Skin and Diet:An Update on the Role of Dietary Change as a Treatment Strategy for Skin Disease
ABSTRACT
摘要
英文原文
An increasing body of research indicates that dietary change may serve as a component of therapy for certain skin conditions. This includes conditions such as acne, atopic dermatitis, aging skin, psoriasis, and rosacea. Certain nutrients, foods, or dietary patterns may act as disease “triggers”, while others may prove beneficial. Avoidance or elimination diets may be helpful in some conditions, although testing may be recommended first. In terms of beneficial effects, an eating pattern that emphasizes the consumption of whole foods over highly processed foods may help in the treatment of certain skin conditions, and will certainly help in the prevention of associated comorbidities.
对应中文
越来越多的研究表明，改变饮食可以作为某些皮肤疾病治疗方案的一个组成部分。这包括痤疮、特应性皮炎、皮肤老化、牛皮癣和玫瑰痤疮。某些营养物质、食物或饮食模式可能是疾病的“诱因”，而其他营养物质可能是有益的。在某些情况下，避免或排除饮食因素可能有帮助，但可能建议先进行检测。就有益影响而言，强调食用天然食品而非高度加工食品的饮食模式可能有助于治疗某些皮肤疾病，并肯定有助于预防相关的疾病。
Introduction
引言
英文原文
Dietary change has long been considered an important treatment strategy for certain skin conditions. For example, dermatologists have long discussed the role of dietary triggers in rosacea and insulin resistance in acanthosis nigricans. As an increasing body of research has demonstrated, dietary change may play a role in treatment strategies for other skin diseases as well.
对应中文
长期以来，改变饮食习惯一直被认为是治疗某些皮肤疾病的重要策略。例如，长期以来皮肤科医生一直在讨论饮食诱发因素在玫瑰痤疮中作用和黑棘皮病中胰岛素抵抗的作用。随着越来越多的研究表明，在其他皮肤病的治疗策略中改变饮食也可能发挥作用。
英文原文
In this review, we focus on five major skin conditions for which dietary change may be advised as one component of treatment. As a quick Internet search will reveal, there is much misinformation on the link between skin and diet. Some recommendations are ineffective, while others are potentially harmful, such as untested dietary supplements or severely restrictive elimination diets. It is critical, therefore, that physicians be well-informed in this area in order to provide evidence-based recommendations.
对应中文
在这篇综述中，我们关注五种主要的皮肤状况，对于这些皮肤疾病，饮食变化可能被建议作为治疗的一个组成部分。快速搜索一下就会发现，在互联网上关于皮肤和饮食之间的关系有很多错误的信息。有些建议是无效的，而另一些则可能是有害的，例如未经测试的膳食补充剂或严格限制饮食。因此，为了提供循证建议，医生在这一领域充分了解情况是至关重要的。
Diet and Acne
饮食与痤疮
Triggers
诱因
英文原文
The strongest evidence to date on dietary triggers for acne is for high-glycemic-load diets. In a randomized controlled trial (RCT), acne patients demonstrated significant improvement after 12 weeks of a low-glycemic-load diet.Later studies documented that this dietary pattern resulted in lower androgen bioavailability and altered skin sebum production.In another RCT, a 10-week low-glycemic-load diet improved acne, and histopathological exam revealed decreased skin inflammation and reduced sebaceous gland size.
对应中文
到目前为止，饮食中诱发痤疮的最有力的证据是高血糖负荷饮食。在一项随机对照试验(RCT)中，在12周的低糖饮食后痤疮患者表现出显著的改善。后来的研究证明，这种饮食模式导致雄激素生物利用度降低，皮肤皮脂发生改变。在另一项随机对照试验中，10周的低糖饮食改善了痤疮，组织病理学检查显示皮肤炎症减轻，皮脂腺变小。
英文原文
Some studies have demonstrated an epidemiologically weak association between acne and dairy consumption, possibly more so with skim milk.While further research is needed, it may play a role in some patients, as in a report of five teenagers who developed treatment-resistant acne after starting whey protein supplements.
