How do you manage skin conditions related to the skin microbiome?

From the Guidelines

Managing skin conditions related to the skin microbiome involves restoring balance to the microbial communities on your skin, and the most effective approach is to moisturize regularly and protect against excessive exposure to sunlight, as recommended by the most recent and highest quality study 1. To achieve this balance, consider the following strategies:

• Gentle cleansing using pH-balanced, fragrance-free cleansers once or twice daily to avoid disrupting beneficial bacteria while removing harmful ones
• Moisturizing regularly with products containing ceramides, hyaluronic acid, or prebiotics to support a healthy skin barrier
• Avoiding harsh soaps and using emollients containing prebiotics for eczema management
• Avoiding overuse of antibacterial products and antibiotics unless prescribed, as these can disrupt beneficial microbes Some specific conditions may require additional treatments, such as:
• Topical probiotics like Lactobacillus-containing products for acne
• Antifungal treatments like ketoconazole shampoo for seborrheic dermatitis It's also important to consider lifestyle factors, including:
• Managing stress
• Eating a balanced diet rich in fiber and fermented foods
• Avoiding excessive sweating without cleansing As noted in 1, certain treatments should be avoided, such as greasy creams for basic care, manipulation of skin, and hot blow-drying of the hair, as they may facilitate the development of folliculitis or increase the risk of infection. Additionally, 1 provides guidance on wound care and management of severe skin conditions, emphasizing the importance of gentle cleansing, application of topical antimicrobial agents, and use of nonadherent dressings. Overall, a comprehensive approach to managing skin conditions related to the skin microbiome involves a combination of gentle skin care, targeted treatments, and lifestyle modifications, with a focus on restoring balance to the microbial communities on the skin.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION: Erythromycin Topical Solution should be applied over the affected areas twice a day (morning and evening) after the skin is thoroughly washed with warm water and soap and patted dry. Apply a thin film of Clindamycin Phosphate Topical Solution, Clindamycin Phosphate Lotion, or Clindamycin Phosphate Gel twice daily to affected area.

To manage skin conditions related to the skin microbiome, topical antibiotics such as erythromycin and clindamycin can be applied directly to the affected areas.

• Erythromycin should be applied twice a day, morning and evening, after washing the skin with warm water and soap 2.
• Clindamycin should be applied twice daily as a thin film to the affected area 3. The FDA drug labels for these medications do not provide information on how they impact the skin microbiome, only how to apply them to affected skin areas.

From the Research

Skin Conditions Related to the Skin Microbiome

The skin microbiome plays a crucial role in maintaining healthy skin, and any imbalance or dysbiosis can lead to various skin conditions. Some of the skin conditions related to the skin microbiome include:

• Acne vulgaris: a chronic inflammatory disease of the pilosebaceous unit of the skin, which can be caused by an imbalance of the skin microbiome, particularly the overgrowth of Propionibacterium acnes 4, 5
• Atopic dermatitis: a chronic relapsing and remitting inflammatory skin disease, which can be caused by a complex interaction of immune dysregulation, epidermal gene mutations, and environmental factors that disrupt the epidermis, leading to an imbalance of the skin microbiome 6, 7
• Rosacea and psoriasis: skin diseases that are associated with cutaneous dysbiosis, which can be caused by an imbalance of the skin microbiome 7

Management of Skin Conditions

The management of skin conditions related to the skin microbiome involves a variety of treatments, including:

• Topical therapies: such as retinoids, benzoyl peroxide, azelaic acid, and topical corticosteroids, which can help to reduce inflammation and prevent bacterial growth 4, 5, 6
• Systemic agents: such as oral antibiotics, hormonal therapies, and isotretinoin, which can help to reduce inflammation and prevent bacterial growth 5
• Prebiotics, probiotics, and postbiotics: which can help to restore the balance of the skin microbiome and reduce inflammation 7
• Ultraviolet phototherapy: which can help to reduce inflammation and prevent bacterial growth in moderate to severe atopic dermatitis 6

Treatment Options for Specific Skin Conditions

Some specific treatment options for skin conditions related to the skin microbiome include:

• Acne vulgaris: topical erythromycin 1.5 percent solution versus topical clindamycin phosphate 1.0 percent solution, which have been shown to be clinically equivalent for treating moderate facial acne 8
• Atopic dermatitis: maintenance therapy consists of liberal use of emollients and daily bathing with soap-free cleansers, and use of topical corticosteroids is the first-line treatment for atopic dermatitis flare-ups 6