Psoriasis & the Gut: Cause, Gut Cleanse, Probiotics

Psoriasis is a chronic inflammatory disease that affects millions of people worldwide. It becomes visible on the skin: redness, scaling, itching. But a growing body of research suggests that the condition of the skin is also linked to the condition of the gut.

Perhaps that is why you are wondering whether your gut plays a part in your psoriasis, whether a gut cleanse helps or which probiotics make sense. In this article, you will find out what is really known, where research is still in its early stages and what you can do in everyday life.

In brief: The gut and the skin are connected via the immune system. In psoriasis, the gut microbiome (the gut flora) is often altered, and chronic inflammatory bowel diseases such as Crohn's disease occur more frequently. However, it has not been proven that the gut causes psoriasis. There are no robust studies on gut cleanses, and only a few small initial studies on probiotics. A gut-friendly diet does no harm, but it is no substitute for treatment.

The gut and psoriasis: what the gut-skin axis is

Research has shown that there is a close connection between the gut and the skin. Experts speak of the gut-skin axis: the gut and the skin communicate via immune cells, messenger substances and metabolic products of gut bacteria, and in both directions.

The gut is a complex ecosystem, home to a multitude of microorganisms, including bacteria, viruses and fungi. They play an important role in a healthy immune system. A large proportion of our immune cells are located in the intestinal lining. This is relevant to psoriasis, because it is not purely a skin disease, but an inflammation in which the immune system reacts in a misdirected way.

How the gut, the immune system and the skin are connected

A healthy gut microbiome, often also called the gut flora, supports the balance of the immune system. One important building block: certain gut bacteria ferment dietary fibre into short-chain fatty acids such as butyrate. Butyrate is the most important source of energy for the cells of the intestinal lining and can dampen inflammatory responses.

If the bacterial composition gets out of balance, pro-inflammatory bacteria can gain the upper hand and weaken the regulation of the immune system. Whether and how strongly this affects the skin is the subject of intensive research.

Can skin problems come from the gut?

Partly, probably, but not on their own. Studies show that the gut microbiome of people with psoriasis differs from that of healthy comparison subjects. That is an association, not proof that the gut triggers the skin problems. The connection also runs in both directions: the inflammation of psoriasis can also have an effect on the gut.

Is the gut the cause of psoriasis?

Short answer: no, at least not on its own. Psoriasis develops from an interplay of hereditary predisposition, a misdirected immune system and triggers such as stress, infections, smoking, alcohol or certain medications. According to current knowledge, the gut is one player in this web, not the cause. You can find more about oversimplified explanations of the condition in our article on psoriasis myths.

What researchers know so far

The gut microbiome is altered: Several studies have found a lower diversity of gut bacteria in people with psoriasis than in healthy people.
Bowel diseases are more common: People with psoriasis have an increased risk of Crohn's disease, ulcerative colitis and coeliac disease (more on this below).
The direction is unclear: Whether the altered gut microbiome influences the skin or the inflammation in the body alters the gut microbiome has not been resolved. Probably both.

Leaky gut: a hypothesis, not a finding

You may already have come across the term "leaky gut" in this context, meaning a "permeable gut". Important up front: this is a research topic and a hypothesis, not an established diagnosis and not a proven cause of psoriasis. The idea behind it: if the intestinal lining is less tight, bacterial components and metabolic products that normally stay in the gut could enter the bloodstream and permanently irritate the immune system.

There are initial indications of this. In a Polish study, people with psoriasis had higher blood levels of a marker of damage to the intestinal lining, and the more severe the psoriasis, the higher the levels. However, a study like this does not show whether the more permeable gut wall is a cause or a consequence of the inflammation. "Leaky gut" therefore remains a hypothesis that is still being researched. It is not recognised as a diagnosis, and there is no evidence that a leaky gut triggers psoriasis. Commercial leaky gut tests do not provide a basis for treatment.

You may know the principle from the skin: a disrupted skin barrier also makes you more susceptible to irritation.

