The skin microbiome and its dermatological and surgical role

The skin is our largest organ and serves as our external envelope, with the duty to form a physical barrier to prevent invasion into our body by foreign pathogens (organisms causing disease).

Our skin is teeming with trillions of microorganisms, like bacteria, fungi, and viruses that occur naturally. These invisible life forms are referred to collectively as the skin microbiome (AKA biome). A very similar set-up is seen in our intestines. The skin biome or ‘good bugs’ provide the skin with a defense against invasion by infection-causing bacteria or ‘bad bugs’ by producing antimicrobial proteins and altering the environment on the skin. When we wash, sanitise with alcohol and apply certain topical lotions, we alter the skin’s surface environment. This can prevent the skin biome, the foot soldiers protecting the skin’s immunity from the ‘bad bugs’ from performing their vital function, which is termed dysbiosis. 

The role of the skin biome in disease

When dysbiosis occurs, a diseased skin process can be triggered. The imbalance and resulting dysregulated inflammatory process can exacerbate common conditions like acne, atopic dermatitis, psoriasis and rosacea. The skin’s biome also modulates the immune system by recognising foreign bacteria and producing substances to deter them. Acute and chronic wounds benefit from the local biome during the healing process. Throughout the life cycle of these microorganisms, they release not only antimicrobial proteins, which make it difficult for disease-forming microorganisms to attach to wounds, but they help break down biofilms (the walls bacteria create around themselves to protect themselves from antibiotics). The skin biome also assists with modulating the healing process by impacting enzymes in the skin wound that break down collagen proteins, which help with wound healing. Wound healing is an intricate balance between the immune system and our body forming appropriate amounts of collagen bonds in the wound. Excessive amounts of collagen, however, lead to thickened scars.

Prebiotics, probiotics and postbiotics

Considerable attention in research is currently given to the use of topical and ingested agents to help restore the skin and gut biome. Prebiotics are substances ingested or applied that act like fertiliser to promote the growth of ‘good’ bacteria. Probiotics, on the other hand, contain colony-forming units of bacteria similar to those on your skin and help to replenish the loss of the biome in diseased states. Postbiotics are the new kid on the block. These are bioactive compounds that probiotic bacteria produce when ingesting prebiotics. They have anti-inflammatory, antimicrobial, anti-ageing, moisturising and improved wound healing benefits. Postbiotics applied to the skin after surgery have shown improved wound healing with a better appearance. Postbiotics work actively to enhance the skin barrier and prevent and treat diseases such as eczema. They are pivotal in the treatment of most skin conditions, even showing efficacy in the treatment of acne, scars and psoriasis. Importantly, postbiotics are safe to use from birth and should be part of our daily routine from top to toe. Overuse of antibiotics, everyday stresses, and viral infections have all been shown to decrease the ’good’ bacteria on our skin. Incorporating this knowledge and the treatments into our daily lives and routines, as well as during times of stress, illness and surgery, will help reduce the burden of disease. We are still only scraping the surface of the usefulness of the skin and gut biome in everyday health.

Information supplied by BiomeRenew, written by Dr Ashley Naidoo and Dr Lushen Pillay