Recent advances (2024–2025) have fundamentally reshaped our understanding of the role of microorganisms in psoriasis pathogenesis. Cutting-edge studies using Mendelian randomization have provided the first genetic evidence of bidirectional causality between the skin microbiome and psoriasis, demonstrating that dysbiosis not only triggers but is also perpetuated by the disease. Integrated microbiome–metabolome analyses revealed novel inflammatory loops driven by increased Staphylococcus aureus, Corynebacterium spp., arachidonic acid pathway metabolites, and oxidative stress markers, alongside depletion of short-chain fatty acid-producing bacteria. Biologic therapies show differential effects on gut microbiota: secukinumab restores a healthier Firmicutes/Bacteroidetes ratio and boosts Faecalibacterium prausnitzii, whereas ustekinumab may favor Enterobacteriaceae expansion. Emerging preclinical data highlight the therapeutic potential of topical microbiome transplantation and engineered strains (e.g., modified Roseomonas mucosa). Additionally, urban air pollution was shown to exacerbate psoriasis risk up to 3.6-fold through microbiome disruption.

Psoriasis, skin microbiome, gut microbiota, bidirectional causality, Mendelian randomization, microbiome–metabolome integration, Staphylococcus aureus, Corynebacterium, Firmicutes/Bacteroidetes ratio, secukinumab, ustekinumab, topical microbiome therapy, engineered Roseomonas mucosa, arachidonic acid metabolism, environmental pollution, leaky gut syndrome, superantigen, guttate psoriasis, Faecalibacterium prausnitzii, personalized medicine, microbial therapeutics

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