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Skin microbiome: The gut-skin connection

24 Jan 2024 • 14 min read

Acting as the first line of defence for our bodies, our skin protects us from harmful things, like bacteria. But did you know thousands of helpful bacteria also live on our skin? So, how does this ecosystem work?

The largest organ of the body, our skin is precious to us. But it’s also home to tens of thousands of other microorganisms, including bacteria, fungi, viruses, and parasites1. But what makes up our skin microbiota, and how can we look after it?

In this article, we’ll talk about what the skin microbiota is, what it does, and what affects it. We’ll also touch on the gut-skin axis, as well as give you some tips on how you can look after the microbiome of the skin.

What is the skin microbiome?

The skin microbiome is a community of microorganisms, including bacteria, viruses, and fungi, that live on the skin along with their genes, most of which are either harmless or beneficial to their host.2

These microorganisms have evolved over time to help and support the human body, with each microorganism adapting to the part of the body that they are found in. However, just as some microorganisms have evolved to support human bodily functions, others have evolved to cause disease.3

This is where the crossover with skin and gut microbiome continues, as some of the bacteria that are in our gut, such as Staph, Strep, and Candida, can also be found on our skin.2

What does the skin microbiome do?

The primary role of the skin is to protect us against the outside world – whether that’s the weather, harm from physical objects, or infectious agents, such as harmful bacteria, viruses, and fungi.2 In fact, our skin microbiome, which we all have, is responsible for doing quite a bit, actually.

The thousands of microorganisms that live on our skin protect us against harmful pathogens and, in some cases, provide vital functions that humans have not evolved to do.2 Disruptions in the balance of the microbiome of the skin can result in skin disorders or infections.2

Could skin blemishes be linked to your gut?

Bothered by blemishes on your face or body?

You might not think that acne is connected to what’s going on in your digestive system, but evidence now suggests that gut issues could be an underlying cause of blemishes.4

Acne and gut health

There haven’t been any large-scale clinical studies into the link between acne and increased gut permeability, and it’s probably not something your GP would mention as a potential cause of skin problems as the evidence is still in its infancy.

However recent research has suggested that there is a link between acne, the skin microbiome, and gut health. Although the exact connection is not fully understood, studies have shown that the gut microbiome is involved in acne through interactions with the skin microbiome.5

A new area of medical research has also started to explore what’s called the ‘gut-skin axis’ in a bid to understand how digestion can interact with and affect your skin.6

Is there a ‘leaky gut’ link?

The term ‘leaky gut’ refers to when bacteria can ‘leak’ through the walls of the intestines. It is not a recognised medical condition and some doctors speculate if it is a real condition. However, this ‘leaky gut’ or better phrased as increased permeability is still being studied by scientists. Some research points to a link between increased gut permeability and acne.5

Your gut is lined with a layer of proteins, meshed together in so-called ‘tight junctions’ at particular points. However in some people, there is speculation whether the links between the proteins could become too loose, allowing foreign substances through the gut lining and into the bloodstream.

How ‘friendly’ bacteria could help

Taking beneficial bacteria supplements, like probiotics, may be useful for people with acne. These can help replenish levels of good bacteria in your gut, which may play a role in reducing inflammation.3

This could potentially improve a ‘leaky gut’ and ease blemishes on your skin, although more clinical research is needed, and as a ‘leaky gut’ is not recognised as a medical condition, it is best to speak to your doctor before making any decisions.

What is a healthy skin microbiome?

Generally speaking, a healthy skin microbiome means that there is a good balance of bacteria on the skin, including various different microorganisms that work together in harmony.

This will show itself through un-problematic, healthy-looking skin. A healthy skin microbiome will also act as a barrier that protects against invading pathogens.7

What affects the skin microbiome?

There are multiple things that can affect the microbiome of the skin. There are things you can’t affect, such as your age, sex, or environment.8 But there are things you can control and change, such as your job, the clothes you wear, any medication you take, your use of cosmetic products, your weight, and your diet.9

3 skin conditions associated with gut issues

As we learn more about the relationship between skin and gut health, we’re also starting to understand more about the relationship between skin conditions and gut health. 