Which gut bacteria stand out in psoriasis

Anyone looking up gut bacteria in psoriasis is often hoping for a clear list. It is not that simple. What recurs in studies are shifts in balance, not a single "guilty" bacterium.

Dysbiosis: when the balance tips

Studies have frequently found a change in the gut microbiome of people with psoriasis, known as dysbiosis. This means an imbalance among the gut bacteria: beneficial bacteria decrease, potentially harmful germs spread and diversity declines. There is no uniform "psoriasis microbiome", though. The findings differ from study to study.

Faecalibacterium, Akkermansia and butyrate

Nevertheless, a few names keep cropping up:

Gut bacterium	What it does	Finding in psoriasis
Faecalibacterium prausnitzii	One of the most important butyrate producers in the gut, considered anti-inflammatory	Significantly less common than in healthy people in a Dutch study, similar to chronic inflammatory bowel diseases
Akkermansia	Lives in the mucus layer of the gut wall, associated with an intact gut barrier	Less common in psoriasis and psoriatic arthritis in a US study
Ruminococcus	Helps break down dietary fibre	Also less common in the same US study

These findings come from small studies and cannot be translated into a test or a therapy. But they do show why dietary fibre is so important for the gut microbiome: the bacteria that are often missing in psoriasis live on it. You can read what a microbial balance on the skin looks like in our article on the skin microbiome.

Psoriasis and Crohn's disease: when you should take a closer look

There is one area where the connection between psoriasis and the gut is particularly well documented: chronic inflammatory bowel diseases (IBD). An analysis of nine studies concluded that people with psoriasis have an approximately 2.5-fold increased risk of Crohn's disease and an approximately 1.7-fold increased risk of ulcerative colitis. An increased risk does not mean that you will develop the disease. Most people with psoriasis do not develop IBD.

Woman talking to a female doctor in a bright practice

Why the skin and the gut are connected here

Psoriasis and Crohn's disease share parts of their genetic predisposition and use similar inflammatory pathways in the immune system. This also explains why some medications are used for both diseases. Besides the gut, the joints can also be affected, more on this in our article on psoriatic arthritis.

Important in practice: a bowel disease can influence which psoriasis therapy is right for you. So tell your dermatologist about any digestive complaints, even if at first it does not feel like a skin issue.

Coeliac disease is also more common

An analysis of 18 studies found that people with psoriasis are about twice as likely to have coeliac disease, an intolerance to gluten. However, eating gluten-free only makes sense if coeliac disease or gluten intolerance has been diagnosed by a doctor. Without a diagnosis, you would be needlessly giving up wholegrains and with them valuable dietary fibre. Important: get tested before you cut out gluten, otherwise the test result may be wrong.

You should have these gut warning signs checked by a doctor:

diarrhoea that lasts for weeks
blood or mucus in your stool
recurring, cramping abdominal pain
bowel movements that wake you up at night
unexplained weight loss

Your first port of call is your GP practice, which can refer you to a gastroenterologist if necessary. Complaints like these belong in medical hands, not in a self-made gut reset.

Gut cleanses and gut resets for psoriasis: is there anything to them?

A "gut cleanse" sounds like a spring clean: flush everything through once and it all runs smoothly again. But the term has no medical definition. All kinds of things are offered under this label, from colon hydrotherapy and laxative cures to detox powders and probiotic courses lasting several weeks.

What studies on gut cleanses have shown so far

So far, there are no robust studies on gut cleanses or gut resets as a treatment for psoriasis. The fact that the gut microbiome is often altered in psoriasis does not automatically mean that a cleanse will improve the skin.

How unpredictable interventions in the gut microbiome are is shown by what is probably the most thorough study on the subject to date: researchers in Denmark transferred the gut microbiome of healthy donors to people with psoriatic arthritis (faecal microbiota transplantation). The result: in this small study with 31 participants, the treatment performed no better than a sham treatment, and on one measure even worse. Faecal transplants for psoriasis are therefore purely a research topic.

