Eczema and Gut Health: How Your Skin Reflects Your Microbiome

Eczema, also known as atopic dermatitis (AD), is a chronic inflammatory skin condition that affects millions of people worldwide. Statistics show that one in ten will develop it at some point. It is characterized by dry, itchy, and red skin that can cause significant discomfort and distress. While the exact cause of eczema is not fully understood, recent research has highlighted the important connection between gut health, the skin microbiome, and the development and severity of eczema symptoms.

We’ll cover exactly what it is, how the gut causes eczema, and what you can do to manage it naturally.

What is Eczema?

Eczema is a complex skin disorder that is believed to result from a combination of genetic and environmental factors. It often begins in childhood, with symptoms ranging from mild to severe. The most common symptoms of eczema include:

  • Dry, itchy skin
  • Red, inflamed patches
  • Cracking, oozing, or crusting skin
  • Thickened, scaly skin

Eczema can appear on various parts of the body, such as the face, hands, feet, and creases of the elbows and knees. The condition can be triggered or exacerbated by factors such as stress, irritants, allergens, and changes in temperature or humidity.

The Gut Health-Eczema Connection

The gut-skin axis, a concept that has gained momentum in recent years, suggests a direct relationship between our gut microbiome and skin health. The gut is home to trillions of microorganisms, collectively known as the gut microbiome. These microbes play a crucial role in maintaining overall health, including the health of our skin.

Research shows that people with eczema often have an imbalance in their gut microbiome, a condition known as dysbiosis.1Hulshof, L., et al. (2019). The gut microbiome in atopic dermatitis. European Journal of Dermatology, 29(4), 386-396.

Dysbiosis occurs when there is an overgrowth of harmful bacteria and a reduction in beneficial bacteria in the gut. This imbalance can lead to increased intestinal permeability, also known as “leaky gut,” which allows toxins, allergens, and partially digested food particles to enter the bloodstream. This can trigger an immune response and contribute to the development or worsening of eczema symptoms.2Salem, I., et al. (2018). The gut microbiome as a major regulator of the gut-skin axis. Frontiers in microbiology, 9, 1459.

The skin microbiome also plays a key role in the development of eczema. Studies have shown that individuals with eczema have a different composition of skin microbes compared to those without the condition. In particular, the skin of eczema patients often has higher levels of Staphylococcus aureus, a pathogenic bacteria that can exacerbate skin inflammation and damage the skin barrier.3Byrd, A. L., et al. (2017). Staphylococcus aureus and Staphylococcus epidermidis strain diversity underlying pediatric atopic dermatitis. Science translational medicine, 9(397), eaal4651.

Why are children at more risk of developing eczema?

Children are more susceptible to developing eczema for several reasons.

First, their immune systems are still developing, which can make them more sensitive to environmental triggers and allergens.

Second, children’s skin is more delicate and permeable than adult skin, allowing irritants and allergens to penetrate more easily.4Nutten, S. (2015). Atopic dermatitis: global epidemiology and risk factors. Annals of Nutrition and Metabolism, 66(Suppl. 1), 8-16.

Additionally, factors such as early antibiotic use, caesarean section delivery, and formula feeding have been associated with an increased risk of eczema in children. These factors can disrupt the development of a healthy gut microbiome, which is essential for maintaining skin health and preventing eczema.5Marrs, T., & Flohr, C. (2016). The role of skin and gut microbiota in the development of atopic eczema. British Journal of Dermatology, 175, 13-18.

Research has also shown that the first few months of life are a critical period for the development of the intestinal microbiome. Infants who develop a healthy microbiome during this time are less likely to develop eczema and other allergic diseases later in childhood.6Wopereis, H., et al. (2018). The first thousand days–intestinal microbiology of early life: establishing a symbiosis. Pediatric Allergy and Immunology, 29(5), 428-438.

Eczema and Antibiotics

Antibiotics are commonly prescribed to treat bacterial infections. However, they can also disrupt the delicate balance of the gut microbiome by killing off beneficial bacteria along with harmful ones. This can lead to dysbiosis and increased intestinal permeability, which can contribute to the development or worsening of eczema symptoms.7Kim, J. E., & Kim, H. S. (2019). Microbiome of the skin and gut in atopic dermatitis (AD): understanding the pathophysiology and finding novel management strategies. Journal of clinical medicine, 8(4), 444.

