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The Surprising Autoimmune Skin Disease-Gut Health Connection

Written by Dr. Michael Ruscio, DC on December 19, 2020

Written by Dr. Michael Ruscio, DC on December 19, 2020 — Reviewed by Robert Abbott

Improve Skin Autoimmune Disease Symptoms by Paying Attention to Your Gut

The Gut-Skin Connection|
Autoimmune Skin Diseases|
Gut Health and Autoimmune Disease|
Diet and Lifestyle Improvements|
Bottom Line |

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Key Takeaways

The gut microbiome and the skin are connected via the skin-gut axis, and microbial imbalances (dysbiosis) in your gut or on your skin can contribute to the development of skin diseases.
There are several categories of autoimmune skin diseases, including connective tissue diseases, autoimmune blistering diseases, blood disorders, and discoloration diseases.
Symptoms of autoimmune skin disease vary and can include blistering, skin rashes, visible blood vessels, thickening of the skin, scaly patches, and lesions.
Research suggests some autoimmune diseases respond well to gut support.
Mild to moderate cases of autoimmune skin disease can benefit from natural therapies such as an anti-inflammatory diet, exercise, time in nature, natural sunlight, and probiotics

Autoimmune diseases, including skin autoimmune diseases, are on the rise. While the development of a skin manifestation of autoimmune disease is multifactorial, autoimmune skin diseases like psoriasis or vitiligo are the result of an immune response gone awry. Essentially, your immune system mistakenly attacks your healthy skin.

Just as with other autoimmune diseases, the body is affected systemically, which can impact quality of life and create less-than-ideal outcomes if left untreated [1]. In addition, while many autoimmune diseases are invisible to the naked eye, skin autoimmune diseases are on display for the world to see, which can impact your mental health.

If you’ve been struggling to manage your autoimmune skin disease, improving your gut health may be the missing link. In this article, we’ll discuss the connection between your gut and skin microbiomes, the current research about skin autoimmune diseases, how gut health impacts autoimmunity, and what you can do to improve your autoimmune skin condition.

The Gut-Skin Connection

Research is solidifying the importance of the gut microbiome as an overall driver of health, but did you know the goings on in your gut can also affect your skin? It may seem far-fetched that a scaly psoriasis patch could be connected to your gut health, but we now know there’s a link between the gut and the skin, called the skin-gut axis [2, 3].

The gut and the skin are both important immune system regulators and they each have their own unique microbiomes. When imbalances occur in either, your skin can be affected [4, 5]. As reported in one 2021 literature review, “dysbiosis in the skin and/or gut microbiome is associated with an altered immune response, promoting the development of skin diseases” [6].

Here are a few examples of how the gut-skin axis is involved in the development of skin manifestation of autoimmune disease and immune-mediated skin diseases (IMSDs):

Atopic dermatitis (eczema): While not confirmed as autoimmune in nature, skin microbial diversity is reduced, allowing for the proliferation of Staphylococcus aureus, which is a common cause of skin infections. In addition, there are lower concentrations of Faecalibacterium prausnitzii, which stimulate the production of short-chain fatty acids in the gut to provide an anti-inflammatory benefit [4].
Psoriasis: The skin lesions of psoriasis patients have higher levels of Proteobacteria, which are typically pathogenic, along with a higher Streptococcus-to-Proteobacteria ratio when compared to controls. In addition, the stool of psoriasis patients often has less beneficial bacteria and more of the pathogenic strains of E. coli. [4, 5, 7]. And one 2020 observational study and meta-analysis found gut dysbiosis among psoriasis patients when compared to controls, indicating a role of gut dysbiosis in the development of the disease [8].
Vitiligo: Patients with vitiligo experience the destruction of melanocytes (cells that give the skin its color) from immune cells, cytokines, or autoantibodies. Whereas their healthy skin sites have mainly Actinobacteria, the lesional sites have been found to be high in Firmicutes and Proteobacteria [4].
Systemic lupus erythematosus (SLE): Patients have been shown to have lower ratios of Firmicutes to Bacteroidetes bacteria on their skin and in their mouths [9], and they commonly have leaky gut [10].
Dermatitis herpetiformis: The skin manifestation of celiac disease (an autoimmune disease), resulting from small intestinal damage related to the consumption of gluten [11].

