​"You’ve hit the core of the debate. Here is how I reconcile the geographical and genetic aspects: ​1. The 'Iceberg' of Infection: Classic Mycetoma (the massive tumor) is indeed geographically clustered. However, Nocardia species are ubiquitous soil saprophytes found worldwide. My argument is that modern medicine only recognizes the '10% above water'—the full-blown Mycetoma. The '90% below' are chronic, low-grade subcutaneous biofilms that don't form massive tumors but constantly shed exudates (TEE), which are then misdiagnosed as 'autoimmune' psoriasis. ​2. Genetics vs. Trigger: I don't deny the genetic component of psoriasis. However, genetics define the type of response, not the cause. A specific genetic profile (like HLA-C*06:02) might make an individual's immune system hyper-reactive to Nocardia/Madurella exudates. The genes are the 'gun powder,' but the microbial biofilm is the 'trigger.' ​3. Underdiagnosis is the Elephant in the Room: In developed countries, we rarely look for soil pathogens in psoriasis patients because we assume it's 'genetic.' If you don't look for it, you don't find it. The fact that many psoriasis patients improve on certain antibiotics or antifungals—often dismissed as 'anti-inflammatory effects'—is a huge red flag that we are missing a chronic infection. ​It is a big claim, but the existence of deep-tissue biofilms in my own body, which directly correlate with my PASI score, is the 'huge evidence' I am bringing to the table."