Studies have shown that early exposure to antibiotics, particularly in the first year of life, is associated with an increased risk of developing eczema. This risk appears to be dose-dependent, with higher antibiotic use corresponding to a greater likelihood of eczema development.8Tsakok, T., et al. (2019). Does early life exposure to antibiotics increase the risk of eczema? A systematic review. British Journal of Dermatology, 180(3), 514-523.

Eczema Triggers

Certain foods can trigger or worsen eczema symptoms in some people. The most common dietary triggers include:

  • Dairy products
  • Eggs
  • Soy
  • Wheat
  • Nuts
  • Shellfish

These foods can cause an immune response in sensitive individuals, leading to inflammation and exacerbation of eczema symptoms. However, it’s important to note that dietary triggers can vary from person to person, and not everyone with eczema will react to the same foods.9Nosrati, A., et al. (2017). Dietary modifications in atopic dermatitis: patient-reported outcomes. Journal of dermatological treatment, 28(6), 523-538

Food allergies are also more common in individuals with eczema, particularly in children. In fact, eczema is often the first manifestation of the “atopic march,” a progression of allergic diseases that can include food allergies, allergic rhinitis, and asthma.10Hill, D. A., & Spergel, J. M. (2018). The atopic march: critical evidence and clinical relevance. Annals of Allergy, Asthma & Immunology, 120(2), 131-137.

How does sugar or carbohydrate consumption affect dysbiosis?

A diet high in sugar and refined carbohydrates contributes to dysbiosis by promoting the growth of harmful bacteria in the gut. These bacteria thrive on sugar and can produce toxins that damage the intestinal lining, leading to increased permeability and inflammation.11Vaughn, A. R., et al. (2017). Skin-gut axis: The relationship between intestinal bacteria and skin health. World Journal of Dermatology, 6(4), 52-58.

Moreover, a high-sugar diet can also suppress the growth of beneficial bacteria, such as Bifidobacteria and Lactobacilli, which are important for maintaining a healthy gut microbiome and supporting skin health. Studies show that individuals with eczema often have lower levels of these beneficial bacteria in their gut.12Reddel, S., et al. (2019). The role of the gut microbiota in atopic dermatitis. Current Allergy and Asthma Reports, 19(11), 1-14.

Gluten, Dairy, and Leaky Gut

Gluten and dairy are two food categories that have been linked to the development of eczema and other allergic conditions. This connection is due to their impact on the gut lining and the development of leaky gut.

Gluten, a protein found in wheat, barley, and rye, has been shown to increase intestinal permeability in both celiac and non-celiac individuals.13Fasano, A. (2012). Leaky gut and autoimmune diseases. Clinical Reviews in Allergy & Immunology, 42(1), 71-78.

When you consume gluten, it can trigger the release of zonulin, a protein that regulates the tight junctions between intestinal epithelial cells. Elevated zonulin levels lead to increased intestinal permeability, allowing partially digested food particles, toxins, and bacteria to enter the bloodstream.14Fasano, A. (2011). Zonulin and its regulation of intestinal barrier function: the biological door to inflammation, autoimmunity, and cancer. Physiological Reviews, 91(1), 151-175. This can trigger an immune response and contribute to the development of eczema and other allergic conditions.

Similarly, dairy products, particularly those containing the protein casein, can also contribute to leaky gut syndrome. Casein also stimulates the release of zonulin and increase intestinal permeability.15Barbaro, M. R., et al. (2018). Zonulin and celiac disease. Current Opinion in Gastroenterology, 34(3), 150-154.

Additionally, many people lack the enzyme lactase, which is necessary for the proper digestion of lactose, the sugar found in milk. Undigested lactose can lead to gut dysbiosis and further contribute to intestinal permeability.16Ponte, R., et al. (2020). The role of microbiota in the pathogenesis of atopic dermatitis and new therapeutic options based on its modulation. Microorganisms, 8(10), 1516.

