Beyond the Skin: Exploring the Gut–Skin Axis in Chronic Spontaneous Urticaria and Other Inflammatory Skin Diseases

Aug 28, 2025Biomedicines

The Gut-Skin Connection in Chronic Hives and Other Inflammatory Skin Conditions

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Abstract

Altered gut microbial composition in chronic spontaneous urticaria (CSU) is characterized by reduced diversity and an increase in Proteobacteria.

The gut microbiome may play a critical role in systemic immune responses as it relates to dermatological diseases.
Chronic spontaneous urticaria is recognized as a systemic immune condition rather than just a skin disorder.
Reduced gut microbial diversity and depletion of short-chain fatty acid-producing bacteria may contribute to increased intestinal permeability in CSU.
Animal models indicate that modifying gut microbiota can reduce mast cell hyperreactivity and alleviate urticarial symptoms.
Clinical evidence suggests that probiotics, prebiotics, dietary changes, and fecal microbiota transplantation may be beneficial adjuncts in managing CSU.
Challenges exist in applying microbiome research to therapies due to individual differences and complex host-microbiome interactions.

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Emerging evidence suggests a critical role of the gut microbiome in modulating systemic immune responses, with increasing relevance in dermatological diseases. Chronic spontaneous urticaria (CSU), traditionally viewed as an isolated cutaneous disorder, is now recognized as a systemic immune condition involving complex interactions between innate and adaptive immunity, mast cell dysregulation, and non-IgE-mediated pathways. This review explores the gut-skin axis as a unifying concept linking intestinal dysbiosis to inflammatory skin diseases, including atopic dermatitis, psoriasis, rosacea, and acne. Special emphasis is placed on CSU, where altered gut microbial composition, characterized by reduced diversity, depletion of short-chain fatty acid-producing bacteria, and expansion of Proteobacteria, may contribute to increased intestinal permeability, systemic immune activation via toll-like receptors, and heightened mast cell sensitivity. We discuss findings from animal models demonstrating that gut microbiota modulation can attenuate mast cell hyperreactivity and reduce urticarial symptoms. In parallel, we examine clinical evidence supporting the potential role of probiotics, prebiotics, dietary interventions, and fecal microbiota transplantation as adjunctive strategies in CSU management. Despite promising findings, challenges remain in translating microbiome research into effective therapies due to interindividual variability, the complexity of host-microbiome interactions, and a lack of standardized protocols. Future research should focus on identifying predictive microbial patterns and developing personalized microbiome-targeted interventions. Understanding the bidirectional gut-skin relationship may open new therapeutic avenues beyond symptomatic treatment, positioning the microbiome as a novel target in CSU and related inflammatory dermatoses.

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Beyond the Skin: Exploring the Gut–Skin Axis in Chronic Spontaneous Urticaria and Other Inflammatory Skin Diseases

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