You've seen patients like Sarah walk into your office: A 34-year-old marketing executive with visible frustration etched on her face. She's tried every cream, ointment, and prescription medication her dermatologist recommended for her persistent eczema and psoriasis. She's eliminated foods, changed laundry detergents, and invested thousands in expensive skincare routines. Yet her eczema flares continue to disrupt her sleep, and her psoriasis patches persist despite months of aggressive treatment. She says, "there has to be something we're missing."

You hear this story repeatedly in your practice. This scenario plays out in millions of homes across America every day. While conventional medicine has made significant strides in managing skin conditions, you've likely observed that many of your patients find themselves trapped in a cycle of temporary relief followed by frustrating relapses. The missing piece of the puzzle often lies in understanding the profound connection between the digestive system and skin health.

Recent groundbreaking research has revealed what scientists call the "gut-skin axis," a bidirectional communication highway between the intestinal tract and skin that influences inflammation, immune function, and overall skin health. This emerging field of study is revolutionizing how you can approach chronic skin conditions like eczema and psoriasis in your practice, offering your patients hope for lasting relief by addressing root causes rather than just managing symptoms.

In this final article in this microbiome series, you'll discover how gut health directly impacts skin conditions, learn about cutting-edge functional testing that can uncover hidden triggers, and explore evidence-based strategies that have helped thousands of patients achieve clearer, healthier skin from the inside out. Most importantly, you'll gain practical tools and actionable steps to begin addressing the root causes of your patients' skin concerns.

Table of Contents

Before diving into solutions, it's important for you to understand the magnitude of skin disorders in your patient population. These conditions affect far more people than you might realize, creating not just physical discomfort but significant emotional and economic burdens that impact your patients' overall well-being. 

Eczema affects approximately 31.6 million Americans, representing 10.1% of adults and 13% of children. For many of your patients, eczema is far more than just a cosmetic concern; it’s a debilitating condition that disrupts sleep, affects work performance, and significantly impacts quality of life.

Psoriasis presents an equally challenging picture in your practice, affecting 7.5 million Americans or about 2.2% of the adult population. Beyond the visible symptoms, you should be aware that psoriasis is associated with increased risks of cardiovascular disease, diabetes, and inflammatory bowel disease, highlighting its systemic nature.

Perhaps most concerning for your practice is the trajectory of these conditions. Both eczema and psoriasis rates have been steadily increasing over the past several decades, particularly in developed countries. This trend suggests that environmental and lifestyle factors, rather than genetics alone, play a significant role in their development and progression, areas where you can make a meaningful intervention.

The Conventional Treatment Limitations

For eczema patients in your practice, the standard treatment protocol typically begins with topical corticosteroids. However, you're well aware that long-term use carries significant risks, including skin thinning, stretch marks, and increased susceptibility to infections. When topical steroids prove insufficient, you may prescribe topical calcineurin inhibitors, but these come with potential increased cancer risk concerns with prolonged use.

For more severe cases, treatment escalates to systemic therapies including oral corticosteroids and immunosuppressants, but these medications suppress the entire immune system, increasing your patients' vulnerability to infections and certain cancers. The newest biologics and JAK inhibitors can be highly effective but are expensive, require ongoing monitoring, and still don't address the underlying factors that trigger the inflammatory response.

The fundamental limitation of conventional approaches that you've likely observed lies in their focus on symptom suppression rather than root cause resolution. While these treatments can provide significant relief, they typically require ongoing use to maintain benefits, and when discontinued, symptoms often return with potential rebound effects.

The Gut-Skin Axis: Understanding the Connection

The gut-skin axis describes the bidirectional signaling that occurs between your patients' skin and gastrointestinal tract. This communication happens through multiple pathways, including immune cell migration, inflammatory mediators, microbial metabolites, hormones, and neurotransmitters.

Central to this communication network are the microbiota, the trillions of microorganisms that colonize both your patients' gut and skin surfaces. Your patients' gut microbiome plays a crucial role in training their immune system, producing essential nutrients and metabolites, and maintaining intestinal barrier integrity. When this microbial ecosystem becomes imbalanced, a condition known as dysbiosis, it can trigger inflammatory responses that extend to their skin.

One of the most important pathways involves the production of short-chain fatty acids (SCFAs) by beneficial gut bacteria. These metabolites have powerful anti-inflammatory effects throughout the body. When SCFA production is impaired due to gut dysbiosis in your patients, systemic inflammation can increase, potentially triggering or worsening their skin conditions.