Several studies have supported the connection between gluten, dairy, and eczema. One published in the Journal of Allergy and Clinical Immunology found that children with eczema had higher levels of IgG antibodies against gluten and casein compared to healthy controls.17Ress, K., et al. (2014). Higher prevalence of IgG antibodies to milk and gluten in atopic dermatitis patients. Journal of Allergy and Clinical Immunology, 133(2), AB229. Another found that a gluten-free diet led to significant improvements in eczema symptoms in a subset of patients.18Ewing, W. M., & Allen, P. J. (2005). The diagnosis and management of cow milk protein intolerance in the primary care setting. Pediatric Nursing, 31(6), 486-493.

In addition to eczema, gluten and dairy have been linked to the development of other food sensitivities and allergies.

Leaky gut syndrome allows partially digested food particles to enter the bloodstream, where they can trigger an immune response. Over time, this can lead to the development of food sensitivities and allergies.19Perrier, C., & Corthésy, B. (2010). Gut permeability and food allergies. Clinical & Experimental Allergy, 41(1), 20-28. A study published in the journal Gut found that individuals with non-celiac gluten sensitivity had higher rates of food allergies compared to healthy controls.20Volta, U., et al. (2019). Non-celiac gluten sensitivity: A clinical challenge. Gut, 68(3), 579-580.

The mechanisms by which gluten and dairy contribute to leaky gut and allergic conditions are complex and involve interactions between the gut microbiome, immune system, and intestinal barrier function. Some studies have suggested that gluten and dairy can alter the composition of the gut microbiome, leading to an overgrowth of pathogenic bacteria and a decrease in beneficial bacteria.21Caminero, A., & Verdu, E. F. (2021). Celiac disease and the microbiome. Clinical Gastroenterology and Hepatology, 19(12), 2513-2522. This dysbiosis can further contribute to intestinal permeability and immune dysfunction.

While gluten and dairy are two common culprits in the development of leaky gut and allergic conditions, it’s important to note that other factors, such as stress, infections, and environmental toxins, can also contribute to these conditions.22Bischoff, S. C., et al. (2014). Intestinal permeability–a new target for disease prevention and therapy. BMC gastroenterology, 14(1), 189.

Natural Solutions for Eczema

There are several natural approaches that can help manage and improve eczema symptoms:

  1. Moisturize regularly: Using a fragrance-free, hypoallergenic moisturizer can help keep the skin hydrated and reduce itching and inflammation.23Loden, M. (2012). Effect of moisturizers on epidermal barrier function. Clinics in dermatology, 30(3), 286-296.
  2. Avoid triggers: Identifying and avoiding personal triggers, such as certain foods, stress, or environmental irritants, can help prevent eczema flare-ups.24Lee, J. H., et al. (2016). Role of the environment in the development of atopic dermatitis. Journal of Allergy and Clinical Immunology, 137(2), 346-348.
  3. Wear soft, breathable clothing: Choosing clothing made from soft, natural fibers like cotton can help reduce skin irritation and prevent overheating.25Lopes, C., et al. (2015). Fibers, textiles and their effects on atopic dermatitis. Textile Research Journal, 85(15), 1551-1560.
  4. Practice relaxation techniques: Stress can exacerbate eczema symptoms, so practicing relaxation techniques such as deep breathing, meditation, or yoga can help manage stress and reduce flare-ups.
  5. Use natural topical treatments: Applying natural remedies such as coconut oil, aloe vera, or chamomile cream can help soothe and heal eczema-affected skin.26Vaughn, A. R., et al. (2018). Natural oils for skin-barrier repair: ancient compounds now backed by modern science. American Journal of Clinical Dermatology, 19(1), 103-117.
  6. Improve gut health: Supporting gut health through a balanced diet, probiotics, and prebiotics can help reduce inflammation and improve eczema symptoms.27Makrgeorgou, A., et al. (2018). Probiotics for treating eczema. Cochrane Database of Systematic Reviews, (11).

