Abstract
Background/Objectives: Psoriasis is a chronic immune-mediated disease frequently accompanied by systemic inflammation and metabolic disturbances. Nutrition plays a crucial role in modulating inflammatory pathways, yet the impact of baseline dietary status on systemic therapy outcomes remains underexplored. Methods: A total of 37 patients (20 men, 17 women; mean age 47.8 ± 4.87 years) scheduled for cyclosporine A (CsA) therapy underwent dietary assessment using 24 h recall and food frequency questionnaires. Intake was compared with dietary reference values. Psoriasis severity was measured by using the Psoriasis Area and Severity Index (PASI) and Body Surface Area (BSA) at baseline, day 42, and day 84. Mixed-effects regression models adjusted for body mass index (BMI), age, and sex assessed associations between nutrient adequacy and clinical outcomes. Results: Participants exhibited frequent dietary imbalances, including low polyunsaturated fatty acids, fiber, vitamin D, folate, and minerals such as magnesium and zinc, alongside excess saturated fat and sodium. Adequate intake of fiber, eicosapentaenoic acid (EPA)+ docosahexaenoic acid (DHA), and vitamins A and D, folate, magnesium, and zinc was independently associated with a lower baseline PASI/BSA and faster improvement during CsA therapy (p < 0.05). Higher BMI, older age, and male sex predicted poorer outcomes. Conclusions: Pre-treatment nutritional inadequacies are common in psoriasis and independently predict diminished therapeutic response to CsA. Early nutritional optimization may enhance treatment efficacy and support long-term disease control. Integrating dietary assessment in psoriasis management represents a feasible, impactful adjunct to pharmacotherapy.