Eczema and Psoriasis: Unpacking The Gut-Skin Connection

Have you ever wondered why you have a skin condition, but your siblings or friends don’t? Or why some just seem to have that radiant and glowing skin, while others struggle with eczema, psoriasis, rosacea, and even breakouts and dullness, despite using the best of the best skincare products? Well it turns out, the secret actually may not lie in what’s being applied on the skin, but rather in what's happening deep inside the gut. The gut-skin connection is a well-studied concept, and it's totally fascinating. Today’s blog is aiming to help you understand what may be driving your skin condition, where to investigate, and what may help in the meantime. 

Firstly, let’s just acknowledge that having a skin condition can be absolutely debilitating. Constantly itching, losing sleep, worrying about foods or materials triggering it, obsessing over hiding it or flakes being on your clothes. Then everyone is telling you that stress could have triggered it or that stress makes it worse, which just makes things more stressful, on top of the existing stress of dealing with it! Yikes! Let’s dive into what could be going on..

So how does the gut-skin connection actually work?

The gut-skin connection operates through a complex interplay of immunological, hormonal, and metabolic pathways. At the core of this relationship is the gut microbiome, a diverse community of bacteria that plays a crucial role in maintaining gut barrier integrity. When the gut barrier is compromised, gut hyperpermeability can occur (also known as "leaky gut"), where bacteria and toxins that usually wouldn’t be able to, can now enter the bloodstream, triggering systemic inflammation and immune dysfunction. Leaky gut can be a result of many different things such as what we put in and on our body (foods, chemicals, antibiotics), but stress can also play a MAJOR role. Over time, this presentation manifests its way onto the skin, leading to conditions like acne, eczema, and psoriasis. 

Essentially, what happens in your gut doesn't stay in your gut.

For example, when someone presents with eczema, this often reflects a compromised gut health and subsequent immune dysfunction (likely influenced by the gut). We can usually see this in functional gut testing and to some degree in general pathology testing too. For something like rosacea or acne, there can be an additional hormonal element to be considered. For instance, this concept can be observed in the way some may experience eczema after having antibiotics, an onset of psoriasis after a period of chronic stress, or perhaps rosacea flare-ups at certain parts in the menstrual cycle. These are all prime examples of how the conditions of the gut can lead to systemic inflammation and potentially trigger a presentation on the skin. The way stress impacts our microbiome and integrity of the gut lining makes it a major reason as to why skin conditions can flare depending on our life circumstances. 

To put it bluntly, a skin issue is never truly a skin issue. It’s a gut and immune issue.
Beyond microbes alone, there are more layers of complex biochemical pathways that influence the skin. The gut microbiome influences the production of various metabolites and neuropeptides that regulate skin health too. For instance, short-chain fatty acids (SCFAs) that are produced by gut bacteria have anti-inflammatory properties that can soothe the gut barrier and the skin barrier, whilst influencing communication via the gut-brain axis. Additionally, the gut impacts hormone levels, including cortisol, which can affect skin oil production and immune response. Thus, a balanced gut microbiome not only prevents inflammation but also promotes a harmonious internal environment between many body systems that reflects positively on the skin. And when you get it right, you can really tell. When someone's gut is thriving, their skin has an infinite glow to it. 

So, what can we do to support this gut-skin connection? Especially for the skin conditions mentioned…

• Manage stress, and manage it well! As we know, stress can majorly disrupt the microbiome, reduce stomach acid and damage the gut lining, so including stress-reducing activities and tools into your daily rituals to regulate your nervous system is an absolute must when trying to get on top of any skin condition. Because of this, sometimes the skin condition won’t fully resolve until you reevaluate - change environment, change jobs, etc. 

• Daily bowel movements are SO important for clearing toxins from the body, including excess hormones! Toxins and hormones that would otherwise be recycled back into the bloodstream, put burden on the liver, and likely exacerbate the skin condition. Skin conditions can be linked to deep stagnation in the body (psoriasis especially), so working on daily bowel movements and lymphatic drainage is important. 

