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Brilliant Use Of Probiotic Medication To Treat Psoriasis

by Similoluwa Oluwalana - 035

Brilliant Use Of Probiotic Medication To Treat Psoriasis

Psoriasis, a chronic inflammatory skin disease, severely affects physical and mental health, often causing severe itching. Its prevalence is increasing, especially in developed countries, and is linked to genetics, immune disorders, infections, and environmental factors. Traditional treatments include topical corticosteroids and biologics, but recent research highlights the gut-skin axis, suggesting probiotics may offer therapeutic benefits. This review evaluates the efficacy of probiotic supplementation in treating psoriasis, potentially offering a new approach to managing this condition through immune system modulation.

 

THE STUDY BACKGROUND

Psoriasis is a chronic inflammatory skin disease that significantly impacts patients’ physical and mental well-being. The condition often leads to severe itching and is associated with genetics, immune disorders, infections, environmental influences, and endocrine factors. Studies have shown that the global prevalence of psoriasis ranges from 0% to 8.5%, with an increasing trend in developed countries [1-4]. The pathogenesis of psoriasis is thought to involve the hyperactivation of certain functions of the adaptive immune system [5].

Traditional therapeutic options for managing psoriasis primarily include topical treatments such as corticosteroids, vitamin D analogs, calcineurin inhibitors, and keratolytics [6-8]. For moderate-to-severe cases, immune-modulatory agents and biologics are often used as first-line treatments [9-11]. These treatments focus on reducing skin inflammation and modulating the immune response. Despite their effectiveness, there is a continuous search for new therapeutic strategies that can offer improved outcomes and fewer side effects.

Recent studies have proposed the “gut-skin axis” theory, highlighting a significant link between gut health and skin homeostasis [12]. Both skin and intestinal cells originate from the same embryonic layer and share similar signaling mechanisms. The gut microbiome maintains skin immune homeostasis by mediating innate and adaptive immunity [12]. Research indicates oral probiotics can modulate gut flora, potentially reversing pro-inflammatory and anti-inflammatory imbalances and reducing skin inflammation in psoriasis [13].

Moreover, probiotics have been shown to modulate immune responses by regulating the intestinal flora, thus effectively reducing skin inflammation in psoriasis [14]. The proposed mechanism involves increasing the enrichment of Foxp3+ regulatory T cells in the skin and reducing apoptosis-mediated skin inflammation, thereby restoring homeostasis through immunomodulation [14]. This systematic review and meta-analysis aim to evaluate the efficacy of probiotic supplementation in treating psoriasis, potentially offering a novel immunomodulatory approach to managing this chronic condition.

 

THE STUDY METHOD

The study’s meta-analysis followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and was registered with PROSPERO. The search strategy involved querying several databases, including Cochrane Library, Embase, Web of Science, and PubMed, up to November 10, 2023. A combination of medical subject headings (MeSH), titles, and abstracts using specific keywords related to probiotics and psoriasis was employed to identify relevant studies.

Inclusion criteria were randomized controlled trials (R.C.T.s) published in English involving patients diagnosed with psoriasis, with the test groups treated with probiotics and the control groups treated with a placebo. The primary outcomes assessed were the Psoriasis Area and Severity Index (PASI) and the Dermatology Life Quality Index (DLQI). These outcomes are critical measures for evaluating psoriasis severity. Studies were excluded if they were non-RCTs, involved pregnant or lactating women, were irrelevant to the experimental and control groups, were duplicate publications, or were animal trials or studies with unavailable data.

Literature screening and data extraction were performed by two independent authors who first reviewed the titles and abstracts against the eligibility criteria, excluding irrelevant studies. The researchers also examined the full texts of the remaining studies to confirm inclusion. A third author resolved any disagreements. Data extracted included study characteristics, interventions, comparisons, and outcomes.

The methodological quality of each included trial was assessed using the Cochrane collaboration tool, which evaluates studies based on seven items to determine the risk of bias as low, high, or unclear. Disagreements in this assessment were resolved through discussion with another author.

 

ANALYSIS

For the statistical analysis, Review Manager (RevMan) version 5.3 was utilized to conduct meta-analyses. Continuous data with identical measurement units were analyzed using the weighted average difference and 95% confidence intervals. The standardized average difference and 95% confidence intervals were employed

 for continuous data with different measurement units. 

A random-effects model was used to assess heterogeneity if the I² statistic was greater than 50% or the p-value was less than 0.05, indicating significant heterogeneity. Otherwise, a fixed-effect model was applied. When ten or more studies were included for the same outcome, a funnel plot was used to evaluate potential publication bias. Statistical significance was determined with a two-tailed p-value of less than 0.05.