Putting gut cleanse experiences into perspective

In forums you will find many personal accounts in which the skin improved after a gut reset. These accounts are often well-meant, but difficult to assess:

Psoriasis comes in flare-ups. Improvements also happen without any intervention.
Anyone doing a cleanse usually changes more than just their gut: less alcohol, more vegetables, more exercise and often less stress, too.
Anyone who has invested a lot of money and hope perceives improvements more strongly.

Which factor helped in an individual case cannot be separated out. We understand that psoriasis is very individual and that every person affected has their own story. What does one person good will not necessarily work the same way for you.

Gentle rather than radical: what you can do in everyday life

We advise against laxatives, colon cleanses or strict fasting cures without medical supervision. They tend to put a strain on the body rather than build up the gut microbiome. If you want to do something good for your gut, you are better off relying on small habits over weeks and months:

dietary fibre every day, for example from pulses, oats, wholegrains, vegetables and nuts
variety: as many different plants as possible spread over the week
fermented foods such as natural yoghurt, kefir or sauerkraut on a regular basis
cutting down on alcohol, building exercise into everyday life, sleeping well and keeping an eye on stress

Bowl of porridge with blueberries, apple and walnuts on a linen cloth

This is not a therapy plan for psoriasis, but it is a good foundation for your general health.

Probiotics for psoriasis: what the studies say

Probiotics are live microorganisms that can have a positive effect on the gut microbiome. You can find them in fermented foods such as yoghurt and sauerkraut or as food supplements. For psoriasis, there are in fact the first controlled studies, but they are small.

Jars of sauerkraut, kefir and natural yoghurt on a light kitchen worktop

What small studies have shown

Spanish study (2019): 90 adults with psoriasis took either a mixture of three bacterial strains or a placebo for 12 weeks. After 12 weeks, the skin had improved by at least 75 % in 66.7 % of the probiotic group, compared with 41.9 % in the placebo group.
Irish study (2013): In 26 people with psoriasis, a specific bifidobacterium strain lowered inflammatory markers in the blood (CRP and TNF-alpha) over eight weeks. Whether this improved the skin was not investigated.
Analysis of seven studies (2024): Overall, there are signs of a slight benefit, for example in the severity of psoriasis and in inflammatory markers. However, the difference in the proportion of people with a clear improvement was not statistically significant. The researchers are calling for larger studies.

Why probiotics are no substitute for therapy

The results are promising, but preliminary. On top of that, the effect depends on the exact bacterial strain. What has been shown for a specific strain mixture in a study cannot be transferred to any product from the chemist's shelf.

Safety also plays a role: if your immune system is weakened, for example while taking certain psoriasis medications, live bacterial cultures can in rare cases be problematic. So talk to your doctor before taking them, ideally with the exact product name including the bacterial strains.

Nutrition for the gut and skin in psoriasis

Food is not a therapy, but it is a lever you have in your hands every day. A balanced diet rich in dietary fibre, fruit, vegetables and probiotic foods can help to improve gut health. This is not about a miracle diet, but about keeping your gut bacteria well supplied.

What you are better off avoiding

Avoiding certain foods that are considered pro-inflammatory can help to reduce inflammation in the body. You do not have to be perfect, often less is already enough:

Sugary foods and refined carbohydrates such as white flour: plenty of energy, hardly any fibre for the gut bacteria
Lots of saturated fats from processed meats, ready meals and fried food
Alcohol is considered a possible trigger of flare-ups
Excess weight: A large genetic study suggests that a higher body weight does indeed increase the risk of psoriasis. Losing weight can therefore be worthwhile, without a crash diet

What your good gut bacteria like

Above all, variety. Not a single superfood, but as many different plants as possible spread over the week. Mediterranean cuisine, with plenty of vegetables, pulses, olive oil, nuts and fish, is a good model for this. In a large French survey, people with severe psoriasis had eaten a Mediterranean diet less often. This is not proof that diet improves psoriasis, but it is an interesting indication.

