E-ISSN:2456-3110

Review Article

Acne Vulgaris

Journal of Ayurveda and Integrated Medical Sciences

2025 Volume 10 Number 2 FEBRUARY
Publisherwww.maharshicharaka.in

Exploring the relationship between Gut Dysbiosis and Acne Vulgaris in Adolescence and Young Adults: A Narrative Review

Sanjita K1*, Lakshmeesha DR2, Prajna3, Swathi S4
DOI:10.21760/jaims.10.2.24

1* Konsam Sanjita, Post Graduate Scholar, Department of Naturopathy, Alva’s College of Naturopathy and Yogic Sciences, Moodabidri, Dakshina Kannada, Karnataka, India.

2 Lakshmeesha DR, Associate Professor, Alva’s College of Naturopathy and Yogic Sciences, Moodabidri, Dakshina Kannada, Karnataka, India.

3 Prajna, Associate Professor, Alva’s College of Naturopathy and Yogic Sciences, Moodabidri, Dakshina Kannada, Karnataka, India.

4 Swathi S, Assistant Professor, Alva’s College of Naturopathy and Yogic Sciences, Moodabidri, Dakshina Kannada, Karnataka, India.

Acne vulgaris is a common skin condition, particularly in adolescents and young adults, resulting from clogged hair follicles due to excess sebum and dead skin cells. While its causes include genetic, hormonal, and environmental factors, recent research suggests gut dysbiosis plays a significant role in acne development. This review examines the connection between gut microbiota imbalance and acne, focusing on the gut-skin axis, where disruptions in the gut microbiome can trigger systemic inflammation and affect skin health. Dysbiosis may compromise both the gut and skin barriers, contributing to acne through inflammation, altered lipid metabolism, and immune dysfunction. Factors like diet, antibiotics, and stress can worsen this imbalance. Interventions such as probiotics, prebiotics, and dietary changes show promise in managing acne by restoring gut health and reducing inflammation. This review also highlights the importance of understanding the gut-skin axis in acne treatment and alternative therapies such as acupuncture, herbal medicine, and naturopathic approaches in managing acne vulgaris. Further research is needed to elucidate the exact mechanisms and therapeutic potentials of gut-skin interactions in acne management.

Keywords: Acne vulgaris, Gut Dysbiosis, Gut - skin axis, Naturopathy treatment

Corresponding Author How to Cite this Article To Browse
Konsam Sanjita, Post Graduate Scholar, Department of Naturopathy, Alva’s College of Naturopathy and Yogic Sciences, Moodabidri, Dakshina Kannada, Karnataka, India.
Email: 		Sanjita K, Lakshmeesha DR, Prajna, Swathi S, Exploring the relationship between Gut Dysbiosis and Acne Vulgaris in Adolescence and Young Adults: A Narrative Review. J Ayu Int Med Sci. 2025;10(2):171-178.
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https://jaims.in/jaims/article/view/3990/

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2025-01-08 2025-01-18 2025-01-28 2025-02-08 2025-02-25
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© 2025by Sanjita K, Lakshmeesha DR, Prajna, Swathi Sand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

J Ayu Int Med Sci 2025;10(2)171
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Konsam S et al. Relationship between Gut Dysbiosis and Acne Vulgaris

Introduction

Acne vulgaris is the most common dermatological condition, occurring when hair follicles are blocked by dead skin cells and sebum, leading to pimples, oily skin, comedones, and scars.[1] It is a chronic inflammatory condition of the pilosebaceous unit, often affecting sebaceous-rich areas like the face, chest, and back. Its causes include hormone-induced sebum production, follicular hyperkeratinisation, and inflammation from P. acnes.[2]

The gut microbiota may influence acne onset and development through the gut-skin axis, which impacts the inflammatory immune response.[3] Dysbiosis of both skin and gut microbiota is linked to autoimmune and inflammatory conditions.[4]

The skin, as the body’s largest organ and first line of defence, is inhabited by bacteria, viruses, fungi, and mites, these microorganisms that usually coexist harmlessly with skin cells.[5,6] The gastrointestinal tract is a major interface between the host and environment.[7] The gut microbiome impacts both gut and skin tissue function and balance.[8]

