Bacteria's Role in Psoriasis

Psoriasis is a chronic inflammatory skin disease that affects approximately 2% of the world’s population.

Bacteria play a major role in the pathology of psoriasis. In fact, researchers have been studying gut bacteria’s role in psoriasis for decades.  This is known as the Gut-Skin Axis. The skin itself is covered in over 1 trillion commensal bacteria, representing hundreds of different species. When these diverse ecosystems are out of balance, disease states are promoted.  Recent discoveries show that psoriasis patients share similar bacteria profiles in their guts and on their skin.  

What is the Gut-Skin Axis? 

The gut-skin axis is a bidirectional communication system between the gut microbiome and skin.

(2021) Gut–Skin Axis: Current Knowledge of the Interrelationship between Microbial Dysbiosis and Skin Conditions

Summary:

• The gut microbiome is the largest endocrine organ, producing at least 30 hormone-like compounds, e.g., short chain fatty acids (SCFAs); secondary bile acids; cortisol; and neurotransmitters such as gamma-aminobutyric acid (GABA), serotonin, dopamin, and tryptophan.
• The gut microbiome plays a crucial role in maintaining skin health and preventing skin diseases.
• Dysbiosis of the gut microbiome has been implicated in several skin diseases, including acne vulgaris, rosacea, atopic dermatitis, psoriasis, and skin cancer.
• The gut microbiome can influence skin health through several mechanisms, including immune regulation, microbial metabolites, and microbial competition.

What is the The Gut Microbiome? 

Your gut microbiome, meaning “little life” is the ecosystem of trillions of microbes and their genes that dwarf your own human cells and DNA. It contains bacteria, viruses, fungi, and protists, which perform services like helping us digest food and protecting us against infections. Your gut microbiome has a direct interface with your immune system.  Up to 80% of your immune system resides in your gut. 

(2018) The Gut Microbiome as a Major Regulator of the Gut-Skin Axis

Summary:

The adult intestine hosts a vast universe of diverse bacterial species that reside mostly in the lower gut maintaining a symbiosis with the human habitat.

• The gut microbiome plays an important role in regulating skin health and disease.
• The gut-skin axis is a bidirectional communication system between the gut microbiome and skin.
• The gut microbiome can influence skin health through several mechanisms, including immune regulation, microbial metabolites, and microbial competition.

Over the past few years there has been a dramatic increase in the number of studies examining the role of the microbiome in autoimmune diseases in general and in psoriasis in particular. It is well known that the microbiome plays a role in human health and disease pathogenesis.

Psoriasis is a chronic, immune-mediated inflammatory disease that affects around 125 million people worldwide.

Research evidence from the recent decade suggests that psoriasis, a chronic inflammatory immune-mediated disorder affecting 3% of individuals, or approximately 7.5 million people from the United States, is not an isolated pathology of the skin, but a systemic condition involving multiple organs and systems, with bacteria playing a central role. 

Is Psoriasis a Bowel Disease?

Dr Haines Ely, a board certified dermatologist from UC Davis who studied the cause of psoriasis for 45 years thought the cause of psoriasis was in the gut.

In 2018, his journal article “Is psoriasis a bowel disease? Successful treatment with bile acids and bioflavonoids suggests it is.” blew the minds of researchers and clinicians worldwide.

Dr Ely explained that psoriasis is “the dysregulation of the gut-liver-skin axis and is caused by the absorption of bacterial byproducts through dysbiosis and a leaky gut, resulting in the skin shedding the toxins the psoriatic liver cannot handle.”

Here are some of his observations from a lifetime of study:

• All current treatments for psoriasis involve disrupting the immune system response near the inflamed skin but not addressing what is being brought to* the skin (so in his words, “like addressing the smoke and not the fire”)
• All psoriatics have high levels of serum IGA and thus indicates all have leaky gut
• Psoriasis livers are similar to alcoholic livers show a liver/bile deficiency
• Psoriasis does not itch. If it does, suspect and test for Blastocystis Hominis (a protozoa) and Helicobacter pylori (a bacteria)
• Psoriasis patients share a dysbiotic gut microbiome. (Your gut microbiome, meaning “little life” has trillions of microbes with genes dwarfing your own human cells and dna.*

Here is a quick summary of his solution:

1. Test for specific bacteria Helicobacter pylori and Streptococcus pyogenes (He says this step *must* be addressed in order for any treatment to work)
2. Break up endotoxins and keep them from getting absorbed
3. Protect your liver and gut wall
4. Avoid anything that promotes leaky gut - especially peppers, emulsifiers, gluten and alcohol.
5. Eat fruits and vegetables to promote a diverse and healthy gut microbiome and avoid fatty foods because your liver cannot break down.

