Have you ever noticed that the health of your gut is connected to the health of your skin? For example, have you ever had more carbs, sugar, dairy, or alcohol than usual, and noticed more pimples on your face? The gut and skin are connected, and this gut-skin axis is important to understand when treating skin conditions.
When a patient comes to see me for a chronic skin rash, I don’t treat the rash as most doctors do using topical or oral corticosteroids or immune-suppressive drugs. My approach, instead, is to look into the health of the gut to make sure food allergies are removed, dysbiosis is treated, and inflammation is reduced. Once gut health is restored, rashes slowly go away, and it is an amazing process to witness.
The Science Behind Gut Health and Skin
If you look at the anatomy and physiology of the gut and the skin they both have many similarities, which may surprise you.
- They both provide a physical barrier to the outside world preventing pathogens and toxins from entering your body
- They both have their own distinct diverse microbiomes that can change based on the environment around them
- They both contain networks of nerve cells, immune cells, and endocrine cells that help communicate with other systems of your body
- They both are highly vascularized with blood vessels
There have been many studies looking at how gut health and skin conditions are related. Here are some examples of chronic skin conditions that have been discussed in the medical literature:
- Rosacea
- Psoriasis
- Dermatitis herpetiformis
Rosacea
Rosacea is a chronic inflammatory condition of the face that results in redness and irritation with occasional pus-filled bumps. In a small pilot study 51% of patients with rosacea where given a diagnosis of Small Intestinal Bacterial Overgrowth (SIBO), compared to 27% of patients in the general population. Those treated for SIBO using Rifaximin (a non-absorbable antibiotic used to treat SIBO) experienced a significant improvement in their rosacea for up to nine months, which suggests that SIBO, or dysbiosis, plays a role in skin health.
Clinical Tip: For those with rosacea, I find that (in addition to treating SIBO) including digesting enzymes that have HCL (hydrochloric acid) with meals can really help reduce symptoms.
Psoriasis
Psoriasis is an immune-mediated skin condition that affects 3% of the world’s population. It is characterized by raised, thick, and scaly patches that can affect any part of the body, but is particularly common along the elbows, knees, and scalp. A recent clinical study showed that those with psoriasis and psoriatic arthritis had less diversity in the gut microbiome compared to controls. Researchers concluded that this low diversity can lead to an inability of the gut to regulate immune responses, which can affect local or systemic inflammation. Psoriasis is also more common in those suffering from Crohn’s disease.
Clinical Tip: For those who have psoriasis, gluten and dairy seem to be the biggest triggers, so you may want to completely avoid gluten and dairy for 2+ months and see if your psoriasis improves.
Dermatitis Herpetiformis
Dermatitis herpetiformis is an itchy and blistering skin condition associated with celiac disease. For those that have celiac disease, the consumption of gluten containing grains triggers an immune response that deposits IgA (Immune globulin A) under the top surface of the skin. Treatment involves strict removal of gluten from the diet and, over many years, the IgA deposits will disappear, and the rash will improve.
Clinical Tip: for those with dermatitis herpetiformis and celiac disease, I’ve found that treating underlying dysbiosis and inflammation can accelerate gut and skin healing
How I Typically Treat Chronic Skin Conditions
The first thing that I do when a patient presents with a skin rash like rosacea, eczema, or psoriasis is to inquire about the health of their gut. I find the following factors to be very important for understanding where to go next with treatment:
- Food Allergies
Is there a food or food group that is leading to chronic immune system activation causing skin inflammation? Common food allergies include gluten, dairy, eggs, citrus, corn, nightshades, and sugar. I’ll typically have patients complete a food allergy elimination diet for 1 month to assess reactions to foods and skin health. Sometimes, I’ll also order an IgE/IgG food allergy panel to assess food allergies.
- Dysbiosis in the Gut
Dysbiosis is an imbalance of gut flora, and SIBO and candida overgrowth are two common examples of dysbiosis. I have even seen intestinal parasitic infections cause chronic skin conditions. Since the microbiome is intimately connected with immune system function, dysbiosis can cause inflammation locally and systemically. There are many ways to determine if you have dysbiosis including breathe testing (SIBO), stool testing, and making a clinical diagnosis using overall symptoms picture.
- Inflammation in the Gut
Sometimes calming down inflammation in the gut can help improve skin conditions. You’ll want to make sure you treat an underlying leaky gut, as increased intestinal permeability can cause an overactive immune response leading to an increase in inflammation. Typically this first involves removing food allergies, pathogenic bugs and dysbiosis followed by restoration of the microbiome and gut lining. I like to make sure a broad-spectrum probiotic is on board along with anti-inflammatory herbs and nutrients to calm down inflammation and promote intestinal healing. In fact, research has shown that certain probiotics like Bacillus coagulans can improve skin conditions by improving the intestinal environment.
Treating chronic skin conditions takes time, and often from start to finish can take a year or more to completely resolve a skin condition. I suggest working with an experienced functional or integrative medicine practitioner as some skin rashes need more than gut support to resolve.
References:
https://www.wjgnet.com/2218-6190/full/v6/i4/52.htm
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6048199/
https://www.jaad.org/article/S0190-9622(12)02330-4/fulltext
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6023392/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4280348/
https://gluten.org/resources/dermatitis-herpetiformis/
https://www.tandfonline.com/doi/abs/10.1080/089106002760002694
