The Effectiveness and Safety of Probiotic Supplements for Psoriasis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Preclinical Trials

Abstract

Background. Patients with psoriasis need long-term medication to control their condition. Recent studies suggest that changing the intestinal flora may be a potential treatment. Methods. The databases were utilized to search the randomized controlled trials (RCTs) and preclinical trials about probiotic supplement in the treatment of psoriasis. The retrieval time is from the establishment of these databases to December 2020. RevMan5.3 was used for the risk assessment of bias and meta-analysis. This systematic review was registered in PROSPERO (CRD42021232756). Results. A total of 3 RCTs involving 164 participants were included. Two RCTs showed that probiotics can improve PASI and thereby improve the condition. For inflammation-related indicators, only one RCT showed that probiotics can improve the levels of CRP and TNF-α but have no obvious improvement effect on IL6. One RCT demonstrated the total effective rate of probiotics in the treatment of psoriasis. For adverse events, one RCT showed that the incidence of adverse events of probiotic treatment was low. Preclinical studies showed that continuous intervention with oral probiotics can significantly improve the progression of psoriasis and reduce the expression of inflammatory factors. The meta-analysis showed that the PASI between two groups was of no statistical significance (SMD 1.83 [-0.41, 4.07], P = 0.11 ). Meanwhile, probiotics may improve skin thickness (SMD -5.87 [-11.34, -0.41], P = 0.04 ) in animal model. Conclusion. Prebiotics may have a positive effect on alleviating the clinical symptoms of psoriasis, but a large sample of RCTs is still needed to support its therapeutic effect in psoriasis.

The role of lifestyle and nutrition in psoriasis: Current status of knowledge and interventions

“…Multiple observations point to a promising role of probiotics and prebiotics 39 . Bile acid deficiency is reported to correlate with LPS translocation in the bloodstream and with psoriasis.…”

“…A study of 800 psoriasis patients divided in two groups, treated for 1–8 weeks with oral bile acid (dehydrocholic acid) supplementation or with conventional treatment, showed that 57.9% of patients treated with bile acid had no relapse after 2 years, compared to 6% of patients from the other group 3 . Another RCT showed a reduction of the PASI of up to 75% in the probiotic group (vs. 41.9% in the placebo group) and a lower risk of relapse at a 6‐month follow up 39 …”

“…Multiple observations point to a promising role of probiotics and prebiotics. 39 Bile acid deficiency is reported to correlate with LPS translocation in the bloodstream and with psoriasis. A study of 800 psoriasis patients divided in two groups, treated for 1-8 weeks with oral bile acid (dehydrocholic acid) supplementation or with conventional treatment, showed that 57.9% of patients treated with bile acid had no relapse after 2 years, compared to 6% of patients from the other group.…”

“…3 Another RCT showed a reduction of the PASI of up to 75% in the probiotic group (vs. 41.9% in the placebo group) and a lower risk of relapse at a 6-month follow up. 39…”

A Novel E3 Probiotics Formula Restored Gut Dysbiosis and Remodelled Gut Microbial Network and Microbiome Dysbiosis Index (MDI) in Southern Chinese Adult Psoriasis Patients

“…A handful of clinical trials have explored the efficacy of probiotics ( Bifidobacterium infantis , Bifidobacterium longum , Bifidobacterium lactis , Enterococcus , Lactobacillus rhamnosus ) as the treatment of psoriasis with a modest improvement in the Psoriasis Area and Severity Index (PASI) [ 38 , 39 , 40 , 41 ]. Although a recent meta-analysis concluded that probiotics and the control group did not yield statistical significance ( p = 0.11) [ 42 ], possibly due to increased compliance in both groups after enrolment into clinical trials [ 37 , 43 ], probiotics demonstrated potentially positive effect with minimal adverse effects in psoriasis patients and warranted further studies.…”