Dr. Trevor Cates
March 5, 2017
When most dermatologists look at your skin, their goal is to suppress skin problems, but I want to encourage you to take a different look at skin because it’s trying to give you clues about your overall health. Your skin is your magic mirror providing an outward sign of your inner health. When your hormones, digestion, blood sugar, immune system, or other body systems are out of balance, it can show up on your skin.
When you ignore its messages, you’re missing an opportunity. And, if you continue to avoid the true underlying causes, your health can be impacted in other ways. For example, I’ve seen patients with eczema later develop asthma and autoimmune diseases because they ignored their magic mirror.
Medications, such as antibiotics and steroids, suppress skin symptom but can create further imbalances. These treatments are overused and often used too quickly without first considering more natural options. Antibiotics can kill off harmful bacteria, but they also destroy the beneficial bacteria in and on our bodies at the same time, which can actually worsen the problem. In addition, antibiotic resistance due to over and misuse has become a real problem.
Your skin is your largest organ, and it’s right on the surface of your body. You don’t need special imaging like x-rays or MRIs to see this organ. All you need is a mirror, so let’s take a closer look…
One message your skin may be trying to give you is about your microbiome (the range of micro-organisms, including bacteria, fungi, viruses and parasites that live on your skin as well as their genes and metabolites).
Your skin has its own unique microbiota (community of microorganisms) that are crucial for its health. As the wealth of knowledge from research continues to grow, we’re learning more about the benefits of a healthy microbiota of the gut and also skin. Many of the microbiome studies to date have focused on describing the gut microbiota, but the skin microbiota has been gaining more attention over the past 10 years.
The increase in this research is likely due to the growing number of people with chronic skin conditions. Acne is the most common skin condition in the United States—affecting close to 50 million Americans and is the eighth most prevalent disease worldwide. In addition, 32 million people are estimated to have eczema, and rosacea affects over 16 million Americans. And those are just a few of the many dermatologic conditions that plague us. Aging skin is also a big concern in the U.S. because of the large number of baby boomers in their 50’s and beyond.
The growing research on the skin microbiota have revealed that the skin is colonized with a larger number of microorganisms than had been discovered previously. We’re also learning more about the connection between the gut and skin, and there’s even more attention on the gut-brain-skin axis.
The gut-brain-skin axis theory makes a connection between disturbances in emotional states (due to stress, anxiety and depression) and changes in the gut flora as well as hyper-permeability of the gut (“leaky gut”). These gut changes create an inflammatory response that can trigger skin issues such as acne, eczema and rosacea. For example, a study showed that patients with rosacea had a tenfold greater incidence of small intestinal bacterial overgrowth (SIBO) than healthy controls. Another study, showed H. pylori infection to be significantly higher in rosacea patients than controls. Acne severity has also been linked to changes in gut microbes.
The human digestive tract contains a delicate balance of microorganisms, and throughout our lives, when we encounter toxins, stress, infections, poor dietary choices, antibiotics, and other medications, our microbiome is compromised; so, in turn, is the health of our skin.
A well-balanced skin microbioata protects your skin from harmful pathogens and promotes the natural lipid barrier and skin immune system. Ultimately, this function helps prevent acne, eczema, other skin eruptions, as well as premature wrinkles.
The good news is taking probiotics and eating prebiotic and probiotic rich foods appears to help address gut imbalances and restore healthy skin. Topically, probiotics also have the potential for direct effect at the site where applied by supporting the skin’s natural defense barriers as well as enhancing the activity and growth of healthy skin microbiota. We still need more research on the exact strains that help treat skin conditions topically.
We do know that one of the big factors that impacts the skin microbiota is the external pH of the skin. The surface of human skin has a natural pH level of about 4.5. (A reminder from chemistry class: A pH below 7 is considered acidic; a pH above 7 is considered alkaline.) Skin’s mild acidity helps keep the skin’s microbiota in balance; a more alkaline pH (around 8 to 9) kills or disrupts that balance.
Even water is too alkaline for skin. After water touches your skin, it’s important to rebalance the pH to a mildly acidic level using high-quality skin care products. Many common skin care products, such as cleansers, serums, and moisturizers often have a pH of 5.5 and higher, which can dry out your skin and make it more prone to infections, outbreaks, and premature aging.
A skin care product’s formula helps determine its pH, and there are many natural ingredients, such as citric acid, that reduce the pH to the mildly acidic range. The Spa Dr. skincare products have this mild acidity, but not all skin care products are made with mild acidity in mind. So, look closely at the label, and if the pH is not listed then contact the manufacturer to find out. You also don’t want your skincare products too acidic (below 4.5).
In addition, there are oils that help support the mild acidity and have other balancing effects for skin. For example, argan kernel oil can restore resilience to the acid mantle and impart luminosity and protect against dryness. Argan oil is rich in vitamin E, fatty acids (vitamin F), carotenoids such as beta-carotene, and phytosterols. Argan oil is a non-comedogenic (non-clogging) and anti-inflammatory, so it’s good for all skin types including acne-prone skin.
In my practice, I find that a combination approach to addressing the microbiome is most effective at supporting healthy radiant skin. For my patients, I recommend addressing gut imbalances with a diet that includes high fiber vegetables and probiotic-rich foods such as fermented vegetables and coconut yogurt. And, I often recommend a high quality probiotic supplement. Topically, I recommend using a mildly acidic skincare regime, and I refer them to DIY skincare recipes in my book Clean Skin From Within that help support the skin with ingredients such as plain organic yogurt.
When the microbiome is properly balanced, we see the difference in clear, youthful-looking skin. If you’ve struggled with skin issues for years, especially if you’ve taken or used topical or oral antibiotics or stripped your skin with cosmetic products and procedures, the microbiome is a primary root cause you’ll want to address. You can learn more about your skin type and other primary root causes in my new book Clean Skin From Within.
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 Gravina, A, Federico, A et al: Helicobacter pylori infection but not small intestinal bacterial overgrowth may play a pathogenic role in rosacea. United European Gastroenterol J: 3(1):17-24, 2015.
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