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It’s more than just pretty gift-wrap for our bones and muscles. Our skin is the body’s largest organ, our first line of defense against the outside world, and — as it happens — a powerful indicator of our overall health.

“Inflammation in other areas of the body can often be seen first on the skin,” says Jeffrey Bland, PhD, author of The Disease Delusion: Conquering the Causes of Chronic Illness for a Healthier, Longer, and Happier Life.

Skin expresses inflammation that originates elsewhere, he notes, particularly in the microbiome and gut, where 70 percent of the immune system resides.

“That same inflammation can also lead to diabetes, cardiac disease, arthritis, dementia, and other conditions,” he says. “These things are all interconnected.”

As much as they annoy us, the bumps, lumps, and rashes we experience can offer important clues — warning signals meant to alert us to deeper, more significant problems in one or more of our bodies’ major systems.

We generally wish these symptoms would just disappear, because even if acne, psoriasis, warts, and skin tags serve some practical purpose in getting our attention, they also make us cringe.

In fact, medical experts acknowledge that the psychological pain associated with skin conditions can be worse than the physical discomfort. “We don’t want anyone looking at us,” says Andrea Nakayama, CNC, a functional nutritionist in Portland, Ore. On some level, she notes, we fear that when others observe the condition, it is “painful for them, too.”

As tempting as it may be to simply suppress the symptoms, the best way to resolve chronic skin problems for good is to work with a skilled health practitioner — one who can help you address underlying issues that may be doing damage not just to your epidermis, but to your overall well-being.

Here’s a look at six common skin complaints and the systemic issues that may be triggering them, plus strategies for healing them from the inside out.

1. Skin Tags

Small, sac-like protrusions found on the neck or eyelids, under the breasts or armpits, or around the groin.

What might be causing them: Blood-sugar and hormonal problems.

There’s at least one good thing about skin tags, according to Michael Stone, MD, MS, a functional practitioner in Ashland, Ore.: “If you figure out the cause and respond appropriately, you might just prolong your life.”

Stone explains that skin tags can form when high blood-sugar levels drive an increase in our epidermal growth factor, which controls how fast certain areas, or what doctors call “islands,” of skin grow. They can be a sign of insulin resistance, a condition where cells don’t respond properly to the insulin that normally helps them absorb blood sugar.

Some experts estimate that up to 75 percent of the U.S. population has insulin resistance. And it’s connected to metabolic syndrome, a group of traits linked to obesity and diabetes.

When Stone evaluates skin tags, he looks far beyond the skin. He also considers the amount of fat a patient carries around the waist, since an apple-shaped silhouette indicates that the body is converting glucose into visceral fat instead of using it for necessary body functions. He tests for fasting blood sugar and fasting insulin, and administers a two-hour glucose-tolerance test. He discusses the patient’s history, finding out when the patient started noticing the skin tags and what life events were taking place at that time.

“I approach the physical exam as if I’m Sherlock Holmes,” Stone says. “The great thing is that we can often treat skin conditions with diet and lifestyle changes.” As a rule, he says, “skin tags will markedly reduce and even go away once the insulin resistance is treated.”

2. Eczema

An itchy, uncomfortable, scaly, and sometimes blistering rash, often found on the face, hands, feet, behind ears, and in crooks of knees and elbows. 

What might be causing it: Food sensitivities, microbial imbalances, or other gut-level irritations triggering an immune response.

Some 30 million Americans suffer from eczema, whose name comes from the Greek ekzein, meaning “to boil over.” In some cases, eczema can be triggered by an external irritant, such as an environmental toxin. But like psoriasis, eczema can also be driven by several other factors, including gut and immune issues, which may in turn be caused by food sensitivities or other lifestyle-related triggers.

In the case of food-based triggers, avoiding any offending foods for six to eight weeks — enough time for the skin to completely turn over and rejuvenate itself — can often eliminate eczema symptoms without medication.

Elizabeth Boham, MD, MS, RD, has observed this in her own life, as well as in her practice at the UltraWellness Center in Lenox, Mass. When her son was a baby, he developed both terrible eczema and some asthma-like restrictions in his airway when he switched from breast milk to cow’s milk. Boham eliminated dairy from his diet. After six weeks, he was not only breathing easy, but his eczema was gone as well.

