Dermatologists John H. Stokes and Donald M. Pillsbury were the founders of the gut-skin-brain axis way back in 1909. They made the connection at this time between the health of the gut-brain and skin. Happy gut, happy skin!


Acne being one of my most common treatments in clinic and my favourite skin condition to treat I am fascinated with the gut-skin-axis. We are hearing more today about how the gut affects the skin but I am amazed that even in the early 1900's this connection had been made.  

Why are we still so slow in making this more well known to the general public?

In study with over 13,000 adolescents it showed that those with acne were more likely to experience gastrointestinal symptoms such as constipation, halitosis, and gastric reflux. Those with acne were also 37% more likely to get abdominal bloating.  

Stokes and Pillsbury showed that there is a link between intestinal flora health, acne and other inflammatory skin conditions and psychological symptoms such as depression and anxiety where interlinked.  

The brain-skin-gut-axis showed:

  • The skin is influenced by emotional and nervous states
  • Stokes and Pillsbury connected emotional states such as depression, anxiety and worry to altered gastrointestinal tract function which then changes the microbial flora in the gut which promoted inflammation in the body. 
  • They also notes that 40% of acne sufferers had hypochlorhydria, less than sufficient stomach acid which alters normal intestinal microflora.
  • Stokes and Pillsbury also noted that stress induced changes to the microflora could increase intestinal permeability (aka leaky gut) which can lead to local and systemic inflammation.

The treatments recommended by Stokes and Pillsbury for Acne

  • Probiotics as we know of these today, at that time they referred to these as acidophil organisms in cultures. 
  • Cod liver oil was there other internal recommendation to be taken for its anti-inflammitory properties and rich source of omega 3 fatty acids.  

complexion perfection

Probiotics And The Skin:

  • Studies have shown that unfermented pasteurized dairy is associated with acne, yet fermeneted dairy is not. 
  • Oral probiotics reduce inflammation and oxidative stress, both of which are elevated in those with acne. 
  • Probiotics can release cytokines (help with inflammation) in the skin
  • Maintain the intestinal barrier
  • Influencing nutrient and omega-3 absorption

The cells of the gut, brain and skin are linked by common embryonic origin, with shared signalling and innervations. Skin conditions are often complex, with no single avenue of pathogenesis; therefore, ‘We must approach this exciting yet largely hypothetical landscape, the gut-brain-skin triangle, with scientific vigour.

I will be writing more on this topic as this fascinates me and it needs investigating further.  

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