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19 Sep 2023 | CAPS Clinic

Internal links to skin health

There is more to the skin than what we see on the surface. Being the body’s largest organ, it covers the entire outer surface. The skin is a window to a person’s health, and in skin clinics today, it is crucial to consider this when treating patients. This blog will go into further detail about how the skin is affected by internal factors and why consideration of these things should be warranted as part of your treatment plan for optimal skin health.

Drivers to skin change:


With today’s society being very fast-paced and people working more and taking on more, increased stress and adrenal fatigue are evident in patients we see regularly. Increased cortisol and being in the constant fight-flight response not only affects things like sleep, appetite, and mental health, but it also affects hormones and digestion. Our daily habits, what we put into our bodies through diet, and our lifestyle choices all affect how we age and how the skin’s overall health presents. In research, there is evidence to support increased cortisol levels factoring into the development of skin cancers, psoriasis, skin inflammation and ageing of the skin [1].


With an ageing population, menopause is one factor that affects many women for longer. Menopause is a typical period when women notice considerable changes to their skin. As many as 64% of women attending menopause clinics report skin-related symptoms [2].

The skin is one of the most affected organs during menopause, with skin quality being the primary concern. Menopause decreases collagen, water content, elasticity, and thickness and impacts all the skin layers, affecting overall quality. Menopause affects every female differently and can cause havoc on some, presenting various symptoms [3].

The skin is affected by physiological changes that happen with ageing, and oestrogen also dramatically affects the skin. The decrease in oestrogen accompanying menopause intensifies the effects of intrinsic and environmental ageing since oestrogens play a vital role in increasing collagen, skin thickness and skin moisture content. Due to the loss of hydration in the skin, the skin’s overall barrier function will be affected, leading to increased skin conditions like allergic contact dermatitis and eczema, with itchiness being a commonly reported symptom [2, 3].

With this, women present in skin clinics regularly with the same concern that their skin has changed dramatically from what it once was. A rapid decline in skin collagen can be seen following menopause, with nearly a third of collagen lost in the first 5 years and a decline of 2.1% per year over the 15 years following menopause. The breakdown of elastin increases with menopause and is evident in skin laxity and increased wrinkling [2].

Flushing is experienced in 75% of perimenopausal and menopausal women. This is due to vasodilation of the dermal and subcutaneous blood vessels and is possibly due to a loss of peripheral vascular control associated with oestrogen deficiency [2].

During the pre-menopausal shift, our hormones are unbalanced. It is prevalent to see hormonal breakouts during this time, as most explain as adult acne, which can generally be seen around the jawline. Hair growth with hormonal changes can generally be noted in the chin and inner thigh areas. The pathophysiology of menopausal acne is unclear; however, an imbalance between oestrogen and androgens is thought to be implicated [2].


Polycystic ovaries syndrome is another common condition seen in practice which causes an increase in androgens in the body, stimulating an increase in sebum production and presenting commonly with hormonal breakouts on the skin. Hair growth can be another common symptom of this condition.


The thyroid can play a role in skin health. Effects on the skin can be different in an overactive thyroid and underactive thyroid. With hypothyroidism, the skin can appear coarse, thin, oedemic and scaly in appearance and skin conditions like acquired ichthyosis and vitiligo can be seen. With hyperthyroidism, the skin presents smooth, moist, and warm. Alopecia, dermatitis, and vitiligo are associated with thyroiditis and alopecia and eczema are frequently correlated with Graves’ disease [4,5].


Medications can affect the skin and show through sensitivity, pigmentation, and vascularity. Antibiotics can affect the gut microbiome, and blood thinners can cause bruising and vascularity. Pigmentation can also be seen when the liver struggles to detoxify the body from medications and hormones. Understanding the root cause of what is presenting on the skin helps with the overall longevity of your treatment outcomes in the clinic.

Lasers and light-based treatments can help treat patients’ presenting symptoms or concerns, but understanding the body’s overall functioning and why these things are happening helps treat the skin holistically, managing overall health and wellbeing.

Inflammation internally:

Increased inflammation within the body from the gut is often seen on the skin as inflammatory skin conditions. I like to explain to my patients that our bodies have a threshold, and our glasses fill up over time, but once we hit a point where our bodies cannot cope, that glass starts overflowing, and with the skin, this is usually seen with reactions on the skin. Usually, when we have these reactions on the skin, the stress, trauma, food intolerances, and inflammation internally have been there for a while and are at the point that it has turned chronic now, affecting the skin.

