Interconnections Between Psoriasis, Obstructive Sleep Apnea, and the Skin and Gut Microbiomes: Mechanistic and Therapeutic Perspectives

Introduction Psoriasis is an inflammatory, immune‐mediated skin disease in which interleukin (IL)‐17 and IL‐23 have central roles. Immune disruptors, including sleep deprivation, may exacerbate disease activity. Among sleep disorders, obstructive sleep apnea (OSA) has attracted attention because it shares several pathogenic mechanisms with psoriasis, suggesting a potentially bidirectional relationship. Changes in the gut microbiota have been linked to OSA, particularly as a consequence of the intermittent hypoxia characteristic of the condition. Similar alterations may occur in the skin microbiota. This brief review synthesizes the available evidence on the connections between psoriasis, OSA, and the gut and skin microbiota. Methods A PubMed search identified 48 relevant studies. Results Psoriasis disrupts sleep quality, particularly through pruritus. As a systemic condition, psoriasis can both exacerbate OSA severity and be aggravated by it. The intermittent hypoxia and sleep fragmentation due to OSA may induce intestinal dysbiosis, affecting immune regulation and promoting cutaneous inflammation. In psoriasis, gut and skin dysbiosis are marked by reduced microbial diversity, increased pro‐inflammatory microbial populations, and decreased beneficial microbes. Altered skin microbiome, connected to the gut–brain axis, potentially worsens psoriasis. Microbiota‐targeted therapies, including probiotics, prebiotics, synbiotics, and fecal microbiota transplantation, seem promising in regulating microbial diversity, modulating immune pathways, and relieving psoriasis, along with promoting sleep regulation. Conclusions The microbiota and modulation of the skin–gut–brain axis may interact with psoriasis and OSA. Recent clinical interventions targeting psoriasis may improve skin and gut microbiota, which can be enhanced by regulated sleep quality, as sleep is crucial to the immune balance.