While more research needs to be completed, it does appear that skin autoimmune diseases are related in part to gut health. One example being the association between psoriasis and gut-related autoimmune diseases such as celiac and inflammatory bowel disease (IBD) [12, 13].

Common Autoimmune Skin Diseases

The full list of autoimmune skin conditions is exhaustive, but some of the more common ones include bullous pemphigoid, scleroderma, psoriasis, autoimmune vasculitis, and dermatomyositis. Additionally, while not previously considered autoimmune in nature, one 2019 systematic review and meta analysis found a strong association between autoantibodies and atopic dermatitis, indicating an immune-mediated connection [14].

There are several categories of skin autoimmune diseases:

Connective tissue diseases, such as dermatomyositis, morphea, scleroderma, psoriatic arthritis, and psoriasis. These diseases are often characterized by rashes, thickening of the skin, or changes in the collagen and connective tissue. Psoriasis is the most-researched autoimmune skin condition.
Autoimmune blistering diseases, such as linear IgA bullous disease, pemphigus and other pemphigoid diseases, and dermatitis herpetiformis. As the name implies, patients commonly have blisters or blister-like rashes.
Blood disorders like autoimmune-mediated vasculitis, which causes inflamed blood vessels in the skin.
Discoloration diseases, like systemic lupus erythematosus (SLE) — otherwise known as lupus — and vitiligo, in which the skin cells that create pigment die.

It’s difficult to say how many people have autoimmune skin conditions, as there are so many different types. The incidence of individual conditions is low, varying between 0.2% for scleroderma [15] and 3.2% for psoriasis [16].

Autoimmune Skin Disease Symptoms

Symptoms of autoimmune skin diseases vary widely, but skin manifestation of autoimmune disease is typical along with some of the common autoimmune symptoms, such as joint pain, fatigue [17], recurrent fevers, and problems with internal organs.

The most common symptoms include:

Blisters or blistering
Skin rashes
Visible blood vessels
Thickening of the skin or scaly patches
Lesions

Skin autoimmune diseases are typically diagnosed by a dermatologist or rheumatologist, who may evaluate your symptoms along with a general screening blood test for antinuclear antibodies (ANA). If the ANA test is positive, your doctor may order follow-up testing, such as skin biopsies or additional blood tests, to determine a diagnosis.

In moderate to severe cases, the skin manifestation of autoimmune disease can have a significant impact on quality of life by disrupting cosmetic appearance, sleep, and general comfort.

Gut Health and Autoimmune Disease

Many researchers and doctors have hypothesized that leaky gut — otherwise known as intestinal permeability — is a root cause of and a major risk factor for autoimmune diseases. While there is certainly evidence to suggest they’re connected, there isn’t research to confirm this yet.

Autoimmune diseases are thought to develop from a genetic predisposition, an environmental trigger, and the element of increased intestinal permeability [18]. While there is not yet data to suggest that repairing intestinal permeability improves autoimmune skin conditions directly, it makes sense that targeting root cause in the gut could lead to symptom improvement.

Research does suggest that some autoimmune disorders are responsive to gut support, particularly Hashimoto’s thyroiditis and IBD [19, 20, 21]. Let’s summarize what we know about how improving gut health can improve autoimmune diseases.

Hashimoto’s Thyroiditis and Gut Health

Hashimoto’s thyroiditis has been closely associated with small intestinal bacterial overgrowth (SIBO) [22, 23, 24], and resolving gut infections such as H. pylori [19] and Blastocystis hominis (a parasite) [25] has been shown to improve thyroid autoantibodies. Additionally, treatment with probiotic supplements has been shown to reduce fatigue and needed thyroid medication, likely because they help restore balance to the gut microbiome [26, 27, 28, 29, 30, 31, 32, 33].

Inflammatory Bowel Disease (IBD)

Inflammatory bowel disease encompasses several digestive diseases, including Crohn’s disease and ulcerative colitis. IBD appears to be related to the composition of the gut microbiome. In two studies, at least one-third of IBD patients had pathogenic bacterial infections in their guts [34, 35].

