A growing body of evidence suggests that the health of your gut and its microbiome — the assortment of microorganisms like bacteria and viruses — can affect the severity of your psoriasis symptoms. An important part of gut health is balancing good and bad bacteria. As a result, some people, including MyPsoriasisTeam members, wonder if treatment for psoriasis should include probiotics, beneficial live bacteria that support the microbiome.

Psoriasis is a chronic autoimmune condition that causes inflammation and the accelerated production of skin cells. Skin builds up more quickly than it can shed, causing patches of thickened, scaly skin that can crack, bleed, and itch — as well as other symptoms.

Although research is limited, scientists have indeed found instances of probiotics — found naturally in certain foods and in supplements — helping relieve psoriasis symptoms. Understanding how these good bacteria can affect your immune system is useful when considering adding them to your diet. However, as with any new treatment, it’s important to speak to your doctor first.

Understanding the Immune System and the Microbiome

The microbiome refers to all the microbes in the human body and their genetic material. The human body harbors more than 100 trillion microbes — microscopic organisms, especially bacteria — in places like the skin, respiratory tract, and digestive tract (also referred to as the gut).

The species of bacteria found within the gut are diverse and can be “good” and “bad.” The human body must try to maintain balance between the good and bad bacteria. A healthy gut microbiome is involved in many processes, including:

• Food digestion
• The production of vitamins B and K
• The regulation of the immune system

The regulation and symbiosis (harmony) of the gut bacteria and immune system are important for inhibiting an immune response against the body’s own tissues.

When the good and bad bacteria are out of balance — a situation known as dysbiosis — problems can result. Autoimmune conditions such as type 1 diabetes, multiple sclerosis, and rheumatoid arthritis are associated with an unbalanced microbiome. Recent studies also suggest that the microbiome may play a role in the dysregulation of the immune system during psoriasis and psoriatic arthritis.

Immune Cell Development

The gut is home to immune cells including B and T lymphocytes, also known as B cells and T cells. The environment in the gut can influence the way these cells develop. Depending on the balance of bacteria in the microbiome, immune cells can develop in ways that either promote or inhibit inflammation. For instance, T cells in the gut can either develop into regulatory T cells that can help lower inflammation, or pro-inflammatory T cells that may contribute to an abnormal immune response.

The Intestinal Barrier and Leaky Gut Syndrome

The immune system is also important for maintaining your intestinal barrier. The intestinal barrier prevents food particles, microbes, and associated toxins in the intestine from absorbing into the blood. Gut dysbiosis or certain diseases can occur in an intestinal barrier that is not fully intact, a condition known as leaky gut syndrome.

When the intestinal barrier is leaky, it allows undigested food particles, microbes, and toxins to pass through the intestinal wall and into the bloodstream. Leaky gut syndrome contributes to immune system activation and persistent inflammation.

It’s thought that leaky gut syndrome occurs in many diseases, including:

• Inflammatory bowel disease (IBD)
• Systemic lupus erythematosus
• Rheumatoid arthritis
• Multiple sclerosis
• Eczema
• Psoriasis

Psoriasis and the Microbiome

Studies have shown that individuals with psoriasis often have an unbalanced gut microbiome and fewer bacterial species. People with psoriasis display low levels of helpful bacteria such as Lactobacillus and Bifidobacterium, and increased levels of harmful species including E. coli and Salmonella. The gut dysbiosis in people with psoriasis could lead to more inflammation and activation of immune cells. All of these changes could ultimately affect the level of inflammation in the body.

Although scientists do not know if leaky gut syndrome occurs regularly during psoriasis, some evidence suggests a connection. Additional studies are required to confirm the presence of leaky gut syndrome during psoriasis. However, the evidence suggests that treatment options targeting the microbiome could be beneficial for some people living with psoriasis.

Probiotics for Psoriasis

Probiotics are beneficial live bacteria that support the microbiome — in other words, good bacteria. When people talk about using probiotics to treat psoriasis or another health condition, they are generally referring to foods or supplements containing these good bacteria. Foods containing probiotics include:

• Yogurt
• Kefir
• Tempeh
• Kombucha
• Sauerkraut

Probiotic supplements are also available as pills, powders, or liquids.

Limited studies have been performed on humans using probiotic supplements as a psoriasis treatment. In a study of individuals with psoriasis who were treated with the probiotic supplement Bifidobacterium infantis, participants had decreased levels of substances that promote inflammation after treatment.

In a separate study, people with severe pustular psoriasis were treated with the probiotic supplement Lactobacillus sporogenes three times daily. Many of the study participants showed significant improvement within two weeks of treatment, and some even achieved remission after four weeks.

Some MyPsoriasisTeam members have shared how using probiotics seems to have eased their psoriasis symptoms. “The best help for me was getting on a good probiotic,” one member shared.

Another echoed positive results: “I haven't been on the probiotic for long, and my legs are almost totally clear.”

Start a Conversation With Your Doctor

The evidence is promising, but more research is needed to understand how changes in the microbiome affect psoriasis, and what impact probiotics can have on managing psoriasis flares.

Your dermatologist can help you understand if probiotic foods or supplements will benefit your psoriasis. As always, consult your doctor before adding any supplements to your diet. Some nutritional or herbal supplements can interfere with medications or cause their own side effects.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 89,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Have you added probiotics to your diet? How has it affected your psoriasis symptoms? Share your experience in the comments below, or start a conversation by posting on MyPsoriasisTeam.