Dietary Patterns Shape Outcomes Across Skin Conditions

Recent investigations have expanded the understanding of how nutrition interacts with skin physiology, immunity, and disease activity. While dermatology has long emphasized topical and systemic therapies, diet is now recognized as a modifiable factor influencing inflammation, microbiome composition, and barrier function. Evidence across multiple inflammatory skin conditions, particularly acne, psoriasis, hidradenitis suppurativa (HS), and atopic dermatitis (AD), supports incorporating dietary assessment and intervention into patient care.¹

The Gut–Skin Connection

The gut microbiome serves as a dynamic interface between diet, metabolism, and immune signaling, according to researchers behind a recent review. Microbial metabolites, especially short-chain fatty acids, secondary bile acids, and neurotransmitters like serotonin, can affect systemic inflammation and cutaneous homeostasis. Dysbiosis, or an imbalance in gut microbial populations, can amplify inflammatory cascades and disrupt skin integrity. Diets rich in fiber, antioxidants, and omega-3 fatty acids support microbial diversity, while high-fat and high-sugar diets appear to promote dysbiosis and inflammation.²

Researchers stated clinical implications of this connection are profound: modifying gut health through nutrition or probiotics may influence dermatologic disease expression and response to treatment.

Acne and Nutrition
Acne vulgaris remains one of the most extensively studied skin conditions in relation to diet. Researchers noted high-glycemic-load foods, dairy intake, and whey protein supplementation have consistently been associated with greater acne severity. These dietary factors are thought to elevate insulin and IGF-1 signaling, which in turn increases androgen activity and sebum production.

Conversely, low-glycemic diets and adherence to a Mediterranean-style eating pattern—rich in vegetables, whole grains, and healthy fats—have been linked to fewer inflammatory lesions and improved skin texture. Supplementation with omega-3 fatty acids, probiotics such as Lactobacillus and Bifidobacterium, zinc, and vitamins (particularly nicotinamide and vitamin E) has shown additive benefits in some clinical trials.

Hidradenitis Suppurativa
HS, characterized by chronic nodules and sinus tract formation, has also been connected to diet-related inflammation, according to the review. Obesity, insulin resistance, and mechanical friction worsen disease severity, and gut microbial imbalances may play a contributory role. Studies suggest that weight reduction, elimination of dairy or brewer’s yeast, and anti-inflammatory diets can decrease flare frequency and improve pain and quality of life. Zinc supplementation and adequate vitamin D status have also been reported to support clinical improvement in patients with HS.

Psoriasis and Diet Quality
Psoriasis demonstrates a strong systemic inflammatory component, closely tied to metabolic dysfunction. Nutritional interventions that target weight reduction, particularly hypocaloric or Mediterranean diets, have been shown to enhance therapeutic response and lower PASI and DLQI scores. These diets emphasize anti-inflammatory foods such as olive oil, nuts, fruits, and fish while minimizing refined carbohydrates and processed meats.

Researchers found gluten-free diets may also help a subset of patients with serologic evidence of gluten sensitivity. Although studies of vitamin D, selenium, and fish oil supplementation have yielded mixed results, these nutrients remain under investigation for their immunomodulatory potential.

Atopic Dermatitis and Nutritional Modulation
In AD, compromised skin barrier function and immune dysregulation are influenced by both dietary factors and microbiota composition. Patients with AD often exhibit reduced microbial diversity and overgrowth of Staphylococcus aureus. Diets abundant in fruits, vegetables, and plant-based omega-3 sources (such as flaxseed or hempseed oil) may improve barrier repair and decrease disease activity.

While elimination diets can help patients with proven food allergies, indiscriminate restriction carries risks, including nutritional deficiency and new sensitizations. Probiotic supplementation has shown moderate benefits, particularly in pediatric populations.

Clinical Implications

Collectively, these studies underscore the value of addressing diet as part of comprehensive dermatologic management. Evidence supports anti-inflammatory, low-glycemic, and Mediterranean-style eating patterns, along with targeted supplementation in select patients. Researchers noted clinicians should consider brief nutritional screening and, when appropriate, referral to a registered dietitian.

Future research should focus on personalized dietary approaches based on microbiome profiles and metabolic status, aiming to refine dietary guidelines for chronic skin disease management.

References

1. Shah V, Tran T, Chang S, Sadur A, Lio P, Choudhary. Role of dietary intervention in the management of selected skin diseases: A systematic review. JOID. doi:10.64550/joid.6xqjpf49
2. De Pessemier B, Grine L, Debaere M, Maes A, Paetzold B, Callewaert C. Gut-skin axis: current knowledge of the interrelationship between microbial dysbiosis and skin conditions. Microorganisms. 2021;9(2):353. Published 2021 Feb 11. doi:10.3390/microorganisms9020353