That means if you’re experiencing inflammation in your gut, you’re likely to see symptoms appear on your skin (and, in fact, throughout your body). But it also means that by correcting the cause of your gut inflammation, you can alleviate skin conditions like acne, rosacea, psoriasis, and more. Read on to learn more about the link between your gut health and your skin, and find out what you can do to support a healthy gut microbiome.
What do rosacea, acne, psoriasis, eczema, and dermatitis herpetiformis all have in common? Potential problems with gut health. Find out more about how inflammation in the gut can lead to these skin issues. #optimalhealth #functionalmedicine #chriskresser
How Gut Inflammation Can Lead to Skin Problems
How does the gut have such a profound impact on your skin? Through the gut–skin axis. The gut–skin axis is a bidirectional pathway that connects the gut and skin. Through this connection, your gut microbes send signals to your skin that influence things like skin structure, inflammation, and the production of sebum (the oily, waxy substance normally found on skin). If anything in your gut is disrupted in that signaling process, your skin will feel the effects. (2)
Inflammation can easily cause that disruption. Your gut health relies on healthy gut microbiota and the integrity of your intestinal barrier. If your gut microbial community is disrupted (a condition known as gut dysbiosis) or if the integrity of your intestinal barrier is compromised (a condition known as intestinal permeability or “leaky gut”), your gut health will suffer as a result. A number of factors can lead to gut inflammation—anything from autoimmunity to diet to infection—and any of those can compromise the health of your gut microbiota and the integrity of your intestinal barrier.
This is, unfortunately, a common occurrence. In my clinical experience, people with skin conditions frequently have underlying gut problems that need to be addressed. (Just to note, it doesn’t necessarily work in reverse: people with gut conditions won’t always experience skin-related symptoms.) That’s why, as part of my Functional Medicine approach to care, I focus on addressing those underlying gut issues that are causing the problem in the first place.
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Five Skin Problems Associated with Your Gut
So which skin conditions are most closely associated with your gut health?
Acne occurs when the skin produces too much sebum, which clogs pores and hair follicles. Acne is generally categorized as noninflammatory, which shows up as comedones, or inflammatory, which can cause pustules, cysts, papules, and nodules on the skin. Conventional treatments are often topical, and they tend to focus on reducing sebum production and treating any active skin infections (frequently with antibiotics). (3)
As you might guess, topical treatments won’t do much to address what’s causing the acne (and antibiotics have their own set of potential problems). Addressing any underlying gut issues, however, may offer a cure.
Acne, Gut Dysbiosis, and Leaky Gut
In the case of acne, that may mean correcting gut dysbiosis and leaky gut.
If you’re experiencing acne, you may also be experiencing gut dysbiosis. Your gut microbiome influences lipids and tissue fatty acid profiles and may influence sebum production as well as the fatty acid composition of the sebum. (4) Disrupted sebum could lead to acne; and in fact, this may explain why one study found that 54 percent of people with acne have significant alterations to their gut flora. (5)
Leaky gut can occur when your intestinal barrier malfunctions, allowing undesirable and incompatible substances from the gut to “leak” into the bloodstream. That leakage causes your immune system to launch an inflammatory response, leading to local and systemic inflammation, which, in turn, contributes to skin disease.
Research has shown that when the intestinal barrier is disturbed, intestinal bacteria and microbiota metabolites can gain access to the bloodstream and accumulate in the skin, which will harm your skin’s health. (6) We also see evidence that increased intestinal permeability is an issue for a significant number of people with acne, suggesting a link between leaky gut and acne. (7, 8)
2. Dermatitis Herpetiformis
Dermatitis herpetiformis (also called Duhring’s disease) is a condition characterized by itchy bumps and blisters that appear most frequently along the hairline, on the forearms near the elbows, and on the knees and buttocks. (9)
Celiac disease is the cause of dermatitis herpetiformis. In fact, this skin condition is considered “the specific cutaneous manifestation of celiac disease”; conventional treatment involves a “lifelong gluten-free diet” and potentially drugs to control the symptoms. (10)
Dermatitis Herpetiformis and Celiac Disease
Celiac disease is characterized by an immune response to specific proteins and enzymes found in gluten, and untreated celiac disease can cause tissue damage, especially in the small intestine. In some people with celiac disease, part of that immune response acts against the skin, resulting in lesions characteristic of dermatitis herpetiformis. (11) People with celiac disease may also have increased frequency of other skin-related issues, oral mucosal lesions, alopecia, and vitiligo. (12)
Adopting a gluten-free diet is crucial if you have celiac disease. There really is no other way to ensure that you won’t experience that disruptive and damaging immune response.