Read on to find out more about the 3 skin conditions that have been associated with gut issues.

1. Psoriasis

Psoriasis affects roughly 1.5% of people in the UK and 120 million people worldwide, making it the most common autoimmune disease.10,11 Its exact cause has never been pinned down, but research suggests the gut might have a key role to play.

In psoriasis, this autoimmune response causes skin cell production to go into overdrive. Excess skin cells build up in patches called plaques.9 These plaques are often very sore and itchy. Psoriasis can also affect the joints, causing swelling, stiffness, and pain (known as psoriatic arthritis).9

Some scientists think that psoriasis may be caused by an imbalance in the gut microbiome.10 A 2016 study found higher levels of E. coli (which has been associated with conditions such as inflammatory bowel disease) and lower levels of F. prausnitzii (which is thought to be crucial to intestinal and general health).10

Although more research is needed, the study’s author suggested that ‘the skin might function as a mirror of the gut’ in people living with psoriasis.

2. Eczema

Eczema, sometimes called dermatitis, is a skin condition that causes dry, cracked, itchy skin.12 It usually develops in early childhood, but some cases can develop in adulthood too.13 On average, it will affect 10% of people in their lifetime.14

Eczema is a common inflammatory skin condition where the skin gets red, irritated, bumpy, and itchy and it may be more noticeable at night.12 The exact cause of eczema is unknown, but some believe that it is caused by an overactive immune system – a bit like with psoriasis.13

Research into the link between eczema and gut health that was published in 2018 found that the skin microbiome of people with eczema doesn’t work as well to keep harmful bacteria out, and instead, some bad bacteria do seep in.15  Like with psoriasis, probiotics have been proposed by experts as a potential treatment for eczema, introducing more good bacteria into the gut with the hope that it will make its way to the microbiome of the skin, and as more clinical trials are taking place there is more promising results for the use of probiotics.16

3. Rosacea

According to the NHS, rosacea is a long-term skin condition that primarily affects the face. It’s most common in women and in people with lighter skin, but symptoms can sometimes be worse in men.17

Rosacea is a very common skin condition that usually starts with frequent blushing of the nose, cheeks, forehead, and chin – as well as a burning sensation when your face comes into contact with water or skincare products.16 Scientists have found that people with acne-like rosacea tend to react to a certain bacteria (bacillus oleronius), which causes the immune system to overreact.18

Research into this found that a high percentage of adults with rosacea also had gastrointestinal disorders like irritable bowel syndrome, inflammatory bowel disease, and coeliac disease.19

Since diet may impact rosacea through the gut-skin connection, scientists have advised that working on a healthy gut microbiome by going on a fibre-rich, prebiotic diet could be the way forward.20

What can we do to look after our skin microbiome?

The microbiome on our skin is responsible for a lot, and so it’s important that we look out for it as best we can, which will enable it to continue to do its job well.There are several things we can all do to nurture skin and give it the TLC it deserves.

For instance, we can: 
  • Eat a healthy, balanced diet and stay hydrated – There’s an association between our skin microbiome and immune system, therefore eating the right food and drinking enough fluids can help make sure our gut and skin bacteria stay happy.20 
  • Steer clear of trigger foods – Try and avoid any foods that might trigger allergies or food intolerances, e.g. dairy, gluten, or sugar, as these can affect the microbiome of the skin. 21
  • Take care of your gut microbiome too – One of the ways you can do this is by taking prebiotics and probiotics. A recent 2022 study found that probiotics are anti-aging and anti-wrinkle.22
  • Don’t be over the top with hand sanitising – This can actually unsettle your skin’s natural PH balance. Just like with washing our hair, it pays to not over wash your skin. Too much hand sanitiser can dry out your skin and cause skin irritation.23
  • Try to stay calm – i.e. be as stress-free as possible, which may be easier said than done, but stress can negatively impact our bodies in so many ways, skin included.24
  • Stay active – Regular exercise can help lower stress levels, as well as potentially help us to lose weight, sleep better, and generally be more fit.25  It may even boost our gut health too.

