Gut-Skin Axis: Psoriasis
In our last blog, we wrote about the gut-skin axis. We looked at how important the gut microbiome is for skin health. Today we look at psoriasis, a particular skin condition that is related to the gut-skin axis and gut health. But how exactly is psoriasis related to the gut? This blog will answer that question so read on for more info!
In this blog, you will learn:
- What is psoriasis?
- Is psoriasis connected to the gut-skin axis?
- What is the mechanism and link between psoriasis and the gut?
What is Psoriasis?
Psoriasis is an autoimmune condition that affects the skin. It is a chronic and systemic inflammatory skin disease. It is characterized by red, scaly patches that can cause itching, discomfort and sometimes pain. These patches are typically on the elbows, knees, scalp, and lower back, but can be on any part of the body. It may also involve swelling, stiffness, and joint pain. Psoriasis can negatively affect quality of life.
In psoriasis, the immune system overreacts. It produces increased levels of pro-inflammatory cytokines. Immune cells attack self-skin cells, which causes the skin symptoms.
Like other autoimmune conditions, the cause of psoriasis is complex. It involves genetic factors, immune system overactivation and dysfunction, gut health issues, in particular leaky gut, and environmental triggers like stress, food intolerances or infections. As an autoimmune condition, it is very much tied to gut health. We have written a series of blogs about autoimmunity, gut health and leaky gut here.
What is the Mechanism of Action for Psoriasis?
Gut and immune health are closely related to psoriasis. Gut bacteria/ microbe composition, abundance and diversity, gut microbiome disorders, lower production of short chain fatty acids (SCFAs), imbalances in bacteria levels and a leaky gut are all typically part of psoriasis.
Gut health and Dysbiosis: Often gut dysbiosis (an imbalance between the good and bad gut bacteria) is present which contributes to gut permeability or leaky gut. Gut permeability and an unhealthy gut microbiome contribute to inflammation and the development of psoriasis.
Immune system dysfunction: Because gut health is dysfunctional, the immune system in psoriasis is dysfunctional. As with other autoimmune disorders, the immune system gets overactivated, makes a mistake and attacks healthy cells. In the case of psoriasis, it is the skin cells that are mistakenly attacked.
Genetic predispositions are often involved in autoimmunity. In psoriasis, this is often an issue with gluten tolerance that causes immune overactivation /hypervigilance and impaired detoxification pathways.
There can be other factors. It is usually not only one single genetic factor that causes autoimmune activity.
Putting it all together: Autoimmunity, Gut Dysbiosis, Leaky Gut & Psoriasis
- Psoriasis is an autoimmune condition.
- Autoimmunity happens when the gut lining is leaky or permeable. In addition, there is a genetic predisposition + an environmental trigger. Read more on autoimmunity here.
- Leaky gut, or a damaged intestinal barrier, is typical in psoriasis cases. Causes of dysregulated gut microbiome may be due to gut dysbiosis, insufficient good bacteria, H pylori or other infections. With leaky gut, the tight junctions in the gut lining loosen, creating tiny ‘holes’. This provides enough space for molecules that belong in the gut to escape into the bloodstream and into circulation.
- As a result, there are high levels of proinflammatory cytokines. Inflammatory cytokines are produced with leaky gut because bacteria can move or translocate from the gut into the bloodstream and activate the immune response.
- The immune system detects these molecules as foreign invaders and attacks. This attack happens over and over again because the gut remains leaky.
- The immune system shifts into overdrive, chronically overreacting (unless the gut lining is healed) and an overactivated immune response sets in and attacks self tissue. This is autoimmunity.
- Which tissue is attacked determines the specific autoimmune condition. In psoriasis the skin is attacked. In MS the myelin sheath is attacked. In Hashimoto’s, the thyroid is attacked. And so on.
- Leaky gut results from gut dysbiosis, chronic stress, gluten, dairy & other food sensitivities, alcohol, gut infections like H pylori, and so many other causes. It can be repaired. See our blog here on causes & treatment of leaky gut.
Inflammatory gut issues are often associated with skin problems. Inflammatory bowel disease (IBD) is often seen with psoriasis: 7–11% of patients with IBD also have psoriasis (De Pessemier B, 2021). IBD involves pro-inflammatory immune cells and a low level of the beneficial microbes in the gut microbiome.
Gut Microbes
In psoriasis, people have reduced numbers of the gut microbes Bacteroidetes, Proteobacteria, Actinobacteria, Akkermansia muciniphila, Firmicutes, Akkermansia and Ruminoccocus (Mahmud MR, 2022).
Bacteroides promotes the anti-inflammatory response. Lower Bacteroides levels can alter how the immune system and the pro-inflammatory response behave.
Akkermansia muciniphila and Ruminoccocus prevent pathogens from settling in and competitively inhabiting the microbiome.
Lower levels of these good gut microbes are part of the picture of a leaky gut and the movement of bacteria from the gut into the bloodstream circulation in psoriasis patients (Mahmud MR, 2022).