Fecal microbiota transplant (FMT) has been shown in several research studies to improve or resolve IBD [20, 21]. And finally, probiotic supplementation has been shown to improve the success rate of conventional IBD treatment [36] and to improve symptoms and quality of life for IBD patients [37, 38, 39, 40].

IBD is associated with the skin autoimmune disease psoriasis.

Other Autoimmune-Gut Connections

Type 1 diabetes and rheumatoid arthritis have also been shown to be related to gut health.

In one clinical trial, all the type 1 diabetes patients had results indicating leaky gut [41], leading the researchers to suggest small intestinal health plays a role in the development of type 1 diabetes.

Rheumatoid arthritis (RA) has also been shown in several studies to be affected by gut health. A meta-analysis suggests that more virulent strains of H. pylori are likely to increase the risk of rheumatoid arthritis, as well as lupus, autoimmune gastritis, and autoimmune pancreatitis [42]. Other research suggests that RA patients are more likely to have dysbiosis than controls [43, 44], and that probiotic supplementation improves inflammatory markers and disease activity [41, 45].

So while we have limited specific evidence that improving gut health can improve autoimmune skin disease, research suggests that improving the gut microbiome and gut health can impact autoimmune disease symptoms and disease markers. So we can cautiously presume that enhancing gut health would positively affect autoimmune skin conditions. Some limited evidence supports this notion.

Let’s discuss diet and lifestyle strategies that can be an adjunct to your standard medical treatment.

Can Diet and Lifestyle Improve Skin Autoimmunity?

Conventional treatment for skin autoimmune diseases typically includes immunosuppressive medications such as azathioprine. However, many of these medications come with challenging side effects [46]. Biologic medications are also used, and a 2021 systematic review and meta-analysis of randomized controlled trials found biologic medications such as infliximab, risankizumab, and brodalumab to be safe and effective for the treatment of psoriasis [47].

While immunosuppressive and biologic medications may be required for the treatment of severe skin autoimmune diseases, those with mild to moderate symptoms may experience significant relief from nutrition and lifestyle-related strategies like an anti-inflammatory diet, exercise, sun exposure, and probiotics.

Anti-Inflammatory Diet

A well-balanced, anti-inflammatory diet is foundational for improving gut and overall health for people with autoimmune diseases, and this goes for autoimmune skin conditions as well.

Let’s take a look at some of the research regarding diet and autoimmunity:

Gluten

Some evidence suggests that gluten may be a trigger for some skin conditions such as eczema [48, 49].
Celiac disease, an autoimmune condition that damages small intestine villi due to an immune reaction to gluten proteins, is associated with psoriasis [12].
A gluten-free diet has been shown to improve autoimmune thyroid disease and IBD [50, 51, 52, 53].

Low FODMAP

A 2019 systematic review found a low FODMAP diet may be helpful for improving gastrointestinal symptoms in those with scleroderma [54].

While more research needs to be completed, a whole-foods diet that’s gluten-free and low in processed and sensitive foods, sugars, and trans fats is worth a trial to reduce the inflammation that is the hallmark of autoimmune disease [55, 56, 57, 58, 59].

You can begin by incorporating more fresh, whole foods, or try an anti-inflammatory meal plan such as the Paleo diet.

If the Paleo diet doesn’t lead to symptom improvement, you might consider trying the low FODMAP diet or the Autoimmune Protocol (AIP) diet.

Exercise

If you have an autoimmune skin condition, creating good exercise habits can help improve your health, quality of life, and possibly disease activity.

Regular moderate exercise has been shown to decrease inflammation and general intestinal permeability [60, 61]. And one 2021 systematic review found exercise improved disease activity, pain, fatigue, skin symptoms, and quality of life in psoriatic arthritis patients [62]. In addition, a few studies have shown exercise to improve psoriasis [63], especially when combined with weight loss [64].

In the case of scleroderma, high-intensity interval training (HIIT) and resistance training twice a week for 12 weeks led to symptom reduction [65], and an at-home exercise program improved physical performance, quality of life, and disability [66].

A 2020 randomized controlled trial found resistance training to improve physical function and quality of life, but not disease activity, in women with Sjogren’s syndrome [67].

