What is psoriasis?
Psoriasis is a long-lasting skin condition, where your body's defense system goes into overdrive, making your skin cells grow and divide rampantly (NIAMS). This condition leads to patches of the skin becoming rough and red, mostly found on your scalp, elbows, or knees, but it can show up anywhere on your body (NIAMS). The exact cause of the condition remains a mystery, it is thought to be a glitch in the immune system, where cells meant to fight off infections wrongly target healthy skin cells (MFMER, 2024). Scientists suspect that both genetics and environmental factors contribute to this issue (MFMER, 2024). It's important to note that psoriasis is not contagious (MFMER, 2024).
Role of the gut microbiome on the pathogenesis of psoriasis
Many studies have linked the health of the digestive system to the balance of the skin, noting disruptions in both the makeup and operation of the gut microbiome in psoriatic patients (Buhas, et al., 2022). This connection between gut bacteria and immune system control offers a new perspective on understanding how various complex diseases, like psoriasis, develop over time (Buhas, et al., 2022).
Intestinal microbiota dysbiosis or the balance of gut bacteria in psoriasis patients varies depending on the severity and stage of the disease. Different studies yield contrasting findings regarding the types of bacteria present in the intestines of individuals with psoriasis. For instance, levels of Prevotella spp. were reported to be both higher (Hidalgo-Cantabrana, et al., 2019) and lower (Shapiro, et al., 2019) in psoriasis patients compared to healthy individuals, indicating gut dysbiosis in either case. A study examining microbiota and inflammation-related factors suggested that gut dysbiosis might trigger an abnormal immune response in psoriasis (Buhas, et al., 2022). Changes in the microbiome were linked to levels of inflammation-related markers that were irregular in psoriasis patients, notably the IL-2 receptor, which showed a positive correlation with Phascolarctobacterium and a negative correlation with Dialister (Buhas, et al., 2022).
Gut-microbiome targeted therapies for psoriasis
Recent findings propose that adjusting the balance of gut bacteria, either by dietary changes or by taking probiotics and prebiotics, could be a promising new approach for treating autoimmune conditions such as psoriasis (Buhas, et al., 2022). Adding probiotics to the treatment regimen could offer a fresh approach to addressing imbalances in gut bacteria in psoriasis patients (Buhas, et al., 2023). Research suggests that supplementing with probiotics has been linked to notable improvements in psoriasis-related symptoms and a decrease in inflammation, as observed in both lab experiments and studies involving patients (Buhas, et al., 2023).
The Mediterranean diet promotes a rich intake of plant-based foods like fruits, vegetables, nuts, legumes, grains, and olive oil, while limiting the consumption of red meat, dairy, and processed foods (Buhas, et al., 2022). Recent research indicates that following the Mediterranean diet may influence inflammatory markers in autoimmune conditions and could potentially alleviate the severity of certain skin conditions (Buhas, et al., 2022). The anti-inflammatory benefits of the Mediterranean diet may be attributed to its high content of omega-3 fatty acids, which have been associated with positive effects in psoriasis patients (Guida, et al., 2014). Additionally, the Mediterranean diet may enhance the diversity of gut bacteria, including those with anti-inflammatory properties (Illescas, et al., 2021).
Recent studies indicate a correlation between psoriasis and celiac disease, with individuals with psoriasis having a higher risk of developing this autoimmune condition. Therefore, it's important for psoriasis patients to undergo screening for celiac disease to facilitate more accurate and effective nutritional therapy, particularly for addressing gastrointestinal and inflammatory symptoms. The National Psoriasis Foundation conducted a systematic review focused on dietary recommendations for adults with psoriasis or psoriatic arthritis (Buhas, et al., 2022). Their findings suggest that a gluten-free diet is only recommended for psoriasis patients who have been diagnosed with celiac disease (Buhas, et al., 2022). They propose a 3-month trial of a gluten-free diet for psoriasis patients with gluten sensitivity alongside regular treatment (Buhas, et al., 2022). However, for patients without symptoms of gluten sensitivity, a gluten-free diet is not recommended due to limited data on its effectiveness in this population (Buhas, et al., 2022).
Conclusion
In conclusion, psoriasis is a complex, chronic skin condition influenced by both genetic predisposition and environmental factors. Recent research highlights the significant role of the gut microbiome in the pathogenesis of psoriasis, with dysbiosis potentially triggering an abnormal immune response. This understanding opens new avenues for treatment, with gut-microbiome targeted therapies showing promise in alleviating symptoms and reducing inflammation. Strategies such as dietary modifications, including the adoption of the Mediterranean diet, and the consideration of gluten sensitivity, offer additional options for managing psoriasis alongside traditional treatments. By integrating these insights into clinical practice, healthcare professionals can offer more personalized and effective care for individuals living with psoriasis, ultimately improving their quality of life and long-term outcomes. Continued research in this field holds the potential to further refine our understanding and treatment of this challenging condition.
References
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Psoriasis: Overview of Psoriasis. National Institute of Health. https://www.niams.nih.gov/health-topics/psoriasis#:~:text=Psoriasis%20is%20a%20chronic%20(long,can%20be%20affected%20as%20well.
Mayo Foundation for Medical Education and Research (MFMER). (07 Feb 2024). What is Psoriasis: Causes. Autoimmune Association. https://autoimmune.org/disease-information/psoriasis/
Buhas, M. C., Gavrilas, L. I., Candrea, R., Mocan, A, Miere, D., and Tataru, A. (20 Jul 2022). Gut Microbiota in Psoriasis. Nutrients. doi: 10.3390/nu14142970.
Buhas, M.C., Candrea, R., Gavrilas, L. I., Miere, D., Tataru, A., Boca, A, and Catinean, A. (07 Jul,2023). Transforming Psoriasis Care: Probiotics and Prebiotics as Novel Therapeutic Approaches. Int J Mol Sci. 24(13): 11225. doi: 10.3390/ijms241311225
Hidalgo-Cantabrana, C., Gomez, J., Delgado, S., Requena-Lopez, S., Queiro-Silvo, R., Margolles, A., Coto, E., Sanchez, B., and Coto-Segura, P. (18 Jul 2019). Gut microbiota dysbiosis is a cohort of patients with psoriasis. Br J Dermatol. 181(6): 1287-1295. doi: 10.1111/bjd.17931.
Shapiro, J., Cohen, N. A., Shalev, V., Uzan, A., Koren, O., and Maharshak, N. (29 May 2019). Psoriatic patients have a distinct structural and functional fecal microbiota compared with controls. J Dermatol. 46(7): 595-603. doi: 10.1111/1346-8138.14933.
Guida, B., Napoleone, A., Trio, R., Nastasi, A., Balato, N., Laccetti, R., and Cataldi, M. (Jul 2014) . Energy-restricted, n-polyunsaturated fatty acids-rich diet improves the clinical response to immuno-modulating drugs in obese patients with plaque-type psoriasis: a randomized control clinical trial. Clin Nutr. 33(3): 399-405. doi: 10.1016/j.clnu.2013.09.010.
Illescas, O., Rodriguez-Sosa, M., and Gariboldi, M. (29 June 2021). Mediterranean diet to prevent the development of colon diseases: A meta-analysis of gut microbiota studies. Nutrients. 13(7): 2234. doi: 10.3390/nu13072234 Assessed and Endorsed by the MedReport Medical Review Board