Functional Medicine Approach To Skin Health

Many of us take our clear skin for granted, that is, until it becomes red, irritated, itchy and hard to face in the mirror. Quite literally, our skin is an external reflection of our internal health.

Oftentimes when something shows up on your face, it’s an important clue to something deeper going on in the body. 

If you are beginning to notice fine lines, wrinkles and other signs of aging or are dealing with acne, rosacea or another skin condition, Functional Medicine has a lot to offer your healing journey by working to address the root causes of your skin complaints.  

Functional Medicine is based on the premise that all systems in your body are interconnected. The skin doesn’t live and function separately from anything else in the body.

What is happening elsewhere affects the skin and what happens to the skin affects the body as well. Everything is connected. 

Keep reading to learn more about skin health from this important perspective. Let’s dive into:

  • Understanding the structure and function of your skin
  • The skin microbiome and the connection with the digestive system
  • How toxins affect the skin
  • 4 key steps to better skin from a Functional Medicine approach 

All About Your Skin 

Your skin is your largest organ with the important function of separating you from the outside world. In addition to being an essential barrier, it also is important for hydration and detoxification. 

The skin is made of three layers: the epidermis, dermis and subcutaneous tissue. 

The Epidermis is the top, outer layer that provides a waterproof barrier and contains melanin, which determines skin tone. Much like the cells that line the digestive tract, the cells that make up the epidermis slough off and regenerate all of the time. 

The middle layer, the dermis, is where you find hair follicles, sweat glands, the sebaceous glands that secrete oil and lots of collagen and elastin that help to give your skin its shape, flexibility and plumpness (click here to watch my video on the benefits of collagen).

This is where you’ll also find an abundance of blood vessels and nerve endings, which are responsible for your sense of touch and allow you to sense pressure, pain and heat. 

The deepest layer of the skin is called the subcutis or subcutaneous tissue. This is the fatty layer that keeps us warm. Importantly, it’s also where the body produces vitamin D in the presence of sunlight. 

Conventional western medicine divides the body into separate systems. If you have a rash or acne, you might go to a dermatologist for some testing or skin supportive medications or creams, which may be helpful and have their place. Functional Medicine, in contrast, really honors the connections between all the organs and systems in the body.

Many issues and conditions that show up as symptoms on the skin, may have roots elsewhere. A new way to think about skin health is really to dive down into these connections. One of the common ones is between skin health and gut health. 

The Skin Microbiome 

When you hear the word microbiome, you most likely think of the gut. The digestive tract, and mainly the colon, is where most of the microorganisms in the body live. Quite remarkably, the skin has its own microbiome with around 1 billion organisms living on every square centimeter of the body. 

Think of the skin as an ecosystem of bacteria, yeasts, fungi and viruses. Ideally, these microorganisms are in balance and the beneficial ones help to keep any pathogens in check. This microbiome as a whole – including the gut and skin-specific microbiomes – are largely established at birth as the baby passes through the birth canal. 

You may be familiar with the gut-brain access – the science behind the gut serving as our “second brain” of the body where communication isn’t a top-down phenomenon, but rather a two way street.

The microbes in the gut shape how the brain fires neurons as well as the production of neurotransmitters, which are both necessary for how you experience your life.

It’s now understood that there is also a gut-skin axis and a gut-brain-skin axis, showing that everything is connected. The brain is talking to the gut and the gut is talking to the skin and vice versa.

The gut microbiome is a key regulator of the skin. So, improving the gut microbiome improves the health of the skin by improving the skin microbiome, reducing inflammation and allowing the skin to be more structurally sound so that it can perform all of its important functions.

Research has shown favorable outcomes for the use of probiotics and prebiotics in improving dermatological disease. For example, risk of atopic dermatitis in children reduced by 60% when mothers took prenatal and postnatal probiotics and supplemental prebiotics (the food to feed the beneficial bacteria) also helped to reduce the risk of childhood eczema. 

The Toxin Connection 

Just as environmental toxins and chemicals affect all parts of an ecosystem, when the body is exposed to toxins it may cause disruptions in all areas of physiology. Since the skin is our largest organ and an important organ of detoxification, when the body is trying to get rid of toxins, you may notice it in the skin as redness, itchiness, rashes and acne. 

As we continue to worry about toxins in the air from forest fires, indoor air pollution including mycotoxins from mold and other exposures, many of us may be seeing increased skin symptoms and irritation. 

