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It is a genuine point of variation in practice
A small clinical trial of 20 patients randomized to metabolic surgery or standard medical therapy found that metabolic surgery can positively affect the gut microbiota

[DOI] [PubMed] [Google Scholar] 143.Wilson NR, Kang J, Hueske EV, Leung T, Varoqui H, Murnick JG, Erickson JD, Liu G

The method of treating psoriasis depends on the severity of the disease and includes topical or systemic treatment

Gentle swirling is always the recommended method
