The Microbiome’s Impact on Acne: The Gut Skin Connection

For decades, the narrative surrounding acne has been predominantly focused on the role of the bacteria Cutibacterium acnes (formerly known as Propionibacterium acnes) and its contribution to the development of this common skin condition. However, recent advancements in research and evolving perspective to consider the whole person are painting a more complex picture of acne, one that transcends the surface of the skin to include the gut microbiome. 

This makes sense because we know that what you eat affects acne and what you eat influences the gut flora. So the foods that influence your gut may also be influencing the bacteria on the skin as well as the levels of inflammation. 

This article explores the evolving understanding of acne and how our gut influences our skin.

What is the Microbiome?

The human microbiome consists of trillions of microorganisms including bacteria, viruses, fungi, and other microscopic living entities inhabiting our bodies, notably in regions like the gut, skin, and mucous membranes. 

The microbiome is composed of not only bacteria but also fungi, yeast, and viruses. What we eat, stress, our exercise, and general environment influence composition of the microbiome. And it turns out eating a healthy diet with lots of fiber and moderating stress (and also getting acupuncture) help improve your microbiome. 

lactic acid bacteria

The Microbiome’s Role in Skin Health

The microbiome’s influence extends beyond the gut, having significant implications for skin health through improving barrier function, immune modulation, and regulating the inflammatory processes.  

Systemic Inflammation: An imbalance in gut microbiota can lead to systemic inflammation, a key factor in acne pathology, as inflammatory mediators can exacerbate skin inflammation.

Neuroendocrine Effects: Stress and hormones influenced by gut microbial health can worsen acne by increasing sebum production and skin cell turnover.

Metabolic By-products: Compounds produced by gut bacteria, such as short-chain fatty acids, have potential anti-inflammatory effects on the skin. Conversely, other by-products can increase inflammation, impacting acne severity.

Dysbiosis: An Imbalanced Microbiome

The concept of dysbiosis—imbalance in the microbiome—may involve an overgrowth of harmful bacteria or a lack of beneficial bacteria, disrupting the homeostasis of the gut and leading to systemic effects that manifest on the skin. 

Gut dysbiosis may lead to:

Increased Permeability: Often referred to as “leaky gut,” increased intestinal permeability allows bacterial by-products, toxins, and other inflammatory substances to enter the bloodstream, potentially triggering inflammatory responses that exacerbate acne.

Pro-inflammatory State: Dysbiosis can promote a pro-inflammatory state within the body. Chronic inflammation, fueled by immune responses to imbalanced gut flora, directly impacts the skin and can increase the severity of acne.

inflammatory acne

Specific Bacterial Associations with Acne

Research into the gut microbiome has highlighted significant correlations between various bacterial groups and the incidence of acne in patients (1). This section summarizes the relationships between specific bacterial groups and their relative abundance in acne patients, as well as their potential association with the condition. 

Actinobacteria: These bacteria are found in lower abundances in individuals with acne compared to healthy controls. The reduced presence of Actinobacteria, which are known for their role in inhibiting harmful bacteria, suggests a significant association with acne development. Diet rich in fiber from vegetables, fruits, and whole grains enhances the growth of actinobacteria. (2)

Proteobacteria: In contrast to Actinobacteria, Proteobacteria are found in higher concentrations in acne patients. This group includes various pathogens that can exacerbate inflammation, making their increased abundance particularly relevant in the context of acne. In general, higher levels of this bacteria can lead to inflammation throughout the body. (3)

Bifidobacterium: This beneficial bacterial group is significantly lower in individuals with acne. Bifidobacteria are crucial for maintaining gut health, modulating inflammation, and immune functions. Diets high in fiber and fermented foods help encourage the growth of bifidobacterium.  It is also one of the most common probiotic components. (4)

Lactobacillus: Similar to Bifidobacterium, the Lactobacillus group is also found in lower abundances in acne patients. This group is important for protecting the gut lining and helping in the digestion of food, which may influence skin health indirectly through immune regulation.

Butyricicoccus: Known for producing butyrate, a compound that supports the gut lining and has anti-inflammatory effects, Butyricicoccus is found in lower levels in acne sufferers. This decrease may contribute to inflammation and barrier dysfunction, exacerbating acne symptoms. High fiber diets are associated with increases in butyricicoccus. (5)

These findings underscore the complexity of acne as a disease influenced not only by local skin conditions but also by systemic factors including the composition of the gut microbiota. 

How does Dysbiosis Influence the Gut 

The dysbiosis may influence our immune system, hormone levels and sebum production, and stress-related neuro-endocrine pathways.

In terms of treatment, understanding the link between the gut microbiome and acne suggests that modifying the gut microbiota through diet, probiotics, herbal medicine, acupuncture, and prebiotics could offer natural methods for treating acne and may be one of the reasons acupuncture and herbal medicine are and effective treatment. 

The Impact of Stress on Skin Health: Understanding the Cortisol Connection

Stress is a well-known trigger for various health issues, and is particularly significant for individuals with acne. Research has shown that higher stress levels, indicated are associated with increased sebum production (which leads to more acne) and decreased skin hydration. (1)

acupuncture on belly

Managing Stress for Better Skin Health

Given the clear connection between stress and skin health, managing stress is important for individuals prone to acne including techniques such as mindfulness and meditation, regular exercise, healthy diet, and acupuncture. 

