The human body, including the skin, is host to thousands of bacterial and fungal species. Some of these bacterial and fungal species are harmful, and some are known to be beneficial. All bacterial environments in the body are different. The microbiome is the invisible top layer of the skin, made up of millions of microbes that work in tandem with our epidermis. These microbes can bring harmony or dysfunction to the skin’s surface, depending on what kind of species exist and in what concentrations. The skin flora is different from that of the gut, although a stomach suffering from bacterial overload may also show symptoms on the skin (this is especially true in cases of acne, rosacea and other dermatological disorders).
The professional therapy field has addressed the concept of skin microbiota, but until recently, no one had identified this massive iceberg in our physiognomy with a name. Rebecca James Gadberry gave a comprehensive lecture on the skin microbiome back in 2015, but in the past two years, microbiome care has suddenly become the trend and focus of marketing efforts in the skin care industry.
Investigating The Microbiome
For decades, we have maintained a healthy microbiome in the skin with professional treatments. Post-treatment infusions include fractionated oils that mimic the skin’s natural sebum combined with a polarized herb and water blend replicating the acid mantle. Beta-glucans support the skin’s immune system. Lactic acid also plays a role in timely skin turnover and microbiota maintenance.
Despite these tools, my business partner asked me to formulate some “probiotic products” because they were trending in the skin care industry. At first, I scoffed at this, thinking, “Those companies are putting dried yogurt into creams. It’s a dead product that has little to do with probiotics!” Then, I saw some stunning research out of Japan, in which the relationship between eczema and the skin’s microbiome was proven to be connected. Since eczema has always been an intrepid skin disease that we could temporarily treat but never truly cure, I jumped into the research to give me some direction on how to approach the skin’s microbiome and better treat eczema.
I attended a skin microbiome conference in Boston where a group of leading R&D scientists (and a few just plain good scientists) gave comprehensive dissertations on their studies and research. As I sat there at the end after two days, I was reminded of an old Indian folktale about four blind gentlemen confronting an elephant for the first time and describing what they “saw.” Grabbing the tail, one exclaimed, “Aha, the elephant is like a living rope!” The next one shouted, “You are wrong, it’s like a snake!” as he grabbed the trunk. A third man laughed and said, “You are both crazy; it’s like a wall,” as he slapped the elephant’s side. The last one claimed they were all wrong as he touched the ear: “The elephant is like a fan!” They were all individually correct in describing the elephant, but collectively, it was the old “Can’t see the forest for of the trees” syndrome.
It was the same story at this conference. Each speaker had a point of view from their intense study of specific skin conditions and the bacterial aspects of bringing skin to homeostasis. Each speaker had similar knowledge of the various elements of skin microbiome; some, especially the young Japanese scientists, were quite brilliant and even had me on the edge of my seat as they flashed their charts and graphs, their laser pointers flickering wildly! But then I would sink back after waiting for conclusive concepts—there were none, though the whole thing ended with the organizer giving an emotional closing filled with what the future may hold, with more understanding of the body’s new layer of skin beyond the epidermis—the microbiome!
I took copious notes, especially on what was shared amongst the group, and went away filled with ideas that would take me a year to compile into usable concepts. I was highly amused to see so many young “lab rats” sent by Proctor and Gamble and other huge corporations looking to create new commercially viable products under the probiotic buzzword.
Pre- and Probiotics Solved
New research into the mysteries of eczema and other inflammatory diseases led me to explore more efficient ways to maintain the skin’s microbiome at levels that would ward off the invasive “bad” bacteria while protecting beneficial bacteria with pre- and probiotics.
Prebiotic materials stimulate the existing “good” but failing bacteria colonies in specific skin areas, helping them increase over the entire epidermal areas on less-than-healthy skin. Prebiotics also help convert detoxified waste materials and hydrolyzed proteins into active proteins, or “skin food.” These are known as Chemoorganotrophs, capable of breaking down organic material such as dead skin cells and converting them into organic material that kick-starts dormant (usually from aging) extracellular enzymes, particularly the transferase gang, whose job is to send “wake up” messages across cell membranes! Autrotrophs from green plants also have a conversion role in skin, along with heterotrophs. While they do not necessarily directly fight harmful bacteria, they do love to munch up other toxins, including carbon dioxide.