I also want to note that celiac disease has other potential implications for skin health. People with celiac disease often experience impaired niacin absorption in their diets (due to a swollen and thickened intestinal lining that’s common in the disease). (13) A niacin deficiency can lead to pellagra, a condition that causes dermatitis (among other very serious side effects).
Eczema is an autoimmune condition characterized by flare-ups of red, itchy skin. Eczema damages the skin barrier, leaving it dry and prone to itchy rashes and skin infections, among other problems. (14) The cause of eczema isn’t well understood in conventional medicine, and treatment generally involves a process of avoiding known triggers, like dry skin, irritants, and excess stress.
The Link between Autoimmunity, Gut Health, and Eczema
Your gut health is closely linked to your immune system. Metabolites of beneficial gut bacteria, such as short-chain fatty acids, contribute to a healthy and robust immune system, and gut dysbiosis may impair your immune response. (15) The gut microbiota also affect the development of autoimmune disorders—your gut microbes regulate T cell differentiation (and thus, your microbiome plays an immunoregulatory role) and modify proteins present in your gut, which could produce an autoimmune response. (16, 17, 18) Leaky gut may also trigger an autoimmune response attack. (19)
While we still have a lot to learn about autoimmunity in general and eczema specifically, some research supports the idea of a gut-eczema connection. One study involving people with seborrheic dermatitis (a type of eczema) noted disruptions in the normal gut flora. (20) And research indicates that people with eczema show signs of leaky gut. (21)
Similar to eczema, psoriasis is an autoimmune condition that manifests itself on the skin. In the case of psoriasis, skin symptoms can include raised plaques or scales, and some people also experience swelling, stiffness, and pain in their joints. (22) And again, similarly to eczema, the cause of psoriasis isn’t well understood in the conventional world, and treatment involves a process of identifying and then learning to avoid triggers that lead to a flare-up of the condition.
Psoriasis, Gut Dysbiosis, and Leaky Gut
As I said, the gut and immune system are closely linked, and we can see that connection again with psoriasis. Gut dysbiosis has been linked to the development of psoriasis (along with several other non-intestinal autoimmune disorders, like lupus, multiple sclerosis, and Graves’ disease). (23) People with psoriasis seem to have dysregulated gut microbiomes and elevated levels of proinflammatory cytokines—potentially caused by bacteria moving from the gut into the bloodstream (aka leaky gut). (24)
There may be a link between inflammatory bowel disease and/or Crohn’s disease and psoriasis. People with Crohn’s disease can develop skin manifestations, including psoriasis-like plaques, and one study showed that a drug normally used to treat psoriasis is also effective for Crohn’s disease. (25)
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Rosacea is a somewhat common skin condition, causing symptoms like:
- Persistent facial redness, generally in the central part of your face
- Swollen, red bumps that resemble acne
- An enlarged nose
- Eye problems characterized by swollen eyes and eyelids
The cause of rosacea isn’t known, though it’s thought to be a combination of genetic and environmental factors. Women over age 30 with light skin may be at higher risk for developing rosacea (especially if their skin is sun-damaged or they have a family history of rosacea). (26)
Conventional rosacea treatment again focuses on avoiding triggers (in this case, that could include spicy foods, hot drinks, alcohol, exposure to sunlight or wind, extreme temperatures, certain drugs, and more) and may include topical drugs to reduce redness and antibiotics to eliminate acne-like bumps and lesions. Increasingly, light therapy is taking hold as a treatment option for reducing redness. (27)
Rosacea, Small Intestinal Bacterial Overgrowth, and Helicobacter pylori
There appears to be a connection between rosacea and small intestinal bacterial overgrowth (SIBO), a condition characterized by an overgrowth of bacteria in the small intestine. SIBO negatively affects the function and structure of the small intestine. It causes damage to the cells lining the small bowel, which can interfere with food digestion and nutrient absorption and lead to leaky gut.
