Is Staph Aureus Causing Your Eczema Flares? Part 1 & 2 (S6E2 &E3)

 

Did you know that 9 out of 10 eczema sufferers experience an overgrowth of staph aureus? Is staph aureus contributing to your eczema or topical steroid withdrawal (TSW) skin flares?

Why does this matter and how can it affect your skin flares?

In this episode, you’ll learn all about:

✅ What is staph aureus?

✅ Why does staph occur & how does this affect you?

✅ Top tips to treat staph aureus

✅ How do we test for staph aureus on the skin?

✅ How are your skin pH levels tied to staph aureus?

In this episode, we interview Dr. Julie Greenberg, a Naturopathic Doctor (ND) and Registered Herbalist RH (AHG) who specializes in integrative dermatology.

STAPHYLOCOCCUS AUREUS: WHAT IS IT AND HOW TO TREAT IT? 

• Staph aureus is a bacteria that can contribute to flares and skin infections, including eczema
• You can test for Staph aureus on the skin with a wet sample
• 9 out of 10 people who suffer from eczema have an overgrowth of staph aureus
• Our skin PH can influence the overgrowth of Staph aureus, the flares, and skin conditions
• The treatment of Staph aureus depends on the skin infection
• The best way of treatment is to look for the root cause and not only symptom management

Part 1:

Part 2:
 

What is Staph aureus, and how can it affect you?

Staph aureus is short for Staphylococcus aureus. It is a bacteria naturally present on the skin and does not necessarily cause harm. However, it can affect those who have eczema (1).  

Research shows that staphylococcus aureus can colonize the skin of patients with eczema and atopic dermatitis (AD). In these patients, you can often find it in eczematous skin lesions. There seems to be a link between eczema’s severity and the amount of S. aureus, which is an important factor in aggravating skin lesions. 

The Staph aureus found on the skin will rise before a flare-up. Meanwhile, other good natural microbes on the skin start to plummet and disappear.  Thus, Staph aureus takes over, and the skin starts to flare.

If you find that you have a flare, then there is likely an overabundance of Staph aureus. In this podcast episode, Dr. Julie shares what she focuses on when treating her patients for staph aureus when eczema is active among patients. 

Can we test for staph aureus on the skin?

You can culture the skin, but you must wait seven or more days for the result to confirm if it’s Staph aureus causing the flare-up.  

However,  a wet sample is needed to culture it (as it will not work on dry skin). You can also culture from an infected oozing skin to determine the organism.  

In spite of this, Dr. Julie mentions that she rarely orders the skin to be cultured.  Sometimes skin infections are treated with an antibiotic, but if the person is not responding to it, it would be a good time to culture the lesion.

**In our Conquer Eczema program, we have successfully helped fight against skin infections through natural topical antimicrobials and herbal antibiotics. Of course, this is only on a case-by-case basis, and if you require actual antibiotics from your doctor, we can still work together with you on this. Book a complimentary call to learn more.

Did you know that nine out of 10 people who suffer from eczema have an overgrowth of staph aureus? 

This is not a very common problem people often discuss. 

Dr. Julie adds that usually, there are two common places where you can find staphylococci on the body:

1.       Crook of the elbow (antecubital fossa)
2.       Behind the knees (popliteal fossa)

These are the first places where the Staph aureus tends to overgrow.  They are also the main areas where people tend to have persistent eczema (mainly because the skin here is so thin).

So, where is all this Staph aureus coming from? Why do people with eczema have staph? And why is it growing out of control?

To answer this question, first, we need to look at the skin’s pH levels, as it influences our flares. 

Our skin pH levels should be acidic (2). This is due to a protective fatty acid mantle on the skin that is acidic (3). 

On the skin, there is also a protein called “Filaggrin,” which creates a natural moisturizing factor (NMF) that sets the tone for creating an acidic pH on the skin (4).

According to studies, the central role of NMF is to maintain adequate skin hydration. Having the right hydration encloses three primary functions: 1) keep the plasticity (protects from any damage); 2) support enzymatic function; and 3) contribute to a better barrier function.  

There seems to be a relationship between a reduction or lack of NMF and an increase in the skin’s abnormalities leading to dry skin areas with scaling, flaking, or even fissuring or cracking. 

Washing your skin with soap can increase the risk of removing NMF from the outer skin’s layer. Constant exposure to UV lights can also have a negative effect. 

Some people with eczema have a genetic mutation that doesn’t produce as much filaggrin, reducing NMF levels (5). 

However, even if there is no gene mutation, anyone with a flare of eczema can experience decreased levels of filaggrin and natural moisturizing factors, which change the skin pH levels. Now, the skin is no longer acidic.  It’s neutral or alkaline.

This creates problems since Staph aureus loves a higher skin pH (ideally around 7.5), which is more neutral and alkaline. (6) 

Antimicrobial peptides in the skin, such as defensins (7), can help fight staph aureus. The only problem is that it needs a healthy and acidic skin pH.  Therefore, with a neutral or alkaline pH, staph aureus grows out of control, leading to more inflammation and eczema or topical steroid withdrawal (TSW) flare-ups.  

This whole skin pH balance change could lead to a cycle of frequent flares.  The key remains to get the pH back down to an acidic place.

Keep in mind that eczema is not contagious. A healthy person won’t get it when touching someone with eczema because their skin is acidic and will protect itself.

