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What Is The Microbiome And How Does It Impact Eczema

The microbiome is a word that sounds like it just came straight out of a science fiction book. It evokes images of far-flung civilizations that live under domes. But, in reality, it's a vital aspect of the human body that can help protect your skin from invading pathogens.


Skin is often associated with beauty and vigor rather than health, but it’s essential. An adult usually has 21 square feet of skin containing 11 miles of blood vessels. Your skin accounts for 15% of your overall body weight, making it your largest organ. When you realize just how much skin there is on your body, it’s easy to see how it plays a vital part of your overall health.

Understanding the microbiome can help you approach skincare in a better way. If it's healthy, there's less chance of dermatological issues. Perhaps you want to know all about the microbiome to care for your skin in a better way, or maybe you’re just interested in why it’s so important. Learning about the microbiome’s role in causing eczema can give sufferers of the condition a serious edge in the fight against flare-ups.

What Is The Microbiome

Micro: Small or microscopic

Biome: A naturally occurring community of flora and fauna occupying a major habitat

The skin’s surface is made up of bugs, bacteria, fungi, and viruses that form the microbiome. Each person’s microbiome can be slightly different. The makeup of a microbiome depends on the amount of sunlight the skin gets, the hormonal differences from one person to the next, and the humidity. Age and gender play a significant part in the makeup of the microbiome as well. For example, an older woman will have a different microbiome than a male high school athlete.

Your microbiome begins to develop from birth. Your skin becomes host to bacteria from your mother during childbirth, from breastfeeding, the environment, your diet, other humans, and so much more. Bacteria is what makes up your stratum corneum (skin barrier). It’s essentially an ecosystem all of its own. Your skin is the environment, and the microbiome is a vast conglomerate of beings that occupy it. In nature, things go wrong when the ecosystem becomes out of balance, the same can happen to your skin’s microbiome. 

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Microorganisms and the Skin


Back in the late 1970s and early 1980s, Mayo Clinic Dermatology consultant and professor, Arnold Schroeter, MD began teaching his Dermatology residents to consider the influence of yeast and bacterial overgrowth in stubborn Dermatologic conditions. He was the first Dermatologist that we know of, to understand that overgrowth and imbalance of microorganisms on the skin were driving some of the runaway inflammation we see in poorly controlled dermatitis and psoriasis patients. The other Dermatology professors would sometimes roll their eyes when Dr. Schroeter was teaching his residents to culture the skin of patients who were exhibiting poorly controlled inflammation, but not a true infection.


It was considered only appropriate to culture and identify microbes when there was a full fledged infection, with pain, heat, and swelling. In fact, it remains that way today. Innovator Dr. Schroeter was teaching his residents that therapies to put the microorganisms back into a more normal balance could be very important in some cases, not all.


This was 20 years before scientific research began elucidating the mechanisms in our immune system that are involved in immune dysregulation and runaway inflammation. It was years before we knew humans had both an innate immune system and an adaptive immune system. It was four decades before we knew the specific cytokines (reactive and regulatory and pro-inflammatory proteins produced in our immune system) involved in Atopic dermatitis and a different set involved in driving psoriasis.

Dr. Schroeter’s insight was right on track for what was often contributing to driving these inflammatory cytokines to excess.

It was well known in Dr. Schroeter’s time that Superantigens from Steptococcal bacteria could be involved in certain diseases like Rheumatic fever. But Schroeter was the first we know of to realize that many other microorganisms could be driving these cytokines to be produced in excess.
It’s always important to realize Research doesn’t just look for answers. It looks for ways to make money. There was not a lot of Industry interest in Dr.Schroeter’s ideas of simple inexpensive strategies to get the microbiome back into proper balance. The Biopharmaceutical world was searching for patents and novel and very specific therapies. No one was interested in inexpensive stategies that helped a wide range of conditions. Speakers at Dermatology meetings speak about patented and branded products. They aren’t sent there to speak about the concepts Dr. Schroeter envisioned. It was up to his Dermatology residents to carry this on and take it forward.

What Causes A Microbiome Imbalance

Your microbiome is probably already out of balance in some way or another. Think about the pollution in the air, which is far from natural. Mix it in with a poor diet, lousy skincare routine, medications (like antibiotics), harmful topical products, and you can see how the microbiome can become easily disturbed. For example, severe eczema medication can leave the microbiome out of balance. Likewise, you’re altering your microbiome every time you wash your face. If you excessively use something which isn’t natural, you can damage your first line of defense: your skin barrier.