Perhaps most importantly, the gut-skin axis involves the migration of immune cells between these distant sites. Activated immune cells can travel from the gut to the skin and vice versa, carrying inflammatory signals that can trigger or perpetuate disease processes.

The Science Behind Gut Dysbiosis and Skin Inflammation

Eczema and Gut Health Research

A comprehensive systematic review published in the Journal of Clinical Medicine examined gut microbiome differences between adults with atopic dermatitis and healthy controls. The study revealed that adults with atopic dermatitis showed increased levels of potentially harmful bacterial groups, including Bacteroidetes, Enterobacteriaceae, and Clostridium perfringens, bacteria associated with increased inflammation and compromised gut barrier function in your patients.

What makes these findings particularly significant for your clinical practice is that even your patients with mild to moderate eczema showed these microbial imbalances, suggesting that gut dysbiosis may be an early feature of the condition. Clinical trials demonstrated that interventions targeting the gut microbiome, particularly with specific Bifidobacterium and Lactobacillus strains, could improve eczema symptoms in patients.

Psoriasis and Intestinal Inflammation

Recent research from Uppsala University revealed that 50% of psoriasis patients had increased intestinal barrier permeability (“leaky gut”) compared to healthy controls. These patients with compromised gut barriers reported significantly more gastrointestinal symptoms than those with normal intestinal function, a correlation you may see in your own patients.

The research revealed that psoriasis patients had higher numbers of specific immune cells in their small intestine, showing pro-inflammatory activity. Remarkably, the same types of activated immune cells found in inflamed intestines were also present in psoriatic skin lesions, providing direct evidence of the bidirectional nature of gut-skin inflammation.

The Leaky Gut Connection

Both eczema and psoriasis research point to a common mechanism you can address: compromised barrier function. When your patients' intestinal barrier becomes compromised, bacterial lipopolysaccharides, food antigens, and other inflammatory compounds can enter the bloodstream and trigger systemic immune responses that travel to the skin.

The good news is that you can help your patients restore intestinal barrier function through targeted interventions. Specific nutrients like L-glutamine, zinc, and omega-3 fatty acids support barrier repair, while probiotics and prebiotics help restore microbial balance.

Real-World Success Stories

Case Study 1: Jordan and Rave - Father-Daughter Healing

This case demonstrates how comprehensive gut health testing can guide targeted interventions for both pediatric and adult patients in your practice. Jordan Katzman, a tech entrepreneur and father, first discovered the power of gut health testing when his young daughter Rave began struggling with eczema during infancy. Rather than continuing trial-and-error treatments, Jordan investigated Rave's gut health through comprehensive microbiome testing.

The results revealed borderline low levels of Bifidobacterium bacteria and an overall microbiome health score in the 35th percentile. Working with a microbiome specialist, they implemented a targeted protocol including evidence-based Bifidobacterium probiotics and Human Milk Oligosaccharides (HMO) supplementation.

Within two months, Rave's microbiome health score improved to the 53rd percentile, and her eczema symptoms began resolving. The family reduced their reliance on topical treatments while achieving better results.

Inspired by his daughter's success, Jordan tested his own gut health, revealing impaired SCFA production and a microbiome score in the 30th percentile. He had struggled with chronic acid reflux and obsessive compulsive disorder (OCD) symptoms. After implementing a comprehensive gut health protocol including fermented foods, probiotics, and stress management, his acid reflux completely disappeared within weeks, and his OCD symptoms significantly improved.

Case Study 2: Sarah - Adult Chronic Eczema and Psoriasis

Sarah represents the complex challenges faced by adult patients with long-standing skin conditions who have tried multiple conventional treatments without lasting success — patients you likely see regularly in your practice.

After a decade of battling severe eczema and psoriasis with limited success from conventional treatments, Sarah underwent comprehensive testing that revealed significant gut dysbiosis, a hidden gut infection, compromised intestinal barrier function, multiple food sensitivities, and nutrient deficiencies.

Rather than focusing solely on symptom suppression, Sarah's treatment plan addressed these root causes through a three-phase approach: removing inflammatory triggers (including targeted antimicrobial therapy), restoring gut health with probiotics and healing nutrients, and rebalancing with long-term dietary modifications.

Sarah's improvement was gradual but profound. Within three months, her skin was noticeably calmer. Between months three and six, her eczema patches began clearing completely, and her psoriasis lesions became smaller and less inflamed. Two years later, she maintains clear skin with only occasional minor flares and has discontinued all prescription medications.

