Raja Sivamani, MD, FAAD, discusses highlights from his lecture on Probiotics and Prebiotics at the 2021 Elevate-Derm Conference.

In this video

Dr. Sivamani notes that gut testing isn't yet routine in dermatology, but says "there's never a situation where you wouldn't want to do gut testing" — it reveals a patient's microbiota makeup, inflammatory state, and diet. He doesn't reflex it on everyone, but offers it to patients with psoriasis, acne, or rosacea who want a deeper dive into their gut health. He also breaks down the difference between non-spore probiotics (most of which "arrive into the gut dead" after the gastric and bile acids) and spore-based probiotics, which stay in a suspended, "clammed-up" state, resist those acids, then germinate and take hold in the warm environment of the gut.

Looking ahead, he argues gut health "should end up becoming a core of how we approach dermatology," pointing to Ayurvedic, naturopathic, and traditional Chinese medicine, which have long treated the gut as central — the "second brain," and maybe even the first. He connects the gut microbiota to inflammatory conditions like acne, rosacea, hidradenitis suppurativa, and psoriasis. On a personal note, he shares that he eats plant-based and whole-foods-focused — steel-cut oatmeal in the morning, earthy squashes and pumpkins per his Ayurvedic body type — and favors a "just-right carb diet" over no-carb eating.

  • Gut testing can technically be done on anyone; Dr. Sivamani reserves it for patients who want a deeper dive, especially those with psoriasis, acne, or rosacea.
  • Non-spore probiotics mostly arrive in the gut dead after passing through gastric and bile acids.
  • Spore-based probiotics survive in a suspended, cocooned state, resist those acids, then germinate in the gut before re-sporing further down the colon.
  • The gut microbiota — bacteria, fungi, and yeast — drives inflammation or produces beneficial secondary metabolites that affect conditions like acne, rosacea, hidradenitis suppurativa, and psoriasis.
  • He expects gut testing and gut health to become a core part of dermatology, particularly in the inflammatory space.