The Skin-Gut Axis

As a natural health practitioner, we’re always working to identify the underlying drivers to our clients health concerns. That way we can address the root cause, rather than just treating symptoms, providing you with long term changes to your health. When it comes to skin health, I find Nutritional Medicine so powerful and key when resolving any issues whether it be eczema, psoriasis, acne or rosacea for example.

While under researched there’s increasing scientific and anecdotal evidence that our diet and gastrointestinal health have a strong impact on our skin, and can be key in the management of chronic skin conditions.1 This intrinsic connection between our digestive health and our skin, is known as the Gut-Skin Axis.

What is the Gut-Skin Axis?

Both the skin and gut are large contact organs sharing a number of important characteristics, one of the major ones being that they’re massively colonised with distinct microbial communities. The gut microbiome has an immune modulating effect on the skin and there’s a bidirectional link between the health of our gut and our skin which is known as the gut-skin axis.

This two-way relationship can have both positive and negative effects. A healthy functioning gut and microbiome can help modify the skin and reduce inflammation. And the skin too affects our gut, for example by producing chemicals like Vitamin D which support our gut health. However in an imbalanced state, dysbiosis in the gut has been linked to most skin conditions,1 due to this altered immune response which promotes the development of skin diseases such as atopic dermatitis, psoriasis, acne vulgaris, rosacea and dandruff.

The Role of Diet in Skin Disorders

Diet and specifically food allergies and sensitivities play a major role in the gut-skin axis. Some foods can act as triggers to skin conditions, for example in rosacea it’s well known anecdotally that certain foods may trigger the rosacea lesions, such as hot/spicy foods and alcohol, along with many lifestyle factors including hot temperatures and sun exposure.
Food allergies and sensitivities not only cause increased gut permeability (i.e. leaky gut syndrome), they also initiate an immune response, driving inflammation in the body which is often represented in chronic skin conditions.
Several studies have also found that psoriasis patients have a high incidence of Coeliac Disease and may benefit from following a gluten free diet.
Apart from the role of dietary triggers, we also know that our diet can also positively shape the health of our gut, for example pre and probiotics. We know that a diet rich in prebiotic fibres feeds and nourishes the healthy bacteria in our gut. So our diet can both be a trigger and a treatment consideration for maintaining a healthy gut and therefore healthy gut-skin axis.

Rosacea + SIBO

Rosacea is a chronic inflammatory skin condition which affects 15% of the population and the drivers behind it are multifactorial. However an increased risk of gastrointestinal disorders has been identified in rosacea patients, suggesting a strong role for the gut-skin axis in addressing this condition. And clinically over the years in my practice, this is something I have also observed.

Studies have shown that the prevalence of small intestinal bacterial overgrowth (SIBO) is in fact increased in rosacea patients. And that the eradication of SIBO in these patients, induced an almost complete regression of their cutaneous lesions.2

In another study of 50,000 rosacea patients, the prevalence of coeliac disease, Crohn’s disease, ulcerative colitis, Helicobacter pylori infection, SIBO, and IBS were all higher among patients with rosacea as compared with control subjects.3

Further research into this area is required as some results are still conflicted, however clinically I see a lot of clients with rosacea who have associated gastrointestinal issues, most notably SIBO. And the evidence seems to stack up against this. In another study, researchers found that patients with rosacea were 13 times more likely to have SIBO.4

Supporting a healthy gut microbiome along with identifying dietary triggers is a great treatment goal for clients suffering from rosacea who have often tried multiple therapies with little to no improvement. Conventional treatment often involves long term antibiotic use which is not only ineffective but negatively impacts their gut health and microbiome, leaving them in a worse state in the long term.


Since our diet and gastrointestinal health have shown to play such a key role in modulating our skin, identifying underlying bacterial dysbiosis and/or food sensitivities are two invaluable clinical tools in identifying the underlying drivers to chronic skin conditions.

The two most common tests we use clinically are:

GI-Map Stool Test
This easy at home stool test gives us a complete insight into one’s gastrointestinal health, identifying key gut pathogens like SIBO for example, which are often driving these skin conditions. The SIBO Breath Test is something we might also use in conjunction with this test.

Food Intolerance Test
This simple blood draw or finger prick test can be done in clinic with your practitioner or at home, and tests for 96 general foods. This is a fantastic test for identifying any food sensitivities which may be driving your chronic skin condition and/or other symptoms.

Our digestive health really does impact our overall health. And more and more research is going into what role our gut and its microbiome plays throughout our body and in chronic disease, including the gut-brain axis and the gut-skin axis as discussed. The research and clinical evidence does provide some promising insights into treatment considerations for chronic skin conditions. And through addressing our diet and gastrointestinal health, we can reduce inflammation throughout the body and address common skin conditions which often fail to respond to conventional treatments or are given little answers.

Get in touch with our Nutritionist Amanda Powell for more information, or please make a booking here.


1. O’Neil A. et al, 2016, ‘The Gut-Skin axis in health and disease: a paradigm with therapeutic implications.’ Bioessays 38: 1167–1176, 2016 WILEY Periodicals, Inc.

2. Parodi A. et al, 2008, ‘Small intestinal bacterial overgrowth in rosacea: clinical effectiveness of its eradication,’ Clin Gastroenterol Hepatol, 6(7) p759-64.

3. De Pessemier, Britta et al, 2021, “Gut-Skin Axis: Current Knowledge of the Interrelationship between Microbial Dysbiosis and Skin Conditions.” Microorganisms vol.9(2) p353

4. Weiss E, Katta R. 2017, ‘Diet and rosacea: the role of dietary change in the management of rosacea.’ Dermatol Pract Concept. Vol.7(4) p31-3

pHClinic Team

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