对应中文
一些研究表明，从流行病学的角度来看，痤疮与乳制品消费之间的联系并不紧密，可能与脱脂牛奶之间的联系更紧密。虽然还需要进一步研究，但它可能在一些患者中发挥作用，比如在一份报告中，开始服用乳清蛋白补充剂后五名青少年出现了难治性痤疮。
Beneficial Measures
有益措施
英文原文
Studies in humans are limited and, therefore, despite promising in vitro, animal, or anecdotal reports, recommendations for foods or supplements containing probiotics, omega-3 fatty acids, zinc, antioxidants, fiber, and vitamin A cannot be made with certainty at this time. Omega-3 fatty acids warrant further study; in one 10-week RCT, omega-3 fatty acid supplements and gammalinolenic acid supplements both resulted in clinical and histopathological improvement in acne lesions. Probiotics warrant further study as well; in one RT, minocycline with probiotic supplementation resulted in a lower total lesion count as compared to antibiotics alone.
对应中文
饮食在人体上研究是有限的，因此，尽管在体外、动物或趣闻报告中很有前景，但目前还不能确定推荐含有益生菌、ω-3脂肪酸、锌、抗氧化剂、纤维和维生素A的食物或补充剂。ω-3脂肪酸需要进一步研究；在一个10周的随机对照试验中，ω-3脂肪酸补充剂和γ-亚麻酸补充剂都能改善痤疮病变的临床表现和组织病理学状况。益生菌也值得进一步研究；在一项RT试验中，与单独使用抗生素相比，米诺环素与益生菌补充剂可导致病变总数较低。
英文原文
Zinc bears special mention, as it has been studied in several RCTs. While some trials have not been successful, others have demonstrated efficacy in acne treatment. Further research is warranted, as published trials have utilized multiple dosages and forms of zinc, including zinc gluconate, zinc sulphate, and methionine-bound zinc, among others. Some formulations have better absorption and result in less gastrointestinal side effects. Other factors that impact zinc absorption include age and meal components.In addition, some successful trials have utilized zinc in combination with other components, such as antioxidants and lactoferrin. Future research must account for these multiple factors.
对应中文
锌值得特别注意，因为在几个随机对照试验中它已经进行了研究。虽然一些试验没有成功，但其他一些试验已经证明了在痤疮治疗中锌的有效性。由于已发表的试验已经使用了多种剂量和形式的锌，包括葡萄糖酸锌、硫酸锌和蛋氨酸结合锌等，因此对于锌有必要进一步的研究。一些配方可以更好地被吸收，胃肠道副作用较少。影响锌吸收的其他因素包括年龄和膳食成分。此外，一些成功的试验将锌与抗氧化剂和乳铁蛋白等其他成分结合使用。未来的研究必须考虑到这些多重因素。
Diet and Aging Skin
饮食与皮肤老化
Triggers
诱因
英文原文
For patients who present for cosmetic treatment of aging skin, lifestyle factors that impact this process are an important aspect of treatment. While smoking and sun protection are commonly reviewed, dietary factors should be as well.
对应中文
对于正在接受老化皮肤美容治疗的患者来说，其中一个治疗的重要方面是影响这一过程的生活方式。虽然常见的问题是吸烟和防晒，但饮食因素也应该得到重视。
英文原文
While it has long been recognized that diabetics experience poor wound healing, there is now a greater recognition that these effects on collagen can promote skin wrinkling. Higher levels of blood sugar can result in the production of advanced glycation end products (known as AGEs) via glycation and cross-linking of collagen fibers, which ultimately results in a loss of elasticity.Consumption of preformed AGEs, created during certain cooking processes such as deep-frying, can also be detrimental.