Leaky gut caused by gut dysbiosis allows for bacteria, toxins and metabolites to leak into blood circulation and eventually reach the skin, via the gut-skin axis. The skin microbiome is affected by these toxins, SCFAs, neurotransmitters and hormones produced by gut microbiota (Xue M, 2025).
To Read About Blog Topic, Scroll Down
Want To Work With Our Clinic?
Do you have a chronic or mystery illness that no one has been able to help you with? Are you simply wanting to re-connect with a healthier version of yourself? It’s Time To Finally Feel Better!
Gut infections can also affect the skin microbiome via the gut-skin axis. For example, the Helicobacter pylori bacterial gut infection can increase the incidence of psoriasis (Xue M, 2025).
The Pathogenesis of Psoriasis
The pathogenesis of psoriasis is still not fully understood. But we do know that the pathogenesis of psoriasis can be triggered by many possible factors such as skin trauma, infections, lifestyle factors, genetic predisposition, gut dysbiosis, sleep disorders, psychological stress, insulin resistance, dysregulated lipid metabolism or food sensitivities. Once the process starts, it can become chronic if certain factors amplify the autoimmune process.
The activation of inflammatory pathways and an overactivated immune system eventually become an autoimmune disorder. In psoriasis, there is an uncontrolled proliferation of keratinocytes (KCs). KCs are a skin cell type that make up about 90% of skin cells. They are important for the skin barrier function and protect against environmental damage and pathogens.
In psoriasis, the skin is flooded with immune cells. As a result, proinflammatory cytokines and keratinocytes (skin cells) rapidly divide and accumulate, forming into thick, scaly plaques. The KCs secrete antimicrobial peptides (AMPs).
Once psoriasis develops, activated keratinocytes (KCs) increase and trigger the production of cytokines/ other molecules which worsen the psoriasis-type inflammatory immune reactions. The immune system releases inflammatory cytokines, which further stimulate keratinocyte proliferation and attract immune cells to the skin (Xue M, 2025).
The action of keratinocytes and immune cells create a positive feedback loop, continuing the inflammatory process and the development of psoriasis. Cytokines are released, which act on keratinocytes to promote the proliferation of more keratinocytes. These stimulated keratinocytes actively release large amounts of antimicrobial peptides and cytokines which brings more immune cells to the lesion, thereby amplifying the inflammatory response in the local skin (Xue M, 2025).
What are Possible Psoriasis Triggers?
For reducing psoriasis flare-ups, it is very helpful to identify, recognize and avoid your triggers. Common psoriasis triggers include stress, certain medications, smoking, heat, chemicals and certain foods.
- Environmental toxins: Exposure to environmental toxins, such as heavy metals, various chemicals or pesticides, can trigger or worsen psoriasis.
- Chronic infection: A virus or some other type of unresolved infection can trigger autoimmunity. The immune system may become chronically overactivated if the infection remains unresolved over time.
- Food sensitivities especially gluten & dairy: These damage the gut lining and increase leaky gut.
- Stress: Stress is often a part of the autoimmune activation process. Chronic stress can damage gut health, impair the gut lining and weaken the immune system. As a result, the immune system may under-react to infections or become hypervigilant to environmental substances that would normally be well tolerated. Sources of stress can be mental, emotional or physiological. Things like surgery, sleep deprivation, chronic anemia, a major accident, physical trauma, another autoimmune activation/ disease, a robust pathogenic microbe, toxicity, chronic viral infection are all events that can become potential triggers.
- In the case of adrenal stress, there may be insufficient cortisol to support the immune system and mount an anti-inflammatory defense mechanism. This can be common in people who are overworked, under-rested and sedentary. This is especially true if there is a chronic underlying viral infection and/or food sensitivities. Either would expose the body to intense stressors on a daily basis.
- Nutritional deficiencies: Nutrient deficiencies can impair immune system function or the detox function. Deficiencies in vitamin D, zinc, copper, Vitamin A, folate (B9) or B12 may be involved in psoriasis. They can result from a diet with low nutrient levels, poor digestion, poor absorption or a genetic issue with how well the cells can utilize nutrients.
Can Psoriasis be Treated?
Autoimmune conditions can be improved and, in some cases, resolved with diet, supplements and lifestyle changes. The key in autoimmunity (and all disease) is to be proactive and practice early prevention. But even after psoriasis or another autoimmune condition sets in, we can still do many things to improve/reverse the condition.
- Improving gut health is a key step. This can be done with diet and supplements.
- Heal any gut infections (for example H pylori), overgrowths (of bad bacteria, SIBO) or imbalances (dysbiosis).
- Heal leaky gut.
The gut-skin axis is critical for healthy skin and resolving autoimmune skin diseases like psoriasis. Continue to follow our blog as the next blog will be about how to address and treat psoriasis.
If you are suffering from symptoms of psoriasis or other skin issues then get in touch with us at the Medicine with Heart clinic. We can help you to best manage and optimize your gut-skin health!
