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doi: 10.1007/s00394-010-0119-6 6 Dhonukshe-RuttenRAPluijmSMde GrootLCLipsPSmitJHvan StaverenWA

An increase in oxidative stress and decrease in glutathione (GSH) levels have been demonstrated to be associated with psoriasis2,3 both locally4 and systemically.5 Obese patients with psoriasis have been shown to have decreased plasma adiponectin and elevated oxidized GSH levels associated with enhanced systemic inflammation and oxidative stress.6 Oral GSH supplementation has generally been found to have a negligible effect on cellular GSH levels when ingested by humans.7,8 Total body GSH levels are best raised by ingestion of GSH precursors.9 N-acetylcysteine (NAC) is a well-studied drug that is an effective GSH precursor and in common use in clinical settings, such as acetaminophen overdose10 and chemoprophylaxis against radiological intravenous dyes.11 Its use as a daily supplement is limited by its side effect profile, generally gastrointestinal symptoms.12 Immunocal (Immunotec Inc.) is a nonprescription, oral, whey protein supplement indicated as a GSH precursor.13,14 It serves to deliver nondenatured proteins high in cysteine and cysteine residues