The Importance of Understanding the Skin Microbiome in Managing Eczema

Eczema is one of the most common chronic inflammatory skin disease of the modern world. (3)

Those who suffer from eczema know that it can be a tricky condition to manage. The itching skin, the dry skin, and the constant skin discomfort can all feel frustratingly persistent. Flare ups often reoccur despite initial improvement.

Traditionally Accepted Treatment Options for Managing Eczema

There is currently accepted no cure for eczema however there has been strategies used and trusted for decades and still used today. 

The current mainstay treatment for mild to moderate eczema aims to control symptoms of inflammation and itching with first line therapy being emollients (moisturisers) combined with treatments to reduce inflammation - often steroid creams.(1) Antibiotics can also be recommended by doctors in more severe cases. (3)

The exact cause of eczema has been accepted as largely unknown except for the knowledge that it appears that those with a family history are more likely to develop it. (2)

How is the science of the skin microbiome changing the way we understand eczema?

Science has now established there are three main mechanisms in the body that contribute to eczema .(3)(4)

• Imbalance of the Skin Microbiome
• Skin Barrier Dysfunction 
• Immune Disregulation (3)(4)

In this blog post, we’ll focus on and explore some key aspects of the skin microbiome and examine how it might factor into a comprehensive approach to managing eczema. 

By examining the complex interaction of bacteria and other organisms that live on and within our skin, we can better understand eczema - and ultimately manage it more effectively.

The Skin Microbiome and Eczema

First, let’s talk about what the skin microbiome actually is. 

Essentially, it’s the community of microorganisms that live on our skin and help to keep it healthy.  We can think of it as its own ecosystem. While these microorganisms include bacteria, viruses, mites  and fungi, it’s important to understand that not all microbes are harmful. In fact, our skin is home to a vast array of microbes that work together to support its overall health and function and are amazingly beneficial. When the balance between different types of microbes is disrupted, dysbiosis occurs. It is in this state of dysbiosis that the skin microbiome is not working at its best and it can lead to skin conditions, one being eczema. 

Research has found that people with eczema have a different balance of bacteria on their skin than those without eczema.  The evidence suggests that there is an important relationship between the skin microbiome and eczema. 

Role of Specific Bacteria in Eczema

A person has  typically about 1000 species (and thats just the bacteria on their skin. (5) Predominant are Staphylococcus, Corynebacterium and Propionibacterium genera.  (3) The inhabitants vary depending on which area of the body and each individual microbiome makeup is unique to each individual.

If one microbe becomes more  dominant  then we  see a decrease in other inhabitants. This is what we call a dysbiosis. And in eczema the dysbiosis is caused by an overpopulation of dominant Staph Aureus.  An imbalance has occurred.

What is the difference between 

• Dysbiosis, 
• Colonisation and 
• Infection

It is important here to discuss three completely different states that can occur with an individuals microbiome with different outcomes.

Colonization is simply the presence of bacteria but no signs on illness, inflammation, irritation. This is happy, normal skin.

Dysbiosis- is where we see an imbalance in the microbiome so one or two bacteria are dominating and we are losing the benefits of the some of the beneficial microbes. 

The microbiome doesn’t work at it’s best and we get barrier impairment and decreases immune regulation leading to a redness, itching, dryness and irritation on the skin. The level of irritation can be mild to moderate. An example is very dehydrated skin, redness and flaking . 

Infection- clinical signs of illness and inflammation consistent with an infection (pain, tenderness, warmth, honey coloured crust. Broken skin, oozing, pus, fever, swelling). This is an infection and requires immediate doctor referral and antibiotic treatment in most cases.

The Microbiome Threshold 

The Skin Microbiome Threshold represents the level of diversity in the microbiome  at which our skin microbiome changes form colonisation to dysbiosis. 

A simplified way of understanding that at a certain level of diversity  the microbiome balance is imbalanced enough to cause skin symptoms , this is a move into dysbioisis. 

How can we keep our Skin Microbiome balanced?

 

So how can we keep our skin microbiome balanced.

• Respect it with education and understanding
• Use skincare serums that care for the skin microbiome. 
• Gut Microbiome/Skin Microbiome Axis- diet
• Lifestyle

Respecting the Skin Microbiome 

Even though the skin microbiome is invisible, we know it can contribute to the general appearance of the health of our skin. It is best to use gentle skincare options.

Prebiotic and Probiotic Skincare to Maintain The Skin Microbiome 

 

One approach to encourage the health of the skin microbiome is either Prebiotic or Probiotic Skincare. What is the difference between pre and probiotics in skincare and which now should I be using ?

Probiotics in Skincare

 

 

 

 

Probiotics are by definition live bacteria and yeasts that can be beneficial to our skin health. Studies have suggested that probiotic skincare might help to improve the balance of bacteria on the skin. However in Australia at the moment majority of skincare products labelled as probiotics do not contain live bacteria. Rather they are ingredients treated with probiotics at some stage in the manufacture or they are lysates which is a probiotic that has been lysed or cut in half. They still give benefits, but the affects are very transient and they are not by definition probiotics at all. 

Prebiotics in Skincare

The ingredients of choice for the skin is actually prebiotic skincare as it is gentle, safe and works with the unique microbiome of the user. Prebiotics gently feed the good bacteria giving microbiome care and maintenance. 

Prebiotics show more potential benefit to the skin microbiome and give short and long term results. However it is important to note that the skin microbiome, is completely different to the gut microbiome and it is important to choose expert skincare brands that work with skin specific prebiotics that nourish the specific unique beneficial microbes  on our skin.

In conclusion, understanding the skin microbiome is becoming increasingly important in the management of skin conditions such as eczema where a dysbiosis may be present on the skin microbiome contributing to the condition.

By recognising the complex interplay between bacteria, fungi, and other organisms on the skin, we can make more informed decisions about our skincare routines and explore new options for managing symptoms. 

While there is still much to learn about the skin microbiome, the evidence suggests that it might play a central role in eczema.

 By taking a holistic approach that focuses on the whole body, maintaining  skin barrier and skin microbiome  rather than simply treating symptoms, we can move toward better outcomes for people with eczema.

 

Author Michelle Miller Bachelor of Pharmacy Advanced Diploma in Cometic Science 

Founder Australia Expert Microbiome Skincare  theSkinBiotic® - Microbiome and Barrier Care Focused Skincare .

References

1. Pothmann A, Illing T, Wiegand C, Hartmann AA, Elsner P. The Microbiome and Atopic Dermatitis: A Review. Am J Clin Dermatol. 2019 Dec;20(6):749-761. doi: 10.1007/s40257-019-00467-1. PMID: 31444782.
2. https://nationaleczema.org/eczema/
3. Weidinger S, Beck LA, Bieber T, Kabashima K, Irvine AD. Atopic dermatitis. Nat Rev Dis     Primers. 2018 Jun 21;4(1):1. doi: 10.1038/s41572-018-0001-z. PMID: 29930242
4. Kim J, Kim BE, Leung DYM. Pathophysiology of atopic dermatitis: Clinical implications. Allergy Asthma Proc. 2019 Mar 1;40(2):84-92. doi: 10.2500/aap.2019.40.4202. PMID: 30819278; PMCID: PMC6399565.