对应中文
人们虽然早就认识到糖尿病患者的伤口愈后不佳，但现在更广泛地认识到，这些作用在胶原蛋白上会促进皮肤起皱纹。通过胶原纤维的糖基化和交联，血糖水平升高产生晚期糖基化终末产物(即AGEs)，最终导致弹性丧失。在某些烹饪过程中，如油炸，食用这种预先成型的AGEs也可能有害。
英文原文
Even in non-diabetics, effects on collagen may be seen. Even after accounting for degree of sun damage and smoking, as study subjects’ blood glucose level increased, their perceived age increased.
对应中文
即使在非糖尿病患者中，也可以看到血糖对胶原蛋白的影响。随着研究对象血糖水平的升高，即使考虑到阳光伤害和吸烟程度，他们被感知的年龄也会增加。
Beneficial Measures
有益措施
英文原文
Many laboratory and animal studies have found that multiple different antioxidants (AOs), found in foods ranging from various fruits and vegetables to tea leaves and seeds, act to limit the damaging cutaneous effects of ultraviolet (UV) radiation.Experimental human studies of a few AOs have noted the same, as in one study in which subjects consuming tomato paste daily for 12 weeks experienced less UV-induced erythema, as well as lower levels of UV-induced matrix metalloproteinase.It is important to note that research indicates AOs consumed via dietary sources appear to function in a different fashion than those found in isolated supplements.
对应中文
许多实验室和动物研究发现，从各种水果和蔬菜到茶叶和种子的食物中存在多种不同的抗氧化剂(AOs)，可以限制紫外线辐射对皮肤的伤害。针对少数AOs的人体实验研究也发现了同样的现象，比如在一项研究中，受试者连续12周每天吃番茄酱，紫外线引起的红疹减少，紫外线诱导的基质蛋白酶水平降低。值得注意的是，研究表明，通过膳食来源摄入的AOs与那些单独的补充剂中的功能似乎不同。
英文原文
Other human studies suggest that a diet high in phytonutrients can limit photodamage. One study reported higher intake of vegetables, legumes, and olive oil appeared to protect against actinic damage.In another study of over 4000 women, patients’ skin was analyzed for features of skin aging. After controlling for other factors, a diet reported as high in potassium and vitamins A and C correlated to fewer wrinkles.
对应中文
其他人体研究表明，富含植物营养素的饮食可以限制光损伤。一项研究报告称，摄入更多的蔬菜、豆类和橄榄油似乎可以防止光化损伤。在对4000多名女性进行的另一项研究中，对患者的皮肤进行了皮肤老化特征分析。据报道，在控制了其他因素后，高钾饮食和维生素A和C与较少的皱纹有相关性。
Diet and Atopic Dermatitis
饮食与特应性皮炎
Triggers
诱因
英文原文
Food allergies are highly correlated with atopic dermatitis (AD). In some cases, they are causative.Foods may trigger an AD flare via three main mechanisms.
对应中文
食物过敏与特应性皮炎(AD)高度相关。在某些情况下，它们有因果关系。食物可能通过三种主要机制引发特应性皮炎发作。
英文原文
Immunoglobulin E (IgE)-mediated allergy, also known as Type 1 or immediate-type hypersensitivity, may trigger a flare within minutes to hours.The six common trigger foods are milk, eggs, wheat, soy, seafood, and nuts. Testing with skin prick test or blood test may screen for this allergy, but due to a high rate of false positive results, confirmation requires double-blind, placebo-controlled food challenge (DBPCFC).
对应中文
免疫球蛋白E(IgE)介导的过敏，也称为1型或即刻超敏反应，可能会在几分钟到几小时内引发红疹。六种常见的诱发食物是牛奶、鸡蛋、小麦、大豆、海鲜和坚果。皮肤点刺试验或血液试验可以筛查这种过敏原，但由于假阳性率很高，确认双盲安慰剂对照食物激发试验(DBPCFC)。
英文原文
Systemic contact dermatitis, screened for by patch testing, is a T-cell mediated reaction. In balsam of Peru allergy, some persons allergic to fragrance additives may experience a cutaneous flare following ingestion of certain foods, including tomatoes, citrus, and cinnamon.
