“Love the skin you’re in,” so the saying goes. Sometimes that’s easier said than done. Skin conditions, ranging from mildly irritating to painfully debilitating, are ubiquitous nowadays. Even mild-to-moderate symptoms can take a serious physical and emotional toll.
I started thinking about skin the other day after a bout of nostalgia had me revisiting old reader success stories . Going through the archives, I was reminded how many readers reported that their acne, psoriasis, eczema, and other skin conditions were “miraculously” resolved after going Primal.
I’m not surprised. I’ve always believed that there is a deep connection between skin health, gut health , and inflammation. The Primal Blueprint is designed to support a diverse, well-balanced microbiome, reduce chronic inflammation , and provide epigenetic  signals that optimize health. It makes sense that clearer skin would be one of the benefits.
As I perused the success stories, it occurred to me that it’s been a while since we talked about skin issues  here. Today I’m going to cover three of the most common, along with some alternative (non-pharmaceutical) approaches to addressing them. Don’t get me wrong. I’m not judging anyone for opting for pharmaceutical options. However, many conventional treatments—antibiotics, oral steroids, hormonal birth control pills, and isotretinoin (sold with brand name Accutane)—have serious, sometimes downright scary, side effects.
Given that, I know many of my readers are interested in diet and lifestyle interventions that might help. They won’t fix all your skin issues, but they’re bound to improve some aspects of your life, even if your skin doesn’t clear up completely.
Acne is widespread among adolescents and adults. The most common form of acne is acne vulgaris. You’re undoubtedly familiar with the characteristic whiteheads and blackheads usually found on the face, chest, back, and shoulders. Cystic and nodular acne are severe types of acne vulgaris involve large, deep, painful blemishes that take longer to heal.
Acne doesn’t have a single root cause. Sebum (oil) production, pore blockage, bacteria (Propionibacterium acnes), and inflammation each contribute. Androgens increase sebum production, and hormonal changes due to puberty, menstruation, pregnancy, PCOS, or menopause often lead to outbreaks.
As common as these skin issues are today, they are not an inevitable part of the human condition. Grandfather of the ancestral health movement Loren Cordain asserts that acne is basically unheard of in traditional-living societies.1  This strongly suggests that modern lifestyle factors that affect epigenetics, inflammation, and hormones, underlie much of what we see today.
What to Do About Your Acne
Because acne is multifactorial, there is no single magic pill for acne. Sufferers may try a variety of topical, pharmaceutical, and lifestyle interventions before (hopefully) finding the key that works for them. It can take trial and error, luck, and time. There are also a lot of old wives’ tales that send people down all sorts of rabbit holes looking for answers. Many fall into the category of “can’t hurt, might help.” A few are actually backed by science:
Many supposed dietary causes of acne aren’t substantiated by research. (Chocolate  doesn’t seem to cause acne, thankfully.) However, the American Academy of Dermotology (AAD) agrees that two factors matter:2 
Both observational and experimental studies link greater intake of high-glycemic carbohydrates to more frequent and more severe acne symptoms. For some people, acne is significantly improved simply by lowering the glycemic load of their diet.
High-glycemic load diets probably promote acne through several metabolic pathways, including by stimulating insulinlike growth factor 1 (IGF-1) and androgen.3  4  Acne sufferers would do well to moderate their carb intake, especially high-glycemic carbs. The good news is that if you’re already eating a Primal-aligned diet, you’ve probably greatly cut down your glycemic load by removing grains and added sugars, as well as legumes . Fruit can also carry a heft wallop.
The AAD recommends that acne sufferers limit dairy intake.5  The available data is observational, so take it for what it’s worth. Still, a recent meta-analysis found that folks who drink more milk are more prone to acne. There was no significant relationship for cheese or yogurt consumption.6  This jibes with tons of anecdotal evidence from people who report significant relief from acne symptoms when they cut out dairy.
What about other food sensitivities?
I can’t tell you how many readers have confided they struggled for years, even decades, with acne before switching to a Primal diet and finally getting relief. Many of them have traced their problem back to gluten. Some are particularly affected by dairy, others by soy. Occasionally, random food sensitivities are the issue.
Despite the preponderance of anecdotal evidence, there is a glaring lack of scientific studies on food sensitivities and acne, so the link remains somewhat controversial. No matter. This is one of those cases where proof is in the pudding as far as I’m concerned.
If you are suffering from stubborn acne, consider what foods may be triggering for you. Start with the usual suspects. Track your symptoms and see if you can spot any patterns. When you identify likely culprits, try eliminating them for a few weeks and see what happens with your skin.
What If Dietary Changes Alone Don’t Solve My Acne?
First things first, look at your gut health. There is a strong gut-skin connection.7  Addressing underlying gut health issues, as well as supplementing with probiotics (Lactobacillus and Bifidobacteria), can reduce acne.8  You have nothing to lose by adding sauerkraut  or kimchi to your meals. If you’re not sensitive to dairy, try kefir, one of my favorite sources of probiotics. You can even try doing a yogurt mask since topical probiotic treatments could be beneficial.
Finally, work on your skin’s surface. Some people swear by using coconut oil on their face, but it can be aggravating for others. Try topical applications of manuka honey, tea tree oil (diluted), witch hazel, green tea extract, or apple cider vinegar. None of these is likely to be a slam dunk on its own, but use them alongside dietary changes and wise supplementation, and you might just arrive at a winning combo.
As with acne, there are several forms of eczema. The most common is atopic dermatitis. Eczema is characterized by dry, itchy, swollen rashes that appear most often on the face, neck, elbows, and knees. People of any age can develop eczema, but it’s more common in babies and children. Up to 20 percent of children and 5 percent of adults are afflicted.12  Doctors aren’t sure what causes it. Rashes seem to be triggered by an immune system reaction, but it’s not clear why. Specific triggers differ from person to person.
