Abstract Description

The gut and skin represent the largest microecosystems in the human body, hosting diverse communities of bacteria, archaea, fungi, and viruses that are central to maintaining health. Diet may lead to imbalances in the microbiota, which may result in impaired barrier function and systemic inflammation. Although we are beginning to understand these perturbations, there are substantial gaps in our knowledge, particularly across Africa, where rapid urbanisation and lifestyle changes contribute to a shift from traditional fibre-rich diets to highly processed, sugar- and fat-rich foods. This study investigates the influence of diet on the gut microbiota and its subsequent impact on skin health among urban and rural South African populations. The urban cohort comprised participants from universities in the Western Cape, with further enrolment planned from rural communities in KwaZulu-Natal. Skin condition was clinically assessed by a dermatologist using the Investigator Global Assessment system. Stool and skin samples were collected for 16S rRNA amplicon sequencing. To date, 133 paired skin and stool samples have been collected from the urban cohort. Clinical assessments revealed that 56.4% of participants presented with clear skin, 21.3% with mild to moderate acne, 13.8% with moderately severe acne, and fewer than 1.0% with severe acne. These results highlight the clinical diversity of Acne Vulgaris (AV) in the cohort and provide a strong foundation to link dietary patterns, microbial communities, and skin health outcomes. Ongoing sequencing and analysis will yield new insights into the role of gut and skin dysbiosis in AV within African populations. This work represents the first comprehensive dataset addressing the diet–gut–skin connection in Africa. By integrating dietary assessment, microbiome profiling, and clinical evaluation, the study establishes a critical platform for advancing understanding of dysbiosis, its role in inflammation-associated conditions, and the mechanisms of the gut–skin axis in African populations.