The Gut-Skin Connection: How to Heal A Crohn’s Disease Rash - Dr. Michael Ruscio, DC

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The Gut-Skin Connection: How to Heal A Crohn’s Disease Rash

Why Gut Health Matters When It Comes to Clearer Skin

Key Takeaways:

  • There are many different skin conditions linked to Crohn’s disease, including fissures, canker sores, and erythema nodosum.
  • Healing the skin begins with fixing the gut, and eating an anti-inflammatory diet, like the low FODMAP or Paleo diet, is a great place to start.
  • Probiotics can help resolve symptoms of Crohn’s by reducing inflammation, restoring the gut flora, and regulating the immune system.
  • Stress management and treating any gut dysbiosis are essential for getting IBD Skinsymptoms under control.

They say that our skin is a reflection of our digestive health. And when it comes to dealing with a Crohn’s disease rash, this couldn’t be closer to the truth. If red bumps, rashes, cracks, or other skin lesions have recently popped up, it’s probably time to time to take a deeper look — at your gut.

Most people who have Crohn’s disease are very familiar with the digestive complaints that serve as the hallmark sign of this condition. However, nearly half of those diagnosed with this Crohn’s have non-digestive symptoms, with the skin being the next most commonly affected organ [1]. Erythema nodosum, canker sores, abscesses, and fissures (cracks) are all common manifestations of Crohn’s disease, and this is just to name a few. 

If you’re suffering from a Crohn’s disease rash, relief is on the way. When you have inflammatory bowel disease (and even if you don’t) healing your skin begins with addressing your gut health. Our 4-step, get-healing plan for Crohn’s disease includes a low FODMAP diet, probiotics, stress reduction, and fixing any gut bacteria imbalances. 

These tools can help lower inflammation, regulate your immune system, and get your digestive tract back to optimal health. Not to mention they will help you face the world with clear, glowing skin.

The Gut-Skin Connection

Research now supports that your skin is a representation of your digestive health [2, 3, 4]. Many skin conditions are thought to be linked to the gut, including acne, eczema, and psoriasis [5, 6, 7, 8, 9, 10].

While the exact mechanism of this connection isn’t quite clear, it’s likely due to an altered immune response. One study showed that those with rosacea (an inflammatory skin condition) often have small intestinal bacterial overgrowth (SIBO), which can cause inflammation. After the gut dysbiosis was treated, 93% of participants also saw an improvement in their rosacea [11].

Furthermore, people with psoriasis (an autoimmune skin condition), have more pathogenic bacteria in their gut, less healthy bacteria, and higher rates of dysbiosis than healthy populations [12, 13, 14, 15].

We may not have a rock-solid explanation quite yet, but the link between the skin and the gut is strong. The skin-gut axis is further supported by how common skin lesions are in autoimmune GI diseases, like IBD. In fact, a quarter of those diagnosed with Crohn’s disease had skin symptoms that preceded their digestive symptoms [1].

With this in mind, unhealthy skin can be seen as a warning sign that something deeper is going on. This is why it’s so important that we listen to what our body has to say and pay attention to our gut health.

What Is A Crohn’s Disease Rash?

woman scratching her itchy back with allergy rash

Crohn’s disease is a type of inflammatory bowel disease (IBD) that primarily affects the gastrointestinal tract and frequently presents with skin problems. A Crohn’s disease rash can take many different shapes and show up anywhere on the body.

Abscesses, fissures (cracks), and fistulas (a passage between the intestines and the skin) present near the anus and are at the top of the list, as they affect a third of those with Crohn’s. Oral skin lesions, like aphthous ulcers (canker sores), are also common and are similar to the intestinal ulcers found in IBD [1].

However, when it specifically comes to Crohn’s disease rashes, the most common rash is erythema nodosum. Erythema nodosum presents as red or purple nodules that lie under the skin, primarily on the shins, and are often painful [16].

For a comprehensive list of skin manifestations of inflammatory bowel disease, see the chart below [1]:

Keep in mind that there are a lot of different skin conditions that can be linked to Crohn’s disease and you don’t really need to know all of the information below. However, it’s here as a reference and can help point you in the right direction if a new rash or other skin lesion starts to pop up.

