How disruption in the gut-skin axis can lead to skin diseases | AAD 2026

The gut and skin are both barrier organs, and they speak to each other through three main channels, Sonal Choudhary, M.D., FAAD, a dermatologist and dermatopathologist at the University of Pittsburgh, said in a recent interview. (See figure below the video.)

The first is immune signaling — when the gut barrier is compromised, inflammatory cytokines enter systemic circulation and can trigger or worsen conditions like acne, eczema, and rosacea. The second is metabolites, particularly short-chain fatty acids (SCFAs) like butyrate, which healthy gut bacteria produce from dietary fiber. These SCFAs have a calming effect on the immune system, and when dysbiosis depletes the bacteria that make them, that anti-inflammatory buffer disappears. The third is the neuro-endocrine stress pathway: chronic stress elevates cortisol, which simultaneously weakens both the gut barrier and the skin barrier.