Karan Lal, DO: Relationship Between Psoriasis and the Skin, Gut Microbiome

In an interview segment with HCPLive, Karan Lal, DO, MS, FAAD, spoke on several topics regarding psoriasis treatment advances and research into the gut microbiome. He began with a discussion about gene mutations and their effect on generalized pustular psoriasis.

Lal serves as the director of cosmetic surgery and pediatric dermatology for Affiliated Dermatology Scottsdale. Additionally, he works as the social media chair for the Society for Pediatric Dermatology.

GPP and Genetic Mutation

“For me generalized pustular psoriasis is very interesting,” he explained. “I've seen about two to three patients with the actual genetic mutation. It's considered a rare disease right now. And I think that the approval of (spesolimab) is going to allow us to educate people more about GPP.”

Lal explored the topic further, explaining the role of gene mutations in the pathogenesis of generalized pustular psoriasis.

“And we're learning that it's not just this mutation with the IL-36 receptor, but that there are other mutations involved,” he said. “And we're learning that there can be overlap with psoriasis and overlap with other conditions. So I think this is going to open up the door for us learning about a whole new type of psoriasis that I essentially think has been on the backburner and has been forgotten and potentially misdiagnosed for many years by all of us, because we just didn't know.”

Gut Bacteria and Psoriasis

Lal later went into his views on the relationship between psoriasis and the bacteria found in the gut microbiome, as well as the differences between the skin microbiome and the gut microbiome.

“I think for atopic dermatitis, definitely, there's a lot that we already know, and that we're learning about managing the skin microbiome,” he said. “Although in theory, the skin microbiome probably has a role in a lot of different inflammatory conditions, I just think that with psoriasis, it has a unique genetic profile where there’s less risk of developing infections.”

Lal elaborated on this point, explaining his views on the gut microbiome and its relationship to conditions like psoriasis.

“However, the gut microbiome is very different,” he said. “We know that with psoriasis, if they have a leaky gut, they have association with inflammatory bowel disease and a lot of gut issues. And so maybe that's why people translate that into the ‘skin microbiome.’ But again, that's a lot of the people who don't really understand the true relationship with the skin gut axis.”

For more from Dr. Lal’s discussion with HCPLive on psoriasis research, view the interview segment above.