Eczema and the intestine-skin axis: what is the link?

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The human body is quite amazing. As we learn more about how the different parts interact, it becomes even more amazing. There is growing interest in how our gut and skin communicate with each other.

The “intestine-skin axis” refers to all of the connections between our skin and our digestive system. Both the skin and the digestive tract interact with our internal and external environment. This means that they are in constant communication with the world around us and the world inside us.

Much of this communication takes place through our body’s microbiome. Our microbiome is made up of billions of bacteria, fungi and other living things. They live in and on our bodies, mainly in our intestines and on our skin.

These microbes play an important role in our health. An imbalance in microbes in the skin or gut often affects the other. Alterations in the microbiome are observed under various health conditions. These include mental health issues, irritable bowel syndrome (IBS), diabetes, and skin issues.

Eczema is an inflammatory skin condition. People with eczema have distinct differences in their microbiomes. We are yet to discover how our microbes can be altered to promote better health. The hope is that this information can help find better treatments for eczema.

Treatment for eczema is no longer just about targeting your skin. It’s possible that changing your gut microbiome will improve your skin as well.

The constitution of the microbiome begins at birth. There is a number of factors that influence the colonies that settle in your gut and on your skin.

These include:

  • delivery method (vaginal or cesarean delivery)
  • how you were fed as an infant (breast milk or infant formula)
  • your age
  • stress
  • your genetic makeup
  • where in the world you live
  • the use of certain medications, including antibiotics

There isn’t a single healthy microbiome. A healthy person will not have the same microbiome as another healthy person.

Research noted distinct differences in the microbiome of people with certain diseases. We don’t know what happens first.

In babies and children, eczema can be an early sign of allergy risk. Eczema and allergies are both triggered by an abnormal immune response.

The immune system usually only responds to a real threat such as a virus or harmful bacteria. It will send an army of inflammatory proteins to fight an invader. With allergies or eczema, the immune system is triggered by something that shouldn’t trigger it.

Babies with eczema are more likely to develop food allergies or asthma. Allergy testing is often recommended for babies and children with eczema. Removing all allergens from the diet will often improve the skin.

Children with eczema have different skin bacteria compared to children without eczema.

Studies gut microbiome support the idea that skin and gut health are linked. Children without eczema have more gut microbiome the diversity compared to those who suffer from eczema. Greater diversity in the gut microbiome is often a sign of better health.

Sometimes children come out of eczema. In adults, especially the elderly, several changes occur naturally in the skin. This changes the skin’s microbiome to promote more beneficial bacteria. This crowds out many inflammatory bacteria associated with eczema. This may explain why some cases of eczema improve with age.

There are theories that changing the gut microbiome could improve eczema. Everyone’s microbiome is slightly different. It’s impossible to know what the “perfect” microbiome would look like to prevent or manage eczema.

There is also the continuing question of which comes first. Is something causing a change in the microbiome, leading to disease? Or is the disease causing a change in the microbiome?

Common treatments for eczema include topical creams or narrowband ultraviolet therapy. These can be found at change the skin microbiome. They promote healthy bacteria and reduce inflammatory bacteria on the skin. This relieves the symptoms of eczema.

You may have heard of fecal transplants. This is when gut bacteria from a healthy donor are introduced into someone else’s gut. This was done to restore healthy gut bacteria in people with inflammatory bowel disease (IBD) or Clostridium difficile (C. diff) infection.

Skin microbiome transplants could be the next step. Research is looking to see if it can help treat eczema. In theory, healthy skin bacteria from donors could restore balance to the skin microbiome. There is still work to be done before this becomes standard practice.

Probiotic supplements can be helpful for people with digestive symptoms. With skin and gut microbes so connected, could oral probiotics also support skin health? There are theories that changing gut bacteria with probiotics can improve skin as well. So far, there are no results to support this idea.

A 2018 Cochrane The review explored 39 randomized controlled trials on this topic. The review looked at whether oral probiotics would improve eczema. No trials have shown significant improvement in eczema with probiotic supplements.

At this point, there is no specific probiotic supplement to improve eczema. With further research, this may change.

There may be a promise with symbiotic. Symbiotic supplements include both probiotics and prebiotics. Probiotics are healthy bacteria, and prebiotics are food for probiotics. This combination can increase the chances that certain bacteria will thrive in the gut.

A Meta-analysis 2016 examined whether symbiotics could be useful for people with eczema. He has shown that specific symbiotics can help treat dermatitis in children aged 1 year and older. More research is needed to find out if symbiotics can play a role in preventing eczema.

People with eczema have more Staphylococcus aureus (S. aureus) bacteria on their skin. This bacteria is associated with greater inflammation. The more severe the eczema, the more S. aureus bacteria are present.

There are several species of beneficial bacteria that live on the skin. Many act as barriers to prevent harmful invaders from entering the body. Some bacteria actually have antimicrobial properties to block pathogens. The population of S. aureus makes it harder for beneficial bacteria to live on the affected areas of the skin.

There are things you can do to support gut health. At this point, it’s unclear exactly what the “best” gut microbiome is for eczema. People with eczema and other inflammatory conditions tend to have less diverse microbiomes.

Certain lifestyle choices can promote greater diversity in your microbiome:

  • Eat a diet high in fiber. A diet high in fiber is associated with greater diversity in your gut microbiome. Sources of fiber feed healthy bacteria in your gut. You can get fiber in your diet from whole grains, nuts, seeds, beans, vegetables, and fruits.
  • Incorporate fermented foods. Fermented foods are created using microbes. They are great sources of probiotics and can improve your gut health. Fermented foods include yogurt, kefir, tempeh, kimchi, and sauerkraut.
  • Limit alcohol consumption. Alcohol consumption has been shown to alter the gut microbiome. It can lead to the intestine dysbiosis. It is best to cut down on alcohol consumption if you can.
  • To manage stress. If you often feel stressed out, you know that stress can really affect how you feel. Research suggests that it may also change our microbiome. It’s unrealistic to let go of your stress completely, but finding ways to deal with it better can help.

We have billions of bacteria, fungi and other living things that live in and on our bodies. It makes up our microbiome. Most of these microorganisms live on our skin and in our intestines. These microorganisms are in constant communication. This is called the gut-skin axis.

Everyone’s microbiome is a little different, and there isn’t a perfect microbiome. There are distinct changes seen with certain conditions. People with eczema have different colonies of bacteria compared to people without eczema.

There is hope that modifying these colonies may play a role in the treatment of eczema. Many current treatments reduce inflammatory bacteria and promote the growth of beneficial bacteria. There are things you can do to support a healthy and diverse gut microbiome. It can also improve the health of the skin.


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