Probiotics support all skin repair modalities, boost natural immune functions and calm inflammatory conditions. The Probiotic maintains the probiotic bifido cultures and the lactic acid group bacteria that guard against bad bacteria and fungus attacks. It also helps increase the metabolic activity of the skin’s immune system and helps with glycosylation. The microbiome influences all parts of the skin, and many dysfunctions, such as foot fungus, body rashes, and folliculitis, can be linked to a microbiome system that is out of balance.
Good, Bad and Ugly Bacteria
Many skincare products can affect the microbiome simply by not helping to maintain the homeostasis of good/bad bacteria, allowing the bad bacteria to take over and resulting in a breakdown of the skin’s natural defense mechanisms. This is why we have added specific microbiome products to our already supportive arsenal of skin defense weapons—giving us maximum control over our skin’s ecosystems. I believe skin afflicted with eczema, fungus, and S. Aureus will be the major beneficiaries of pre-, pro-, and post-biotics. However, nearly every skin condition can benefit from highly active products.
One university bacteriologist in Australia referred to skin bacteria as “The Good, The Bad, and The Ugly,” from the old spaghetti western starring Clint Eastwood, and in a way, his analogy was spot on. Our skin is colonized by good bacteria, (defense mechanisms designed to ward off attack), the bad guys, (who wreak havoc) and the ugly (the sometimes-neutral, sometimes-damaging parasites we all possess). Just look at a blown-up photo of the demodex mite, one of the culprits in rosacea! Nothing more nightmare-ish and ugly than those little varmints!
Let’s identify the unmutated bacteria we all start with on our skin to better understand what we, as skin practitioners, are up against.
Bacteroides Fragilis
These species are part of the normal flora found in the human colon. They are generally commensal but can cause infection if let into the bloodstream via microneedling or PRP on the skin or surrounding tissue following surgery. They can become “bad” during trauma from acne, dermatitis, rosacea and eczema
Firmicutes
These gram-positive bacteria with strong cell walls do have some species of lactobacillus, the good guys that act as a major portion of bacterial homeostasis (the most important word in the microbiome). They are anti-inflammatory and antibiotic. Conversely, gram-negative bacilli make up a very small portion of the skin flora. They are mainly found in the toe webs and Axillae. They are the P.U. factor from the armpits. However, we do need them in the correct numbers to create homeostasis in the entire skin flora.
Proteobacteria
This strain can create nitrogen phagocytosis, facilitating the acquisition of toxic debris and cell nutrients. However, they can be strong predators of bad bacteria that are gram-negative.
Lactobacillus Plantarium
We get this beneficial bacteria when we eat fermented foods such as sauerkraut or kimchi. To suggest a “sauerkraut mask” may not be so outrageous after all!
S. Epidermis and S. Aureus
These two hate each other and are mostly found in eczema and atopic dermatitis research. S. Epidermis is a major denizen of the skin and, in some areas, makes up more than 90% of aerobic flora! S. Aureus, on the other hand, is a bad bacterium, very common on the nose and perineum, and accounts for 40% of the microbiome in normal adults. But this can rise to 80-100% on the skin of patients with various skin disorders such as atopic dermatitis. S. epidermis can roll right over S. aureus and destroy it in minutes.
Malassezia
This is in the fungus category and is natural to almost everyone’s skin. When allowed to become predominant, sometimes accompanying Eczema, it can cause both hypo- and hyper-pigmentation, thus often mis-diagnosed. Pre- and probiotics can help set up defenses against this sneaky fungus, but primary enzymatic removal treatment is required to get rid of it, with ongoing pre- and post-biotic home treatment to maintain homeostasis. Older cases can vanish within 48 after treatment.
Micrococci
It is not common but frequently found on normal skin and reflects poor skin habits, diet, and contaminated surroundings.
Streptococci
Very harmful bacterium not seen on normal skin. Lipids such as healthy sebum are lethal to this species. Some of these species start in the mouth and then spread to the skin—very symbiotic to viruses such as herpes. In fact, viruses, bacteria and parasites love to party together, leading to many flawed diagnoses and falsely presumed causes of dozens of skin disorders such as “acne rosacea,” used for decades until the medical field disowned it as a disease. I still hear that dermatologists use it globally.
Bifidobacterium
These are the angels of bacteriology and most often used in “functional foods” and supplements due to their health promoting probiotic properties-and act as protection, not predators against pathogens.