CategoryType of LesionPrevalence
Specific LesionsCutaenous lesions: ulcers, fissures, abscesses, fistulae, or skin tags found in the mouth or near the anus/rectum

Metastatic Crohn’s disease: plaques, nodules, or ulcers found on the face, genitals, arms, and legs
Up to 33% of Crohn’s patients have perianal fissures/ fistulae
Reactive LesionsPyoderma gangrenosum: tender papules or pustules that turn into an ulcer

Sweet’s Syndrome: neutrophilic dermatosis, papules and plaques on the head, neck, and arms
Sweet’s syndrome is relatively uncommon and presents with fever, high white blood cells, and muscle pain
Associated LesionsErythema Nodosum: red nodules typically found on the shins

Oral lesions: aphthous ulcers (canker sores), pyostomatitis vegetans, periodontitis (gum disease)
Erythema nodosum occurs in 6-15% of Crohn’s patients and it is more common in women

Oral lesions appear in 10% of those with Crohn’s
Drug-induced LesionsAppear similar to eczema or psoriasis

Caused by anti-TNF (tumor necrosis factor) therapy: infliximab, adalimumab, etanercept, etc.
Presents in 5-10% of those taking anti-TNF drugs

How to Treat a Crohn’s Disease Rash Naturally

As we saw above, Crohn’s disease rashes come in many different shapes and sizes, and can occur just about anywhere on the body. However, they all have the same underlying cause — an unhealthy gut.

We created an IBD-friendly guide to healing your gut, that can also leave you with clear and healthy skin. The foundations of Crohn’s disease treatment include:

  1. Eating an anti-inflammatory diet
  2. Supporting the gut with probiotics
  3. Changing your lifestyle to better manage stress
  4. Treating any bacterial overgrowth

Let’s dive into step one. 

Step 1: An Anti-Inflammatory Diet

diet & exercise mat fruit

One of the best, natural ways to get your immune system under control is to start with an elimination diet based on an anti-inflammatory framework. They remove foods that frequently trigger an immune response in the gut and further contribute to inflammation (and skin disorders).

Weight loss, malnutrition, and vitamin deficiencies are common in IBD, so it’s important you are eating nutrient-dense foods. We like to start patients on a whole-foods Paleo diet, which removes common, potential food triggers, including gluten, dairy, sugar, alcohol, trans fats, and processed foods.

Unsurprisingly, many of these are on the list of foods that IBD patients claim to worsen their symptoms [17, 18, 19].

Do your best to stick with it for 2-3 weeks. If you see improvement, you can slowly reintroduce foods back into your diet one at a time. If any symptoms pop back up after introducing a food, it’s probably best to leave it out of your diet a while longer while you continue to work on healing your gut.

A Low FODMAP Diet

If you don’t see any improvement in your symptoms after a month, it’s probably time to move on to another diet. You can try the low FODMAP diet next, which removes specific sugars, starches, and fiber that can feed an overgrowth of bacteria in the gut.

A 2016 systematic review of 12 clinical trials found that elimination-based diets (like the Paleo diet) and a low FODMAP diet were both effective at treating the symptoms of IBD [20]. Not only is the low FODMAP diet beneficial for reducing abdominal pain, diarrhea, and bloating in those with IBD [21], but it also restores the gut bacteria that help regulate the immune response in the GI tract [22].

Again, try this for 2-3 weeks to see if it works for you. If you have your diet dialed in and you are still experiencing symptoms, it’s time to move on to step two: introduce more healthy bacteria. 

Step 2: Probiotics

White medicine capsules probiotic powder inside

Probiotics are excellent at calming the immune response in the gut and reducing inflammation levels [23, 24, 25]. These benefits make them highly suitable for treating IBD symptoms, including skin rashes. Two separate studies show that probiotics are equally effective as the drug mesalamine in treating IBD, though combining the two therapies appears to deliver the best results [26, 27].

Probiotics can also restore the balance of your gut microbiome, and research shows that they may increase the number of beneficial bacteria in those with IBD [23, 28]. As a 2019 meta-analysis found that those with IBD have higher rates of dysbiosis and bacterial overgrowth [29], probiotics are likely a great tool in the treatment of Crohn’s symptoms.

Taking multi-strain probiotics seems to be even more effective at putting active IBD into remission, which is helpful for reducing overall symptoms [28, 30]. We recommend using triple probiotic therapy, which involves taking probiotics from three different categories to offer you the most benefit. 

