Psoriasis is a common chronic inflammatory non-infectious skin disease. Skin microbiota pattern plays a significant role in psoriasis pathogenesis. Recent studies have shown a relative increase in Streptococcus and Staphylococcus but a decrease in Malassezia and Cutibacterium in psoriasis patches. Primary changes in the skin microbiome may be a driving force of the onset or exacerbation of psoriasis. These changes can be a consequence of proinflammatory microenvironment formation on the skin with maceration, excoriations, or they can be related to the chronic infection foci in internal organs or skin with dermal appendages. It is now evident that psoriasis pathogenesis may involve impaired immune tolerance to cutaneous microorganisms, resulting in therapy-resistant disease exacerbations. Streptococci and staphylococci are still the most relevant pathogens. In this regard, in the context of routine clinical practice, when it is difficult to accurately identify possible pathogens inhabiting the skin of psoriasis patients promptly, it is advisable to use combined topical corticosteroids. Skin microbiome pattern with the prevalence of pathogenic microorganisms may contribute to a slowly progressive form of psoriasis. This situation may also be aggravated by the chronic inflammation in other body sites, especially inflammatory diseases of the mouth, nasopharynx, urogenital tract, as well as onychomycosis and other fungal lesions of the skin and dermal appendages, or development of secondary infection due to damage/maceration of the skin with psoriasis patches.