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Efficacy of probiotics for psoriasis: A systematic review and meta-analysis

Apr 30, 2024
Learning objective: After reading this article, learners will be able to cite a new clinical development in psoriasis.

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The pathogenesis of psoriasis is thought to be linked to the adaptive immune system, and traditional treatments for psoriasis have focused on reducing the skin inflammation caused by immune hyperactivation. The ‘gut-skin axis’ is a theory that the health of the gut is linked to skin homeostasis and improving the gut microbiome can change immune responses. Therefore, it is theorized that using probiotics could improve the symptoms of psoriasis.

Here, we summarize a systematic review and meta-analysis by Wei et al.1 published in the Journal of Cosmetic Dermatology on the efficacy of probiotics in patients with psoriasis.


  • A search was performed in various databases up to November 10, 2023, with the search strategy: “probiotic” and "psoriasis" or “psoriasis pustulosis of palm”.
  • Trials were included in the meta-analysis if the patients had a diagnosis of psoriasis and were treated with probiotic, and a control group that was treated with placebo.
  • Studies were required to report Psoriasis Area and Severity Index (PASI) and /or Dermatology Life Quality Index (DLQI).

Key findings1

  • A total of 5 trials with 286 patients were included in this study. The characteristics of the included trials are shown in Table 1. All studies used PASI and DLQI to measure outcomes, apart from trial 5 which used only PASI.

Table 1. Trial characteristics*



Probiotic strain

Duration (months)



1. Suriano, et al., 2023.2

Standard of care plus probiotics
(n = 50)

Standard of care plus placebo
(n = 53)

Lactobacillus rhamnosus


2. Moludi, et al., 2021.3

Probiotic (n = 25)

Maltodextrin capsule (n = 25)

Lactobacillus acidophilus,

Bifidobacterium bifidum, Bifidobacterium lactis, and Bifidobacterium langum


3. Akbarzadeh, et al., 2022.4

Synbiotic product and
hydrocortisone (n = 27)

Hydrocortisone and placebo (n = 25)

Lactobacillus strains, Bifido-bacteria

strains, Streptococcus thermophilus, plus



4. Gilli, et al., 2023.5

Probiotic (n = 18)

Placebo (n = 17)

Lactobacillus acidophilus, Bifidobacterium bifidum, Bifidobacterium lactis, and Bifidobacterium langum


5. Moludi, et al., 2022.6

Probiotic (n = 23)

Placebo (n = 23)

Lactobacillus rhamnosus


*Data from Wei, et al.1

  • In general, PASI scores were significantly lower (p < 0.00001) in the probiotic group compared with the placebo group (Figure 1A).
  • Overall, DLQI scores were also lower in the probiotic group compared with the placebo group (Figure 1B).

Figure 1. The mean difference in A PASI and B DLQI between the test and control groups in each trial* 

DLQI, Dermatology Life Quality Index; PASI, Psoriasis Area and Severity Index.
*Adapted from Wei, et al.1

Key learnings

  • In this study, probiotic supplementation showed good efficacy in patients with psoriasis, as measured by PASI and DLQI scores. Single strain probiotics did not appear to be less efficacious than mixed strains.
  • This analysis is limited by the small number of trials included and lacked laboratory indicators.
  • Despite this, probiotics may be a good option as a complementary treatment for psoriasis alongside traditional maintenance therapy in helping to stabilize the disease.

  1. Wei K, Liao X, Yang T, et al. Efficacy of probiotic supplementation in the treatment of psoriasis-A systematic review and meta-analysis. J Cosmet Dermatol. 2024. Online ahead of print. DOI: 10.1111/jocd.16299
  2. Suriano ES, Souza MDM, Kobata CM, et al. Efficacy of an adjuvant Lactobacillus rhamnosus formula in improving skin lesions as assessed by PASI in patients with plaque psoriasis from a university-affiliated, tertiary-referral hospital in São Paulo (Brazil): A parallel, double-blind, randomized clinical trial. Arch Dermatol Res. 2023;315(6):1621-1629. DOI: 10.1007/s00403-023-02553-1
  3. Moludi J, Khedmatgozar H, Saiedi S, et al. Probiotic supplementation improves clinical outcomes and quality of life indicators in patients with plaque psoriasis: A randomized double-blind clinical trial. Clin Nutr ESPEN. 2021;46:33-39. DOI: 10.1016/j.clnesp.2021.09.004
  4. Akbarzadeh A, Alirezaei P, Doosti-Irani A, et al. The efficacy of Lactocare® Synbiotic on the clinical symptoms in patients with psoriasis: A randomized, double-blind, placebo-controlled clinical trial. Dermatol Res Pract. 2022;4549134. DOI: 10.1155/2022/4549134
  5. Gilli IO, da Silva GC, Mendes V, et al. The Role of probiotics as an adjunctive therapy in psoriasis. Dermatology. 2022;8(2):49-55. DOI: 10.1177/24755303221142296
  6. Moludi J, Fathollahi P, Khedmatgozar H, et al. Probiotics supplementation improves quality of life, clinical symptoms, and inflammatory status in patients with psoriasis. J Drugs Dermatol. 2022;21(6):637-644. DOI: 10.36849/JDD.6237

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