对应中文
通过皮肤过敏试验筛选出的系统性接触性皮炎是一种T细胞介导的反应。在对秘鲁香膏过敏中，一些对香料添加剂过敏的人在摄入某些食物（包括西红柿、柑橘和肉桂）后可能会出现皮肤炎症。
英文原文
An expert panel, representing 34 agencies and groups, published guidelines on food allergy, and concluded that elimination diets are not recommended in unselected AD patients.In other words, dietary changes should be guided by results of testing. If suspected by history, though, a single food elimination diet for 6 weeks may be attempted in adults.
对应中文
一个代表34个机构和团体的专家小组发布了关于食物过敏的指南，并得出结论，不建议在未经选择的AD患者中排除饮食。换句话说，改变饮食应该以测试结果为指导。然而，如果既往史怀疑，患者可能会尝试6周的单一食物排除过敏饮食。
Beneficial Measures
有益措施
英文原文
Synbiotics, which are probiotics in combination with prebiotics, have shown promise in the treatment of AD. Probiotics are live bacteria, similar to those found naturally in the human body, and which may be beneficial to health. They may be found in supplements or in certain foods containing live, active cultures.Prebiotics, such as certain plant fiber, are defined as nondigestible carbohydrates that stimulate the growth of probiotic bacteria in the intestine.A meta-analysis of synbiotics in AD treatment found the most promise with a combination of different strains of bacteria and when used for at least 8 weeks in adults and children over the age of 1 year.However, the optimal dose, bacterial strains, and treatment duration remains unclear.
对应中文
合生元，即益生菌与益生元的结合，在AD的治疗中表现良好的前景。益生菌是一种活细菌，类似于那些在人体中自然发现的细菌，可能对健康有益。它们可能存在于补充剂或某些含有活性物的食物中。例如某些植物纤维，益生元被定义为刺激肠道益生菌生长的不可消化的碳水化合物。一项关于合生元治疗AD的荟萃分析发现，在成人和1岁以上儿童中使用合生元至少8周时，结合不同菌株的合生菌最有希望。然而，最佳剂量、菌株和治疗时间仍不清楚。
英文原文
Vitamin D has not been shown to be helpful in most AD patients, but further research is recommended for certain groups, specifically those with very low levels of vitamin D, those with food allergies, and those with frequent bacterial skin infections. Studies of evening primrose oil and borage seed oil have been disappointing, while studies of Chinese herbal medicine have either not shown efficacy, or have been of low quality. Limited research is available for fish oil supplements.
对应中文
对大多数AD患者维生素D没有帮助，但建议对某些人群特别是维生素D水平极低的人群、食物过敏的人群和经常发生细菌性皮肤感染的人群，进行进一步的研究。对月见草油和琉璃苣籽油的研究令人失望，而对中草药的研究要么没有显示疗效，要么质量不高。针对鱼油补充剂的研究较少。
Diet and Psoriasis
饮食与银屑病
英文原文
The importance of diet should be emphasized to all psoriasis patients, primarily due to the higher risk of comorbid conditions, including diabetes, hypertension, and cardiovascular disease, that may be prevented or ameliorated by dietary approaches.In addition, dietary change leading to weight loss has resulted in better treatment efficacy, as well as improved psoriasis area and severity index (PASI) scores in some patients.
对应中文
应向所有银屑病患者强调饮食的重要性，主要是因为银屑病患者有较高的风险出现并发症，包括糖尿病、高血压和心血管疾病，可以通过饮食方法预防或改善这些疾病。此外，改变饮食导致体重减轻，产生更好的治疗效果，并改善了部分患者的银屑病面积和严重程度指数(PASI)得分。
Triggers
诱因
英文原文
It is well recognized that smoking and increased alcohol intake are associated with psoriasis, and all psoriatic patients should be advised of their potential role.