 

RESULTS

  1. Study Selection Process:
  • Initial retrieval of 454 studies from four literature databases.
  • After removing duplicates, 78 studies remained.
  • Screening of abstracts and titles led to the removal of 38 studies.
  • Further exclusion based on full-text reading left 35 studies out.
  • Ultimately, five studies were included in the analysis.
  1. Characteristics of Included Studies:
  • The included studies varied in sample size, age of participants, interventions, and duration.
  • Interventions ranged from standard-of-care plus probiotics to specific probiotic formulations.
  • The duration of interventions varied from 2 to 6 months.
  1. Types of Probiotics Used:
  • The types of probiotics used in the included studies included Lactobacillus rhamnosus, Lactobacillus acidophilus, Bifidobacterium, and Streptococcus thermophilus.
  • Different formulations and combinations of probiotics were utilized across the studies.
  1. Outcome Measures:
  • All studies reported outcomes based on the Psoriasis Area and Severity Index (PASI) and the Dermatology Life Quality Index (DLQI).
  • Meta-analysis of PASI scores showed a significant reduction in the probiotic supplement group (SMD = -1.40, 95% CI = -2.63 to -0.17, p < 0.00001).
  • Meta-analysis of DLQI scores also indicated a decrease in the probiotic supplement group (SMD = -0.92, 95% CI = -1.86 to 0.01, p < 0.00001).
  1. Assessment of Bias:
  • Cochrane’s risk of bias assessment revealed unclear risks regarding adverse events reporting and selective reporting.
  • Other biases were rated as low across all studies.
  1. Publication Bias:
  • Publication bias detection was not performed due to the limited number of studies for each outcome (n < 10).

 

DISCUSSION

This study conducted a comprehensive review and analysis of randomized controlled trials to evaluate probiotic supplementation’s efficacy in treating psoriasis. The meta-analysis revealed a significant decrease in both Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) scores following probiotic supplementation [1]. Psoriasis, a common immune-mediated chronic inflammatory skin disease, has multifactorial triggers, including genetic predisposition, immunological dysfunction, infections, and metabolic disorders [23]. While the precise association between probiotic deficiency and psoriasis remains uncertain, emerging evidence suggests potential roles of probiotics in modulating the gut microbiota and inflammatory pathways associated with dermatological conditions.

Several studies have highlighted the correlation between gut microbiota dysbiosis and inflammatory dermatoses, suggesting a pivotal role of the gut-skin axis in conditions like psoriasis [24]. Microbiome dysbiosis may lead to increased epithelial permeability of the intestinal mucosa, activation of effector T cells, and subsequent chronic systemic inflammation [24]. Animal experiments have further demonstrated that oral supplementation of probiotics can modify psoriasis-like pathological phenotypes and inhibit the release of inflammatory cytokines associated with the IL-23/Th17 cell axis [26].

Clinical research corroborates these findings, showing that probiotic supplementation can alleviate symptoms and decrease skin inflammatory markers such as TNF-α, IL-6, and IL-17 in psoriasis patients [27]. Mechanistically, probiotic supplementation may increase levels of acetate and propionate in the gut, which have been linked to the suppression of cytokine activity [30]. Moreover, psoriasis is often associated with metabolic syndrome and cardiovascular disease risk [31], and probiotic supplements have shown promise in reducing cholesterol, triglyceride levels, and uric acid, providing additional benefits beyond symptom relief [32].

The relationship between gut flora and skin health is increasingly recognized, with dysregulation of microbiota observed in various inflammatory skin conditions, including psoriasis, acne, seborrheic dermatitis, and atopic dermatitis [33]. Probiotic supplements have emerged as a potential adjunctive treatment for these conditions, with studies demonstrating their efficacy in improving symptoms and stabilizing disease progression [35]. While multi-strain mixtures of probiotics have been widely used, the analysis suggests that single-strain probiotics may be equally effective in treating psoriasis [40]. Although biologics remain the primary treatment for psoriasis, probiotics offer a complementary therapeutic approach that may help maintain disease stability in long-term maintenance therapy. Further clinical studies are warranted to validate these findings and explore the full potential of probiotic supplementation in psoriasis management.

 

STUDY LIMITATIONS

  • Small Number of Included Studies and Sample Size:
  • The study acknowledges the relatively small number of included studies and participants. This limitation suggests the need for validation through numerous multicenter, large-sample clinical studies to bolster the robustness of the findings.

 

  • Reliance on Clinical Scores for Efficacy Assessment:
  • Another limitation highlighted is the reliance solely on clinical scores to assess efficacy. The study underscores the necessity for additional laboratory indicators to demonstrate effectiveness more comprehensively.

 

CONCLUSION

The research systematically and comprehensively reviewed relevant studies, affirming the beneficial role of probiotics in psoriasis treatment. The meta-analysis summarized evidence demonstrating that probiotic supplementation significantly reduces psoriasis severity and improves associated symptoms and clinical signs compared to a placebo group. However, despite these positive outcomes, the specific mechanisms underlying the effectiveness of probiotics in psoriasis treatment remain unclear. The study emphasizes the need for further high-quality, large-sample, and long-term trials to elucidate these mechanisms and provide more reliable and accurate efficacy evidence in the future.

 

References

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