Dr Haines Ely : "Pathogens, including Helicobacter pylori and Streptococcus pyogenes, must be eliminated with antimicrobial therapy for any treatment to work"

Other researchers are also studying the gut’s role in the etiology of psoriasis.

In this journal article, researchers studied the gut microbial composition in patients with psoriasis. They think they have discovered a core psoriatic microbiome. Or, a shared gut microbiome profile in psoriasis.
“The study of the gut microbiome and enterotype shows from the first time a specific ‘psoriatic core intestinal microbiome’ that clearly differs from the one present in the healthy population.”

This is the first time attempting to reveal the gut microbiome composition of psoriatic patients with a prospective study including a group of patients with plaque psoriasis, analyzing their gut microbiome and the relationship between the microbiome composition and bacterial translocation.

Here is some of the latest research about psoriasis, bacteria, and the microbiome “the gut skin connection”: Most recently, due to major advances in the next-generation of sequencing bacterial DNA, scientists have been able to see the composition of our microbiome with precise acuity.

(2022) Gut Microbiota in Psoriasis

Current evidence suggests that modulation of the gut microbiota, both through dietary approaches and through supplementation with probiotics and prebiotics, could represent a novel therapeutic approach. 

• The gut microbiome plays an important role in regulating immune function and inflammation, and has been shown to be altered in psoriatic patients.
• Alterations in the gut microbiome may contribute to the development and progression of psoriasis.
• Modulating the gut microbiome through diet, probiotics, and fecal microbiota transplantation may be a promising therapeutic approach for psoriasis.

(2022) Assessing microbial manipulation and environmental pollutants in the pathogenesis of psoriasis

• “The cutaneous microbiome is increasingly recognized as a contributor to skin diseases like atopic dermatitis (AD) and psoriasis.”

(2021) Psoriasis and Gut Microbiome-Current State of Art

• Psoriasis is a chronic, immune-mediated inflammatory disease that affects around 125 million people worldwide.
• Several studies concerning the gut microbiota composition and its role in disease pathogenesis recently demonstrated significant alterations among psoriatic patients.
• Certain parameters such as Firmicutes/Bacteroidetes ratio or Psoriasis Microbiome Index were developed in order to assess gut microbiota composition in psoriasis.
• Modulating the gut microbiota through diet, probiotics, and fecal microbiota transplantation may be a promising therapeutic approach for psoriasis.

(2020) Skin and Gut Microbiome in Psoriasis: Gaining Insight Into the Pathophysiology of It and Finding Novel Therapeutic Strategies

Psoriasis is a chronic inflammatory skin disease that affects millions of people worldwide.

• Alterations in the skin and intestinal microbiome play an important role in the pathogenesis of psoriasis.
• Restoration of the microbiome is a promising preventive and therapeutic strategy for psoriasis.
• This review discusses recent insights into skin and gut microbial communities, including their interaction with host metabolism and the immune system, their composition and functional association with human health and psoriasis, and diagnostic or therapeutic approaches targeting these communities.

(2020) Gut Microbiome in Psoriasis: An Updated Review

A growing body of evidence highlights that intestinal dysbiosis is associated with the development of psoriasis.