对应中文
众所周知，吸烟和酒精摄入增加与银屑病有关，所有银屑病患者都应该被告知其潜在的作用。
英文原文
Dietary factors may also play a role. Gluten-containing foods may act as a trigger in some patients, and testing for celiac antibodies is warranted in those who report gastrointestinal symptoms. While estimates vary, one large study found a 2.2 fold higher risk of celiac disease as compared to matched controls, while a meta-analysis found a 2.4 fold higher risk of certain celiac antibodies.In such patients, a gluten-free diet may result in psoriasis improvement, as demonstrated in small trials and case reports, although further studies are required to confirm.
对应中文
饮食因素也可能在疾病中起作用。一些病人的疾病诱因可能是含谷蛋白的食物，因此对那些报告有胃肠道症状的病人进行乳糜泻抗体检测是必要的。虽然估计结果各不相同，但一项大型研究发现，与匹配的对照组相比，患乳糜泻的风险高出2.2倍，而一项荟萃分析发现，患某些乳糜泻抗体的风险高出2.4倍。在这些患者中，无谷蛋白饮食可能引起银屑病的好转，尽管还需要进一步的研究来证实，但这在小型试验和病例报告中得到了证实。
英文原文
ChIn a systematic literature review, increased severity of psoriasis appeared to correlate with a higher body mass index (BMI), although the authors noted the difficulty in determination of temporality due to study designs.It is believed that obesity likely predisposes to psoriasis, and vice versa.While the reasons for this are multifactorial, it has been shown that weight loss can improve response to systemic psoriasis therapies and improve disease severity.
对应中文
在一项系统的文献综述中，银屑病严重程度的增加似乎与身体质量指数(BMI)较高相关，尽管作者指出，由于研究设计难以确定时间。人们认为，肥胖很可能导致银屑病，反之亦然。虽然原因是多方面的，但已经证明，减肥可以改善系统性银屑病治疗反应，并改善疾病的严重程度。
英文原文
An excellent review article summarizes the effects of weight loss interventions in psoriasis.In a meta-analysis of five RCTs of lifestyle intervention via diet or exercise in overweight or obese psoriasis patients, a greater reduction in PASI score was seen in weight loss intervention groups.In a limited number of case reports and retrospective studies, some obese patients have experienced significant improvements in psoriasis following gastric bypass surgery.
对应中文
一篇优秀的综述文章总结了减肥管理对银屑病的影响。在对超重或肥胖银屑病患者通过饮食或运动进行生活方式管理的五个随机对照试验的荟萃分析中，减肥干预组的PASI评分下降幅度更大。在有限数量的病例报告和回顾性研究中，一些肥胖患者在胃旁路手术后银屑病得到显著改善。
英文原文
Weight loss has also improved response to systemic therapy, as in one RT trial of patients on cyclosporine.In examining factors associated with response to biologic therapy, one analysis found that BMI had the strongest effect across studies, although several studies found no association.
对应中文
减轻体重也改善了对全身治疗的反应，比如在一项环孢素患者的RT试验中一样。一项分析发现，在检查与生物治疗反应相关的因素时，在所有研究中BMI具有最强的影响，尽管有几项研究没有发现关联。
英文原文
While specific dietary recommendations are not clear, one observational study found an inverse association between PASI score and degree of adherence to the Mediterranean diet.
对应中文
虽然具体的饮食建议还不清楚，但一项观察性研究发现PASI评分与地中海饮食的坚持程度之间存在负相关。
英文原文
In terms of nutritional supplements, Millsop et al. summarized multiple studies and found that further investigation was needed, with fish oil showing the most promise and oral vitamin D demonstrating some promise in open label studies. There was limited evidence for benefit of vitamin B12 and selenium
supplementation.
对应中文
Millsop等人总结了多项研究发现，在营养补充剂方面，需要进一步的研究，其中鱼油最有前景，在开放标签研究中，口服维生素D也有一些前景。补充维生素B12和硒对人体有益的证据有限。
Diet and Rosacea
饮食与玫瑰痤疮
Triggers
诱因
英文原文
Although dermatologists frequently counsel rosacea patients on avoidance of dietary triggers, there is a lack of research in this area. In one survey of patients by the National Rosacea Society, 78% had altered their diet, and 95% of this group reported subsequent reduction in flares.
