REVIEW article
Front. Immunol.
Sec. Inflammation
This article is part of the Research TopicImmune regulatory networks in the skin during normal and aberrant immunological responses: mechanisms, modulation, and therapeutic targetsView all 8 articles
The Brain–Gut–Skin Axis in Inflammatory and Disfiguring Skin Diseases: Mechanistic Insights, Clinical Correlations, and Therapeutic Strategies
Provisionally accepted
- China Academy of Chinese Medical Sciences Guang'anmen Hospital, Beijing, China
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Emerging evidence suggests that the brain–gut–skin axis (BGSA) plays a critical role in the pathogenesis of inflammatory and disfiguring skin diseases. Conditions such as acne, atopic dermatitis, psoriasis, rosacea, vitiligo, and alopecia areata, once regarded as localized disorders driven mainly by cutaneous immune dysfunction, are now recognized as systemic conditions associated with neuroendocrine stress responses, gut microbial dysbiosis, and chronic low-grade inflammation. Mechanistic studies elucidate the intricate interorgan communication mediated by microbial metabolites (e.g., short-chain fatty acids and tryptophan derivatives), cytokine networks, neuropeptides, and hypothalamic – pituitary – adrenal (HPA) axis signaling. Building on these insights, therapeutic strategies are evolving rapidly. Microbiome-directed interventions (probiotics, postbiotics, dietary modification, and fecal microbiota transplantation), together with psychoneuroimmunological approaches, have shown potential to alleviate disease severity. Integrative therapies, including traditional herbal medicine, offer promising effects; however, we emphasize that mechanistic depth and robust clinical validation for these modalities are currently limited. This review integrates mechanistic findings, clinical correlations, and emerging therapeutic approaches, while critically distinguishing between correlation and causation. Future studies should emphasize longitudinal multi-omics analyses and standardized clinical trials to clarify causal pathways and guide precision, patient-centered management for systemic and cutaneous health.
Keywords: brain–gut–skin axis, Gut Microbiota, Inflammatory skin diseases, Integrative Medicine, neuroimmunology, psychodermatology
Received: 01 Nov 2025; Accepted: 09 Feb 2026.
Copyright: © 2026 Guo, Yang, Zang, Yang and Xu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Chenchen Xu
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