Chinese Herbal Medicine

Chinese herbal medicine can help restore and maintain a healthy balance in the gut microbiome. By using specific herbs known for their anti-inflammatory, antibacterial, and gut-healing properties, TCM can address the root causes of skin conditions rather than just the symptoms.

Clearing Heat and Reducing Toxicity

When it comes to treating acne, one of the primary goals in TCM is to clear heat and reduce toxicity in the body. Many of these herbs have been shown to reduce the dysbiosis by discouraging the bad bacteria and encouraging the good bacteria

Huang Lian (Coptis Root): This powerful herb has strong antimicrobial and anti-inflammatory effects. It’s often used in TCM to clear heat and toxins from the body, helping to balance the gut microbiome and reduce acne.

Jin Yin Hua (Honeysuckle Flower): Known for its ability to clear heat and detoxify the body, Jin Yin Hua is often used to treat inflammatory skin conditions like acne. It helps to cool the blood and reduce swelling.

Lian Qiao (Forsythia Fruit): Lian Qiao is another heat-clearing herb that helps to eliminate toxins from the body. It’s particularly effective in treating skin conditions characterized by redness and swelling.

Moving the Blood

Stagnation of blood flow can contribute to the development of acne by impeding the delivery of nutrients and the removal of toxins. Herbs that move the blood help to improve circulation and reduce the buildup of toxins in the skin.

Dan Shen (Salvia Root): Dan Shen is known for its ability to invigorate the blood and remove blood stasis. It helps to promote healthy circulation, which is essential for clear skin.

Chi Shao (Red Peony Root): Chi Shao helps to cool the blood and move blood stasis. It’s particularly useful in treating inflammatory skin conditions and reducing redness.

Tao Ren (Peach Kernel): This herb is used to break up blood stasis and promote the smooth flow of blood. It can help to reduce the appearance of acne scars and improve overall skin texture.

Boosting Qi

Once the acne has been cleared, it’s important to boost the body’s Qi (vital energy) to maintain skin health and prevent future breakouts. Strengthening the body’s Qi helps to support the immune system, improve digestion, and promote overall vitality.

Bai Zhu (Atractylodes Rhizome): Bai Zhu not only supports digestive health but also encourages the growth of beneficial bacteria. Its ability to strengthen the spleen and stomach functions aids in better nutrient absorption and a healthier microbiome.

Ren Shen (Ginseng Root): Ren Shen is a powerful Qi tonic that helps to boost energy levels, improve digestion, and support the immune system. It is often used to restore vitality and balance in the body.

Dang Shen (Codonopsis Root): Dang Shen is a gentle Qi tonic that supports digestive health and boosts overall energy. It is commonly used in TCM to promote long-term health and well-being.

woman meditating in field


Acne is not merely a skin-deep issue but a manifestation of systemic imbalances, including gut dysbiosis, inflammation, and hormonal fluctuations. Research highlights the significant roles of various bacterial groups within the gut microbiome and their associations with acne. The reduction in beneficial bacteria like Actinobacteria, Bifidobacterium, and Lactobacillus, along with the increase in Proteobacteria, illustrates the complexity of microbiome interactions influencing skin health. 

Addressing gut dysbiosis through dietary modifications, probiotics, prebiotics, and herbal medicine can help restore balance and alleviate acne symptoms.

The role of stress in exacerbating acne further emphasizes the need for integrative approaches that include stress management techniques such as mindfulness, meditation, acupuncture, and regular exercise. By considering the whole person and incorporating both modern scientific findings and traditional practices, a more effective and sustainable acne treatment strategy can be developed.

Incorporating these holistic principles into daily life can lead to significant improvements in skin health and overall well-being, offering a promising path for those struggling with acne.

If you are looking for help with acne, please call us at 212.319.5757 to make an appointment. You can also make an appointment online.  


This blog post aims to inform and educate readers about the concept of  the microbiome and TCM. However, it’s not a substitute for professional medical advice. Always consult a healthcare provider and a trained TCM practitioner before starting any herbal medicine or new health practice.


  1. Sivamani RK, Maloh J, Nong Y. Correlating the Gut Microbiota and Circulating Hormones with Acne Lesion Counts and Skin Biophysical Features. Microorganisms. 2023;11(8):2049. doi:10.3390/microorganisms11082049.
  2. Binda C, Lopetuso LR, Rizzatti G, Gibiino G, Cennamo V, Gasbarrini A. Actinobacteria: A relevant minority for the maintenance of gut homeostasis. Dig Liver Dis. 2018;50(5):421-428. doi:10.1016/j.dld.2018.02.012.
  3. Rizzatti G, Lopetuso LR, Gibiino G, Binda C, Gasbarrini A. Proteobacteria: A Common Factor in Human Diseases. Biomed Res Int. 2017;2017:9351507. doi:10.1155/2017/9351507.
  4. Chen J, Chen X, Ho CL. Recent Development of Probiotic Bifidobacteria for Treating Human Diseases. Front Bioeng Biotechnol. 2021;9:770248. doi:10.3389/fbioe.2021.770248.
  5. Kwon D, Zhang K, Paul KC, et al. Diet and the gut microbiome in patients with Parkinson’s disease. npj Parkinson’s Dis. 2024;10:89. Published online April 22, 2024. doi:10.1038/s41531-024-00360-0.
Joseph Alban

Joseph Alban, L.Ac.

Joseph Alban is a Doctor of Acupuncture, New York Licensed Acupuncturist, and NCCAOM Board Certified Herbalist providing the highest quality Acupuncture and Chinese medicine care tailored to your needs.

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