What’s the connection between food intolerances and skin? The lining of the small intestine has limited permeability, allowing nutrients to pass into the bloodstream while toxins and improperly digested food remain behind.

Over time, eating foods that we don’t tolerate increases the permeability and can cause toxins to “leak” into the bloodstream, a condition known as leaky gut syndrome. Then the body’s immune system goes on a rampage, not only attacking the toxins but our own cells. The result is a cascade of inflammation expressed in a variety of disorders, including eczema. (For more on leaky gut syndrome, see “How to Heal a Leaky Gut”.)

3. Dry Skin

Rough, flaky, or cracked skin that may itch, peel, or cause discomfort. 

What might be causing it: Nutrient deficiencies, -hormonal imbalances, or circulatory disorders.

We tend to think of dry skin as a hydration problem, but slathering on moisturizing creams and increasing water intake isn’t always an effective solution.

Persistent dryness (called xerosis) can be triggered by low thyroid function, circulatory problems, and a variety of other environmental exposures and medical conditions, says Stone.

Diet is also a contributing factor, which is why good practitioners take careful histories, conduct physical exams, and when necessary, use labs to confirm suspected causes rather than simply treating dry-skin symptoms.

One cause of dry skin might be a deficit of healthy fats. Another might be a lack of B vitamins — which help the body process those healthy fats — perhaps due to genetic factors or to long-term use of antacids, which interfere with the body’s assimilation of vitamins and minerals.

For many such cases, Stone prescribes an increase in healthy dietary fats, along with more B vitamins and fat-soluble vitamins like A, D, and E.

He also encourages patients to use plant-based emollients like coconut oil, which are easily absorbed and can help diminish surface dryness and inflammation. He advises they steer clear of conventional, chemically laden and fragranced topical products, noting that even healthy skin can react badly to their additives. (For more on the importance of clean, plant-based body-care products, see “Beauty Beware”.)

4. Psoriasis

Itchy spots, reddish plaques, and thick flaky lesions, sometimes accompanied by pain, stiffness, and swelling in the joints. 

What might be causing it: An irritated gut, an overactive immune system, or metabolic syndrome.

Some 7.5 million Americans suffer from psoriasis, according to the National Psoriasis Foundation. Dealing with pain inside and out, psoriasis patients often bounce from one dermatologist to another in search of a cure. They accumulate drawers of topical creams and steroids, but often find limited relief because the treatments don’t address the underlying cause of their misery.

Psoriasis has been most commonly linked to an autoimmune response — but that response can be triggered by all sorts of things, including gut dysfunction, dysbiosis, and stress. Some newer research indicates that psoriasis may also be linked with metabolic syndrome.

“It’s not a simple mechanism that causes psoriasis,” says Valori Treloar, MD, an integrative dermatologist based in Wellesley, Mass., and coauthor of The Clear Skin Diet. Psoriasis can be tricky to diagnose, too, because other conditions, like eczema and candida overgrowth, can produce similar-looking rashy and scaly patches.

For psoriasis sufferers who have the excess belly fat associated with metabolic syndrome, Treloar urges a suite of lifestyle changes. She advises them to stop smoking, cut back on alcohol, and stick to a nutrient-dense, low-glycemic diet with plenty of antioxidant-rich vegetables.

The first step functional nutritionist Nakayama takes in treating psoriasis is irritant elimination. She calls this “clearing the muddy waters.” Clients typically start by removing three of the most inflammatory foods: gluten, dairy, and sugar. This often relieves irritation in the gut and allows it to resume normal function.

Nakayama and likeminded practitioners also support intestinal healing with aloe vera juice and L-glutamine, then restore gut flora with probiotic supplements and bacteria-rich foods like sauerkraut and coconut kefir. They encourage whole-food diets rich in essential fats, and often supplement with fat-soluble vitamins A, E, and D; omega-3 fatty acids from flax, hemp, and fish; and anti-inflammatory evening primrose oil.

Nakayama notes that sometimes individualized care requires more investigation and fine-tuning. “We’ll use many different approaches to sooth and heal that inflamed gut,” she says. “And by healing that inner skin, we often see results on the outer skin.”