Busting 5 skin microbiome myths

It can be difficult to know the difference between fact and fiction when there’s such a vast amount of information about the microbiome of the skin on the internet.

To help you out and to help set the record straight about the skin microbiome, we’ve taken some of the most common myths and debunked them for you.

Take a look, we’ve listed five of them below:

MYTH #1: Skin microbiome doesn’t really do very much

Fact – Now this couldn’t be further from the truth!

The skin’s microbiome is a real force to be reckoned with. It’s essentially a powerful ecosystem that’s designed to help keep your skin healthy and in check. Now, for the science bit….

Skin microbiome is made up of diverse colonies of microorganisms, including bacteria, fungi, and viruses along with their genes.

Many of these microorganisms are harmless and, in some cases, provide vital functions, such as helping to preserve the balance on your skin.26

MYTH #2: We’ve all got the same skin microbiome

Fact – We haven’t at all.
Our skin microbiome is as unique to us as our fingerprints.

In fact, human skin microbiomes have been described as a ‘microbial fingerprint’ due to how different they are from one person to the next.

The skin biome is thought to be shaped by our lifestyle and genetic predisposition.8

This is especially true for the epidermal microbiome (the outermost layers of our skin). Interestingly, the skin microbiome that’s present deeper down within the skin, at the dermal layer, is said to be ‘universal’ between healthy individuals.27

MYTH #3: Skin microbiome has got nothing to do with gut microbiome

Fact – This is an easy assumption to make, as the bacteria inside our gut is tucked away deep down inside our bodies and the microbiome on our skin is, well, present on our skin.

However, this doesn’t mean they aren’t interlinked because they are.

Our skin bacteria and skin immune system actually ‘talk’ to each other and communicate with the bacteria living in your gut too.28

Just like with your gut, having a diverse balance is the key to a happy skin microbiome.29

MYTH #4: Our skin microbiome becomes unbalanced on its own

Fact – Our everyday lifestyle habits, in particular our cleaning habits, play a big part in settling and unsettling the natural state of our skin microbiome.
Having hot showers and taking baths every day, increased washing generally, and using ingredient-packed products that strip the skin of its natural oils can quickly result in our skin microbiome getting out of sync.

This is due to something that’s known as transepidermal water loss, which can result in moisture escaping from the skin.

How can you tell if your skin microbiome balance isn’t quite right? Your skin can become dry, irritated, or red.5

MYTH 5: There’s nothing we do to help our skin microbiome do its job

Fact – There’s actually a whole lot of things we can do.

In fact, a lot of what we do on a day-to-day basis influences the state and overall condition of our skin microbiome. 

Here are just some of the skin microbiome-boosting habits worth taking note of: 
  • be gentle to your skin – By using products that help protect and preserve your skin’s PH and its microbiome while you wash. I.e. use products that are gentle. 
  • stay hydrated – It’s no secret that staying hydrated can really help our skin overall.
  • think about your gut microbiome – It’s important to give your gut microbiome some TLC if you can as this may support your skin microbiome. 
  • exercise – As we all know, staying active and taking part in regular exercise can help us to stay healthy, as well as sweat out toxins and contribute towards better skin health overall.

Feeling a bit more clued up about skin microbiome now?


Well, now you can hopefully distinguish between some of the myths and some of the real truths about what is your skin’s microbiome and how it functions.

As you’ve most probably realised by now, skin microbiome is literally a whole world in itself that can influence how your skin looks and feels.

The key, as with most of the inner workings of our body, is taking the time to consider yours and trying to understand what makes your personal skin microsystem tick.

The final say

To recap, your skin is a precious living organ, and the skin microbiome provides a lot of benefits to the human body. The skin microbiome protects us from harmful pathogens – like bacteria or fungi.2

There’s also a link between a healthy skin microbiome and a healthy gut microbiome. Taking care of the good bacteria in your gut means you’re taking care of your skin, too.