A 2008 study found that SIBO is 10 times more prevalent in people with rosacea than it is in healthy controls and that correcting SIBO led to clinical improvement in rosacea symptoms. (28) The exact mechanism behind this connection isn’t yet known, but leaky gut may play a role in the inflammatory symptoms we see with rosacea.
H. pylori infection may also influence the development of rosacea. In one study, nearly 50 percent of people with rosacea also had an H. pylori infection, and treatment of that infection led to “significant improvement of skin symptoms.” (29)
The microbes in your gut aren’t the only ones that influence your skin. Your skin has its own microbiota (your skin is home to around 1 billion microbes per square centimeter). (30) In fact, changes in the health and makeup of your skin’s microbiome are also associated with acne, eczema, psoriasis, and rosacea. (31, 32, 33, 34) The skin microbiome is a dense topic all on its own, so see this article for more information.
How to Correct Gut Inflammation and Improve Your Skin
The best way to improve your gut and skin health is to first get treatment for any active infections (like H. pylori) and conditions like SIBO. Next, ensure that you’re getting enough of what your body needs to be healthy. You may be able to reduce symptoms or even correct your issue by focusing on specific minerals and nutrients, probiotics, and diet and lifestyle changes.
Get Enough Minerals and Nutrients
A variety of minerals and nutrients can help mitigate inflammation and improve your skin health:
Find Out What Else You Need for Healthy Skin
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Include Probiotic Foods in Your Diet
Probiotics are also helpful for correcting gut issues and improving skin health. Orally consumed pre- and probiotics have been shown to reduce systemic markers of inflammation and oxidative stress, which could help reduce inflammatory acne and other skin conditions. (41, 42, 43) There is also evidence of a link between SIBO and acne, so reestablishing a healthy, balanced gut microbiome is an important step in treating that skin condition.
You can add more probiotics to your diet by eating more fermented foods like sauerkraut, kimchi, yogurt, and kefir, or supplemental probiotics may help.
Adopt a Gut-Healthy Diet and Lifestyle
Adjusting your diet may also be necessary. That could include taking steps like:
- Eliminating gluten, if you have celiac disease
- Adopting a nutrient-dense, anti-inflammatory diet (and an ancestral diet is a great place to start)
- Getting enough fermentable fibers
- Adding polyphenols to your diet (found in berries, coffee, tea, and hazelnuts, to name a few options)
Adopting a gut-healthy lifestyle can also help attenuate your symptoms. That includes:
- Getting enough sleep—meaning around seven to eight hours of shut-eye each night
- Managing your stress through practices like meditation, mindfulness, and deep breathing
- Engaging in regular exercise every day
- Avoiding environmental toxins that can contribute to gut inflammation, like bisphenol A, pesticides, and toxins found in unfiltered water and skincare products
If you’ve tried these methods to improve your gut and skin health without improvement, or if you’re having trouble implementing these changes, I recommend working directly with a Functional Medicine care team. That could mean enlisting the help of a practitioner who can identify the underlying cause of your problem, consulting with a nutritionist to fine-tune your diet, and working with a health coach to help you develop your plan for behavior change.
For those of you who are looking for all of that support in one place, our team at the California Center for Functional Medicine (CCFM) is ready to help. CCFM offers a virtual health transformation program designed to help you make sustainable, long-term changes. Find out how we can help you.
I hope this article has helped you understand how your gut can influence the health and appearance of your skin. By addressing that underlying cause and improving your gut health, you can alleviate symptoms of your skin condition and dramatically improve your overall health.