From birth, it plays key roles in protection, metabolism, and immune regulation.[9,10] Several skin diseases are linked to gut disorders, with studies showing a bidirectional relationship between gut dysbiosis and skin imbalance, particularly in inflammatory diseases.[11]

Acne affects over 85% of adolescents, with moderate to severe cases impacting 20%, and continues to affect 64% of individuals in their 20s and 43% in their 30s, especially in adult women.[12,13] Acne is one of the top three most common skin conditions globally, with scars prevalent in 52% of Asia, 51% of Europe, and 31% of Africa.[14,15]

In alternative and complementary medicine, J.H. Tilden suggested that the accumulation of toxins in the body continues until the body's nerve energy is restored and the causes are removed. He viewed all diseases as crises of toxaemia, a result of the body's effort to eliminate toxins from the bloodstream. According to naturopathy, acne vulgaris is caused by a disruption in nature's balance, which can be triggered by various factors such as poor lifestyle choices, a high-fat diet, bowel toxaemia, stress, and anxiety.

These factors lead to hormonal imbalances, increased glandular activity, and a build-up of dead skin cells that clog pores. The clogged pores create an environment for bacterial growth, causing inflammation. Naturopathy also emphasizes the role of detoxification, proper diet, stress management, and balancing the body's natural processes to treat acne. It proposes that restoring the body's natural functions and promoting internal harmony are key to healing and preventing acne.[16]

Aims and Objectives

This narrative review aims to explore the relationship between gut dysbiosis and acne vulgaris in adolescents and young adults and the objectives is to see the role of gut dysbiosis to acne vulgaris.

Methodology

Relevant data were gathered using terms such as "acne vulgaris" and "gut dysbiosis" through electronic databases like Google Scholar, PubMed, and various books for pertinent citations. A total of 1,140 references from these databases, covering the period from inception to 2022, were reviewed. The focus was on case studies, review papers, and case series published in English, specifically those addressing the gut-skin axis in relation to natural treatment approaches for acne vulgaris. The collected information was then analysed to explore the underlying pathogenesis associated with the condition.

Pathophysiology of Acne Vulgaris

The pathogenesis of acne vulgaris is multifactorial involving environmental factors, diet, smoking, stress, and lifestyle,[17] characterized by excess sebum production, sebaceous gland hyperplasia, keratinocyte obstruction, Cutibacterium acnes (C. acnes) proliferation, and immune cell dysfunction.[18]

Excess sebum is triggered by elevated androgen and IGF-1 levels, activating mTORC1, which enhances sebaceous gland and keratinocyte activity. Leucine a common amino acid found in meat and dairy proteins also activates mTORC1.[19,20] IGF-1 also amplifies androgen production, creating a feedback loop that boosts sebum. Insulin and growth factors influence keratinocyte changes and sebum production.[21]


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jaims_3990_01.jpg
Figure 1: Dietary impact on mammalian target of rapamycin complex 1 (mTORC1)[22]

jaims_3990_02.jpg
Figure 2: Naturopathic understanding of acne[23]

Skin Microbiota in Acne Vulgaris

C. acnes triggers innate and adaptive immune responses by interacting with pattern recognition receptors (PRRs), especially Toll-like receptors (TLR-2 and TLR-4). TLR-2 activation activates the NF-κB pathway, releasing proinflammatory cytokines like IL-1, IL-6, and TNF.

IL-1 and IL-6 promote keratinocyte proliferation and sebum production, while IL-1 decreases linoleic acid levels, causing inflammation and follicular blockage. C. acnes also secretes lipases, proteases, hyaluronidase, and neuraminidases, contributing to inflammation.[24] Malassezia hydrolyzes triglycerides into free fatty acids, promoting hyperkeratinization and comedones.[15]

Gut Dysbiosis and Acne Vulgaris

The gut microbiome helps break down indigestible complex polysaccharides and produce essential nutrients like vitamin K. Dysbiosis, an imbalance in gut flora, is linked to various conditions, including metabolic, neurodegenerative, and neoplastic diseases. Altered gut flora can lead to an overregulation of T cells, contributing to autoimmune disorders.[3] Gut microbiota influences acne through interactions with the mTOR pathway, affecting cell proliferation, lipid metabolism, and other metabolic processes. Disruptions in the gut barrier and dysbiosis create a positive feedback loop of inflammation, leads to aggravate acne.[25]