For more help on where to start when using probiotic supplements, check out our probiotics starter guide

Step 3: Stress Management

Woman meditating at home

Our third pillar of treating inflammatory bowel disease focuses on lifestyle. Stress is a well-known trigger of IBD flare-ups, so it’s essential to find ways to mitigate it. Regular exercise, getting enough sleep, and finding ways to destress during the day are essential for those with chronic inflammation. 

Meditation can improve a Crohn’s disease rash in 3 important ways:

  1. It reduces stress and anxiety, which often affect the digestive system
  2. It invokes a relaxation response that can positively alter the genes involved in IBD
  3. It lowers inflammation that contributes to IBD disease activity

Mindfulness-based stress reduction (MSBR) is a practice that allows you to focus on your bodily symptoms, and your emotional responses to them, without judgment. MSBR can reduce anxiety related to digestive symptoms, depression, and stress in those with IBD [31, 32, 33].

Lowering your stress levels has an overall anti-inflammatory effect that helps create a healthier environment both in your gut and on your skin. 

Step 4: Tackle Gut Dysbiosis

A low FODMAP diet and probiotics are a great first step for fixing a gut bacteria imbalance, but they may not completely resolve IBD symptoms for everyone. If you still have persistent symptoms after following the above steps, it’s time to move on to the final phase — antimicrobials and/or an elemental diet for gut dysbiosis.

Natural antimicrobials are a great way to clear out any pathogenic bacteria or an overgrowth of “good” bacteria that may be underlying a Crohn’s disease rash. The incidence of SIBO is significantly higher in those with IBD [29], and this bacterial overgrowth has inflammation-promoting effects that may contribute to the development of IBD symptoms.

Several anti-inflammatory and antimicrobial herbs have been found to be helpful in treating IBD, including [34, 35, 36]:

  • Curcumin
  • Boswellia serrata (frankincense)
  • Plantago ovata (psyllium) 

If you prefer to address dysbiosis through diet, an elemental diet typically comes as a meal replacement shake and has anti-inflammatory and anti-microbial benefits. An elemental diet contains all the essential nutrients that your body needs and they come pre-broken down, making them easier to digest.

One study found that laboratory markers of SIBO normalized in 80% of participants after completing a 2-week elemental diet [37]. Furthermore, there is ample research on the effectiveness of elemental dieting in improving IBD symptoms, and it even may be just as effective as prednisone for putting IBD into remission [38, 39, 40, 41, 42, 43, 44, 45, 46, 47].

For a great-tasting formula, head on over to our online store where we have a variety of elemental diet options. 

The Conventional Approach

woman doctor patient consult consultation visit

If you have Crohn’s disease and are experiencing any type of skin lesion you should always check in with your healthcare provider, especially if you are in pain. More severe skin manifestations of Crohn’s disease may require extra support.

Conventional treatment of a Crohn’s disease rash involves prescription pharmaceuticals that primarily fall into the categories of anti-inflammatories, antimicrobials, and/or immunosuppressants. These drugs are also used to treat Crohn’s disease without skin complications and include [48]:

  • Sulfasalazine
  • Azathioprine
  • Mesalamine
  • Biologics (infliximab, adalimumab)
  • Methotrexate
  • Medicated mouthwashes for oral lesions

Your doctor may prescribe creams, like topical corticosteroids, that are used for inflammatory skin disorders and don’t come with the same side effects as oral steroids. Your gastroenterologist may make other recommendations to help get your IBD under control, such as avoiding smoking, NSAIDs, and alcohol (and we completely agree). 

If your skin rash is unrelated to Crohn’s disease or ulcerative colitis, or if your doctor isn’t sure which type you have, they will likely refer you to dermatology, where a biopsy can be performed.

Stop Your Crohn’s Disease Rash In Its Tracks

There are numerous types of skin disorders that can accompany IBD, but treating your Crohn’s disease rash almost always starts with healing the gut. Starting an anti-inflammatory diet, introducing more healthy bacteria into the digestive tract, and fixing a bacterial imbalance are great ways to reduce inflammation and heal your skin. 

While the above therapies are a great, natural way to fix your gut, more severe IBD flares or skin conditions may also require the use of prescription medications.  

Feel free to reach out to our functional medicine clinic, or check out my book, Healthy Gut, Healthy You, for more help with your symptoms.

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.

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Discussion

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