Many people with psoriasis experiment with diets, such as cutting back on red meat and processed foods, or even following a gluten-free or a Mediterranean diet. Another dietary consideration is whether you’re taking a biologic medication for psoriasis.

Biologics are a treatment option for moderate to severe psoriasis. These drugs can improve skin symptoms and slow psoriasis disease activity. However, biologics increase your risk of foodborne illnesses because they weaken your immune system. Some examples of biologics for psoriasis include:

• Abatacept (Orencia)
• Adalimumab (Humira)
• Etanercept (Enbrel)
• Infliximab (Remicade)
• Risankizumab-rzaa (Skyrizi)
• Ustekinumab (Stelara)

Because biologics suppress the immune system, they may lead to a higher risk of infection, including food poisoning. If you’re on or starting a biologic to manage your psoriasis, these are some foods you should consider avoiding to steer clear of illness.

1. Unpasteurized Dairy Products

Raw or unpasteurized milk poses a significant health risk for anyone, especially people on biologics. The pasteurization process (heating milk to a specific temperature) is an essential step to eliminate harmful bacteria from cow, goat, or sheep dairy products. Check the food label for the word “pasteurized” to ensure the product is safe to consume. Avoid buying milk products (including cheese and ice cream) from farmers markets or stands where you may not be able to ensure their safety.

2. Mold-Ripened Soft Cheeses

Soft cheeses that are ripened with mold are safe for most people to consume. However, biologics for psoriasis can increase your risk of a fungal infection from cheeses like:

• Blue cheese
• Brie
• Camembert
• Gorgonzola
• Feta
• Goat cheese

Hard cheeses made from pasteurized dairy are a safer option. If you notice mold starting to grow on a block of cheese, you can cut about 1 inch around the moldy spot. If you’d prefer to avoid any risk, you can throw out the cheese. Buying smaller amounts can help ensure you eat all the cheese before any mold develops.

3. Undercooked Red Meat, Poultry, or Seafood

Undercooked meat and seafood can pose major health risks. People with a compromised immune system from biologics must be cautious to ensure that animal products are cooked to a sufficient temperature. Cooking foods like meat and seafood to the right temperature kills any organisms that could cause an infection.

Undercooked meat or seafood can contain dangerous bacteria and parasites, even when it’s from a fancy restaurant. The risk goes up when this food is not prepared correctly. When cooking at home, using a food thermometer is the best way to know if your food is safe to eat.

Cook animal products until they reach these internal temperatures to reduce your risk of foodborne illness:

• Fish — 145 degrees Fahrenheit
• Ground meat and sausage — 160 degrees Fahrenheit
• Ham — 145 degrees Fahrenheit for raw, 165 degrees Fahrenheit to reheat precooked
• Pork chops or roasts — 145 degrees Fahrenheit
• Turkey and chicken (whole bird or legs/thighs/wings) — 165 degrees Fahrenheit

Clams, oysters, and mussels should be cooked until the shells open from the heat. For other seafood, like shrimp, scallops, crab, or lobster, heat well until the flesh becomes opaque.

4. Raw Eggs

Raw eggs may carry salmonella bacteria, so it is important to cook and handle them carefully. Avoid runny yolks or eggs over easy. Instead, make scrambled or fried eggs that are fully cooked and eat them while they’re still hot off the pan.

Watch out for other foods that may use raw eggs as an ingredient, such as some salad dressings, homemade mayonnaise, or raw cookie dough. If you’re unsure about a menu item at a restaurant, ask your server for more details on how it’s prepared.

5. Leftover Rice

The safest time to eat rice is right after you’ve finished cooking it. If cooked rice has been sitting in the refrigerator for 24 hours or more, you’ll need to thoroughly reheat it before eating. This is because uncooked rice may contain spores of a bacteria called Bacillus cereus, which can survive even after rice is cooked. When the rice is left cooked and sitting out at room temperature, the spores may grow into bacteria that can multiply. The toxins produced by these spores may lead to diarrhea and vomiting, especially in people with a compromised immune system.

To prevent the risk of food poisoning from leftover rice, cook rice in small batches or try steam-in-the-bag rice that’s individually portioned and fast to prepare.

6. Fresh Sprouts

Sprouts contain beneficial antioxidants and fiber, but unfortunately, they can also be a source of bacteria such as E. coli and salmonella. The shape and texture of sprouts can make them difficult to clean and easy for bacteria to grow and hide. Raw sprouts, like alfalfa sprouts, may not be worth the risk if you’re on biologics. Cook your sprouts thoroughly before eating to ensure safety from bacteria.

7. Well Water

Most home well water systems go through an extensive filtration system. But it’s always best to be on the safe side when taking biologics. If you’re traveling to a different country or visiting a rural area, make sure the water is safe to drink. When in doubt, choose purified, bottled water or bring water to a boil for one minute and let it cool before drinking. The same rules apply to ice, so you may choose to skip the ice if you’re not sure whether it was prepared using properly filtered water.

Additional Food Safety Tips

Following general food safety tips, such as washing your hands before cooking and storing food at the proper temperature, can help you avoid infections while taking biologics. When in doubt, seek out medical advice from your dermatologist.

Not all biologics are the same. Your individual guidelines may vary, especially if you have allergies or other risk factors. Overall, no food is completely off-limits. However, it is important to understand the risks involved with different food groups and how best to take precautions. For extra help creating an individualized healthy diet, ask your dermatology provider for a referral to a registered dietitian nutritionist.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. More than 126,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Have you ever gotten food poisoning while on biologics? What tips on food preparation do you have for others searching for their psoriasis care team? Share your experience in the comments below or start a conversation by posting on your Activities page.