The Gut-brain-skin Axis and Acne Vulgaris: Current Understanding and the Management Implications

It is known that a diverse microbiome is pivotal in maintaining physical health, with disruptions leading to multiple diseases such as inflammatory bowel disease, irritable bowel syndrome, diabetes mellitus, cardiovascular disease, and even skin conditions such as acne vulgaris. Although it is known that certain bacteria, such as Propionibacterium acnes , are strongly associated with acne development, other organisms have also been identified, such as Bacteroidetes, Prevotella, and Malassezia species, while species such as Lactobacillus and Bifidobacterium. Therefore, studies regarding the gut-brain-skin axis have been carried out, revealing the association between gut health and skin microbiome and the activation of the hypothalamic-pituitary-adrenal axis with the development of acne. This literature review summarizes the pathophysiology behind this complex process, introducing a promising outlook on the potential role of probiotics, especially consisting of Lactobacillus, and diet high in omega 3 fatty acids and fiber, as possible treatment methods, as insinuated by a number of randomized controlled trials revealing its beneficial role. However, there remains to be a paucity of consistent data supporting these methods in vivo , thus warranting further research.