Mediterranean food with chickpea and vegetable salad, salmon, olive oil and almonds

More of	Less of
Vegetables, fruit, herbs	Sweets, sugary drinks
Pulses, wholegrains, oats	White flour products
Nuts, seeds, olive oil	Fried food, ready meals
Fish, e.g. salmon or mackerel	Processed meats and lots of red meat
Natural yoghurt, kefir, sauerkraut	Alcohol

However, the gut microbiome cannot be influenced by diet alone. Taking a holistic view, stress management, enough exercise and enough sleep also count. You can read how closely stress and psoriasis are linked in our article on psoriasis and the mind. You can find more approaches for everyday life in our natural remedies for psoriasis, and lots of recipes and routines in the e-book "Leben mit Psoriasis".

What else you can do for your skin

Even though diet and gut health can play a supporting role, daily skincare remains a central part of living with psoriasis. Dry, scaly and irritated skin also needs moisture and lipid-replenishing care from the outside. This helps to gently loosen scales and protect the skin barrier.

natüür care for psoriasis: Our Med Care range with the neem active complex NEEMAVERA® has been developed for very dry, scaly and irritated skin, free from fragrances and vegan.

Cream forte: intensive care for very dry, scaly and irritated skin
Skin Balm: rich balm for very dry, rough patches of skin
Scalp Oil: overnight care for a dry, itchy scalp
Pso Kit: all three together as a care set for psoriasis

Our skincare is no substitute for medical treatment, but it can accompany it in everyday life. Our studies and proof of efficacy show how we handle evidence.

Conclusion: the gut is one building block, not the solution

The connection between the gut and the skin in psoriasis is an exciting field of research that is still being investigated. It is well documented that the gut microbiome is often altered in psoriasis and that bowel diseases such as Crohn's disease are more common. Whether the gut contributes to triggering psoriasis, on the other hand, remains open. Gut cleanses are not supported by evidence, while there are initial promising but small studies on probiotics.

A gut-friendly diet with plenty of fibre, little sugar and alcohol, plus exercise, sleep and less stress: this does your whole body good and can support your wellbeing. Combined with medical treatment and good skincare from the outside, this is a realistic, holistic approach. And if your gut sends warning signs, have it examined by a doctor.

Frequently asked questions about psoriasis and the gut

Does psoriasis have anything to do with the gut?

Yes, there is a connection. In people with psoriasis, the gut microbiome is often less diverse, and chronic inflammatory bowel diseases occur more frequently. However, it has not been proven that the gut causes psoriasis.

Does a gut cleanse help with psoriasis?

So far there is no robust evidence for this. The term gut cleanse is not protected and is used for very different offers. Gentle measures such as a high-fibre diet do no harm, but we advise against laxative cures and colon cleanses without medical supervision.

Which probiotics help with psoriasis?

No specific probiotic can be recommended at present. In a small Spanish study, a mixture of three bacterial strains improved the skin more than a placebo, but the effect depends on the exact strain. Discuss taking them with a doctor first, especially if you take medication that suppresses the immune system.

Which gut bacteria are missing in psoriasis?

In studies, Faecalibacterium prausnitzii, Akkermansia and Ruminococcus, among others, were less common than in healthy people. However, the results vary between studies, and there is no uniform pattern.

Do people with psoriasis have Crohn's disease more often?

Yes. An analysis of several studies found an approximately 2.5-fold increased risk of Crohn's disease and an approximately 1.7-fold increased risk of ulcerative colitis. Persistent diarrhoea, blood in the stool or unexplained weight loss should therefore be checked by a doctor.

Should I avoid gluten if I have psoriasis?

Only if coeliac disease or gluten intolerance has been diagnosed by a doctor. Although coeliac disease is more common with psoriasis, without a diagnosis you would be needlessly giving up wholegrains and fibre. Get tested before you cut out gluten.

Psoriasis and the Gut: How Are They Connected?