Want to know more about your skin? We’ve got handy guides on the essentials for healthy skin as well as the basics of a good skincare routine.

Handpicked content

Disclaimer

 

Sources

1. Colella M, Charitos IA, Ballini A, Cafiero C, Topi S, Palmirotta R, Santacroce L. Microbiota revolution: How gut microbes regulate our lives. World J Gastroenterol. 2023. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10415973/
2. Grice EA, Segre JA. The skin microbiome. Nat Rev Microbiol. 2011. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3535073/
3. Ogunrinola GA, Oyewale JO, Oshamika OO, Olasehinde GI. The Human Microbiome and Its Impacts on Health. Int J Microbiol. 2020. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7306068/
4. Dréno B, Dagnelie MA, Khammari A, Corvec S. The skin microbiome: a new actor in inflammatory acne. American journal of clinical dermatology. 2020. Available at: https://link.springer.com/article/10.1007/s40257-020-00531-1
5. Young Bok Lee, Eun Jung Byun, Hei Sung Kim. Potential Role of the Microbiome in Acne: A Comprehensive Review. Journal of Clinical Medicine [Internet]. 2019 Jul 7 [cited 2024 Jan 22];8(7):987–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6678709/
6. O'Neill CA, Monteleone G, McLaughlin JT, Paus R. The gut‐skin axis in health and disease: a paradigm with therapeutic implications. Bioessays. 2016. Available at: https://onlinelibrary.wiley.com/doi/abs/10.1002/bies.201600008
7. Byrd, A., Belkaid, Y. & Segre, J. The human skin microbiome. Nat Rev Microbiol. 2018. Available at: https://www.nature.com/articles/nrmicro.2017.157
8. Grice EA, Segre JA. The skin microbiome. Nat Rev Microbiol. 2011. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3535073/
9. Brandwein M, Katz I, Katz A, Kohen R. Beyond the gut: skin microbiome compositional changes are associated with BMI. Human Microbiome Journal. 2019. Available at: https://www.sciencedirect.com/science/article/pii/S2452231719300120
10. Raharja A, Mahil SK, Barker JN. Psoriasis: a brief overview. Clin Med (Lond). 2021. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8140694/
11. Armstrong AW, Read C. Pathophysiology, Clinical Presentation, and Treatment of Psoriasis: A Review. JAMA. 2020. Available at: https://jamanetwork.com/journals/jama/article-abstract/2766169
12. Eppinga H, Sperna Weiland CJ, Thio HB, van der Woude CJ, Nijsten TE, Peppelenbosch MP, Konstantinov SR. Similar Depletion of Protective Faecalibacterium prausnitzii in Psoriasis and Inflammatory Bowel Disease, but not in Hidradenitis Suppurativa. J Crohns Colitis. 2016. Available at: https://pubmed.ncbi.nlm.nih.gov/26971052/
13. Nedorost ST. Generalized dermatitis in clinical practice. Springer Science & Business Media; 2012.
14. Frazier W, Bhardwaj N. Atopic dermatitis: diagnosis and treatment. American family physician. 2020. Available at: https://www.aafp.org/pubs/afp/issues/2020/0515/p590.html
15. Kim BE, Leung DYM. Significance of Skin Barrier Dysfunction in Atopic Dermatitis. Allergy Asthma Immunol Res. 2018. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5911439/
16. Makrgeorgou A, Leonardi-Bee J, Bath-Hextall FJ, Murrell DF, Tang ML, Roberts A, Boyle RJ. Probiotics for treating eczema. Cochrane Database Syst Rev. 2018. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6517242
17. Zhang, H., Tang, K., Wang, Y. et al. Rosacea Treatment: Review and Update. Dermatol Ther (Heidelb). 2021. Available at: https://link.springer.com/article/10.1007/s13555-020-00461-0
