Gut-Skin Axis: Current Knowledge of the Interrelationship between Microbial Dysbiosis and Skin Conditions

Abstract

The microbiome plays an important role in a wide variety of skin disorders. Not only is the skin microbiome altered, but also surprisingly many skin diseases are accompanied by an altered gut microbiome. The microbiome is a key regulator for the immune system, as it aims to maintain homeostasis by communicating with tissues and organs in a bidirectional manner. Hence, dysbiosis in the skin and/or gut microbiome is associated with an altered immune response, promoting the development of skin diseases, such as atopic dermatitis, psoriasis, acne vulgaris, dandruff, and even skin cancer. Here, we focus on the associations between the microbiome, diet, metabolites, and immune responses in skin pathologies. This review describes an exhaustive list of common skin conditions with associated dysbiosis in the skin microbiome as well as the current body of evidence on gut microbiome dysbiosis, dietary links, and their interplay with skin conditions. An enhanced understanding of the local skin and gut microbiome including the underlying mechanisms is necessary to shed light on the microbial involvement in human skin diseases and to develop new therapeutic approaches.

Keywords: acne vulgaris; atopic dermatitis; dandruff; dietary; gut dysbiosis; probiotics; psoriasis; rosacea; skin cancer; skin microbiome; wound healing.

Figure 1

Inflammatory and microbial influences between the gut and skin for a healthy state (left) and a dysbiotic state (right): The intestinal and epidermal barriers are connected through the systemic circulation (blood and lymph) and are visualized here together in a simplistic manner. The dysbiotic state is characterized by an impaired gut barrier (imbalance in gut microbiome, reduced mucus layer, reduced IgA secretion, barrier disruption, intestinal permeation into the bloodstream, and gut inflammation) and an impaired skin barrier (imbalance in skin microbiome, reduced human and microbial antimicrobial peptides (AMP) production, skin rashes/thickening/lesions, and skin inflammation). Gut and skin dysbiosis are connected through an immune imbalance (Th2 skewing in this example), whereas crosstalk can be bidirectional.