对应中文
尽管皮肤科医生经常建议玫瑰痤疮患者避免相关饮食诱因，但在这一领域还缺乏研究。在一项国家玫瑰痤疮协会对患者的调查中，78%的患者改变了他们的饮食，其中95%的人报告随后症状减轻。
英文原文
In this group, 75% were affected by spices and 54% by hot sauce. Other trigger foods included tomatoes (30%), chocolate (23%), and citrus (22%). Alcohol was another frequent trigger, including wine (52%) and hard liquor (42%), as well as hot beverages such as coffee (33%) and tea (30%).
对应中文
在这一组中，75%的人受香料影响，54%的人受辣酱影响。其他引发疾病的食物包括西红柿(30%)、巧克力(23%)和柑橘(22%)。另一个常见诱因是酒精，包括葡萄酒(52%)和烈性酒(42%)，以及咖啡(33%)和茶(30%)等热饮。
英文原文
While the underlying pathophysiologic mechanism of these reported triggers is unknown, transient receptor potential (TRP) channels may play a role. These are expressed throughout the body, including on neuronal tissues, and may be activated by cold or hot temperatures, as well as certain foods.Specific dietary activators include capsaicin and cinnamaldehyde, which act on certain of these channels to stimulate an increase in skin blood flow via neurogenic vasodilatation.Capsaicin is found in some spices, while cinnamaldehyde is found in cinnamon, tomatoes, citrus, and chocolate.
对应中文
虽然这些被报道诱因的潜在病理生理机制尚不清楚，但是瞬时受体电位(TRP)通道可能发挥作用。它们在身体各处都有表达，包括在神经元组织上，并可能被低温或高温以及某些食物激活。特定的饮食激活剂包括辣椒素和肉桂醛，它们作用于某些通道，通过舒张神经源性血管来刺激皮肤血流量的增加。辣椒素存在于一些调味料中，肉桂醛存在于肉桂、番茄、柑橘和巧克力中。
Beneficial Measures
有益措施
英文原文
Research indicates the possible role of a gut-skin connection in rosacea. In a population-based cohort study of close to 50,000 patients with rosacea, the prevalence of celiac disease, Crohn’s disease, ulcerative colitis, Helicobacter pylori infection, small intestinal bacterial overgrowth (SIBO), and irritable bowel syndrome were all higher among patients with rosacea as compared with control subjects.
对应中文
研究表明，肠道与皮肤的连接可能在玫瑰痤疮中起作用。在一项基于人群的队列研究中，近5万名玫瑰痤疮患者中，与对照组相比，玫瑰痤疮患者中腹腔疾病、克罗恩病、溃疡性结肠炎、幽门螺杆菌感染、小肠细菌过度生长(SIBO)和肠易激综合征的患病率均较高。
英文原文
Although research is ongoing, the pathogenic link remains unknown. One intriguing study found that patients with rosacea were 13 times more likely to have SIBO, with a suspected role for increasing circulating cytokines.Treatment of SIBO with antibiotics in 40 patients led to remission of rosacea in all cases, which persisted in the majority at 3-year follow-up.
对应中文
尽管研究仍在进行中，但致病的联系仍然未知。一项有趣的研究发现，玫瑰痤疮患者患SIBO的可能性是其他患者的13倍，这可能与增加循环细胞因子有关。在40名患者中使用抗生素治疗SIBO，所有病例的玫瑰痤疮症状均得到缓解，在3年的随访中，大多数患者的玫瑰痤疮症状持续存在。
英文原文
In one case report, a reduction of gut transit time via a high-fiber intervention resulted in improvement of rosacea.As SIBO has been linked to decreased gut motility, further research on such intervention is warranted.