• Cod liver oil is a nourishing source of DHA omegas, including nutrients like vitamin A and vitamin D to repair both the gut and skin barrier.

• Zinc is an important mineral for gut repair, skin barrier repair, increasing stomach acid and reducing sebum and androgen production which may be contributing to acne. Oysters, pepita seeds and red meat are beautiful sources of zinc. 

• Kiwi fruit is a great source of vitamin C for collagen production and tissue repair, but also increases faecalibacterium prausnitzii, a bacteria that when in reduced amounts, has been correlated to greater prevalence and severity of psoriasis. Kiwi can sometimes not be ideal for those with eczema. 

• Polyphenols like olives, olive oil, cacao, berries, cherries, green tea and flaxseeds known to increase akkermansia muciniphila, a bacteria that when in reduced amounts, has also been correlated to greater prevalence and severity of psoriasis. 

• Probiotics and fermented foods are fantastic for restoring the microbiome, where low levels of beneficial bacteria such as lactobacillus and bifidobacterium have been linked to many skin conditions including eczema. However, your ferment tolerability depends on how much histamine is playing into the individual skin condition. Histamine-degrading bacterias can be useful in ferments, such as Kultured Wellness Coconut Kefir. 

• Strain-specific probiotics such as Lactobacillus salivarius and Lactobacillus rhamnosus are known to decrease eczema prevalence and severity due to their abilities to degrade histamine and also stabilise mast cells. 

• Limiting toxin exposure is vital for calming down the immune system by reducing the toxin load on the liver and bowels. What toxins we put on our skin also disrupts the microbiome! When our skin is red and itchy and inflamed especially, the last thing we want to do is apply anything but pure, soothing ingredients. Beef tallow, aloe vera, calendula, and zinc oxide based herbal creams can be perfect applications. 

The bottom line…

Next time you’re faced with a skin issue, consider looking inward - your gut might just hold the key to resolving it. We must consider the complex role that the gut and immune system play in the development and/or exacerbation of skin condition, and the way stress impacts this too. 

Whilst gut and nutrition can be the resolving factors MOST of the time, some skin conditions do require much deeper investigation into things like mould, heavy metals and environmental allergies. Each case is different, as is its unique treatment, which is why working with a holistic health professional will not only assist the process, but will likely get you results much faster than you would have alone. 

This is why we have a team of dedicated natural medicine practitioners in our online clinic. Don’t suffer alone! 

References:

Codoñer, F. M., Ramírez-Bosca, A., Climent, E., Carrión-Gutierrez, M., Guerrero, M., Pérez-Orquín, J. M., Horga de la Parte, J., Genovés, S., Ramón, D., Navarro-López, V., & Chenoll, E. (2018). Gut microbial composition in patients with psoriasis. Scientific Reports, 8(1), 3812. https://doi.org/10.1038/s41598-018-22125-y

Drago, L., Lemoli, E., Rodighiero, V., Nicola, L., De Vecchi, E., & Piconi, S. (2011). Effects of Lactobacillus salivarius LS01 (DSM 22775) treatment on adult atopic dermatitis: a randomized placebo-controlled study. International Journal of Immunopathology and Pharmacology, 24(4), 1037-1048. https://doi.org/10.1177/039463201102400416

Gao, Z., Tseng, C. H., Pei, Z., & Blaser, M. J. (2007). Role of skin and gut microbiota in the pathogenesis of psoriasis, an inflammatory skin disease. Journal of Investigative Dermatology, 127(7), 1747-1751. https://doi.org/10.1038/sj.jid.5700812

Reddel, S., Del Chierico, F., Quagliariello, A., et al. (2019). Gut microbiota profile in children affected by atopic dermatitis and evaluation of intestinal persistence of a probiotic mixture. Scientific Reports, 9, 4996. https://doi.org/10.1038/s41598-019-41486-0