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    Differences in microbiome observed in patients with psoriasis

    Understanding of the microbiome and dysbiosis may result in new psoriasis therapies


    Potential new therapies could either act in an adjunctive capacity or as a monotherapy. "I would not be surprised if new modalities, based on our understanding of the microbiome, are able to control the condition (psoriasis)," says Dr. Sapijaszko, pointing out a new therapy may end up being a daily oral supplement for patients with psoriasis.

    Dr. Sapijaszko notes other areas of medicine are using the principle of ridding or replenishing various organisms in the microbiome to treat disease. "There are already treatments for inflammatory bowel disease involving fecal transplants," he notes.

    There is evidence to suggest consumption of probiotics, found in foods like yogurt, and consumption of prebiotics, found in cruciferous vegetables, foster growth of a healthy microbiome, according to Dr. Sapijaszko.

    The challenge is that the microbiome becomes established in the first few years of life. "It is not easy to significantly alter it later in life," notes Dr. Sapijaszko. "It is an ongoing effort to change the microbiome."

    Happily, technology is emerging that allows for genetic sequencing of the organisms that make up the microbiome. "DNA analysis tells us about species in the microbiome," explains Dr. Sapijaszko. "We do not have to culture them. The DNA analysis will give us a complete picture whereas the culture will not. Much of our evidence (in the past) has been based on cultures, which are inherently unreliable."

    Tremendous strides in the management of psoriasis, such as the advent of biologic agents that target the immune systems of patients with psoriasis, have been made owing to the accumulation of greater knowledge of the disease, and that accumulation of knowledge continues. "The acquisition of knowledge does not stop," says Dr. Sapijaszko. "Emerging knowledge about the dysbiosis seen in patients with psoriasis may result in us, as dermatologists, using therapies that we cannot imagine now. This may see other treatments relegated to second-line and third-line therapies."

    The prescription of antibiotics, both topical and systemic, should be curtailed in dermatology in an effort to maintain a healthy skin microbiome, maintained Dr. Sapijaszko.

    William W. Mohn, PhD, Professor in the Department of Microbiology and Immunology at the University of British Columbia in Vancouver, British Columbia, Canada, echoed Dr. Sapijaszko's sentiments about overprescribing of antibiotics.

    "They (antibiotics) upset the microbial community that is largely in the gut," says Dr. Mohn.  "Upsetting the microbiome early in life appears to cause dysregulation of the immune system that can last a lifetime. We should aim to avoid upsetting the microbiome and let it develop naturally as much as possible."

    Pathogenic organisms are less likely to infect an individual whose microbiome is intact and who has normal flora, explains Dr. Mohn.

    Many immune-mediated diseases, including skin diseases like psoriasis, are linked to an overactive immune system, says Dr. Mohn. 


    Dr. Sapijaszko and Dr. Mohn had no relevant disclosures.

    Read more:

    New research focuses on B lymphocytes in psoriasis

    Insurers make prescribing biologics difficult

    What should dermatologists do when a merger beckons?


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