How to Treat the Root Cause of Psoriasis: The Gut Microbiome

Dr. Greenberg discusses the different types of psoriasis, emphasizing that the condition is not only a skin issue but a systemic inflammatory disease. Various forms of psoriasis affect different body areas, such as plaque psoriasis, inverse psoriasis, genital psoriasis, nail psoriasis, and scalp psoriasis. The talk highlights that psoriasis has multiple comorbidities, including psoriatic arthritis and cardiovascular disease, impacting various organ systems.

The talk elaborates on the pathology and evolution of psoriasis understanding. Initially thought to be a keratinocyte issue, psoriasis is now understood as an immunological disease. Dr. Greenberg explains the shift in treatment from methotrexate and UVB radiation to immunosuppressives like cyclosporine and then to targeted biologics addressing the TH1 and TH17 pathways since 2005, which are the current therapeutic focus.

Dr. Greenberg describes how T-cells, particularly TH17, are activated in psoriasis. He explains the role of dendritic cells in signaling T-cells and the influence of cytokines like IL-1, IL-6, IL-23, and TGF-beta. TH17 cells respond to extracellular bacteria and fungi at mucocutaneous sites such as skin, respiratory tract, and gut, leading to chronic inflammation prevalent in psoriasis. Regulatory cells are underactive in psoriasis, contributing to the inflammation.

Discusses conventional psoriasis treatments, including topical therapies, phototherapy, and systemic drugs like methotrexate and cyclosporine. Focus is on biologics targeting TNF-alpha, IL-17, and IL-23 pathways in controlling psoriasis, acknowledging their role in suppressing symptoms rather than addressing root causes. Talks about side effects and paradoxical reactions; TNF inhibitors can sometimes induce psoriasis.

Exploration of the gut-skin connection in psoriasis, highlighting the impact of gut microbiome on systemic inflammation. Discusses leaky gut syndrome where mucosal barriers degrade, leading to bacteria and endotoxins entering the bloodstream and causing systemic inflammation. Psoriatic patients often exhibit gut hyperpermeability and higher endotoxins, supporting the role of gut health in managing psoriasis.

The correlation between streptococcus infections and psoriasis is discussed. A history of strep throat can lead to guttate psoriasis. Tonsillectomy has shown improvements in psoriasis symptoms due to reducing sources of streptococcal infection. The role of mucocutaneous infections in driving Th17 inflammation in psoriasis is emphasized, using tonsil tissue studies as evidence.

Dr. Greenberg emphasizes the importance of treating the root cause of psoriasis through comprehensive gut microbiome assessment. He conducts tests to examine oral health, digestive function, and details the links between environmental toxins, microbiome dysbiosis, and psoriasis symptoms. He outlines strategies for diagnosing and addressing these areas to provide long-term relief from psoriasis.

Dr. Greenberg covers the role of the skin microbiome, specifically Malassezia yeast, in exacerbating psoriasis. The yeast's inflammatory impact on psoriatic skin is explored, suggesting that treatments targeting this could alleviate symptoms. He discusses naturopathic treatments, including the potential use of herbs like Indigo Naturalis and Skullcap to modulate the immune response, particularly TH17.

Diet and lifestyle impact on psoriasis are discussed, noting that weight management through a calorie-restricted diet is often recommended. Eliminating alcohol, gluten, and nightshades may benefit some but not all psoriasis patients. The inherent variability in how patients respond to dietary changes is noted, highlighting the complexity in directly correlating diet with psoriasis improvement.

Case studies illustrate personalized treatment approaches targeting gut dysbiosis and systemic inflammation. Patients underwent specific treatment plans involving probiotics, prebiotics, herbal antimicrobials, and elimination diets. Dr. Greenberg notes improvements after intervention with less reliance on steroids or pharmaceuticals, demonstrating the effectiveness of holistic management practices.