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Autoimmune disease and skin barrier damage – chicken or egg?

The ESK blog

Autoimmune disease and skin barrier damage – chicken or egg?

01 May 2025

Dr Anne Thomson

One day Ginni and I were chatting about skin, as I’m sure you can imagine we sometimes do (interspersed with our usual chats about what our kids are up to etc!) and we got onto the topic of autoimmune disease. Many autoimmune conditions cause skin symptoms, like the rash of lupus or the thick plaques of psoriasis, so we wondered if there was a link between an immune system gone rogue and skin barrier damage.

I decided to do some digging into the scientific literature and what I found stunned us both!

Turns out there is a growing body of evidence suggesting that skin barrier damage is not just the result of autoimmune diseases but may also be causing them. Say whaat?? They never taught us that in medical school!

What are autoimmune diseases?

There are around 100 known autoimmune diseases, including conditions like SLE (aka lupus), psoriasis, type 1 diabetes, rheumatoid arthritis, celiac disease, multiple sclerosis, Hashimoto’s thyroiditis, vitiligo and Crohn’s disease. They are chronic, often debilitating conditions causing serious tissue and organ damage. Many are associated with skin symptoms such as rashes, itch, pigment changes and light sensitivity.

The basic underlying problem is an immune system gone haywire, mistakenly attacking the body’s own cells. In type 1 diabetes for example, the body produces antibodies against the insulin-producing cells in the pancreas.

How common are they?

They affect anywhere between 5-10% of people, most of them, nearly 80% in fact, are women. In the last 40 years, the number of cases has risen rapidly, with some experts calling it an epidemic!

Why?

Now this is where it gets interesting. Until recently, we didn’t really understand what triggered the body to produce antibodies against itself. We suspected a genetic tendency meeting some kind of environmental trigger.

It turns out the answer could lie in the cells that separate the inside of our bodies from the outside world. Known as epithelial cells, they form our skin barrier and the linings of our guts and respiratory systems. One of their jobs is to sort out what’s a threat and what isn’t, directing the immune system to respond accordingly. They do this with the help of the trillions of beneficial microbes that live on and in us (the microbiome).

If this barrier is damaged, it can become “leaky”, letting in all sorts of nasties, triggering inflammation and an immune cascade that results in the immune system mistakenly producing antibodies against its own body. Voila autoimmune disease.

What’s damaging our epithelial barrier?

The short answer? Probably modern life in our industrialised, urban environment. Which goes some way to explaining the recent and ongoing rise in cases.

Since the 1960s we’ve seen a huge increase in the number of chemicals and toxic substances we’re exposed to. Things like air pollution, detergents and surfactants in our kitchens, laundries and personal care products, food additives in processed foods, microplastics, the list goes on. Research is increasingly showing these may be having devastating effects on the tight junctions between the cells of our skin, gut and respiratory epithelial barriers, allowing toxic substances and harmful germs in.

The role of the microbiome

There’s also increasing evidence that modern life is significantly altering the delicate balance of healthy microbes that play a vital role in the effective barrier function of our skin and gut. One paper even draws parallels between the catastrophic loss of biodiversity on the planet mirroring the loss of biodiversity of the microbiome in us!

We see this in the skin of many autoimmune diseases: patients with lupus have been shown to have lower diversity in the skin microbiome and the lower it is, the worse their symptoms. An altered skin microbiome is seen in patients with systemic sclerosis, and there are links between the gut-skin-brain axis in patients with psoriasis. People exposed to livestock in early life have lower levels of autoimmune inflammatory bowel diseases like Crohn’s disease than their urban counterparts, probably because they have more diverse microbiomes.

So what can we do about it?

A number of the researchers in the papers I read indicated that further understanding of the effects of all these environmental factors on our epithelial barriers is vital to reducing their damaging effects. Many of the solutions are going to have to be at the level of government and regulatory bodies, but there are some steps individuals like you and I can take.

Ensure your skin barrier is at its best by adequately moisturising, sticking to gentle active ingredients with proven barrier-boosting properties like niacinamide, avoiding obvious irritants like soap and fragrance, and protecting your skin from the pro-inflammatory effects of the sun’s UV rays. Check out our deep dive into the skin barrier on the ESK blog for everything you need to know to repair and maintain yours!

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Keep your gut microbiome happy by cutting down on processed foods and eating a nutritious, varied diet packed full of fresh fruit, veg and wholegrains. 

Protect your respiratory tract by not smoking or vaping and choosing “environmentally friendly” household cleaning and laundry products.

For more on how to reduce your exposure to many of the potentially harmful chemicals lurking in your environment, check out the consumer guides on the Environmental Working Group (EWG) website.

All in all, it’s a fascinating area of research that we will be watching closely. And if you’ve skipped all of the above and scrolled down for an answer to the question posed in the title? It’s chicken AND egg!

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