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Eczema and your skin microbiome—how are they related?

Thursday 25 February 2021

A woman with eczema scratches her itchy elbow with a pained expression
Eczema can be very itchy

Did you know your skin is covered in trillions of bugs? But don’t be alarmed. While you can’t see them, most of these bugs, or micro-organisms, are there to help us to stay healthy.

These micro-organisms make up your skin microbiome. When they are balanced and happy your skin usually is, too.

Your skin microbiome works similarly to your gut microbiome, which is also made up of micro-organisms. These micro-organisms mainly contain bacteria that play a key role in digesting food and absorbing nutrients. But there’re good bacteria – and bad bacteria.

The ‘balance’ of our gut can be disrupted by several factors, and this can cause inflammation, which can lead to physical or mental conditions.

Just like your gut, when your skin microbiome is out of balance and the bad bacteria takes over, it can become inflamed, leading to the development of common rash conditions like eczema and dermatitis.

Common skin conditions like acne and dandruff can also be a sign that your skin microbiome is unbalanced.

What is eczema?

Eczema, also called atopic dermatitis, is one of the most common skin conditions affecting Australians. It’s an inflammatory skin condition that can affect both children and adults.

It causes very itchy, scaly, red patches of skin, usually on cheeks, in elbow creases and behind the knees.

Children are more likely to suffer from eczema; however they usually grow out of the condition by the time they reach adolescence.

People with eczema have skin that doesn’t keep the moisture in very well, so it becomes dry and easily irritated.

This causes chemicals to be released, which worsens the irritation and makes you want to scratch. But scratching only makes your skin more itchy and so the cycle repeats itself.

We don’t really know exactly what causes eczema, but we do know that it can sometimes be genetic, and often has an environmental trigger. One gene linked to eczema is called filaggrin and people who get eczema often have a defect which reduces their skin’s ability to repair itself after injury.

The skin has special cells that have an immune function. Eczema causes a breakdown in the skin’s barrier function.

This means that irritants, such as pollens and soaps, can enter the deeper layers of the skin. People who have eczema may also have other conditions like hay fever or asthma.

Sometimes, children with eczema are more prone to developing allergies. Foreign proteins make their way through the damaged skin and activate the immune cells.

A graphic showing a cross section of normal skin vs a cross section of skin with dermatitis

What triggers eczema?

There are a number of triggers that can cause and make eczema worse. For many eczema sufferers, there is often not just one trigger.

Usual triggers include:

  • dry skin
  • scratching the affected area
  • viral or bacterial infections
  • chemicals from swimming pools
  • sand, especially from sandpits
  • some types of carpet or grass
  • animals or house dust mites
  • allergens that you can breathe in, such as pollen
  • artificial colours and preservatives
  • perfumes, soap and chemicals
  • woollen or synthetic fabrics
  • heat or very hot rooms
  • stress

A graphic showing the characteristic markings of different diseases of the skin

How do you treat eczema?

Your doctor will be able to diagnose you with eczema and advise a suitable treatment plan to manage the condition.

This may include an anti-inflammatory cream to help bring your microbiome back into balance.

But remember that everyone’s skin microbiome is different and reacts differently – and an effective treatment for one person may not necessarily work for others.

The most effective way to relieve symptoms and treat eczema is to keep the skin well moisturised by using a non-perfumed moisturiser on your skin every day. Moisturisers could be ointments, creams or lotions. You might have to try a few brands to find the most effective moisturiser for you.

Moisturisers work by repairing the skin barrier and reducing water loss.

Because eczema means allergens can enter the deeper layers of the skin, it’s important not to use moisturisers containing food ingredients. e.g. oats, goats’ milk, almond oil. Using moisturisers containing food ingredients can cause an allergy to that food to be developed.

While we know it’s hard to do, it’s best to avoid itching the area to reduce breaking the skin which can increase the chance of infection.

Eczema is more than skin deep

It’s also important to remember that common skin conditions like eczema are not just skin deep.

Eating well and drinking plenty of water is also important to help keep your skin microbiome healthy, as well as keeping your skin moisturised and protected from the sun.

It may also be useful to avoid harsh soaps such as antibacterial soaps if you have sensitive skin or look at using a soap free wash.

More information

Last updated: 25 February 2021