While SLE patients didn’t experience improvements in disease activity in one trial of moderate to high-intensity aerobic exercise, they did see improvements in fitness level, fatigue, and depression [68].

Time in Nature and Sun Exposure

Spending time in nature isn’t just a good way to tame your stress. It’s also been shown to help autoimmune skin symptoms. Some studies indicate that low vitamin D is associated with greater gut permeability and worse outcomes for people with IBD [69, 70, 71], and sun exposure has been shown to protect against digestive tract disease and inflammation, specifically diverticulitis and IBD [72].

A systematic review and meta-analysis also found that people with alopecia areata (an autoimmune skin condition) were more likely to be deficient in vitamin D [73].

Sun exposure specifically has been shown to reduce symptom severity for people with psoriasis [74]. It’s possible this may be due to increases in vitamin D status. If you have an autoimmune skin condition, consider discussing your vitamin D level and vitamin D supplementation with your healthcare provider.

Other Natural Therapies

Light therapy: Ultraviolet light therapy is a common treatment for those with psoriasis. One 2020 systematic review and meta-analysis of randomized controlled trials found some evidence to suggest a salt bath in addition to UVB light can help improve psoriasis symptoms [75].
Selenium: A 2020 randomized controlled trial found topical and oral selenium helped to improve oral lichen planus lesions as much as topical corticosteroids [76].
Tripterygium glycosides: An active compound of a Chinese herb has been found in a 2021 systematic review and meta-analysis of randomized controlled trials to decrease symptoms and inflammation in people with Sjogren’s syndrome [77].

In additional studies, a combination of Melissa officinalis (lemon balm), Damask rose, and fennel didn’t improve psoriasis more than placebo [78], and fecal microbiota transplant (FMT) was worse than placebo in those with psoriatic arthritis [79].

Probiotics

Probiotics can help promote a healthy immune system [80, 81, 82], rebalance the gut microbiome [80], reduce inflammation [83], and reduce leaky gut [84, 85, 86]. In addition to all the data we have that demonstrate their effectiveness for other autoimmune diseases, a few studies indicate probiotics can improve specific autoimmune skin conditions:

In one study, a group of patients with psoriasis were given a probiotic blend of Bifidobacterium longum, B. lactis, and Lactobacillus rhamnosus alongside topical steroid treatment. After 12 weeks, 67% of patients in the probiotic group had better symptom control compared to 42% of patients in the placebo group [87], and the probiotic group had a lower risk of relapse after six months.
In one additional study, participants with systemic sclerosis who were given a probiotic blend of Lactobacillus paracasei, L. rhamnosus, L. acidophilus, and Bifidobacterium lactis probiotics had lower levels of inflammatory T cells [88].
A 2020 systematic review and meta-analysis of randomized controlled trials found probiotics to improve the skin in atopic dermatitis (which may have an immune-mediated component) [89].
One study found probiotics helpful in improving gastrointestinal symptoms in scleroderma [54].

Given their potential to improve your gut and immune system function and to decrease your autoimmune symptoms without side effects, a trial of probiotic therapy may be worth your while if you have an autoimmune skin condition. For more about how to use probiotics to improve your gut health, see our Probiotics Starter Guide.

The Bottom Line

While more research needs to be completed, there does seem to be some good evidence that the health of the gut microbiome can affect autoimmune skin conditions.

For severe skin manifestations of autoimmune disease, medication may be necessary, but a healthy diet, lifestyle modification, and the addition of probiotics are low-cost, safe interventions that may significantly improve your symptoms and quality of life.

For more information on optimizing your gut health, check out my book Healthy Gut, Healthy You. If you’ve completed the step-by-step process outlined there, but still struggle with autoimmune skin disease symptoms or you desire a more personalized plan, contact the clinic at the Ruscio Institute for Functional Health.

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.

Dr. Michael Ruscio is a DC, natural health provider, researcher, and clinician. He serves as an Adjunct Professor at the University of Bridgeport and has published numerous papers in scientific journals as well as the book Healthy Gut, Healthy You. He also founded the Ruscio Institute of Functional Health, where he helps patients with a wide range of GI conditions and serves as the Head of Research.

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