Peter Lio, MD, discusses key points from his lecture The Skin-Gut Connection on Friday, November 4, 2022, at the PA/NP Elevate-Derm Conference in Tucson, Arizona.

In this video

Dr. Lio describes the past decade of microbiome research as "dizzying," noting that the gut microbiome — and even the skin's — plays a role "much bigger than I think we ever imagined," in both health and disease. He explains how the microbiome supports digestion and the gut barrier: when it "falls apart," the barrier becomes leaky, letting allergens, irritants, and larger proteins that don't belong get through. He points to acne and rosacea as conditions frequently linked to gut dysbiosis, where correcting the imbalance sometimes improves the skin — a relationship that likely runs both directions.

On whether dermatology should be the one "fixing that," Dr. Lio says the jury is still out, since many patients have skin manifestations without gut symptoms and may need treatment or referral. He frames this as the "infant stages" of learning to manipulate the gut microbiome, emphasizing diet, exercise, and lifestyle, and citing compelling evidence for probiotics like Lactobacillus rhamnosus GG in shortening antibiotic-associated diarrhea. Looking ahead, he's interested in personalized, likely multi-strain regimens — possibly paired with prebiotics such as oligosaccharides to "feed the good guys" — rather than a single off-the-shelf strain.

  • The gut microbiome influences digestion and the gut barrier; when it breaks down, the barrier becomes leaky and lets allergens, irritants, and larger proteins through.
  • Conditions like acne and rosacea are often accompanied by gut dysbiosis, and correcting it can sometimes improve the skin — the relationship likely goes both ways.
  • Many patients present with skin manifestations but no gut symptoms, so dermatology may need to act or refer.
  • Diet, exercise, and lifestyle matter; probiotics such as Lactobacillus rhamnosus GG have solid evidence for shortening antibiotic-associated diarrhea.
  • The future is likely personalized, multi-strain regimens paired with prebiotics — not a single off-the-shelf probiotic.