Microbiome Friendly Skincare: Elizabeth’s Battle

By Andrew Middlin (B.Pharm)

Andrew.middlin@formulae.com.au

At Formulae, we see many people with skin issues that have fallen through the cracks and failed with common treatments. The standard treatment protocol for  chronic eczema, is to get the eczema under control with a corticosteroid cream (often just called a steroid cream) and then once it is under control, keep the skin moisturised and hydrated.

However, the skin needs not only to be moisturised but to be brought back to being healthy. This involves fixing some of the underlying physiological changes to the human cells and also nurturing what is known as the skin microbiome on the surface of the skin. Unfortunately, if the skin is only moisturised, then it quite rapidly returns to its inflamed state and more steroid cream needs to be used and the cycle continues.

Often we see parents bring in children who are at the stage where they are ‘parked’ on using steroid creams. The parents are frustrated, the prescribers are frustrated and the child is undoubtedly suffering.

We have documented one of our most recent case studies. Elizabeth presented with a diagnosed skin condition that had led to the parents using potent steroid creams and moisturisers many times a day, for over a year consistently, with negligible effect. The risk was that the steroid creams could have been passing through the skin and into the body and disrupting other hormones in the body.

We examined the physiology of her skin and found the skin had a very alkaline pH. This is consistent with an imbalanced skin microbiome and lower physiological skin health.

To correct the physiology of the skin and restore the microbiome we prepared microbiome friendly products that:

1)were formulated at an acidic pH of 4.5

2)contained a blend of fatty acids that resembled natural skin oil

3)did not contain any ingredient that would be likely to harm the skin microbiome such as preservatives.

The microbiome friendly products included a moisturiser and a very gentle, non foaming cleanser. It is important to use a non foaming cleanser as the detergent agents that produce foam are known to cause dermatitis. The foam in soaps and cleansers is purely a cosmetic sales tactic and a foam has absolutely no advantage in its ability to cleanse the skin.

We also adjusted the water content of the cream initially. One of the things that any parent of a child with excessively dry skin will attest to is that creams often sting when applied. This is because the water in the cream rapidly changes the salt concentrations in the skin tissue and the nerves react. However, the water is the part of skincare that does the moisturising – an ointment will not moisturise at all. Standard creams often are made from about 80% water. In this instance we commenced treatment with a microbiome friendly cream made from about 10% water and gradually increased as the skin became naturally more hydrated and tolerated it.

It is important to note that steroidal therapies should still be used as prescribed, but only intermittently during flareups. The important aspect is to use moisturisers, soaps and ancillary skin products such as shampoo’s that support the physiology of the skin and are microbiome friendly. If this is not done then flareups are likely to occur more often and reliance on steroid creams increases, which is to the detriment of skin and body health.

Whilst her case has not yet concluded, Elizabeth’s story demonstrates what can be achieved by preparing a personalised, microbiome friendly cream that restores the healthy physiology of the skin as well as the skins microbiome.