Support for the treatment of psoriasis through probiotic therapy.
In recent years, our understanding of how the microorganisms in the gut affect the condition of our skin has expanded significantly. One condition that has attracted particular interest in the context of research into the gut-skin axis is psoriasis.
What is psoriasis?
Psoriasis is a chronic inflammatory skin condition of autoimmune origin; according to statistical data, approximately 700,000 people in Poland suffer from it. It is characterised by uncontrolled proliferation and dysfunctional differentiation of keratinocytes, which manifests clinically as the presence of characteristic scales (plaques). Histologically, psoriatic plaques show epidermal hyperplasia covering inflammatory infiltrates of skin dendritic cells, macrophages, T lymphocytes and neutrophils. Tumour necrosis factor α (TNF-α), interferon γ (IFN-γ), interleukin (IL)-23/IL-17A and IL-22 are the main immune molecules responsible for keratinocyte proliferation, inflammation and increased cytokine levels in psoriasis.
The role of gut dysbiosis in autoimmune diseases
There is growing evidence that gut dysbiosis plays a key role in autoimmune diseases, including psoriasis, as it leads to an increase in the levels of these pro-inflammatory molecules circulating in the blood and an exaggerated immune response.
A clinical trial investigating the effect of probiotic and prebiotic therapy as an adjunct to the treatment of psoriasis
In today’s post, we will take a closer look at an interesting and promising clinical trial, the results of which were published in July 2023 in the *International Journal of Molecular Sciences* in an article entitled “Probiotics and Prebiotics as Novel Therapeutic Approaches in the Treatment of Psoriasis” (original title: “Transforming Psoriasis Care: Probiotics and Prebiotics as Novel Therapeutic Approaches”)
The study demonstrated that supplementation with probiotics containing spores of the genus Bacillus (Bacillus indicus HU36, Bacillus subtilis HU58, Bacillus coagulans SC208, Bacillus licheniformis SL307, and Bacillus clausii SC109) and prebiotics (fructo-, xylo- and galacto-oligosaccharides) may bring significant benefits to patients with psoriasis receiving concurrent topical therapy and may represent a new therapeutic strategy. Improvement in the gut microbiome profile leads to significant alleviation of psoriasis symptoms and an improved quality of life.
In the study cited, combined supplementation (prebiotics + probiotics) led to beneficial changes in metabolism, the immune system and the gut microbiota:
- increasing the diversity of the gut microbiome,
- an increase in the number of bacterial species considered beneficial (including an increase in Faecalibacterium prausnitzii and Lactobacillus spp),
- an increase in short-chain fatty acids,
- improved intestinal barrier integrity,
- a reduction in the levels of pro-inflammatory cytokines (TNF-α, IL-6, IFN-γ) and bacterial endotoxin (LPS), and consequently a reduction in inflammation,
- an increase in the level of the cytokine IL-10 (a suppressor of the cellular immune response),
- a significant improvement in patients’ quality of life (a reduction in the DLQI – Dermatology Life Quality Index),
- a significant reduction in skin symptoms (a decrease in the PASI score – Psoriasis Area and Severity Index, a measure of the extent and severity of skin lesions in psoriasis),
- improvement in lipid profile (reduction in triglyceride levels, improvement in the LDL:HDL ratio),
- reduction in uric acid levels (patients with psoriasis, particularly those with severe forms of the condition, are at greater risk of hyperuricaemia).
Summary
In summary, supplementation with probiotics and prebiotics improved the overall health of patients with psoriasis who were receiving topical anti-psoriatic treatment. Firstly, supplementation with probiotics and prebiotics significantly improved quality of life, as evidenced by a reduction in PASI and DLQI scores. Secondly, the BMI and FFM of patients in the intervention group were significantly reduced. Thirdly, supplementation with prebiotics and probiotics promoted an anti-inflammatory response and contributed to symptom improvement in the intervention group by regulating cytokine activity. Furthermore, at the end of the study, the intervention group had significantly better metabolic markers compared to the control group, including lower levels of total cholesterol, LDL-C, triglycerides and uric acid; HDL-C levels increased. Finally, supplementation increased gut microbiota diversity (as indicated by a higher Shannon index), increased the Firmicutes/Bacteroidetes ratio and acetate/propionate production, and reduced the Prevotella/Bacteroidetes ratio and the number of LPS-positive bacteria. Furthermore, there was a reduction in the number of Bacteroidetes spp., Prevotella spp., Prevotella copri and Clostridium difficile, whilst levels of Akkermansia muciniphila, Verrucomicrobia and Ruminococcus spp. increased.
However, further clinical trials are needed to fully elucidate the potential benefits of probiotics and prebiotics in psoriasis and to identify the most effective combination and dosage.