According to the American Academy of Dermatology, acne is the most common skin condition in the United States, affecting up to 50 million Americans annually and can occur at any stage of life, even continuing into one’s 30s and 40s.1 While acne vulgaris is a common skin disease, almost twice as many women seek help for their acne than men and one-third of total acne office visits are made by women over 25 years old.2
Traditionally, the development of acne has been attributed to four main factors, which include sebum production (which is a sticky oily substance the body produces to keep the skin moisturized), Propionibacterium acnes, or P. acnes colonization (which is a gram-positive anerobic bacteria that is associated with acne), follicular hyperkeratosis (which is the excessive development of keratin in hair follicles, that can result in elevated papules or small inflamed bumps) and inflammation.2
Although this traditional approach toward understanding why we are getting acne in the first place is a good jumping-off point toward managing acne, newer research has found that the development of acne is more multifactorial than we originally thought. Additional lifestyle, immunological, hormonal, environmental and nutritional factors can also play a role in the progression and management of acne.
The Gut-Skin Axis
A more recent look into the connection between our gut microbiome and our skin health has shown promising results, suggesting that if we want to support our skin health then we must look at our gut health, as well. As the body’s largest organ, the skin often reflects what’s occurring inside our bodies and can accurately reflect where there might be imbalances internally. A growing body of research suggests that focusing on our gut-skin axis, which refers to the bidirectional relationship between the gut microbiome and skin health (that’s right, your gut and skin communicate with each other, think of them as long distant best friends), can regulate skin health.
Just like we have the gut microbiome, newer research has found that we also have the skin microbiome, suggesting that having a healthier gut could lead to healthier skin. Studies show the gut and skin microbiome fight against pathogens, modulate inflammation and regulate the immune system, all of which are contributing factors to acne.3,4
So how do we actually address our gut health in order to support our skin health? Our first focus should be on supporting the integrity of the gut with a combination of lifestyle and nutritional factors. Minimizing the use of harsh ingredients and chemicals that can disrupt the gut microbiome, such as BPA (bisphenols), phthalates, persistent organic pollutants, heavy metals and pesticides is a great first step, as they can negatively impact the gut microbiome, leading to alterations in microbial composition (and microbial diversity), gene expression and function. This means taking a look at your cleaning products, your cosmetic and skin care products, as well as your water, food, and yes, even supplements.5
Secondly, it is absolutely imperative that you also look at your overall stress “bucket,” or your allostatic load and cumulative burden of chronic stress in your life. Psycho-emotional stress leads to a neuroendocrine (brain hormone) response, which then releases inflammatory cytokines in the skin. Higher reported stress levels have been associated with increased acne in adult women.6 Chronic stress can also negatively affect the gut microbiome, alter intestinal permeability (think “leaky gut”) and even change the composition of our gut bacteria and lower certain nutrients (such as zinc, B vitamins and vitamin C), all of which can influence our skin health (remember the gut-skin axis we talked about earlier).
Lastly, there are several nutrients that can be incorporated into your routine to support your gut-skin axis and ultimately support your clear skin goals!
Zinc—Zinc has been shown to reduce the number of papules and pustules in people with acne. Zinc plays a role in immune function, particularly by maintaining macrophage, neutrophil, and NK cell activity (parts of the immune system) and overall microbial inflammatory balance, and enhancement of tight junctions. As a reminder, disruption to tight junctions can cause a “leaky gut,” which is associated with the progression of acne.8
Short Chain Fatty Acids (SCFAs), such as tributyrin—Tributyrin is a prebiotic that can support healthy digestion by supporting the gut-skin axis and the intestinal barrier. Tributyrin has been shown to reduce “leaky gut” and balance intestinal microbial makeup, bacteria type, and proportions. Tributyrin can help balance the gut microbiota, specifically promoting a balanced Firmicutes: Bacteroidetes ratio, used as a biomarker for acne. Acne patients exhibited lower gut microbiota diversity and a higher ratio of bacteroidetes to firmicutes. Tributyrin provides gut barrier protection via its ability to deliver butyrate, a SCFA substrate that feeds colonocytes (epithelial cells that line the colon) that protect mucosal barrier function.9
Postbiotics—Postbiotics are metabolites (byproducts) of probiotics and have been shown to enhance barrier function through the stimulation of tight junctions. Postbiotics can have both systemic and local immune-modulating properties by stimulating various cytokines and interacting with toll-like receptors (TLR) that mediate inflammatory pathways in the gut and the innate immune response. Postbiotics can modulate the microbiome, as well as help with the production of SCFAs, which can support intestinal barrier function and support skin health via the skin-gut axis. Lactobacillus plantarum has shown promising results in maintaining the integrity of the intestinal barrier.7
Marshmallow root—The scientific name for marshmallow root (Althaea officinalis) comes from the Greek word “altho,” meaning “heal,” which is why it can be a great herb in your acne arsenal. Known for its inflammatory modulating and hydrating properties, marshmallow root can be used to support the GI (gastrointestinal) tract, specifically to soothe GI inflammation that can impact the gut-skin axis. Research in rats has found that marshmallow root may help restore the integrity of the gut lining by helping to form a protective barrier around the tight junctions.10 Polysaccharides in marshmallow roots also provide mucilaginous or moisturizing properties to support the gut-skin axis.
Novel and exciting research on the gut-skin axis confirms that the integrity of your gut can indeed influence the integrity of your skin. Understanding the important interconnected aspects of our gut microbiome and our skin allows us to take a more integrative approach toward acne management.VR
1 American Academy of Dermatology Association, 2019.
2 Zeichner et al., 2017.
3 Thye et al., 2022.
4 Microbiome Reveals New Clues about Skin Aging, 2024.
5 Chiu et al., 2020.
6 Morshed et al., 2023.
7 Mosca et al., 2022.
8 Gupta et al., 2014.
9 Coppola et al., 2022.
10 Zaghlool et al., 2015.
Brianna Diorio holds a PhD in integrative medicine from the University of Natural Medicine and is a clinical nutritionist with a Master’s of Science in Human Nutrition from the University of Bridgeport. She is also a functional diagnostic nutrition practitioner (FDN), an herbal practitioner through the Herbal Academy, a family herbalist through The School of Natural Healing, a NASM certified personal trainer, and a holistic lifestyle coach from the C.H.E.K Institute. Diorio is the host of the Brianna Approved Podcast, which is a podcast for people who like a holistic approach to real science and clinical research on all things nutrition, botanicals and balance. She currently works as a clinician with her private practice that specializes in alternative health, functional medicine and dietary supplements. Diorio works with a vast array of clients and businesses to educate and improve their health and dietary needs.