":"10.1111\/jdv.16209","article-title":"Photoadaptation to ultraviolet B TL01 in psoriatic patients","volume":"34","author":"Pacifico","year":"2020","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"101924","DOI":"10.1016\/j.redox.2021.101924","article-title":"Therapeutic wavelengths of ultraviolet B radiation activate apoptotic, circadian rhythm, redox signalling and key canonical pathways in psoriatic epidermis","volume":"41","author":"Addison","year":"2021","journal-title":"Redox Biol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3001","DOI":"10.1038\/jid.2015.316","article-title":"Circadian Gene Clock Regulates Psoriasis-Like Skin Inflammation in Mice","volume":"135","author":"Ando","year":"2015","journal-title":"J. Investig. Dermatol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1111\/bjd.12622","article-title":"Attenuation of ultraviolet A-induced alterations in NIH3T3 dermal fibroblasts by melatonin","volume":"170","author":"Rezzani","year":"2014","journal-title":"Br. J. Dermatol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.1080\/07420528.2019.1678629","article-title":"Psoriatic and psoriatic arthritis patients with and without jet-lag: Does it matter for disease severity scores? Insights and implications from a pilot, prospective study","volume":"36","author":"Damiani","year":"2019","journal-title":"Chronobiol. Int."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Duszka, K., and Wahli, W. (2020). Peroxisome Proliferator-Activated Receptors as Molecular Links between Caloric Restriction and Circadian Rhythm. Nutrients, 12.","DOI":"10.3390\/nu12113476"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Mart\u00ednez-Lozano, N., Tvarijonaviciute, A., R\u00edos, R., Bar\u00f3n, I., Scheer, F., and Garaulet, M. (2020). Late Eating Is Associated with Obesity, Inflammatory Markers and Circadian-Related Disturbances in School-Aged Children. Nutrients, 12.","DOI":"10.3390\/nu12092881"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"99","DOI":"10.23736\/S0392-0488.18.06223-5","article-title":"Tuscan consensus on the use of UVBnb phototherapy in the treatment of psoriasis","volume":"154","author":"Russo","year":"2019","journal-title":"G. Ital. Dermatol. Venereol."},{"key":"ref_29","unstructured":"The Vegan Society (2021, June 28). So What Do Vegans Eat?. Available online: www.vegansociety.com\/go-vegan\/definition-veganism."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1016\/j.nut.2016.02.011","article-title":"Vegetarianism and cardio- metabolic disease risk factors: Differences between South Asian and US adults","volume":"32","author":"Jaacks","year":"2016","journal-title":"Nutrition"},{"key":"ref_31","unstructured":"Phenol-Explorer (2021, August 18). Database on Polyphenol Content in Foods. Available online: http:\/\/phenol-explorer.eu\/foods."},{"key":"ref_32","unstructured":"(2021, August 18). Food Science Graz. Available online: https:\/\/foodscience.tugraz.at."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.foodres.2011.06.007","article-title":"Carotenoids bioavailability from foods: From plant pigments to efficient biological activities","volume":"46","year":"2012","journal-title":"Food Res. Int."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"5049","DOI":"10.1021\/acs.jafc.7b01279","article-title":"Identification and Quantitation of Furocoumarins in Popularly Consumed Foods in the U.S. Using QuEChERS Extraction Coupled with UPLC-MS\/MS Analysis","volume":"65","year":"2017","journal-title":"J. Agric. Food Chem."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1007\/s13555-017-0183-4","article-title":"Dietary Behaviors in Psoriasis: Patient-Reported Outcomes from a U.S. National Survey","volume":"7","author":"Afifi","year":"2017","journal-title":"Dermatol. Ther."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1572","DOI":"10.1097\/DSS.0000000000002553","article-title":"Comparison of Postsurgical Scars between Vegan and Omnivore Patients","volume":"46","author":"Fusano","year":"2020","journal-title":"Dermatol. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1080\/09546634.2019.1618433","article-title":"Photodynamic therapy for actinic keratosis in vegan and omnivore patients: The role of diet on skin healing","volume":"32","author":"Fusano","year":"2019","journal-title":"J. Dermatolog. Treat."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1001\/archderm.1994.01690060147031","article-title":"Enhancement of PUVA phototoxic effects following celery ingestion: Cool broth also can burn","volume":"130","author":"Puig","year":"1994","journal-title":"Arch. Dermatol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1007\/s00105-006-1164-1","article-title":"Die Bedeutung der Ern\u00e4hrung und begleitender Faktoren f\u00fcr die Psoriasis [The significance of diet and associated factors in psoriasis]","volume":"57","author":"Wolters","year":"2006","journal-title":"Hautarzt"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/0273-2300(91)90029-U","article-title":"Dietary exposure to furocumarins","volume":"14","author":"Wagstaff","year":"1991","journal-title":"Regul. Toxicol. Pharmacol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1038\/s41467-020-17333-y","article-title":"Detection of the thietane precursor in the UVA formation of the DNA 6-4 photoadduct","volume":"11","author":"Reichardt","year":"2020","journal-title":"Nat. Commun."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.jaad.2006.07.003","article-title":"Can dietary furocumarin ingestion enhance the erythemal response during high dose UVA1 therapy?","volume":"56","author":"Beattie","year":"2007","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1210\/jcem-71-3-670","article-title":"5-Methoxypsoralen as a specific stimulating agent of melatonin secretion in humans","volume":"71","author":"Souetre","year":"1990","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_44","first-page":"312","article-title":"Plasma melatonin levels in psoriasis","volume":"68","author":"Mozzanica","year":"1988","journal-title":"Acta Derm.-Venereol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1111\/j.1365-2133.1973.tb02972.x","article-title":"Construction and Development of a Grating Monochromator and Its Application to Study of Reaction of Skin to Light","volume":"89","author":"Mackenzi","year":"1973","journal-title":"Br. J. Dermatol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/j.1600-0781.2009.00487.x","article-title":"Which light source should be used for the investigation of clinical phototoxicity: Monochromator or solar simulator?","volume":"26","author":"Moseley","year":"2010","journal-title":"Photodermatol. Photoimmunol. Photomed."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/9\/2934\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:51:03Z","timestamp":1760165463000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/9\/2934"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,25]]},"references-count":46,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,9]]}},"alternative-id":["nu13092934"],"URL":"https:\/\/doi.org\/10.3390\/nu13092934","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,25]]}}}