5. Acne

The most common skin disorder, characterized by pimples, blackheads, whiteheads, and cysts. 

What might be causing it: An excess of inflammatory foods, a deficiency of highly nutritious ones, a messed-up gut, or hormonal imbalance.

Acne typically plagues teenagers, whose surges of testosterone and other androgens increase oil production in the skin. But Treloar says that the number of adults with acne has increased so much that some healthcare practitioners have started to view it as a chronic disease.

As with most chronic diseases, adult acne often appears linked to diet. It has been tied to hormonal disruptions, gut-level inflammation, and microbiome imbalances, and is an especially common symptom of food intolerances.

A number of epidemiological studies show an association between acne and milk consumption, for example. Although the mechanisms by which food sensitivities trigger acne are not widely agreed upon, many practitioners reference significant clinical evidence as proof of a connection.

“I have my patients do a trial of six to eight weeks of no dairy other than butter, which is mostly just fat,” Treloar says. In many cases, she says, “that alone is enough to clear their skin. They come back and their acne is essentially gone.”

Treloar also encourages her patients with acne to increase their consumption of vegetables and cut way back on grains and fruit. This low-glycemic diet helps minimize rapid fluctuations in blood sugar and insulin, quells inflammation, and provides the building blocks required for healthier skin.

She recommends supplementing with fish-oil capsules and 30 mg of zinc daily. In some cases, she recommends topical creams and cleansers that contain vitamin B3.

In addition, Treloar works with patients on getting enough sleep and managing stress, both of which help reduce inflammation. She also recommends simple forms of meditation that help downshift anxiety (and thus inflammation).

6. Premature Aging

Wrinkles, sagging, dark spots, and loss of luminescence.

What it might mean: Lifestyle-related damage is outpacing your skin’s repair capacity.

The proteins and fats that give skin its youthful appearance (namely collagen and elastin) are highly sensitive to diet and lifestyle factors. Too many oxidizing free radicals (produced by a poor diet, stress, and smoking) can damage skin’s tissues, making skin look old before its time.

Sugar can do an especially nasty number on your skin, according to Nakayama, because it not only drives inflammation and free-radical activity, it also bombards the body’s cells with glycation, a process in which glucose latches onto your skin’s collagen and elastin supply.

This process leads to what are known as “advanced glycation end products” (with the appropriate acronym AGEs), which cause the proteins in skin to become discolored and weak.

“Glycation happens both inside and outside the body,” Nakayama says. “This is another way that a poor diet can inflame the entire immune system, with the repercussions in the skin as the most obvious sign.”

A certain amount of glycation is the unavoidable byproduct of eating and being alive, Nakayama notes, but a high-glycemic, low-nutrition diet amplifies the damage, causing skin to lose its radiance and suppleness far earlier than it otherwise would.

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The Clear-Skin Lifestyle Program

Research shows that simple adjustments in nutrition, activity, stress, and other lifestyle factors can be more effective than drug protocols in treating many chronic inflammatory health conditions — including skin problems. And they can dramatically improve your health in the process.

Since many conventionally trained physicians and dermatologists don’t receive training about lifestyle protocols (and are less likely to advise on them), we’ve gathered articles from our archives that cover the most effective interventions for chronic skin problems — and health challenges — of all kinds.

  1. Identify food intolerances. For a guide to doing an elimination diet, visit The Institute for Functional Medicine’s Elimination Diet Comprehensive Guide and Food Plan
  2. Repair gut damage. How to Heal a Leaky Gut
  3. Rebalance your microbiome. Your Microbiome: The Ecosystem Inside
  4. Eliminate processed carbs. 3 Simple Shifts to Healtheir Eating
  5. Avoid sugars and alcohol. Sugar Breakdown: The Impact of Sugar on Your Body
  6. Emphasize healthy fats. All About Oils
  7. Pack in phytonutrients. What Is a Phytochemical?
  8. Get more fiber. Fiber: Why It Matters More Than You Think
  9. Aim for a blend of activity. Are You Overexercising? Find Your Just-Right Fitness Routine
  10. Get plenty of rest. Why Getting Enough Sleep Is Vital to Your Health
  11. Manage stress. Put Stress in Its Place
  12. Minimize inflammation. Fighting Inflammation

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