18. O'Reilly N. An Investigation of the Role of Bacillus oleronius in the Pathogenesis of Rosacea (Doctoral dissertation, National University of Ireland Maynooth). 2012. Available at: https://eprints.maynoothuniversity.ie/3903/
19. Egeberg A, Weinstock LB, Thyssen EP, Gislason GH, Thyssen JP. Rosacea and gastrointestinal disorders: a population‐based cohort study. British Journal of Dermatology. 2017. Available at: https://academic.oup.com/bjd/article-abstract/176/1/100/6747850
20. Weiss E, Katta R. Diet and rosacea: the role of dietary change in the management of rosacea. Dermatol Pract Concept. 2017. Available at: https://link.springer.com/article/10.1007/s13555-020-00460-1
21. Iweala OI, Nagler CR. The microbiome and food allergy. Annual review of immunology. 2019. Available at: https://www.annualreviews.org/doi/abs/10.1146/annurev-immunol-042718-041621
22. Yu J, Ma X, Wang X, Cui X, Ding K, Wang S, Han C. Application and mechanism of probiotics in skin care: A review. Journal of Cosmetic Dermatology. 2022. Available at: https://onlinelibrary.wiley.com/doi/abs/10.1111/jocd.14734
23. Bissett L. Skin care: an essential component of hand hygiene and infection control. British Journal of Nursing. 2007. Available at: https://www.magonlinelibrary.com/doi/abs/10.12968/bjon.2007.16.16.27075
24. Zouboulis CC, Elewa R, Ottaviani M, Fluhr J, Picardo M, Bernois A, Heusèle C, Camera E. Age influences the skin reaction pattern to mechanical stress and its repair level through skin care products. Mechanisms of ageing and development. 2018. Available at: https://www.sciencedirect.com/science/article/abs/pii/S0047637417300477
25. Mariano, I.M., Amaral, A.L., Ribeiro, P.A.B. et al. A single session of exercise reduces blood pressure reactivity to stress: a systematic review and meta-analysis. Sci Rep. 2022. Available at: https://www.nature.com/articles/s41598-022-15786-3
26. Grice EA, Segre JA. The skin microbiome. Nat Rev Microbiol. 2011 Apr;9(4):244-53. doi: 10.1038/nrmicro2537. Erratum in: Nat Rev Microbiol. 2011. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3535073/
27. Bay L, Barnes CJ, Fritz BG, Thorsen J, Restrup ME, Rasmussen L, Sørensen JK, Hesselvig AB, Odgaard A, Hansen AJ, Bjarnsholt T. Universal dermal microbiome in human skin. MBio. 2020. Available at: https://journals.asm.org/doi/10.1128/mbio.02945-19
28. Md. Rayhan Mahmud, Akter S, Sanjida Khanam Tamanna, Mazumder L, Israt Zahan Esti, Banerjee S, et al. Impact of gut microbiome on skin health: gut-skin axis observed through the lenses of therapeutics and skin diseases. Gut microbes [Internet]. 2022 Jul 22 [cited 2024 Jan 22];14(1). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9311318/
29. Salem I, Ramser A, Isham N, Ghannoum MA. The gut microbiome as a major regulator of the gut-skin axis. Frontiers in microbiology. 2018. Available  at: https://www.frontiersin.org/articles/10.3389/fmicb.2018.01459/full?fbclid=IwAR3uim7TNrsWH28dPGEFnZg2sNWAXP1ZSqcK9LERa-3ZoAqk6-fHTGhDcVU
 
bhupesh-panchal

Bhupesh Panchal

Author

Senior Regulatory Affairs Associate

Joined Holland & Barrett: April 2019

Masters Degree in Toxicology and BSc Hons in Medical Biochemistry

Bhupesh started his career as a Clinical Toxicologist for Public Health England, advising healthcare professionals all around the country on how to manage clinical cases of adverse exposure to supplements, pharmaceuticals, cosmetics, industrial chemicals and agricultural products.

After 7 years in this role and a further year working as a drug safety officer in the pharmaceutical industry, Bhupesh joined Holland & Barrett as a Senior Regulatory Affairs Associate in 2019.
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