Dr. Jungman, who worked in R&D for L'Oréal and has a doctorate in clinical pharmacology, asserts that the protective function of the skin’s ecosystem can be lost due to microscopic populations being altered, and the resources available to them being lowered. When this happens, you see skin problems start to appear.

It’s hard to avoid products that can cause issues with your microbiome. The problem is with excessive usage. Unfortunately, most skincare products contain preservatives like parabens. This quote from Dr. Hamblin sums it up nicely:

The National Institute of Allergy and Infection Disease have found that products containing parabens can block the growth of Roseomonas mucosa from healthy skin,” as noted by Dr. James Hamblin in his book called Clean: the new science of skin. “This bacteria seems to help improve the skin’s barrier function and can directly kill the Staph. aureus that proliferates during eczema flares. The researchers raised the concern that through this chain of events, parabens could leave people more susceptible to eczema flares.”

Preservatives will damage the microbiome and there’s no escaping it. Even moisturizer contains damaging parabens. Yet, if you use the product sparingly, as you should, you can limit the negative effect it has on the microbiome. It’s why so many people moisturize twice a day with no outward-facing problems. 

Microbiome And Eczema

Its clear parabens can indirectly cause eczema flare-ups by affecting the microbiome, but that’s not all. 

The microbiome is diverse and needs to remain diverse in order to thrive. Unfortunately, this diversity is reduced in atopic dermatitis (eczema), specifically with reduced commensal (good) bacteria and increased pathogenic bacteria like S. aureus.

Care for the symptoms of atopic dermatitis often includes strong topical steroids prescribed by doctors, which the patient can only use short-term. When used long-term, these topical creams alter the makeup of your microbiome and can cause more problems such as:

  • Barrier thinning
  • Immune system dysregulation (TSW)
  • Microbiome dysfunction (steroid acne) 

So, if changing the microbiome can make eczema symptoms appear or even worsen the condition, which eczema cream do you use to treat flare-ups? The answer lies in using a cream that is proven safe to use long term. Those suffering from eczema can be forgiven for thinking the highest concentration of topical corticosteroids is the best for dealing with eczema symptoms. In reality, they should consider the collateral damage that high percentage steroids can do to their microbiome. 

Low strength hydrocortisone creams mixed with sulfur has been shown to be effective in dealing with eczema and dermatitis symptoms long term, not just short term.

If a cream has been used long-term with no adverse effects, you can logically infer it isn’t changing the makeup of your microbiome too much. If it were, the skin would react.

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Do More To Care for Your Microbiome

Now you know about the microbiome, you can do more to protect it. After all, the trillion microorganisms on your skin help keep you healthy, so you should do the same for them. Here are some easy tips:

  • Don’t overuse cosmetics. Let your skin breathe.
  • Follow the application instructions on whichever moisturizer you’re using
  • Be careful with prescribed topical creams
  • Don’t spend too much time in the sun.
  • Stay hydrated: drink water (a gallon for men, 0.7gal for women daily)
  • Try to work up a sweat a few times a week (unless you suffer from something like folliculitis)
  • Watch your stress levels
  • Eat a balanced and varied diet
  • Identify and stop any habits that are having a negative effect on your skin

Everyone is different; what damages someone's skin might do nothing to someone else experiencing the same conditions. Therefore, you need to pay attention to your skin’s microbiome by paying attention to your skin. A little care goes a long way.  

If you have a chronic condition like eczema, using a tried and tested eczema cream as a preventative measure makes sense. If the topical eczema cream is safe to use long-term it will work as a good preventative cream meaning you can stop eczema even flaring up in the first place. Those with the condition report that flare-ups usually occur around the same time each year, so it’s easier to be proactive in preventing flare-ups with a safe eczema cream. 

Changing the way you live to benefit your microbiome can be difficult at first. Try it one step at a time. Drink more water, then work on your diet. At the same time, start paying attention to warning labels on cosmetics and creams. Taking the steps a few at a time makes them easier to digest and apply to your life.

Your skin’s microbiome might never have been a concern, but if you suffer from eczema or another dermatological condition you can improve your life by following some of the easy tips above and using an eczema cream that is safe long-term. 

Need More Skincare or Eczema Advice

Microbiome health is essential when seeking to manage eczema and other skin conditions, but there is a lot more to know. Our blog is full of helpful skin care tips, and our skin care care guide can impart age-specific advice to those wanting to learn more. 

If you are worried about topical steroid withdrawal caused by strong steroid creams, check out the fixing TSW article. This PubMed safety study might inform your final decision if you wanted to give SmartLotion® a try but still had reservations due to the low-strength hydrocortisone found in the formula. If there are any unanswered questions, please visit the contact page

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