• Psoriasis is a common and chronic dermatological disease considered as a systemic inflammatory disorder.
• Subclinical gut inflammation and intestinal barrier dysfunction reported in patients with psoriasis gave rise to the concept of the gut-skin axis.
• A growing body of evidence indicates that gut microbiota have a critical role in the regulation of metabolism, the immune system, and intestinal permeability.
• The distortion in the biodiversity and composition of the gut microbiota, known as gut dysbiosis, has been linked to metabolic syndrome, inflammatory arthritis, depression, cardiovascular disease, inflammatory bowel diseases, which all are psoriasis comorbidities.
• Preclinical investigations provide evidence for the role of the gut microbiome in psoriasis pathogenesis.
• These results are supported by clinical observations based on a case series showing improvement in psoriatic skin lesions after antibiotic treatment, modulation of gut microbiota by probiotics or fecal microbial transplantation.

Metagenomic analysis of gut microbiota in non-treated plaque psoriasis patients stratified by disease severity: development of a new Psoriasis-Microbiome Index

• We demonstrated gut dysbiosis in psoriasis patients, suggesting a role in psoriasis pathophysiology.
  
  
• This concordance suggests that there is probably a core gut microbiota in psoriasis patients.

(2019) The gut microbiome in psoriasis and psoriatic arthritis

• The gut microbiome is important in maintaining health and homeostasis.
• The gut microbiome is capable of causing inflammation both locally and systemically.
• Evidence shows that the gut microbiome is involved in many chronic immune-mediated and inflammatory diseases, such as psoriasis and psoriatic arthritis.
• Current research suggests the presence of a unique microbiome characteristic of psoriatic disease
• Studies suggests that probiotics hold promise as adjuvant treatment for a portion of patients.

(2019) Changing our microbiome: probiotics in dermatology

In this study, researchers evaluate whether the clinical data support the use of oral and topical probiotics for certain dermatological diseases.

• In general, the available clinical trials yielded positive results with improvement of the skin conditions after probiotic intervention.

• Oral and topical probiotics appear to be effective for the treatment of certain inflammatory skin diseases and demonstrate a promising role in wound healing and skin cancer.

(2019) The role of gut microbiome in the pathogenesis of psoriasis and the therapeutic effects of probiotics

• Intestinal dysbiosis is a state of imbalanced gut microbiome that eventually has a negative impact on skin function and integrity.
• Probiotic supplementation, the oral administration of living beneficial gut bacteria, has a potential role in the management and prevention of various skin conditions
• Most clinical and mechanistic evidence indicate that psoriasis is primarily driven by the IL-23/IL-17/Th17 axis
• Probiotics have the potential to treat psoriasis, and other skin diseases, through its effect on gut microbiome communities with low risks of adverse effects.

Do Psoriasis Patients Share The Same Gut Microbiome Profile?

Researchers have discovered a different, but shared digestive system in psoriasis patients.

(2018) Gut microbial composition in patients with psoriasis

• Dysbiosis of the gut microbiome in psoriasis allows for bacterial translocation to extraintestinal sites, where they are able to influence immune responsivity and trigger psoriatic plaque formation 
• The study of the gut microbiome and enterotype shows from the first time a specific ‘psoriatic core intestinal microbiome’ that clearly differs from the one present in the healthy population.
• Gut bacteria translocation into the bloodstream via a leaky gut causes an overactive immune response. 
  

Is Strep Throat Associated with Psoriasis?  

(2016) Throat Infections are Associated with Exacerbation in a Substantial Proportion of Patients with Chronic Plaque Psoriasis

Streptococcal throat infections are known to trigger or exacerbate psoriasis, and this study evaluates the potential of tonsillectomy as a treatment. 

All 275 recruited participants, 127 males and 148 females, completed the study questionnaire. The majority of the responders (75%) had been diagnosed with plaque psoriasis, 14% with both guttate and plaque psoriasis and 8% percent with guttate psoriasis. Of those participants: 

• 75% with strep throat experienced worsening of their psoriasis⁠
• 94% percent of patients with guttate psoriasis experienced worsening of their psoriasis⁠
• 72% of patients with plaque psoriasis experienced worsening of their condition

Does Streptococcal Pyogenes Colonize The Gut? 

(2009) Streptococcus Adherence and Colonization

Streptococci readily colonize mucosal tissues in the nasopharynx; the respiratory, gastrointestinal, and genitourinary tracts; and the skin.

Even after decades of research, we are just beginning to understand bacteria's role in psoriasis.  We're excited to learn more and follow the latest research.

 

 

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