Why my dermatologist does not prescribe probiotics?

Posted Wed 24 Jan 2024 14.10 by windowstoweb

Hey, Its been my third visit to my dermatologist, and I am wondering why she does not prescribe any probiotics. She has written Apremilast, with Triamcinolone Acetonide 0.1% ointment and moisturizer. I have plaque psoriasis on my feet. Best Regards.

Posted Wed 24 Jan 2024 14.27 by Acrazydoglady (edited Wed 24 Jan 2024 14.29 by Acrazydoglady)

I bought Skinfood by Dr Thivi Maruthappu and she says 'the reality is that we still don't yet have evidence to recommend specific probiotics reliably for most skin conditions!' Dr Megan Rossi (a gut health specialist at Kings College, London) recommends don't waste your money on probiotics unless there's been a clinical trial on them. So there aren't any to be prescribed currently in the UK - as I'm not sure where you are. I did have plaque psoriasis on my left footsole & top of foot, and I'm currently clear here - so want to give you hope that you can find something that helps you too! I've also taken matters into my own hands via sharing by choosing to be a human guinea pig "Probiotics are helping my psoriasis!!" Please note, it was down to diet (giving up processed food 99% of the time) that helped clear my footsole - but do remember what works for one person doesn't always work for another. I hope you can find something that helps you x

Posted Wed 24 Jan 2024 15.00 by windowstoweb

I am from Pakistan. Hey bro thanks for writing in detail, i respect your words. My psoriasis flares up with processed food, cheesy foods, fatty foods but i am wondering why they say there is no relationship between psoriasis and food. And even my dermatologist has not instructed to avoid such foods haha. Best Regards.

Posted Wed 24 Jan 2024 15.10 by Acrazydoglady

oh bless you, again the issue is that there hasn't been enough research done and this is why. The plan I followed was an anti-inflammatory one, rather than psoriasis specific. For example, the book Skinfood by Dr Thivi Maruthappu, published last year, is actually from the UK's 1st dual qualified dermatologist & nutritionist - how unbelievable?!. The problem is that a specialist focuses on 1 body area, rather than your body as a whole, like how functional medicine does.

Posted Wed 24 Jan 2024 16.50 by kiloran
From Lichen Planus to Plaque Psoriasis to Palmoplantar and Nail psoriasis - newly diagnosed 2023

They can't prescribe things without conclusive research, but hopefully that will change as there is a lot of research into more natural and holistic remedies. Ciclosporin is one example - it was originally found from a fungus before it was made in the lab. There are also plenty of natural remedies which reduce inflammation - turmeric and garlic are big ones and I'm sure they're more present in your diet than most places! I take turmeric and garlic daily and eat a lot of foods containing them. Any excuse for a good spicy meal 😂

Posted Mon 29 Jan 2024 08.08 by mt382

Generally, because probiotic benefit has been blown out of proportion by swarms of papers published by (you guessed it) companies who sell / associate with sellers of probiotics. When you do really controlled research, the effects are much less pronounced, if any. We don't know how many different species of bacteria we have in our gut. It was once thought thousands, but we keep randomly discovering thousands more, and that's without then looking at protozoa, fungi etc. Their interactions are complex, and even within species there is genetic variation and so many produce chemicals which positively effect our health. With probiotics, they analogy often used is your basically trying to replace or populate a rainforest with three plants (e.g. corn, wheat and rye). You can see why that would be devastating to that ecosystem and therefore not necessarily a positive change in our own guts. I just skimmed through some recent reviews and metaanalyses on probiotics vs psoriasis (again, there are plenty of bad papers with agendas with poor methods or misleading outcomes) nd they generally show a perhaps modest but often not significant impact of probiotics on psoriasis. Taking into account that there are already plenty of treatments that show a very strong improvement in most people's psoriasis (people of this forum, including myself are biased toward a severe psoriasis so are not representative - e.g. for many, steroids will clear a flare for months), why bother prescribing something with little to no (and quite shaky) evidence. Probiotics are really falling out of vogue with health scientists, and it's more towards encouraging diversity of gut flora with as many different plants as possible.

Posted Mon 29 Jan 2024 15.40 by Acrazydoglady

what work do you do mt382? Just curious form your comment here! I've been following the plant based diversity approach since Jan-22 (including eating non processed foods 99% of the time) and it starts to help & bam I've had another flare up. Some of us are not so lucky with the comments in your 2nd last para - like me, hence I'm happier being a human guinea pig since I've finally started to see results 4 years later...

