Staphylococcus aureus and Eczema

Studies show the pathogenic bacteria Staphylococcus aureus is associated with eczema in 90% of patients. 

Our skin is the outermost barrier that divides us from the external environment and protects us from pathogenic foreign invaders. This barrier contains an ecosystem composed of over a trillion microorganisms (bacteria, fungi, mites, and viruses), most of which are completely harmless and many of them protect us and keep us healthy. However, sometimes pathogenic bacteria can take hold and drive disease states.

Recent developments in sequencing technology have provided new insights into the structure and function of skin microbial communities. And according to some of the latest research, pathogenic Staphylococcus aureus is the driving force behind a chronic state of dysbiosis in 9 out of 10 eczema patients.

In addition, this dysbiosis includes a decrease in diversity at the phylum level, as observed in atopic dermatitis. This one-two punch of having too many ‘attackers’ (S. aureus) and too few commensal ‘defenders’ (S. epidermidis, R mucosa, S hominis) creates a chronic cycle of inflammation. 

To better understand this chronic state of dysbiosis, we have compiled a list of the latest research published by top scientists in the field.  

First, here is some foundational research on the skin microbiome that will link you to the full articles.  We have summarized the findings. Please click on the title links to go to that published article. 

What is the skin microbiome? 

(2011) The skin microbiome

Dr. Elizabeth and Dr Julie Segre are experts on the skin microbiome. In this article, they share the topographical distribution of bacteria on different skin sites, showing the skin is home to a vast array of microbial ecosystems. 

• A wide range of skin disorders are postulated to arise in part owing to a microbial component. These disorders include atopic dermatitis, acne, seborrhoeic dermatitis and chronic wounds. 
• Commensal bacteria can become pathogenic and cause invasive infection.
• The habitat of the skin varies topographically and is likely to be associated with variation in the colonizing microbiota
• The skin is a physical barrier against invasion by pathogenic organisms and foreign substances. The skin is also an ecosystem, host to a microbial milieu that, for the most part, is harmless.

(2022) The Skin Microbiota: Balancing Risk and Reward

• The skin microbiota is an ecosystem comprised of a multitude of microbial species 

• The skin microbiota promotes defense and immune responses, inhibits colonization and infection by opportunistic or pathogenic organisms, and promotes tissue repair and barrier functions.
• The skin microbiota can be influenced by various factors such as age, sex, genetics, environment, and lifestyle.
• The skin microbiota can be influenced by antibiotics, antifungals, antivirals, and immunosuppressants.
• The skin microbiota can also be influenced by various diseases such as atopic dermatitis, psoriasis, acne vulgaris, rosacea, and skin cancer.

Pathogenic skin microbiota: Staphylococcus aureus

Next, here is the leading research on Staphylococcus aureus and eczema. 

(2017) Skin Colonization by Staphylococcus aureus Precedes the Clinical Diagnosis of Atopic Dermatitis in Infancy

• Atopic dermatitis (AD) is a common skin disease in children.

• AD occurs in the first year of life in 60% and before 5 years in almost 90% of patients.
• AD has a well-established association with skin colonization or infection by Staphylococcus aureus, which can exacerbate the disease.
• The study found that skin colonization by S. aureus precedes the clinical diagnosis of AD in infancy.
• The study also found that infants with AD had a higher prevalence of S. aureus colonization than healthy infants.

(2017)  Staphylococcus aureus density on lesional and nonlesional skin is strongly associated with disease severity in atopic dermatitis

• Atopic dermatitis (eczema) is a multifactorial skin disease with skin barrier damage, progressive sensitization to environmental antigens, and Th2-skewed mediated systemic immune response.
• Staphylococcus aureus colonization is common in eczema patients and may contribute to disease severity.
• The study aimed to investigate the relationship between S. aureus density on lesional and nonlesional skin and disease severity in eczema patients.
• The study found that S. aureus density on lesional and nonlesional skin was strongly associated with disease severity in eczema patients.
• The study also found that S. aureus density on nonlesional skin was a better predictor of disease severity than S. aureus density on lesional skin.

(2017) Evidence that Human Skin Microbiome Dysbiosis Promotes Atopic Dermatitis

• Atopic dermatitis (eczema) is a complex multifactorial disease that has been associated with both genetic risk factors and environmental stimuli.
• Subjects with eczema  are more likely to be colonized by Staphylococcus aureus.
• The study aimed to investigate whether human skin microbiome dysbiosis promotes eczema.
• The study found that human skin microbiome dysbiosis promotes eczema by increasing S. aureus colonization and skin inflammation.
• If S. aureus is present, then the subject tends to have more severe eczema.

(2017) Staphylococcus aureus: Master Manipulator of the Skin

• Staphylococcus aureus promotes skin inflammation through multiple pathways
• S. aureus can cause eczema to occur in susceptible individuals.
• S. aureus can manipulate the skin to promote eczema-like inflammation to promote its own growth

(2013) Staphylococcus δ-toxin induces allergic skin disease by activating mast cells

• More than 90% of patients with atopic dermatitis are colonized with Staphylococcus aureus in the lesional skin whereas most healthy individuals do not have the pathogen

(2022) Controlling skin microbiome as a new bacteriotherapy for inflammatory skin diseases

Colonization with specific skin commensals provides beneficial responses.

• Staphylococcus epidermidis stimulates immune cells to promote tissue repair
• Roseomonas mucosa promotes tissue repair 
• Staphylococcus cohnii promotes local steroid synthesis that suppresses skin inflammation
• Staphylococcus hominis inhibits S. aureus growth and suppresses toxin production

According to some of the latest science, Staph aureus bacterial overgrowth is the driving force behind a chronic state of dysbiosis in 9 out of 10 eczema patients. For this reason, top scientists Dr. Richard Gallo from UC San Diego and Dr Ian Myles from the NIH are working on transplants as the possible future of eczema therapy.

You can read more about the potential for eczema treatment transplants here and here. 

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