The Surprising Autoimmune Skin Disease-Gut Health Connection

Improve Skin Autoimmunity by Paying Attention to Your Gut

Autoimmune skin diseases like psoriasis or vitiligo occur when your immune system mistakenly attacks your normal skin [1]. Like other autoimmune disorders, autoimmune skin diseases affect not only your skin but other parts of the body too. Additionally, they can affect one main marker of your identity: your appearance.

If you’re facing a diagnosis of skin disease, you likely want to take action so you can confidently face the world. To that end, we’ll talk about the connection between autoimmune skin conditions and gut health.

Let’s discuss what research suggests about autoimmune skin diseases, how your gut and your skin microbiomes are connected, how gut health affects autoimmunity, and what you can do to improve your autoimmune skin condition.

Autoimmune skin disease: Cracked and flaky skin on both hands

Common Autoimmune Skin Diseases

The full list of autoimmune skin conditions is exhaustive, but some of the more common ones include scleroderma (which includes psoriasis), autoimmune vasculitis, and dermatomyositis. Newer but inconclusive data indicate that eczema may be an autoimmune condition as well [2].

There are several categories of autoimmune skin 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 [3 Trusted SourcePubMedGo to source] and 3.2% for psoriasis [4 Trusted SourcePubMedGo to source].

Autoimmune Skin Disease Symptoms

Symptoms of autoimmune skin diseases vary widely, but skin symptoms are typical along with some of the common autoimmune symptoms, such as joint pain, fatigue [5], 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

Autoimmune skin disease is 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 find a diagnosis.

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

The Gut-Skin Connection

Autoimmune skin disease: 3D illustration of intestinal villi and lining

It might seem strange that a rash on your arm could be related to what’s happening in your belly, but your skin and your gut play similar roles in immune function [6 Trusted SourcePubMedGo to source]. Evidence suggests that intestinal health can influence your skin condition [7 Trusted SourcePubMedGo to source, 8 Trusted SourcePubMedGo to source] and that imbalances in the gut microbiome can affect your skin [9 Trusted SourcePubMedGo to source].

The skin microbiota likely plays a role in the following immune-mediated skin diseases [10 Trusted SourcePubMedGo to source] and conditions:

  • Atopic dermatitis (eczema)
  • Psoriasis
  • Vitiligo
  • Systemic lupus erythematosus (SLE)

The skin has its own unique and diverse microbiome, just like the gut, and some researchers have hypothesized that imbalances in the skin microbiome contribute to the emergence of autoimmune skin disorders [11 Trusted SourcePubMedGo to source].

For example, psoriasis skin lesions show higher levels of Proteobacteria (which is typically pathogenic), and a higher ratio of Streptococcus to Proteobacteria than controls [12 Trusted SourcePubMedGo to source]. Psoriasis patients also more often had less beneficial bacteria, and more pathogenic strains of E. coli in their stool samples than controls [13 Trusted SourcePubMedGo to source].

Similarly, systemic lupus erythematosus (SLE) patients have been shown to have lower ratios of Firmicutes to Bacteroidetes bacteria on their skin and in their mouths [14 Trusted SourcePubMedGo to source], and they commonly have leaky gut [15 Trusted SourcePubMedGo to source].

There isn’t yet a lot of data that broadly links gut health and autoimmune skin conditions, but consider these two additional specific examples:

  • Dermatitis herpetiformis is a manifestation of small intestine damage from celiac disease and gluten-sensitive enteropathy [16 Trusted SourcePubMedGo to source].
  • Psoriasis, a form of scleroderma, was shown in a systematic review and meta-analysis to be associated with celiac disease and its markers [17]. In another systematic review and meta-analysis, it was also found to be associated with inflammatory bowel diseases (IBD) such as Crohn’s disease and ulcerative colitis [18 Trusted SourcePubMedGo to source].

So while we can’t say that all autoimmune skin conditions are related to gut health, a growing body of data suggest that there is a relationship between what is happening in your gut and what is happening on your skin.

Gut Health and Autoimmune Disease

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

But research does suggest that some autoimmune diseases are responsive to gut support, particularly Hashimoto’s thyroiditis and inflammatory bowel disease [19 Trusted SourcePubMedGo to source, 20, 21 Trusted SourcePubMedGo to source]. However, there is not yet data to suggest that repairing intestinal permeability improves autoimmune skin conditions directly.

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 Trusted SourcePubMedGo to source, 23 Trusted SourcePubMedGo to source, 24], and resolving gut infections such as H. pylori [25 Trusted SourcePubMedGo to source] and Blastocystis hominis (a parasite) [26 Trusted SourcePubMedGo to source] have been shown to improve thyroid autoantibodies. Additionally, treatment with probiotic supplements have been shown to reduce fatigue and needed thyroid medication, likely because they help restore balance to the gut microbiome [27 Trusted SourcePubMedGo to source, 28 Trusted SourcePubMedGo to source, 29, 30 Trusted SourcePubMedGo to source, 31 Trusted SourcePubMedGo to source, 32 Trusted SourcePubMedGo to source, 33 Trusted SourcePubMedGo to source, 34 Trusted SourcePubMedGo to source].

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 [35 Trusted SourcePubMedGo to source, 36 Trusted SourcePubMedGo to source].