Posted Mon 29 Jan 2024 15.57 by kiloran
From Lichen Planus to Plaque Psoriasis to Palmoplantar and Nail psoriasis - newly diagnosed 2023

I think what we're finding is the models and assumptions we've relied on for understanding and improving health are being rapidly undermined by new research. Which probably explains why treatments work for some people and not for others! We're still pretty good at plumbing and electrics but less so at complex diseases like psoriasis (and don't even me started on how woeful our understanding of female health is!) The gut biome is a case in point, it's incredibly complex and constantly changing in response to so many factors (diet, lifestyle, infection, medication).

Posted Mon 29 Jan 2024 16.03 by windowstoweb

Dear @mt382, I got your point and I believe no doctor would prescribe me that thing. They bow towards perks given by pharmaceutical companies to them. Which should I start with? I am from Pakistan Best Regards

Posted Tue 30 Jan 2024 08.14 by mt382

Windowstoweb@ Sorry to hear you think that! I don't know the Intricacies of healthcare in Pakistan, but in the UK a doctor would 100% recommend probiotics if they thought they would work (I've been recommended them by GPs for stomach issues - didn't work and, again, not backed up by very controlled and high quality research). Doctors in the UK get paid regardless of prescription, and only want to help people get better (psycho doctors with weird agendas aside).

Posted Tue 30 Jan 2024 11.28 by windowstoweb

I saw a research recommending Saccharomyces boulardii for psoriasis. If you could recommend some more would be greater help from your side. As I have to start something anyway. Do your doctors in UK give Apremilast? Best Regards.

Posted Tue 30 Jan 2024 14.59 by Acrazydoglady (edited Tue 30 Jan 2024 15.07 by Acrazydoglady)

No one is going to recommend any probiotics on this forum as I've previously advised, unless they've chosen to be a human guinea pig & do their own research like me, as my journey via a functional medicine professional came to an end. What works for one person doesn't work for another! As per previous why don't you try changing your diet since you actually know what your food triggers are? I'd never any idea. A lot of people have great success via the diet route, and I am just one of the unlucky ones, but I did mention to you earlier it cleared my footsole. I've tried boulardii (recommended by my functional medicine professional at the time), do remember what works for one person doesn't work for another. If you specifically want probiotic recommendations you will actually need to consult a functional medicine professional instead, if you have no one else to do so locally. Yes, Apremilast is available in UK.

Posted Tue 30 Jan 2024 15.10 by windowstoweb

hey my Acrazydoglady, you are really helpful to the forum. I would need someone get for online consultation. I live in very backward area, and good doctors are mostly available in big cities of Pakistan. Even though they are not so big but.. Best Regards.

Posted Tue 30 Jan 2024 15.11 by windowstoweb

@Acrazydoglady how many days had you taken this boulardii? Best Regards.

Posted Tue 30 Jan 2024 15.13 by kiloran
From Lichen Planus to Plaque Psoriasis to Palmoplantar and Nail psoriasis - newly diagnosed 2023

The whole issue is that what works for one person doesn't work for another. And sometimes works for a while and then stops. For example, the biologic I've been prescribed for my hand and foot psoriasis has in some patients caused hand and foot psoriasis! If you think about it this makes sense. Our immune systems are designed to adapt to new threats - including treatments. It might take some time but it will adapt. The way I see it is it's like an army sat in barracks. Eventually the troops get bored because there's nothing to do and start messing around, usually resulting in injuries and sometimes fatalities - that's autoimmune disease. Also, the enemy might come up with a new weapon and it takes the scientists (immune system) a while to work out how to defend against it.

Posted Tue 30 Jan 2024 15.32 by Acrazydoglady

@windowstoweb - you are incredibly kind, as I won't lie, it feels incredibly tough speaking out about choosing to be my own human guinea pig on here, and not be compared to being a mouse. I was always told to give things a minimum of 6 months, I must admit I didn't notice any difference with it, so wish you all the very best! Oh wow, that's a great idea about finding someone online! Good luck!!

Posted Tue 30 Jan 2024 16.38 by Acrazydoglady

@windowstoweb I also forgot to add, if you are looking to focus more on your gut health - then general gut health wise, you might be interested in having a read of this https://zoe.com/learn/the-gut-skin-axis and their other gut microbiome articles too. In fact I find all their articles & podcasts full of fascinating facts & information in bitesize understandable chunks from the latest research! I did their Zoe program (only available in UK & USA) back in 2022, This is what inspired me to choose to be a human guinea pig - ha ha!!

Posted Wed 31 Jan 2024 02.34 by windowstoweb

Yes @lady you have gotten to the right point. Whenever i used to eat eggs, fatty foods etc I would have gotten immediate allergic reaction on my feet, and I itched badly. This looks like the gut problem entirely. If gut gets leaky, and i remove inflammation from cells using apremilast or methotrexate. So it’s never ending process then. Best Regards

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