Eczema: What does it mean for you?

Eczema is a chronic inflammatory skin condition affecting up to 20% of the global population. The condition is multifactorial, and treatments are aimed at reducing inflammation and improving the skin barrier with moisturisers and anti-inflammatories. Many natural therapists incorporate internal probiotic supplementation into the eczema regime to address the gut-skin axis. However, the impact of the microbiome residing on the skin’s surface on eczema development and progression is often overlooked.

Staphylococcus, Corynebacterium, and Propionibacterium are the main bacterial species residing on the skin, with 90% made up of Staphylococcus epidermis. This bacterium plays an important role as an antimicrobial and actively contributes to the skin’s innate immune defence. However, approximately 90% of eczema sufferers have pathogenic overgrowth of Staphylococcus aureus, which produces a toxin that causes immunological and structural dysfunctions of the skin, leading to eczematous flares and infections.

Decolonisation through the use of antibiotics is often recommended due to this microbial imbalance, but a Cochrane review found no clinical benefit of this therapy on eczema. This led researchers to propose that directly stimulating the growth of the beneficial bacteria on the skin, S. epidermis, through the use of an external probiotic, Lactobacillus brevis, would be an important and novel way to manage eczema.

In a 2017 randomised placebo-controlled trial, L. brevis was tested for its ability to change microbial diversity, reduce inflammation, and provide structural and symptomatic improvements to eczematous skin. L. brevis produces small molecules capable of enhancing the growth of skin commensals. This probiotic had the strongest growth promoting activity against nine strains of S. epidermis compared to three other strains of L. brevis, which was confirmed by in vitro tests. Further analysis also showed significant anti-inflammatory effects.

In vivo skin testing on 30 healthy volunteers with dry skin for four weeks showed that L. brevis (DSM 17250) was effective in significantly recolonising the skin with S. epidermis and other commensal bacteria, while severely reducing S. aureus in subjects with high baseline levels. Additionally, the externally applied probiotic improved skin barrier function, reducing transepidermal water loss, with around a 70% improvement in skin tightness, roughness, scaling, and sensitivity over the four weeks.

The researchers concluded that this probiotic used externally provides a powerful and gentle solution to treat skin conditions. It specifically and beneficially shapes the skin microbial community while moisturising and improving skin barrier function.

Clinical evidence outlining the existence of a complex bidirectional communication network, the gut-brain axis, and the fundamental role it plays in maintaining digestive and mental health. Poor nutrition is a common concern for patients with mental health conditions and plays a crucial role in onset, severity, and duration of symptoms. Dietary interventions with supportive supplementation have demonstrated significant symptom improvement, making them key treatment approaches for consideration.

A westernised diet rich in sugar, salt, and fat can increase the permeability of the gut lining. As a consequence, gut dysbiosis, HPA axis dysfunction, and intestinal inflammation often occur. The lack of nutrients, coupled with poor absorption in the inflamed intestinal lining caused by the typical western diet, also affects neurotransmitter production and function, which negatively affects behaviour and mood.

In contrast, the consumption of a Mediterranean style diet rich in plant-based foods, fermented foods, prebiotics, and probiotic supplementation is anti-inflammatory has been associated with lower levels of systemic inflammation. A Mediterranean diet includes plenty of fruits, vegetables, whole grains, nuts, seeds, legumes, and healthy fats like olive oil and omega-3-rich fish. These foods provide a variety of nutrients, antioxidants, and phytochemicals that can help reduce inflammation and oxidative stress in the body. Fermented foods like yogurt, kefir, sauerkraut, and kimchi are rich in beneficial bacteria that can improve gut health and reduce inflammation. Prebiotic foods like onions, garlic, leeks, and asparagus serve as food for the good bacteria in our gut, while probiotics like Lactobacillus and Bifidobacterium can be taken in supplement form to help restore and maintain a healthy gut microbiome.

By following a Mediterranean-style diet and incorporating fermented foods, prebiotics, and probiotics, we can support our body’s natural anti-inflammatory processes and promote overall health and well-being.

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