Nutritional Supplements for Eczema

Several dietary supplements and probiotic strains have shown promise in managing or reducing eczema symptoms:

  1. Omega-3 fatty acids: Supplements rich in omega-3s, such as fish oil, can help reduce inflammation and improve skin hydration.28Balić, A., et al. (2020). Omega-3 versus omega-6 polyunsaturated fatty acids in the prevention and treatment of inflammatory skin diseases. International Journal of Molecular Sciences, 21(3), 741.
  2. Vitamin D: Adequate vitamin D levels are important for maintaining skin health, and supplementation may help improve eczema symptoms.29Kim, M. J., et al. (2020). Vitamin D status and efficacy of vitamin D supplementation in atopic dermatitis: a systematic review and meta-analysis. Nutrients, 12(4), 969.
  3. Probiotics: Specific probiotic strains, such as Lactobacillus rhamnosus GG and Bifidobacterium lactis, have been shown to reduce eczema severity and improve gut health.30Wang, I. J., & Wang, J. Y. (2015). Children with atopic dermatitis show clinical improvement after Lactobacillus exposure. Clinical & Experimental Allergy, 45(4), 779-787.,31Navarro-López, V., et al. (2018). Effect of oral administration of a mixture of probiotic strains on SCORAD index and use of topical steroids in young patients with moderate atopic dermatitis: a randomized clinical trial. JAMA dermatology, 154(1), 37-43.
  4. Prebiotics: Prebiotics, such as fructo-oligosaccharides and galacto-oligosaccharides, can help promote the growth of beneficial gut bacteria and improve eczema symptoms.32Foolad, N., et al. (2013). Effect of nutrient supplementation on atopic dermatitis in children: a systematic review of probiotics, prebiotics, formula, and fatty acids. JAMA dermatology, 149(3), 350-355.
  5. Evening primrose oil: This supplement contains gamma-linolenic acid (GLA), which has anti-inflammatory properties and may help reduce eczema-related itching and inflammation.33Simon, D., et al. (2014). An update on the role of omega-3 fatty acids on inflammatory and degenerative diseases. Journal of clinical medicine, 3(2), 579-605.

The connection between gut health and eczema has been further supported by studies involving fecal microbiota transplantation (FMT). In one study, children with eczema who received FMT from a healthy donor showed significant improvement in their symptoms compared to those who received a placebo.34Zhao, H., et al. (2020). Fecal microbiota transplantation for children with moderate to severe atopic dermatitis: A double-blind, randomized, placebo-controlled trial. Journal of Allergy and Clinical Immunology, 146(4), 933-943. This suggests that introducing healthy gut microbes can have a positive impact on eczema and overall skin health.

It’s important to note that while gut health plays a significant role in the development and management of eczema, other factors such as genetics, environment, and overall health status also contribute to the condition. Eczema has been linked to other chronic diseases such as asthma, allergic rhinitis, and even inflammatory bowel disease and celiac disease, highlighting the complex interplay between the gut, skin, and immune system.35Lee, S. Y., et al. (2019). Allergic diseases and their relationship with the gut microbiome. Journal of Asthma and Allergy, 12, 325-340.

Practical Summary

Clearly, the root cause of eczema is much more than skin deep. It’s truly a gut health issue, which is the place you need to look for improving skin health.

By understanding the role of the gut microbiome and skin microbiome in skin health and taking steps to support a balanced gut environment, individuals with eczema can better manage their symptoms and improve their overall quality of life.

A combination of natural remedies, dietary changes, and targeted supplementation, along with guidance from a healthcare professional, can provide a holistic approach to managing eczema and promoting healthier skin.

As research continues to unravel the complex relationship between the gut and skin, we can expect to gain a better understanding of how to prevent and treat eczema and other chronic skin conditions.

There are some things you can take action on right now.

First, you must consider there’s an existing imbalance of good and bad bacteria, favoring the bad.

Next, you need to look at diet and lifestyle choices that feed the bad bacteria, such as stress, sugar, dairy, and in general, a high-carb diet. Reducing the food for the bad bacteria is a crucial first step to stop making things worse.

Then, you can consider natural solutions, such as consistently using certain strains of probiotics, omega-3 fats, and other gut-supporting supplements and foods.

It will take time to reverse eczema, but with a concerted effort to change the diet for good, it can be virtually eliminated. Now that you know, it’s up to you to choose to live and eat in a way that supports your gut instead of harming it.