Because the root causes are unknown, finding relief can also be difficult and frustrating. Patients are advised to keep affected areas moisturized, avoid detergents and soaps that might irritate the skin, opt for cotton clothing, and take baths with oatmeal or vinegar. Doctors may prescribe topical steroids or other creams or, in extreme cases, immunosuppressing drugs.
Other Ways to Address Eczema
Studies of infants and young children have found that eczema sufferers have, on average, less microbial diversity in their guts.13  14  Probiotic supplementation, especially with strains of Lactobacillus, may reduce the risk of developing eczema15  and relieve eczema symptoms.16  A 2012 meta-analysis also concluded that when pregnant women supplement with probiotics, their babies have a significantly reduced risk of developing eczema.17 
However, a recent Cochrane review concluded that there is insufficient evidence to recommend probiotics as an effective eczema treatment.18  There are so many other benefits of supporting a healthy microbiome that it doesn’t hurt to try probiotics, though.
Thanks to its antimicrobial and anti-inflammatory properties, coconut oil applied topically to eczema rashes may provide some relief.19  If nothing else, it will moisturize dry skin and smell great.
Acupressure, acupuncture, and massage
A few small studies have found that acupressure 20 , acupuncture 21 , and massage22  may provide some relief. In addition to physiologic benefits, these treatments may reduce stress, which is known to trigger flare-ups.
Your doctor may use phototherapy treatments, but you can also reap the benefits of ultraviolet light simply by getting out in the sun.23 
Ultraviolet radiation triggers the release of nitric oxide, which in turn activates T cells that modulate the overactive immune response.24 
Dermatologists caution that sun exposure  is not recommended for severe cases, and it exacerbates symptoms for some people. Be careful not to overdo it. Besides the risk of burning, getting too hot and sweaty leads to itching and discomfort.
With plaque psoriasis—the most common form—red, scaly, often itchy or painful patches rise on the scalp, knees, elbows, lower back, or really anywhere on the body. Other types of psoriasis cause red lesions in folds such as the armpit, small dots, or blisters. Psoriasis can also affect the fingernails and toenails.
Psoriasis shares a lot in common with eczema. Doctors don’t know exactly what causes it, but it has a genetic component and is classified as an autoimmune disease. Symptoms come and go, and different people may have different triggers. Doctors usually treat psoriasis with topical creams, but they may also prescribe oral medications to try to get at it systemically.
Unlike eczema, though, psoriasis is more common in adults than children. Up to 30 percent of people with psoriasis develop a related condition called psoriatic arthritis. Because it is associated with systemic inflammation, psoriasis puts you at greater risk for other chronic health conditions such as metabolic syndrome and 25  cardiovascular disease.26 
Treating Psoriasis with Diet
Gluten sensitivity is probably more common among psoriasis sufferers than in the general population. I think gluten sensitivity is more common than is generally recognized, but that aside, I’d strongly suggest that anyone with psoriasis try eliminating gluten  completely for a period of time.
Calorie-restricted diets also yield significant improvements in symptom severity for obese individuals, but it’s not clear whether that is due to the calorie restriction per se, weight loss, or something else.27  28 
If you have psoriasis, you should also limit your alcohol intake. A growing body of evidence suggests that alcohol can worsen symptoms. Psoriasis also comes with a higher risk of liver disease, making excess alcohol consumption potentially more dangerous.29 
Many psoriasis patients try supplementing with fish oil, selenium, and vitamins D and B12, but there is only mixed evidence that they are actually effective.30  (Vitamin D is commonly applied in topical creams.) They may be helpful for some people, though.
There is also a lot of interest in curcumin, a compound found in turmeric . A number of small clinical trials have yielded some success, but it’s still early. A recent meta-analysis concluded that the available data do not support using curcumin topically, but taking it as an oral supplement shows promise.31 
Stress leads to psoriasis flare-ups.32  Therefore, anything you do to moderate stress may help prevent or manage symptoms. Meditation and guided imagery seem to work.33  Or, treat yourself to an at-home spa day. Start with an Epsom salt or oatmeal bath, then apply some topical treatments using stuff you already have in the house. The National Psoriasis Association recommends using aloe vera, apple cider vinegar, and tea tree oil topically, as well as mahonia (Oregon grape) cream (which you probably don’t have lying around).34 
Ultraviolet light, especially UVB, can help with psoriasis symptoms. Certain topical treatments make you more susceptible to sunburn, so check out any medications you’re using.
A 2017 review of studies involving more than 1,000 participants concluded that acupuncture and acupressure can help with psoriasis.35 
Skin disorders are complex. The remedies I mentioned here are not the only ones you might try. Severe or prolonged cases may respond best to a combination of treatments, including medications.
No matter what your specific challenge, the following are always good practice:
Support a healthy gut microbiome through the usual means .
Eat a nutrient-rich diet. Most vitamins and minerals directly and indirectly affect skin health. Vitamins A, D, and E probably get the most attention, but they are all important.
Avoid harsh cleansers and products that might irritate your skin. I have a few posts about Primal skincare , but the most Primal skincare “product” is just plain (clean, filtered) water.
Avoid foods that promote inflammation. If you suspect that food sensitivities make your skin problems worse, simple elimination experiments can provide answers. For skin issues, it’s not generally necessary to undertake a complete elimination diet along the lines of the autoimmune protocol (AIP) or low-FODMAP. However, if you have other symptoms that suggest serious gut health impairment, your practitioner may recommend that you do eliminate a wider swath of foods for a while.
Finally, avoid touching your face as much as possible. That’s just a good idea anyway.
I know I just scratched the tip of the iceberg here. Tell me about your personal successes and challenges. What’s your secret for healthy skin? Maybe your advice can help someone else.