Influence of the skin-gut axis on the effectiveness of acne vulgaris treatment

Abstract

Acne vulgaris is one of the most prevalent inflammatory dermatoses in clinical practice, characterized by sebaceous hyperproduction, follicular hyperkeratinization, proliferation of Cutibacterium acnes, and activation of inflammatory processes. In recent years, scientific evidence has highlighted the role of the skin-gut axis in the pathophysiology of the disease, suggesting that alterations in the gut microbiota may influence the cutaneous inflammatory response and the effectiveness of acne treatment. This study aimed to analyze the influence of the skin-gut axis on the effectiveness of acne vulgaris treatment, emphasizing the role of the gut microbiota and microbial modulation strategies. This is an integrative literature review conducted in the BVS, MEDLINE, and PubMed databases, using the descriptors "Skin Microbiome," "Gastrointestinal Microbiome," and "Acne Vulgaris," combined using the Boolean operator AND. Articles published between 2020 and 2025, available in full text and in Portuguese, English, or Spanish, were included. The studies analyzed indicate that gut dysbiosis can contribute to the worsening of acne by increasing intestinal permeability and releasing systemic inflammatory mediators, such as IL-6 and TNF-α, which intensify skin inflammation. Conversely, interventions aimed at modulating the gut microbiota, such as the use of probiotics, prebiotics, and dietary adjustments, show potential to reduce inflammation, improve skin barrier function, and promote the balance of the skin microbiota. Therefore, integrating these strategies with conventional therapies can optimize clinical outcomes and contribute to a more comprehensive approach to the management of acne vulgaris, reinforcing the importance of the microbiome as an emerging therapeutic target in dermatology.