Let’s take mold, for example. Mold is often a hidden issue and it may take quite some time to realize that the environment is related to symptoms; however, mold may be the root cause for acne and other skin disorders.  

Toxins disrupt the microbial balance in the gut, which affects the gut-skin access. Inflammation in the gut may also show up as inflammation on the face or other areas of the skin. Since the skin is the largest organ of detoxification, it really gets hit hard when the body is under a high burden of toxins. 

It’s also helpful to consider the toxins that we put on the skin. According to the Environmental Working Group (EWG), women apply 168 chemicals to their skin every day. The skin is highly absorbent and these products that are supposed to be caring for the skin (i.e., “skincare”), may actually be causing harm to the skin itself and the skin microbiome. 

A Root Cause Approach To Skin Health

When thinking about skin from a functional medicine perspective, it is essential to address the root causes of skin issues. Root causes might be gut related or toxin related as discussed here.

It’s also possible to have hormonal imbalances, nutrient deficiencies or other areas that contribute, which is why the Functional Medicine approach to skin health is uniquely healing and successful.

Taking this perspective, here are 4 crucial action steps for healing the skin:

1. Support the microbiome. Whether it’s food sensitivities, leaky gut, an infection or all three, balancing the microbiome is sure to improve skin health. 

2. Read How to Improve Digestive Symptoms and Restore Gut Health to learn more about the Functional Medicine 5R protocol for gut healing. This article will walk you through the 5 steps: Remove, Replace, Repair, Reinoculate and Rebalance. The 5R approach is easily customizable for your personal needs and lab test results. 

3. Clean up skin products. Since the skin is so absorbable and our skin comes in contact with toxins from skin care products and the environment daily, and easy place to make a big impact is by switching to non-toxic products. The Environmental Working Group’s Skin Deep Database is a great resource for determining the toxic chemicals in your current products and finding suitable replacements.

While you’re at it, be careful for BPA on receipts and PFAS in clothing as both are also absorbed by the skin. One of my favorite new clean product lines is Nadia Skin Care.

4. Support skin detoxification. Because of the sheer number of chemicals in the environment, supporting detoxification is something to think about every day. Detoxification is especially important when we are facing skin issues, such as fast aging or chronic rashes. The Importance of Detoxification and How to Detox goes into the details for you about to take a whole body approach to detoxification.  

To support detoxification specifically for the skin, sweating from exercise and saunas, dry brushing, bodywork and detox baths are incredibly helpful. 

Boost skin nutrients. Interestingly, many of the same nutrients that support gut health and the immune system are also important for the skin. These include vitamin A, vitamin D, vitamin C, probiotics, omega 3 fats, collagen and others. Start with a whole food, nutrient dense Paleo diet to provide a broad range of nutritional support and layer in a multivitamin and other key supplements as needed. 

The good news is that these 4 steps support healthy aging, epigenetics and total body wellness, so you’ll be supporting skin health, from the inside-out, from multiple angles. 

Our skin is how we face the world; it protects our bodies and allows us to experience life through our sense of touch. Sometimes what is going on internally, whether it be inflammation or a toxin exposure, shows up on the outside of the body as an important clue that leads us to healing.

If we are constantly suppressing skin symptoms with steroids or covering them with makeup, we might miss the important messages that our skin is trying to communicate.

Often, getting to the root of the skin issue isn’t overly complicated, but involves connecting the dots between systems in the body and how we interact with the world around us. As painful as it is to face our skin, doing so is the first step in healing for lifetime relief!


  1. Kong, H. H., & Segre, J. A. (2012). Skin microbiome: looking back to move forward. The Journal of investigative dermatology, 132(3 Pt 2), 933–939. 
  2. Arck, P., Handjiski, B., Hagen, E., Pincus, M., Bruenahl, C., Bienenstock, J., & Paus, R. (2010). Is there a ‘gut-brain-skin axis’?. Experimental dermatology, 19(5), 401–405. 
  3. Salem, I., Ramser, A., Isham, N., & Ghannoum, M. A. (2018). The Gut Microbiome as a Major Regulator of the Gut-Skin Axis. Frontiers in microbiology, 9, 1459. 
  4. Vaughn, A.R., Notay, M., Clark, A.K., Sivamani, R.K. (2017). Skin-gut axis: the relationship between intestinal bacteria and skin health. World journal of dermatology, 6(4), 52-58.