Gut - skin axis interaction with Acne Vulgaris

The gut-skin axis refers to the interaction between the gut and skin,[11] where the microbiome helps regulate inflammation by interacting with the immune system. Gut microbes maintain the intestinal barrier and produce essential nutrients like vitamins K and B12 and short-chain fatty acids (SCFAs) like butyrate.[26,27]

Factors such as antibiotics, diet, lifestyle, and illness can alter the gut microbiome, leading to dysbiosis. This disrupts the gut barrier, allowing toxins and harmful metabolites to enter the bloodstream, impairing immune function and promoting skin inflammation. Disruption of the gut microbiome can lead to imbalances in microbial communities, affecting overall skin homeostasis. Dysbiosis can contribute to skin disorders such as acne, psoriasis, alopecia, and atopic dermatitis.[3,28]

Current Understanding Linking Gut Dysbiosis to Acne Research Summary

Author and Study YearResearch Conclusion
Hui- Min Yan et al., 2018We hypothesize that changes in gut microbiota and reduced butyrate production impair the intestinal barrier and anti-inflammatory mechanisms, exacerbating acne vulgaris. Butyrate, crucial for gut barrier integrity and inflammation regulation, is reduced in acne, along with a decrease in beneficial bacteria like Coprobacillus and Allobaculum.
Britta De Pessemier et al., 2021The gut and skin are interconnected through the bloodstream and lymphatic system, with both maintaining health through intact barriers. In dysbiosis, both barriers are compromised—marked by an imbalanced gut microbiome, weakened gut barrier, and impaired skin barrier—leading to inflammation and immune imbalance, particularly a Th2 response. This creates potential bidirectional crosstalk between the gut and skin.

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Md. Rayhan Mahmud et al., 2022The gut epithelium, influenced by the immune system, diet, and microbial metabolites, releases bioactive compounds like hormones, neurotransmitters, and short-chain fatty acids into the bloodstream, affecting the skin's microbiota and health. Therefore, dietary substances can directly impact skin appearance and health.
Pedro Sanchez- Pellicer et al., 2022A high-fat or high-glycemic diet can alter gut microbiota, increasing intestinal permeability and worsening acne. This suggests that gut microbiota changes, along with factors like proinflammatory lipids from Cutibacterium acnes and genetic variations, may influence acne onset and progression.
Karolina Chilicka et al.,2022The gut microbiota influences acne development and immune function, with studies suggesting probiotics may help reduce outbreaks. The growing markets for probiotic supplements and skincare products offer potential benefits for improving acne.
Spela Suler Baglama et al., 2022The skin and gut microbiomes are key to studying autoimmune and inflammatory skin disorders, with dysbiosis linked to immune system dysfunction. Advanced techniques have revealed that bacterial dysbiosis, alongside viruses and fungi, may influence the pathogenesis of these conditions.
Cao Q. et al., 2023Acne is linked to Allisonella and Bacteroides, while Ruminococcus torques may offer protection. Additionally, Eubacterium soleaferrea, coliform bacteria, Fusicatenibacter, and Lactobacillus are also associated with acne.

Discussion

Acne vulgaris is a multifactorial condition influenced by genetic, metabolic, and hormonal factors, with both the skin and gut microbiota playing key roles. C. acnes are increasingly recognized in acne development, alongside the gut-skin axis. While acne is often linked to elevated androgen levels, insulin and IGF-1, which are nutrition-dependent, also significantly impact it.[29] Changes in the gut microbiome can affect skin conditions, as microbial by-products directly influence health. Factors like environmental elements, host factors (e.g., pH and bile acids), and bacterial elements (like microbial enzymes and adhesion capacity).[7] The gut's mucosal layer acts as a primary defense, activating immune responses and preventing microbial invasion.[30] Cathelicidins like LL-37 maintain the epithelial barrier and have immune-modulatory effects. Tight junction proteins and AMPs protect the gut from harmful bacteria and maintain skin homeostasis.[31] Gut-derived neurotransmitters, such as GABA, acetylcholine, serotonin and dopamine, affect skin function and collagen production.[32] GABA promotes collagen production and skin elasticity, while dopamine can inhibit hair growth by stimulating collagen.[33] Research by Guo et al. found that a high-fat diet in mice led to dysbiosis and inflammation, with reduced AMP release, altered cytokine levels, and gut permeability. Low stomach acid in some acne patients may also contribute to skin irritation.[34,35] A Western diet high in ultra-processed foods, refined carbs, saturated fats, dairy, fatty meals, and chocolate is linked to aggravated acne. High glycemic foods worsen acne, while fruits and vegetables offer protection.[36,37] High-fat diets reduce gut microbiota diversity, increasing endotoxemia and proinflammatory cytokines, which contribute to acne.

