We often work with patients who have skin conditions such as acne and rosacea. These conditions can often be persistent, and while there are treatments for both that focus on the skin, these conditions are not fully addressed until we address gut health.
Both the skin and intestinal lining are barriers to the outside world that are covered with their own microbiota – communities of bacteria and other microorganisms that, when healthy, perform important metabolic functions that are vital to our wellbeing. (The term “microbiome” refers to the combined metabolic activity of the microbiota.) Just like in the gut, friendly (also called “commensal”) microbes on the skin help keep away potentially pathogenic microbes and balance our immune system’s responses. These two barriers have a lot more in common, too. The one we can see, our skin, might be a window into the one we can’t – our gut.
In the 1930’s, dermatologists John Stokes and Donald Pillsbury proposed a relationship between skin conditions, mental health, and the gut. (Maybe you’ve heard of the gut-brain axis? More like a gut-brain-skin triangle!) They hypothesized that depression and anxiety alter gut function, causing changes to the normal microbiome, which in turn cause inflammation that can manifest on the skin as acne, dermatitis, rosacea, and more. This may be a vicious cycle – as anybody who’s had blemished skin will attest, it can certainly affect self-esteem.
Ninety years later, research is just starting to catch up. We now know that anxiety and depression can alter the gut microbiome, leading to inflammation, and that a dysfunctional gut microbiome may alter brain function, leading to anxiety and depression. The microbiome is emerging as a central piece to the puzzle.
In this article, we examine how gut health plays a role in acne and rosacea and discuss the framework for addressing gut health, that will support clear skin.