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12th Nov 2019
There’s so much more to your skin than meets the eye. Think of the average person’s outer layer as a vast wilderness that includes stretches of arid desert, perhaps some scaly, sun-scorched terrain, temperate grasslands, dry crevices, a few oil spills, dense forest and pockets of humid jungle. Each miniature ecosystem has its own micro-climate and a unique community of good bacteria, fungi and pathogens.
It may make you feel itchy just thinking about it, but every square centimetre of your epidermis is home to between one million and one billion microbes, living both on the surface and deep within the dermal layers that extend all the way down to your subcutaneous fat.
Your microbial passengers, which also reside inside your gut, mouth, lungs and urogenital tract, were once thought to outnumber human cells by 10 to one. That ratio is now believed to be closer to one to one, which means you could call your microbiota your ‘significant symbiotic other’. Maybe even your better half? Because, when you think about it, your bacteria are with you from the day you are born (when you are doused in your mother’s microbes via the birth canal or via a swab post- Caesarean section) until the day you die. And they take very good care of you along the way.
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No doubt you’ve already heard about the powerful effect gut microbiome has on your health. In the last decade, we’ve learned they produce neurotransmitters such as serotonin and dopamine; help regulate the stress hormone cortisol, appetite and metabolism; manufacture some vitamins; metabolise nutrients and much more. Studies have also shown a link between gut health and incidence of type 2 diabetes, obesity, mood disorders and some cancers.
The result of all this new knowledge has been an explosion of prebiotic, probiotic and gut-friendly products on supermarket shelves. Some of us have even turned fertilising our ‘inner gardens’ with fermented foods and drinks into full-blown sauerkraut-making, kombucha-brewing hobbies. Meanwhile, we’ve continued waging war on our skin microbiomes with aggressive beauty regimens and anti- bacterial cleansers. Rather than being treated like loyal, life-long lovers, the bacteria that cohabit our largest organs have been enemy number one for longer than we can remember.
But that may be about to change. Emerging science suggests skin bacteria interact with the immune system and play an equally important role in enhancing health. Harnessing the power of skin microbes is being touted as a potential cure for everything from acne, rosacea, dermatitis and inflammation to skin cancer and even ageing. Some research has shown our microbes give us glowing skin, thicker hair, better immunity and may even make us better friends and lovers.
“It is exciting to find more and more evidence of the beneficial functions of the skin microbiome,” says Professor Richard Gallo, a dermatologist and immunologist at the University of California San Diego, who believes one day we may discover it plays an even bigger role than the gut in protecting our health.
“On the skin our microbes are in direct contact with our bodies and are protected in hair follicles,” Gallo says. “In the gut, most are eliminated and separated by a mucus layer from the intestine. [The] gut microbiome has been popular because of the ease of study, not because it is inherently more important.”
To date, Gallo’s research has shown certain types of bacteria on human skin produce anti-inflammatory compounds that have been effective in treating atopic dermatitis. His laboratory has also discovered another strain of bacteria found on human skin which produces a chemical that kills several types of skin cancer cells. “We are making good progress in developing a microbe therapy for eczema [too],” he says.
Gallo also expects treatments containing beneficial bacteria will soon replace the current topical and oral antibacterial protocols used to treat acne, which affects an estimated 85 per cent of adolescents and young adults worldwide. Meanwhile, another study found the microbes living on our skin influence how quickly wounds heal, suggesting we could improve antibiotic dressings with bandages that protect against infection without eliminating beneficial bugs.
So could skin microbes help with anti-ageing efforts? “One interpretation of the ‘fountain of youth’ is the ability to recover rapidly and efficiently from injuries of everyday life,” says Dr Susan Erdman, a microbiologist at Massachusetts Institute of Technology.
“In earlier scientific data, we found that mouse skin heals twice as fast when [the mouse has been] eating probiotics,” Erdman says. “This is specifically comprised of a robust pro-inflammatory immune response to clear debris and squelch invaders, followed by a quick recovery to normal functional tissue. It follows logically that boosting repair of daily skin injuries would reduce signs of ageing, but this hasn’t yet been thoroughly tested on human skin wrinkles. There are lots of opportunities to build on this concept, combining cocktails of microbes and media for more [healthy] and youthful-looking skin.”
Along with making us look better, Erdman suspects microbes may also improve our relationships with ourselves and others. “We envision a gut microbe-brain axis that promotes not only these physical attributes of wellness, but also mental, social and spiritual health,” she says. “In the bigger picture, we aim for healthy lives filled with joy, meaning and a sense of purpose. Research is underway studying relationships between microbes, oxytocin and sociability qualities such as empathy and altruism … It is simply amazing that exposure to microbes once commonplace in humans boosts endogenous oxytocin levels and imparts a microbial hug in animal models.”
While it’s an exciting time to be a microbe – or a microbial host – these are early days and there is still much we don’t know about how to cohabit better with our ‘symbiotic others’. But things are moving fast, says Sydney-based dermatologist Dr Jo-Ann See, thanks to exciting new sequencing technology that allows scientists to identify and analyse individual strains of bacteria.
“First it was the gut, and now we are looking at skin and realising it’s more diverse,” See says. “The skin science is way behind [the gut science], but it will catch up as new techniques are developed.” See predicts that in the not-too-distant future we might be given personalised prescriptions such as moisturisers loaded with specific bacteria to target imbalances in our unique microbial fingerprints.
A recent study conducted by Erdman showed applying a topical cream containing certain strains of beneficial bacteria decreased skin sensitivity. “It’s an interesting idea that tickling with microbes would actually be good for sensitive skin,” Erdman says. “Along these lines, creative topicals for skin and oral health might include combinations of live organisms and sterile [killed] microbe fractions [known as postbiotics] … One interesting idea is to combine dietary and skin applications of these cocktails. Topicalscombining yummy foods for the microbes [such as prebiotics like seaweed or yoghurt] would feed our microbial passengers inside and out for a healthy whole body balance.”
As we wait for scientists to develop these next-gen microbial therapies, there are things we can do now to better protect our skin microbiome.
“Ask for a vaginal delivery [in childbirth], play in the garden and don’t wash off all the bugs,” See says. “Avoid things that strip away the microbiome. The caveman theory of skin is that people weren’t supposed to wash and clean as much: it’s a 21st-century thing. This evolving understanding is really going to turn people around. Maybe they are washing too much; maybe they aren’t getting outdoors enough.”
Apparently skin microbes love to eat the ammonia found in sweat, so exercise is another scientifically proven way to get that microbial glow. And while it’s not scientifically proven, Erdman admits she uses yoghurt and kefir (fermented milk) masks on her face.
A 2014 Swedish study found children from families who washed their dishes by hand, as opposed to using a dishwasher, had less allergies. Perhaps it’s as simple as getting dirty in the garden and giving ourselves a big microbial hug.
This article originally appeared in Vogue Australia’s October 2019 issue.