When under stress, our body’s response involves activation of both the hypothalamic–pituitary–adrenal (HPA) axis and the autonomic nervous system, both are involved with our body’s immune system. Stressful events can contribute to chronic inflammatory skin conditions and chronic inflammatory disorders of the body [6].

Our body can become toxic with inadequate digestion and elimination processes. When we are not absorbing the nutrients required for skin health, our skin can become deficient. With constipation, our waste matter is kept inside the body longer than it should be, causing increased toxic load, which can seep into the bloodstream, causing increased inflammation internally, affecting the skin with breakouts, eczema and dermatitis commonly seen.

Constipation also affects mood as our serotonin is found in the large intestine. The increased inflammation affects our gut villi, affecting how we absorb our nutrients, so it does not matter if we eat well. If we have inflammation and not absorbing due to this, it can affect our skin still. The microbiome of the gut is essential to all ailments of our health. Digestive enzymes are another thing that can affect how we break down our foods such as lactase, proteins, fats etc.

Leaky gut, candida, autoimmune conditions, other comorbidities, nutrient deficiency, and parasites in the gut can all affect the body overall and can be seen through the skin.

Lifestyle factors:

Smoking is one thing that can affect the skin’s health due to not only causing oxidative stress and cell death but also as smoking is a vasoconstrictor, it affects how much oxygen gets to the skin tissue and, in turn, the blood supply to nourish it. Smoking is known to delay wound healing due to these factors.

Sleep is essential for healthy skin, and not getting enough sleep can interfere with hormones, diet, digestion, and stress response. Managing stress is something everyone should be aware of. Many of us live busy lives, and the need to be present, slow down, exercise and give yourself some self-care other than work is essential to ensure your body functions well and your skin is happy. The more you push the body without replenishing and filling your cup, the worse long-term effects this can have on the body in other facets.

Alongside digestion, water intake, good elimination processes, and diet is essential. As the saying goes, you are what you eat. The skin depends on the health of the digestive system, and the body determines skin health. Avoiding highly processed foods, avoiding allergens if needed, lowering sugars, low inflammatory diet and watching things like dairy and gluten may need to be looked at with skin reactions that are affected by food sources and appropriate support is recommended in these instances by a qualified professional such as a nutritionist, dietitian, or naturopath. Naturopaths can work with patients to reduce the inflammatory load on the body whilst increasing the elimination and absorption of foods eaten through herbal preparations and supplements.

How the skin presents will determine the types of preparations and food choices recommended to support the skin’s health.

As you can see, the links between gut health and the skin are significant, and whilst other factors such as lifestyle and internal health come into the overall picture, managing stress, sleep and eating well all have a part to play in the largest body organ – The skin!


Brooke Worthy

Dermal Clinician, Naturopath, Nutritionist

BHSc (Dermal Sciences), Adv. Dip Naturopathy, Adv. Dip Nutrition



[1] Terao, M., & Katayama, I. (2016). Local cortisol/corticosterone activation in skin physiology and pathology. Journal of Dermatological Science, 84(1), 11–16.

[2] Kamp, E., Ashraf, M., Musbahi, E., & DeGiovanni, C. (2022). Menopause, skin and common dermatoses. Part 2: skin disorders. Clinical and Experimental Dermatology, 47(12), 2117–2122.

[3] Reus, T. L., Brohem, C. A., Schuck, D. C., & Lorencini, M. (2020). Revisiting the effects of menopause on the skin: Functional changes, clinical studies, in vitro models and therapeutic alternatives. Mechanisms of Ageing and Development, p. 185.

[4] Mancino, G., Miro, C., Di Cicco, E., & Dentice, M. (2021). Thyroid hormone action in epidermal development and homeostasis and its implications in the pathophysiology of the skin. Journal of Endocrinological Investigation, 44(8), 1571–1579.

[5] Cohen, B., Cadesky, A., & Jaggi, S. (2023). Dermatologic manifestations of thyroid disease: a literature review. Frontiers in Endocrinology, p. 14, 1167890.

[6] Evers, A. W., Verhoeven, E. W., Kraaimaat, F. W., De Jong, E. M., De Brouwer, S. J., Schalkwijk, J., Sweep, F. C., & Van De Kerkhof, P. C. (2010, January 1). How stress gets under the skin: cortisol and stress reactivity in psoriasis. British Journal of dermatology, 163(5), 986–991.


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