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Are You There, God? It’s Me, Your Microbiome

Suppose some of the approximately one trillion microorganisms that live on your skin are finding their living conditions objectionable, even intolerable. How would they let you, their god-like host, know about it?  If you were a commensal microbe living on the skin, Staphylococcus epidermidis,for example, and you just wanted to go about your business keeping your little part of the world relatively pathogen-free, you might consider sending a message in the form of an acne breakout, a rosacea flush or an undesirable rash.

When we start looking at the skin ecosystem from the microbes’ point of view, the entire picture changes. Not only does the rash become less a nuisance and more of a distress signal, but our sense of how we can eradicate the rash changes dramatically. Ideally, our response will be more along the lines of, okay, skin microbiota, you’ve got my attention—what do you need from me? 

Which brings us to the exciting new ways people are approaching the challenge of delivering effective skin care. Skin treatments make a difference when they consider both what we want for our skin and what the microbiota need from us. And this broadened understanding is on the verge of dramatically changing skin care.

An increasing body of evidence suggests that “topical prebiotics, probiotics and bacterial cell lysates do provide demonstrable skin benefits,” Dr. Patricia K. Farris avers in her article appearing in the  Dermatology TimesAre Skin Care with Probiotics Worth the Hype?” The studies she reviewed covered a number of the really tough skin care issues, ranging from acne and atopic dermatitis to aging. Her conclusion: “Skincare products containing these [topical probiotic ingredients] are well positioned for treating conditions characterized by an altered microflora.”

While getting the probiotic green light from the medical mainstream is gratifying, it should not distract us from the importance of the message contained in the doctor’s statement. We stand on the threshold of the great discovery for which we’ve long been searching—a workable, across-the-board method for resolving challenging skin conditions. It looks as if the answer lies in microbial management. The scope of this breakthrough concept has skin care formulators like myself feeling as sobbingly overwhelmed as the Spanish explorers who climbed to the top of that hill and got their first glimpse of the Pacific Ocean: 

“—and all his men looked at each other with wild surmise, Silent on a peak in Darien.”-- John Keats, On First Looking into Chapman’s Homer

Here’s the oceanic vista that confronts us now: the skin microbiome is a vast and little explored territory of staggering complexity. It stretches from the swamp homes of Staphylococci and Cornyebacterium (armpits and knee backs) to the sebaceous gland gourmet ghettoes where Propionibacteriumspecies dine, to arid stretches of arms and backs where diverse species longing for wide-open spaces dwell. It is a trillion microorganisms of a thousand different species cooperating tirelessly to make their communities nice places to live. Their 24/7 tasks include, among many other duties, controlling the colonization of potentially pathogenic organisms, modulating immune response, and maintaining proper barrier function. 

We have decades of exciting exploration ahead of us, but let’s start with a few outposts that intrepid researchers have already established. For example, recent studies demonstrate that skin microfloral disruptions play a significant role in conditions such as atopic dermatitis, psoriasis and acne. Interestingly, rates of these problems are rising at alarming rates: with more children developing eczema at an early age and more adults experiencing acne, even into their forties, fifties and sixties. 

Acne and the gut-brain-skin connection

Just to get some perspective, the relationship between the skin and the gut was proposed by John H. Stokes and Donald M. Pillsbury over 70 years ago. They advocated, among other remedies, using Lactobacillus acidophiluscultures. Recent work validates many aspects of the gut-brain-skin unifying theory, and we now feel comfortable adding topical probiotics to treatment protocols. For example, a topical containing a 5% extract of Lactobacillus plantarum was found to reduce erythema, acne lesion size and improve skin barrier in patients with acne. Some researchers have ventured far enough into the alternative camp to recommend probiotic therapy as a viable replacement for antibiotics. 

For more about treating acne via topical probiotics please see The Acne Answer which contains recipes for rebalancing skin microflora using yoghurt that contains live Lactobacillicultures as cleansers or in masks.


Seventy-five years ago, eczema and acne were quite rare. Now we are seeing younger and younger children with eczema, and older and older people afflicted with acne. As for what lies in between, we are seeing cases of atopic dermatitis, particularly perioral dermatitis, in the mid-thirties age group. It’s strange—ten years ago, no one had even heard of perioral dermatitis—and now it seems everyone has it. (In case you’ve been spared, PD is redness and irritation around the nostrils that can spread down the naso-labial folds to irritate the areas around the mouth.) So, what gives?

It’s not outside the realm of speculation to make a connection between microbial disruption and rising skin sensitivities. Indeed, PD might be the poster child for a peculiarly modern skin condition that coincides with our war on germs. We start at an early age with antimicrobial cleansers and soaps—then when skin becomes dry and irritated we slather on moisturizers loaded with microbe killing preservatives.

We also smearing scented skin products all over our face and body on a daily basis, at the same time as the rate of allergic dermatitis has risen exponentially. The number one cause of allergic dermatitis? Fragrance. Artificial fragrances contain scent fixers like carcinogenic phthalates and up to 95% are contaminated with aromatic hydrocarbons like benzene, so unarguably, you don’t want to have anything to do with them.

But, we hear the faithful objecting, I only use natural essential oils, so I’m fine. Right? Actually, we’ve been led down the garden path by the natural community as much as by Big Cosmo on this one, because essential oils are just as likely to cause allergic reactions as the up-to 1,000 different components of an artificial fragrance, each one of which can cause an allergic reaction in someone. One working hypothesis for why this is, is that essential oils are volatile liquids that disrupt microfloral balance of the skin, making it more susceptible to pathogenic over-colonization. 

The connection between dermatitis and essential oils is well-established, so if you are fragrance sensitive or have ever experienced a reaction, beware the moniker “natural,” and look instead for “fragrance-free” on your products’ label. Do not confuse “fragrance-free” with “unscented,” as unscented products may still contain a masking scent. 


The Anti-Aging Effects of Probiotics reports that the “published literature demonstrate that probiotics restore acidic skin pH, alleviate oxidative stress, attenuate photoaging, improve skin barrier function and enhance hair quality.” That’s a mouthful, and I am especially pleased to hear that hair quality is enhanced, even if I’m not sure what that means. As a lifelong, dues-paying member of the frizzy hair contingent I pledge to investigate further, rest assured. 

The jury is still out on whether probiotics are actually going to be the fountain of youth for skin (I’d reserve that honor for retinol) but here is an encouraging piece of news straight from the skin ageing battlefront.

“Streptococcus thermophilus is a bacterial strain known for its high levels of sphingomyelinase. A cream containing the lysate of S. thermophilus was found to significantly increase stratum corneum ceramide levels in healthy females after two weeks of application.”

This is encouraging because topically applied yoghurt is a simple and inexpensive way to supplement your nightly age-defying skin care routine. And yes, you can apply yoghurt topically even if you are allergic to dairy.

A DIY moisturizer:

Good yoghurts like Noosa contain strains of S. thermophilus. Look for it on the list of live cultures. Apply about ¼ tsp at night in a thin layer. The yoghurt can be layered over your regular serums.