对应中文
在一个病例中报告，通过高纤维饮食干预减少肠道运输时间进而改善玫瑰痤疮。由于SIBO已被证实与肠道运动减弱有关，因此有必要对这种干预措施进行进一步研究。
Conclusion
结论
英文原文
Based on research findings to date, certain dietary recommendations are suitable for patients with multiple different types of skin disease.
对应中文
根据目前为止的研究结果，某些饮食建议适用于多种不同类型的皮肤病患者。
英文原文
1.The results of research support the promotion of eating patterns over specific foods or nutrients.
2.An eating pattern that emphasizes the consumption of whole foods over highly processed foods may help in the treatment of certain skin diseases. It will certainly help in the prevention of associated comorbidities.
3.Multiple eating plans emphasize whole foods as a foundational approach, and may be recommended to patients with skin disease. Such eating plans, rich in dietary antioxidants, fiber, and other phytonutrients, have demonstrated multiple overall health benefits. These may be either cuisine-based, such as the Mediterranean diet, or guideline-based, such as the DASH diet. These particular plans have been shown to reduce the risks of cardiovascular disease and hypertension, respectively.
4.An increased intake of fiber is seen as one key benefit of these whole foods diets. Some plant-derived fiber serves as a prebiotic, which may promote a healthy gut microbiome. Given an increasing body of research demonstrating a gut-skin connection, this may benefit certain inflammatory skin diseases.
5.For some skin diseases, specific dietary “triggers” should be reviewed. Some patients may choose a trial of an elimination diet, such as avoidance of high-glycemic-load foods in acne or vasodilating foods in rosacea. For other conditions, medical testing may be recommended prior to dietary change, as in testing for celiac disease in psoriasis.
6.Dietary supplements, used in the absence of a documented nutrient deficiency, have been demonstrated as beneficial in only a few very specific instances. Despite the marketing of many over-the-counter supplements for the treatment of skin disease, the vast majority of these are not supported by evidence.
7.Referral to integrative physicians, dieticians, or nutritionists may be recommended to help implement and tailor dietary approaches according to food allergies, personal or cultural preferences, and other medical conditions.
对应中文
1.研究结果支持提倡饮食方法而不是特定的食物或营养。
2.强调食用天然食品而非高度加工食品的饮食方法可能有助于治疗某些皮肤病。也可能有助于预防相关的并发症。
3.多种饮食计划强调天然食物是一种基本方法，这可能会被推荐给皮肤病患者。这样的饮食计划富含膳食抗氧化剂、纤维和其他植物营养素，已经证明了多种全面的健康益处。这些饮食可以是以烹饪为基础，如地中海饮食，也可以是以指南为基础，如DASH饮食。这些特别饮食计划已被证明可分别降低心血管疾病和高血压的风险。
4.这些天然食物饮食的一个关键好处是增加纤维摄入量。一些植物来源的纤维作为益生元，可以促进肠道微生物群的健康。鉴于越来越多的研究表明肠道与皮肤的联系，这可能有利于某些炎症性皮肤病。
5.对于某些皮肤病，应回顾具体的饮食“诱因”。一些患者可能会选择一种节食疗法，例如痤疮患者避免食用高血糖负荷食物，玫瑰痤疮患者避免食用引起血管扩张的食物。对于其他情况，建议在改变饮食习惯之前进行医学检测，如在牛皮癣中检测乳糜泻。
6.在没有证明营养缺乏的情况下，膳食补充剂只有在少数非常具体的例子中被证明是有益的。尽管市面上有许多治疗皮肤病的非处方药补充剂，但其中绝大多数都没有证据支持。
7.根据食物过敏情况、个人或文化偏好和其医疗条件，推荐综合医生、营养师或营养学专家帮助实施和定制饮食方法。
REFERENCES
- Katta R, Kramer MJ. Skin and Diet: An Update on the Role of Dietary Change as a Treatment Strategy for Skin Disease. Skin Therapy Lett. 2018 Jan;23(1):1-5.