Meat-heavy diets, high in leucine, activate mTOR, worsening acne, while plant-based diets improve gut diversity and reduce inflammation.[38,39] A study found 66% of acne sufferers aged 13-18 reported chocolate worsened their acne, though other studies found minimal correlation.[40] A low-glycemic load diet reduced acne severity,[41,42] while ketogenic diets lowered IGF-1 and inflammation markers.[43] A case series found whey protein worsened acne in five patients, likely due to leucine activating mTORC1.[44,45] Probiotics, found in cosmetics and supplements, reduce inflammation, protect against infections, and support skin health.[1,5] A study by GW Jung et al. explored combining probiotics with antibiotics for acne, showing probiotics may reduce antibiotic side effects and offer anti-inflammatory benefits.[46] Dall’Oglio F et al. found that prebiotics improved glycemic and lipid levels in women with mild to moderate adult acne.[47] A 2021 study showed green tea-derived compounds inhibited skin pathogens, including S. aureus and C. acnes, suggesting a potential alternative to antibiotics.[48] Korean research found Curcuma longa extract and probiotics helped combat C. acnes, indicating promise for acne treatment.[49] A 10-week study showed omega-3s and γ-linoleic acid reduced acne lesions.[50]In complementary and alternative medicine (CAM), they are concerned about the side effects of drugs, the choice of treatment in CAM, which includes herbal treatment, acupuncture, cupping therapy and dietary adjustments. From Naturopathic perspective, management of skin conditions requires an investigation and understanding the underlying issue that cause psychological imbalance this may leads to dietary intolerance or psychological factor. Skin is considered as the third elimination organ in naturopathy as it acts as both eliminative and absorbs toxins.


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Common interventions used are herbal medicine, hydrotherapy, acupuncture, naturopathic diet, mud therapy, and fasting therapy and massage therapy. (51) Acupuncture, a common treatment in Traditional Chinese Medicine, is increasingly used for acne vulgaris. It involves inserting needles into specific acupoints to unblock Qi energy channels, which is believed to improve health and skin conditions. Acupuncture can also boost nitric oxide levels; reduce heat toxicity, balance androgen levels, and lower sebum production. While studies show acupoint stimulation technique-such as acupuncture, moxibustion, cupping, acupoint injection, and acupoint catgut embedding for treatment of moderate acne vulgaris can reduce inflammatory acne lesions, more large-scale research is needed for conclusive evidence. Herbal medicine and facial masks are quite popular, mostly due to less cost and a common belief that medicines made out of natural herbs have lesser risk of side effects.[52] In one of the single case studies, conclude that fasting therapy with other naturopathy treatment modalities has shown changes in reducing inflammatory response in acne vulgaris.[53]

Conclusion

In conclusion, this narrative review highlights the complex, multifactorial nature of acne vulgaris, emphasizing the significant role of gut dysbiosis in its pathogenesis. The gut-skin axis, which links changes in gut microbiota to skin health, has been shown to influence inflammation, immune responses, and metabolic processes that contribute to acne development. Dysbiosis, particularly an imbalance in gut microbiota and its interactions with the immune system, can exacerbate acne by disrupting both the gut and skin barriers. Environmental factors, such as diet, play a crucial role in acne progression, with high-glycemic and high-fat diets linked to worsening symptoms. Conversely, dietary changes, such as incorporating low-glycemic foods, probiotics, and reducing processed foods, can potentially alleviate acne. Complementary and alternative treatments, including acupuncture, herbal medicine, and naturopathy, offer promising adjuncts to conventional therapies, although further research is required to validate their effectiveness. Ultimately, a holistic approach that integrates gut health management, dietary adjustments,

and complementary treatments alongside traditional acne therapies may provide more comprehensive and sustainable acne care, improving both skin health and overall well-being.

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