Balancing act: the role of the microbiome in eczema care
Experts estimate that 15 to 20 per cent of Canadians are living with eczema – an inflammation of the skin. Due to its chronic nature, eczema is known to come and go, and migrate around the body. Symptoms like dry and itchy skin or a rash typically worsen during a cycle of inflammation, a so-called flare-up.
While the cause of eczema is currently not fully understood, Kateline Turgeon, director of national training for skin care brands La Roche-Posay and Vichy, says three important genetic, immunological and environmental factors need to be considered.
“You’ll see better results if you use cleansers and moisturizers that are not only free of irritants like fragrances, paraben and alcohol, but also help to rebalance the microbiome.”
The first factor is genetic and indicates that people with eczema don’t produce enough lipids, which typically form a natural skin barrier. “The lipid that people with eczema are commonly lacking is called ceramide,” says Turgeon.
She uses the example of a brick wall, where bricks and mortar form an effective barrier. “In the epidermis, you have the cells. And surrounding the cells, you have the intercellular cement, of which ceramide is a major component,” she explains. “Without it, the skin isn’t able to block the whole range of irritants or allergens it is exposed to.”
A second factor contributing to eczema originates with the immune system, says Turgeon. “We find that in people with eczema, the immune system is not fully capable of differentiating between perceived and actual threats. Flare-ups happen because the immune system is constantly reacting to perceived danger.”
Awareness about the third factor comes from a recent discovery that contributed much to the understanding of eczema, says Turgeon. “Now we know that an imbalanced microbiome contributes to the risk of flare-ups.”
A highly diverse microbiome – a blend of a multitude of bacteria, yeast, fungus and different microorganisms – is the skin’s first line of defence against external aggressors. And people living with eczema typically have an unbalanced – and less diverse – microbiome.
“We now understand that even when we treat the intercellular cement with ceramides or have the skin producing more ceramides and reduce the itching with anti-inflammatory ingredients, there is still the risk of flare-ups if we don’t rebalance the microbiome.”
The good news is that a skin care routine – combined with specifically formulated skin care products – can make a significant difference, explains Turgeon. “When you have eczema, it’s important that you don’t further destabilize the microbiome when you clean your skin. You’ll see better results if you use cleansers and moisturizers that are not only free of irritants like fragrances, paraben and alcohol, but also help to rebalance the microbiome.”
For achieving – and maintaining – a microbiome with a better balance, Turgeon recommends a daily moisturizing routine, which can help to reduce the number and severity of flare-ups. She also suggests applying the moisturizer within three minutes after a bath or shower for optimal impact.
Clinical studies of La Roche-Posay’s products evaluate their efficacy based on criteria like itching, skin dryness, inflammation and lack of sleep. “These are the symptoms that show us whether eczema is getting better or worse,” she says. “The results of using moisturizers are typically quite obvious.”
And La Roche-Posay has received many enthusiastic responses, says Turgeon. “We find that a moisturizer that works can be a game-changer for the quality of life for people with eczema.”
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