Functional Testing: Uncovering Root Causes

To effectively address the gut-skin connection in your practice, comprehensive testing is essential. The following functional tests can provide crucial insights into your patients' underlying imbalances:

Gut Zoomer

The comprehensive stool analysis, Vibrant Wellness Gut Zoomer, evaluates your patients' gut microbiome composition, identifying beneficial and pathogenic bacteria, parasites, viruses, and fungi. It also assesses digestive function, inflammation markers, and intestinal permeability, all of which are crucial factors in the gut-skin axis.

Food Sensitivity Testing

Identifying food sensitivities can help you pinpoint dietary triggers that may be contributing to systemic inflammation and skin symptoms in your patients. IgG and IgA food sensitivity panels can reveal delayed reactions that aren't captured by traditional allergy testing.

Micronutrient Panel

Nutrient deficiencies can significantly impact both gut and skin health. Comprehensive micronutrient testing helps you identify deficiencies in vitamins, minerals, amino acids, and fatty acids that may be contributing to your patients' skin conditions.

Hormone Zoomer 

Hormonal imbalances can affect both gut health and skin conditions. The Vibrant Wellness Hormone Zoomer is a comprehensive hormone panel that evaluates sex hormones, adrenal function, and thyroid markers that may be influencing your patients' skin health.

Wheat Zoomer 

The Vibrant Wellness Wheat Zoomer test goes beyond basic celiac testing to identify wheat and gluten sensitivities that may be contributing to intestinal permeability and systemic inflammation in your patients.

The Functional Medicine Approach

When addressing gut-skin connections in your practice, consider implementing the functional medicine 5R protocol:

• Remove: Eliminate inflammatory foods, infections, and toxins 
• Replace: Restore digestive enzymes and stomach acid 
• Reinoculate: Introduce beneficial bacteria through probiotics 
• Repair: Heal the gut lining with targeted nutrients 
• Rebalance: Support ongoing gut health through lifestyle modifications

Dietary and Lifestyle Strategies

Anti-Inflammatory Diet

Guide your patients toward a diet rich in omega-3 fatty acids, antioxidants, and fiber while reducing processed foods, sugar, and known trigger foods identified through testing.

Probiotic Support

Recommend high-quality probiotics containing strains specifically studied for skin health, including Lactobacillus rhamnosus, Bifidobacterium lactis, and Lactobacillus casei.

Stress Management

Since stress affects the gut-brain-skin axis, incorporate stress reduction techniques such as meditation, yoga, or counseling into your patients' treatment plans.

Sleep Optimization

Poor sleep disrupts both gut health and skin repair processes. Help your patients establish healthy sleep hygiene practices.

Addressing the Imbalances for Lasting Skin Relief

The gut-skin axis represents a paradigm shift in how you can approach chronic skin conditions in your practice. By understanding and addressing the root causes of inflammation through comprehensive testing and targeted interventions, you can offer your patients hope for lasting relief from eczema and psoriasis.

Rather than simply managing symptoms, you have the opportunity to address the underlying imbalances that drive these conditions. Through functional testing, personalized nutrition, targeted supplementation, and lifestyle modifications, you can help your patients achieve clearer, healthier skin while improving their overall well-being.

The case studies presented demonstrate that while the journey may take time, the results can be transformative. By incorporating gut health assessment and treatment into your practice, you’ve gone beyond merely treating skin conditions — you’re addressing the interconnected systems that influence your patients' total health.

About the Author

Dr. Susan Lovelle, a former award-winning plastic surgeon, is the Founder of Balanced Performance, offering all-in-one lifestyle health solutions for busy executives and the innovative companies they lead. She specializes in boosting their energy, optimizing weight, and balancing hormones to unlock peak performance in every aspect of life.  Dr. Susan has been featured on The Doctors, the docu-series Exhausted, Lifetime TV, Forbes, DWEN, and Good Morning Washington. Her book, Thrive! The Five-Week Guide to Mastering Your Energy At Any Age is available on Amazon.

Regulatory Statement:

The information presented in case studies have been de-identified in accordance with the HIPAA Privacy protection.

The general wellness test intended uses relate to sustaining or offering general improvement to functions associated with a general state of health while making reference to diseases or conditions. This test has been laboratory developed and its performance characteristics determined by Vibrant America LLC and Vibrant Genomics, a CLIA-certified and CAP-accredited laboratory performing the test. The lab tests referenced have not been cleared or approved by the U.S. Food and Drug Administration (FDA). Although FDA does not currently clear or approve laboratory-developed tests in the U.S., certification of the laboratory is required under CLIA to ensure the quality and validity of the test.