Dermatology and Therapy · 4 authors, 2 centres
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This narrative review examines how gut barrier dysfunction, dysbiosis, and immune dysregulation in psoriasis patients may contribute to paradoxical adverse events—such as new-onset IBD or psoriasiform skin lesions—during anti-TNFα and anti-IL-17 biologic therapy.
This narrative review synthesizes literature on barrier defects, immune dysregulation, and microbiota alterations in psoriasis, and their relationship to paradoxical adverse events during anti-TNFα and anti-IL-17 biologic therapy. The authors describe how impaired gut barrier integrity and dysbiosis in psoriasis patients contribute to increased intestinal permeability and aberrant immune responses, with IBD prevalence in psoriasis patients reported at approximately 1–2%, four times higher than in the general population. Proposed mechanisms include TNFα inhibition-driven cytokine imbalance leading to increased IFN-α production and Th17 cell infiltration. As a narrative review, this work summarizes associations and proposes mechanistic hypotheses rather than reporting original clinical data, and the authors note that current biologic therapy follows a one-drug-for-all strategy rather than a personalized approach.