So how can you tell if it’s an infection or topical steroid withdrawal (TSW)? What is the oozing that comes out during the flare?

In TSW, individuals can have vasoconstriction due to months or years of steroid use.  As a result, their blood vessels can become constricted.

Once we stop the steroids, the vessels start vasodilating.  They over-expand, causing a lot of blood flow to the area (producing red skin). This can also lead the fluid to leak out of the vessels into the skin. Since there is too much blood and fluid, it’s the osmotic pressure that’s causing the ooze rather than an infection. 

So, for many people with TSW, it can look like a staph infection because there’s oozing.  This is when you need to do a culture of the fluid to see if it is just fluid or a staph aureus infection.

Dr. Julie adds that she usually tries to use botanical topicals that work well on staph aureus. If nothing happens, it can be due to the oozing from TSW and not an actual infection.  

It can also be the body’s immune response causing the oozing.  The body is trying to fight the microbes. The pus can result from accumulated dead white skin cells that have come to fight.  

How do we treat Staph aureus? Do we always have to turn to antibiotics, or are there other methods?

According to Dr. Julie, the answer depends on what the staph aureus is doing.

If it’s cellulitis, it will be appropriate to get on oral antibiotics. The infection is deep in the dermis; you can’t put something topical on cellulitis and have it penetrate and get to the Staph in the skin. 

If it’s impetigo, a topical antibiotic can help. Keep in mind that you need to consult with your doctor to prescribe the right antibiotic, and it should be used appropriately.

For eczema patients, the use of antibiotics is not recommended. Here the best action plan is to re-acidify the skin’s pH levels. Other antimicrobial things can be used on top of the skin to reduce the staph aureus.  However, Staph aureus does not only live on the skin but also colonizes the nose.  

This is why people go through these cyclical flares even after taking antibiotics. Here, we can use topicals to avoid recurrent flares.

**In our Conquer Eczema program, we have successfully helped fight against skin infections through natural topical antimicrobials and herbal antibiotics. Of course, this is only on a case-by-case basis, and if you require actual antibiotics from your doctor, we can still work together with you on this. Book a complimentary call to learn more.

Are there other natural topicals that can be used, such as bath soaks or baking soda, to calm the flares?

Natural topicals that are more acidic can be used to help reduce the skin pH levels and the inflammation in the body. 

(Note: if you use an alkaline product to bring relief, such as a bath soak with baking soda or a gentle soap (most soaps are alkaline), we recommend adding in one of the products mentioned below when you get out of the shower to help reacidify the skin. This will help restore the skin barrier and reduce inflammation).  

One example is apple cider vinegar. 

Start with a 50-50 dilution of apple cider vinegar and water or adjust this ratio to 10% vinegar and 90% water, depending on the patient’s tolerance (it can sting).  

Aloe vera gel is also acidic, but sometimes, it might not be tolerated at the start.

Hydrosols are a natural product of the essential oil-making process.  They are acidic but very gentle. They are safe and effective.  They can be a great option at the beginning.

Other good options are cooling compresses made from tea (black, green, or herbal). You can boil a tea bag in water, let it soak, and remove it to let it cool down. Once it’s cooled down, you can pat it on your skin. This can help balance pH levels and can be soothing to the skin, acidic, and antimicrobial.

Hydrosols and teas are water-based products, so they are a good way to start when the skin is very sensitive.

No matter what, people should never experiment with essential oils on themselves alone.  Some of them must be diluted, so it’s always better to work with a professional.

In summary, there are many options to help reduce the inflammation and tackle staph aureus from an internal and topical standpoint. The more we can get to the root cause, the more we can help the body heal from the inside out.

 

References:

1.   Nemeth V, Evans J. Eczema. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538209/
2.   Rippke, F., Berardesca, E., & Weber, T. M. (2018). pH and Microbial Infections. Current problems in dermatology, 54, 87–94. https://doi.org/10.1159/000489522
3.   Surber, C., Humbert, P., Abels, C., & Maibach, H. (2018). The Acid Mantle: A Myth or an Essential Part of Skin Health?. Current problems in dermatology, 54, 1–10. https://doi.org/10.1159/000489512
4.   Robinson, M., Visscher, M., Laruffa, A., & Wickett, R. (2010). Natural moisturizing factors (NMF) in the stratum corneum (SC). I. Effects of lipid extraction and soaking. Journal of cosmetic science, 61(1), 13–22.
5.   Akiyama M. (2010). FLG mutations in ichthyosis vulgaris and atopic eczema: spectrum of mutations and population genetics. The British journal of dermatology, 162(3), 472–477. https://doi.org/10.1111/j.1365-2133.2009.09582.x
6.   Iyer, V., Raut, J., & Dasgupta, A. (2021). Impact of pH on growth of Staphylococcus epidermidis and Staphylococcus aureus in vitro. Journal of medical microbiology, 70(9), 10.1099/jmm.0.001421. https://doi.org/10.1099/jmm.0.001421
7. Scudiero, O., Brancaccio, M., Mennitti, C., Laneri, S., Lombardo, B., De Biasi, M. G., De Gregorio, E., Pagliuca, C., Colicchio, R., Salvatore, P., & Pero, R. (2020). Human Defensins: A Novel Approach in the Fight against Skin Colonizing Staphylococcus aureus. Antibiotics (Basel, Switzerland), 9(4), 198. https://doi.org/10.3390/antibiotics9040198

 

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