What We Do Know
One outstanding imbalance right under our noses all along was the large amounts of S. Aureus that is always present in eczema cases!
One theory was that S. aureus was causing the dry, itchy, and inflamed symptoms of the disease. To fight this, researchers applied copious amounts of pure S. Epidermis and S. Hominis over the affected area (via cultures in a petri dish). The bad guys died within seconds. Follow-up treatment included infusing the good bacteria in a topical cream on a human subject, which reduced eczema by 90% in minutes.
The use of lysates also looks promising. Cell lysis is a purifying process used in laboratories to break open cells to purify and study their contents. Enzymes and detergents of chaotropic agents may be used in this process. Lysis can be used for DNA/RNA extraction and protein purification and as “mulch” to help grow friendly bacteria. Lysates are also powerful inducers of specific immune responses against bacterial infections, especially pulmonary, though it’s not fully understood why yet.
Other global studies are researching which bacteria will fight specific skin conditions. One discovered that Lactobacillus plantarum lotion reduced skin redness and pustule size in persons with acne vulgaris. Others still are investigating ammonia-oxidizing bacteria. This bacteria metabolizes ammonia, a major component of sweat, and may someday be used for acne treatment and even chronic wounds such as austyomitis. For these studies, a strain of nitrosomonas eutropha isolated from soil in double-blind tests resulted in incredibly improved skin on scalps and faces. Nitric oxide, which dilates the blood vessels, can also make it easier for the heart to pump blood flow through the body and helps regulate inflammation.
The days of trying to heal skin diseases by destroying bacteria on the skin may be over sooner than later, outside FDA and EU regulations. It will be certain that our professional tools will include spraying or petrissaging bacteria over our clients’ faces and training them to be less antibacterial-conscious, outside of washing our hands several times a day. Bacterial diversity will become a buzz word and hopefully a trend. Trends are only stable, however, when the trend evolves into effective concepts in science that not only change the way we think—but what we do in our practice.
Conclusion On Pre and Probiotics
Prebiotics should stimulate dying but still viable bacteria on less-than-healthy skin. They induce the detoxifying waste recycling process, rendering it as autophagy which converts inactive proteins into acting proteins necessary as “skin cell food.” They support the skin’s natural skin repair modalities and help boost Langerhans cells and other skin immune defenses. They also calm and repress inflammatory conditions.
Probiotics maintain the probiotic bifudo cultures. They help maintain active skin nutrients after application. They also increase metabolic activity of skin cells and immune systems and protect against environmental stress including solar damage and pollution. Probiotics protect against the overload of bad bacteria, which takes healthy skin out of homeostasis. They are also helpful in cases of glycation. *I would add postbiotics to this because they have to be a daily practice, especially in problematic recurring skin disorders.
I have been asked “what to look for in probiotic products.” Because the field is new, I can only say that all of the above “good” bacteria should be present in the products. The cultures must be alive. There was an owner of a skin care products range that approached our colleague Dr. Jayant Lohkande after one of his lectures on the microbiome at a NASANPRO conference. A month later, this same company took out a full-page ad in an aesthetics magazine claiming to be “the first company with probiotic skin products containing ‘live’ bacteria.” Apparently, this person was not really paying attention to Dr. J’s lecture; because if this is true, putting live bacteria in a cream or lotion is not only against FDA regulations but would cause a myriad of bad skin conditions. Fortunately for them, live bacteria would not stay active in a cream or indeed, on the skin, due to various pH factors and local environmental changes. Using encapsulated live SPORES is another matter. They are hard to get and very expensive to process, and they do not reset our microbiome until placed on the skin in transepidermal products that effectively permeate the skin.
More Knowledge To Come
One thing I have noted in the last few years is therapists are becoming more and more savvy, seeking true education as opposed to trendy product knowledge. It seems more and more industry leaders and customers alike are realizing that the adage “the devil is in the details” is true. Real results can only come from proven scientific research, trial and error proven over time.
So much about the microbiotic world is yet unknown, but my personal opinion is that many of us have been AWARE of the unknown and have been trying many things outside of acceptable medical practice, unknowingly heading in the right direction. We needed a name that evolved into a trend, and the trend is here. And it will change medicine forever. The more we learn about the microbiome, the more we will understand that it is not the presence of bacteria that causes all the anomalies of skin disorders but the imbalance of the types of bacteria that live on our skin.
Lira has also written more information about Microbiome Balance HERE
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