Acne and the Role of the Gut-Skin Axis
- Marcelline Goyen
- Dec 22, 2025
- 4 min read
Updated: 2 days ago
Table of content
Introduction: Acne and the Role of the Gut-Skin Axis
Acne is traditionally viewed as a skin condition. However, years ago, I noticed in my practice that this view is too narrow. When I started asking acne patients specifically about other complaints—such as digestive problems, gut issues, food sensitivities, or even sun allergies—it surprisingly often turned out there was a clear overlap. These observations prompted me to delve deeper into the relationship between the skin and the gut, also known as the skin-gut axis.
The Skin-Gut Axis: Not a New Hype, but Backed by Science
Already in 1930 two dermatologists Stokes and Pillsbury discovered a relation between acne, gut complaints and disorders and mental disbalance. The skin-gut-brain axis theory 'was born'. Many years later, in 2011, doctors Bowe and Logan published a groundbreaking scientific article describing the relationship between acne and gut health. Since then, there has been increasing scientific evidence linking acne to conditions such as SIBO (Small Intestinal Bacterial Overgrowth), IBS (Irritable Bowel Syndrome), and a disrupted gut microbiome. The intestines play a central role in immune regulation, inflammation, and hormonal balance—all factors that directly impact the skin. When the intestinal barrier is disrupted or the microbiome becomes unbalanced, this can lead to systemic low-grade inflammation, which can manifest itself in acne, among other things.
Cutibacterium acnes: Not the Culprit We Thought
For years, Cutibacterium acnes (formerly Propionibacterium acnes) was considered the primary cause of acne. This bacterium, C. acnes, can indeed contribute to inflammation in the sebaceous gland, but this is only part of the story.
C. acnes is also a resident of healthy skin. In fact, the bacterium fulfills a protective function by contributing to the skin's acidity. A skin pH of around 4.7 is essential for a properly functioning skin barrier and maintaining a healthy skin microbiome. C. acnes itself thrives at this pH and simultaneously helps indirectly keep other, harmful microorganisms in check.
The problem, therefore, is not the presence of C. acnes, but which microbes, such as bacteria, dominate, in which environment they live, and how the entire microbiome—of the skin and intestines—functions (or malfunctions).
The forgotten Factors: Diet, Lifestyle, and the Gut Microbiome
What is often overlooked in the classic acne approach is the gut-skin connection and the role of diet and lifestyle. Factors such as cow's milk (known for its pro-inflammatory and hormonal effects), highly processed foods, and sugary snacks play a significant role in the development and maintenance of inflammation. Food allergies and intolerances can also play a triggering role in acne. PUBMED1
Especially during puberty—a period of hormonal changes, increased stress sensitivity, and changing eating habits—the intestines are under increased strain. Combined with mental stress, this can lead to disruption of the gut microbiome, with consequences for the skin.
Therefore, restoring acne doesn't just start with creams or medication, but with restoring the foundation:
• a healthy gut microbiome,
• an anti-inflammatory diet,
• stress reduction, and lifestyle optimization.
From skin complaint to systems thinking
Acne is rarely a standalone problem. It's often a visible sign of an underlying imbalance. By approaching acne from the skin-gut axis, space is created for lasting improvement, rather than simply treating the symptoms.
At the same time, we know that topical and oral antibiotics are still too often used to treat acne to combat a perceived bacterial cause. However, this approach has a downside: antibiotics don't distinguish between harmful and harmless bacteria.
Not only is Cutibacterium acnes inhibited, but also numerous protective, resident bacteria on the skin and in the intestines. The result is a weakened and disrupted microbiome on the skin and in the intestines. This diminishes the intestinal barrier function, which can lead to increased inflammation and a dysregulated immune response. Through the skin-gut connection, this imbalance indirectly affects the skin, including a reduced skin barrier and increased susceptibility to acne and other inflammatory skin complaints.
Acne, prebiotics and probiotics
When intestinal disturbances occur, it's first important to identify the causes, such as dietary errors, nutrient deficiencies, food allergies or intolerances, stress, etc. In addition to a healthier diet and improved lifestyle, prebiotics (food for intestinal bacteria) and probiotics (living or dead bacteria and their cell debris) can be used to restore the intestines and gut microbiome and improve skin diseases like eczema and acne. A growing number of studies demonstrate beneficial effects of probiotics, but determining which probiotic is best for someone with acne (or other skin conditions) requires a tailored approach.
Prebiotics nourish and thus strengthen healthy intestinal bacteria that contribute to a healthy mucus layer and intestinal wall. Prebiotics are already found in dietary fiber from vegetables, fruits, grains, and mushrooms. Additional supplementation, such as inulin supplementation combined with psyllium fiber, can be helpful.
Books about acne and the gut-skin connection
In my latest Dutch book (2023), I delve deeply into this integrated approach to acne, the microbiome, nutrition, prebiotics, probiotics and lifestyle. The book has since been translated into English (2024) and will also be published in German in 2025. It's written for healthcare professionals who want to look beyond the skin, and for people with acne who understand that true skin improvement starts from within.
👉 Insight: Anyone who truly wants to understand and treat acne can no longer ignore the gut. You can read more about this in the scientifically based study book for healthcare professionals below!
Marcelline Goyen BSc Skin Therapy & Author - the Netherlands
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