Fecal microbiota transplant (FMT) has been shown in several research studies to improve or resolve IBD [37, 38 Trusted SourcePubMedGo to source]. And finally, probiotic supplementation has been shown to improve the success rate of conventional IBD treatment [39 Trusted SourcePubMedGo to source] and to improve symptoms and quality of life for IBD patients [40 Trusted SourcePubMedGo to source, 41 Trusted SourcePubMedGo to source, 42 Trusted SourcePubMedGo to source, 43 Trusted SourcePubMedGo to source].

IBD is associated with psoriasis, an autoimmune skin disease.

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 [44 Trusted SourcePubMedGo to source], 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 [45]. Other research suggests that RA patients are more likely to have dysbiosis than controls [46 Trusted SourcePubMedGo to source, 47 Trusted SourcePubMedGo to source] and that probiotic supplementation improves inflammatory markers and disease activity [48 Trusted SourcePubMedGo to source, 49 Trusted SourcePubMedGo to source, 50 Trusted SourcePubMedGo to source].

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 improving 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?

A man running in the field

Standard treatments for autoimmune skin disease are typically immunosuppressive medications such as Azathioprine. However, many of these medications come with challenging side effects [51]. The good news is that in some of the more common autoimmune skin diseases, diet, and lifestyle efforts like probiotics and exercise have helped patients feel better.

Healthy, Anti-Inflammatory Diet

Eating a healthy, anti-inflammatory diet is one of the most important first steps to take to improve your gut and overall health, and this goes for autoimmune skin conditions as well.

Some evidence suggests that gluten may be a trigger for some skin conditions such as eczema [52 Trusted SourcePubMedGo to source, 53 Trusted SourcePubMedGo to source]. Celiac disease, an autoimmune condition that damages the villi in the small intestine due to an immune reaction to gluten proteins, is associated with psoriasis [54].

A gluten-free diet has also been shown to improve autoimmune thyroid disease and inflammatory bowel disease [55 Trusted SourcePubMedGo to source, 56 Trusted SourcePubMedGo to source, 57 Trusted SourcePubMedGo to source, 58]. However, there is as of yet no specific data to show that a gluten-free diet improves autoimmune skin conditions.

That said, a whole foods diet that is gluten-free and low in processed foods, sugars, and trans fats is worth a trial to reduce the inflammation that is the hallmark of autoimmune disease [59 Trusted SourcePubMedGo to source, 60 Trusted SourcePubMedGo to source, 61 Trusted SourcePubMedGo to source, 62 Trusted SourcePubMedGo to source, 63 Trusted SourcePubMedGo to source, 64 Trusted SourcePubMedGo to source]. You can choose to incorporate more fresh, whole foods into your diet or try an anti-inflammatory diet such as the Paleo diet or Whole 30 diet.

If the Paleo diet doesn’t shift your symptoms, you might consider trying the low FODMAP diet or the Autoimmune Paleo Diet (AIP).

Exercise

If you have an autoimmune skin condition, creating good exercise habits can help improve your health.

Regular moderate exercise has been shown to decrease inflammation and general intestinal permeability [65 Trusted SourcePubMedGo to source, 66 Trusted SourcePubMedGo to source]. In a few studies on psoriasis and scleroderma, exercise has also been shown to improve psoriasis [67], especially when combined with weight loss [68 Trusted SourcePubMedGo to source]. Another study showed that high-intensity interval training (HIIT) and resistance training twice a week for 12 weeks reduced the symptoms of scleroderma [69 Trusted SourcePubMedGo to source].

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 [70 Trusted SourcePubMedGo to source, 71 Trusted SourcePubMedGo to source, 72 Trusted SourcePubMedGo to source], and sun exposure has been shown to protect against digestive tract disease and inflammation, specifically diverticulitis and inflammatory bowel disease [73 Trusted SourcePubMedGo to source].

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 [74 Trusted SourcePubMedGo to source].

Sun exposure specifically has been shown to reduce symptom severity for people with psoriasis [75 Trusted SourcePubMedGo to source]. It’s possible this may be due to increases in vitamin D status. If you have an autoimmune skin condition, consider supplementing with vitamin D.

Probiotics

Probiotics help promote a healthy immune system [76 Trusted SourcePubMedGo to source, 77 Trusted SourcePubMedGo to source, 78 Trusted SourcePubMedGo to source], rebalance the gut microbiome [79 Trusted SourcePubMedGo to source], reduce inflammation [80 Trusted SourcePubMedGo to source], and reduce leaky gut [81 Trusted SourcePubMedGo to source, 82 Trusted SourcePubMedGo to source, 83 Trusted SourcePubMedGo to source]. 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, 24% more patients using probiotics had better symptom control [84 Trusted SourcePubMedGo to source] and 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. acidophillus, and Bifidobacterium lactis probiotics had lower levels of inflammatory T cells [85 Trusted SourcePubMedGo to source].

Given their potential to improve your gut and immune system function and to decrease your autoimmune symptoms without side effects, a trial of probiotics 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

Despite a lack of clear data, there is good inferential evidence that autoimmune skin conditions are likely affected by the health of your gut microbiome. A healthy diet, lifestyle habits, and probiotics are low-cost and unlikely to harm you, and they can potentially make a significant difference in your symptoms and quality of life.

➕ References
  1. Use for reference links. Use Pubmed citation NOT just URL when available

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