Covid causing skin issues?
Five years on and we are still seeing the effects of covid 19, this time through its impact on the gut-skin axis. Emerging evidence suggests that disruption of the gut microbiome caused by the virus may contribute to skin conditions such as rosacea, psoriasis, and eczema.
From a clinical perspective, I’ve certainly observed an increase in flares of existing skin conditions. However, this new paper suggests that covid itself may be contributing to the development of inflammatory skin issues. Notably, one condition I’ve seen rise significantly since the pandemic is new onset urticaria (hives).
Unsurprisingly, part of the problem is the effect covid has on the gut microbiome. When the balance is disrupted, it allows inflammatory or detrimental microbes to proliferate and covid drives this imbalance by directly infecting intestinal cells (via ACE2 receptors), which leads to a local inflammatory response and reductions the levels of beneficial bacteria. Of course, this effect can be exacerbated by common medications that may be employed during the infection such as antibiotics, corticosteroids and antivirals. This imbalance then promotes intestinal permeability (aka leaky gut) which in turn allows microbial byproducts to ‘leak’ into circulation triggering systemic inflammation.
In addition to the local gut effects, C19 drives immune dysregulation, which further disturbs gut balance and more widely, contributes to systemic chronic low-grade inflammation.
What is interesting and what I have seen clinically is that even months after the infection has passed, many still show signs of gut microbial imbalance with symptoms such as bloating, chronic constipation / faecal impaction, increases in food sensitivity and new or worsening skin issues.
The why and how of this effect on skin issues is due to a few different mechanisms, including the role of the gut-skin axis. Unfortunately, what happens in the gut doesn’t stay in the gut! As mentioned above, gut dysbiosis can lead to an increase in circulating microbial byproducts (endotoxins) and inflammatory molecules (cytokines) which can migrate to the skin and drive immune dysregulation and inflammation. These changes can trigger skin condition such as:
Eczema – Th2 mediated inflammation driven by dysbiosis and immune dysregulation.
Acne or Rosacea – driven by the systemic inflammation and microbial byproducts created by dysbiosis
Psoriasis - Tied to gut permeability and immune dysregulation.
While this is a compelling narrative, there are also likely to be broader mechanisms at play such as covid related immune dysregulation, which can drive autoimmune processes as well as contributing to presentations such as psoriasis, urticaria, vitiligo and hair loss.
Covid is a hammer!
In the case of skin issues, covid is a hammer that breaks a window - the initiating trigger but not the sole focus of treatment.
How to manage covid related skin flares / new presentations
To understand the impact of covid on skin health, I return to an analogy I have used before – a hammer that broke the window. In this analogy, covid is a hammer that disrupted the gut microbiome balance, immune system and set off a skin issue (the window). There is some evidence that a reservoir of the virus that lingers in the gut for some time once the initial infection has passed, but the management focus isn’t specifically on covid. Rather the focus becomes supporting gut microbiome balance, skin health and immune system regulation to help manage inflammation and, covid, if required. A holistic approach is needed.
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