The co-morbidity of chronic skin conditions and mental health disorders has long been recognized, and in recent years specialty psychodermatology and neurodermatology groups have emerged. Acne vulgaris is a common dermatological disorder frequently associated with depression, anxiety and other psychological sequelae. The mental health impairment scores among acne patients are higher vs. a number of other chronic, nonpsychiatric medical conditions, including epilepsy and diabetes [1-7]. Along with the psychological fallout, there have also been indications that acne patients are at a higher risk for gastrointestinal distress. For example, one study involving over 13,000 adolescents showed that those with acne were more likely to experience gastrointestinal symptoms such as constipation, halitosis, and gastric reflux. In particular, abdominal bloating was 37% more likely to be associated with acne and other seborrheic diseases [8]. The growing awareness that the functional integrity and microbial residents of the intestinal tract may play a mediating role in both skin inflammation and emotional
behavior has shed further light on yet another dimension to the relationship between dermatology and mental health. The notion that intestinal microflora, inflammatory skin conditions such as acne, and psychological symptoms such as depression, are all physiologically intertwined is not a new one. Nor is the notion that so-called beneficial bacteria can mediate both skin inflammation and mental health a novel one - what has changed is an accumulation of evidence which provide some early hints at physiological pathways and potential therapeutic avenues in acne vulgaris. Here we review the 70-year-old gut-brain-skin unifying theory, first postulated by dermatologists John H. Stokes and Donald M. Pillsbury in 1930 [9], and provide a historical perspective to the contemporary investigations and clinical implications of the gut-brain-skin connection in acne.
The Brain-Gut-Skin Theory Drawing on several lines of experimental evidence and clinical anecdotes, Stokes and Pillsbury provided a ‘theoretical and practical consideration of a gastrointestinal mechanism’ for ways in which the skin is influenced by emotional and nervous states. These authors connected emotional states - depression, worry and anxiety - to altered gastrointestinal tract function, changes that cause alterations to the microbial flora, which they theorized, in turn promotes local and systemic inflammation. They provided, as they wrote, ‘an important linkage of
The co-morbidity of chronic skin conditions and mental health disorders has long been recognized, and in recent years specialty psychodermatology and neurodermatology groups have emerged. Acne vulgaris is a common dermatological disorder frequently associated with depression, anxiety and other psychological sequelae. The mental health impairment scores among acne patients are higher vs. a number of other chronic, nonpsychiatric medical conditions, including epilepsy and diabetes [1-7]. Along with the psychological fallout, there have also been indications that acne patients are at a higher risk for gastrointestinal distress. For example, one study involving over 13,000 adolescents showed that those with acne were more likely to experience gastrointestinal symptoms such as constipation, halitosis, and gastric reflux. In particular, abdominal bloating was 37% more likely to be associated with acne and other seborrheic diseases [8]. The growing awareness that the functional integrity and microbial residents of the intestinal tract may play a mediating role in both skin inflammation and emotionalbehavior has shed further light on yet another dimension to the relationship between dermatology and mental health. The notion that intestinal microflora, inflammatory skin conditions such as acne, and psychological symptoms such as depression, are all physiologically intertwined is not a new one. Nor is the notion that so-called beneficial bacteria can mediate both skin inflammation and mental health a novel one - what has changed is an accumulation of evidence which provide some early hints at physiological pathways and potential therapeutic avenues in acne vulgaris. Here we review the 70-year-old gut-brain-skin unifying theory, first postulated by dermatologists John H. Stokes and Donald M. Pillsbury in 1930 [9], and provide a historical perspective to the contemporary investigations and clinical implications of the gut-brain-skin connection in acne.The Brain-Gut-Skin Theory Drawing on several lines of experimental evidence and clinical anecdotes, Stokes and Pillsbury provided a ‘theoretical and practical consideration of a gastrointestinal mechanism’ for ways in which the skin is influenced by emotional and nervous states. These authors connected emotional states - depression, worry and anxiety - to altered gastrointestinal tract function, changes that cause alterations to the microbial flora, which they theorized, in turn promotes local and systemic inflammation. They provided, as they wrote, ‘an important linkage of
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