Sometime around the late winter of 2003, I looked in the mirror and wondered what had happened to my face. I had developed a rash that was most pronounced over my right eye and temple.
Like anyone confronted with a new skin problem, advice came flooding in from friends and family about what to do about it. The overwhelming consensus was that it was probably due to the low humidity of winter, and that all I needed was a good daily moisturizer. So I tried one. Then another, and another and still yet another.
Some would work for a while, but the problem always came back. As Winter turned to Spring, and Spring morphed into Summer, I realized the situation wasn’t improving no matter how often I applied moisturizer. I also began experiencing dry skin on my lower legs.
I tried eliminating all sorts of things from my diet. Sometimes my skin would improve, and just when I thought I’d identified the culprit, I’d be proven wrong.
Out of desperation, I decided to see a dermatologist. This meant an out-of-pocket expense as I didn’t go through my HMO. Those of you who have HMOs know what a hassle it can be to get a referral to a specialist so I decided it was worth the money to avoid the bureaucratic hoops.
Plus, this dermatologist came highly recommended and was quite successful. I’m sure he’d know what to do about my problem.
After filling out some forms asking about medical history and cooling my heals in the waiting area, I was ushered into an examination room. What followed next was a bit surreal.
I don’t think I’ve ever met a doctor who spent more time talking about himself during an examination. Yes, I admit, I was somewhat fascinated hearing about how his former classmate was Michael Jackson’s personal dermatologist. However, at the time I failed to appreciate why this bit of celebrity gossip had anything to do with my rash.
While going on about his school connections, and why I had made the right decision in seeing him, he looked at my skin, asked some perfunctory questions, pronounced that what I had was dermatitis and that the moisturizer I was using was pretty much useless. Great, I thought as I had just spent some big bucks buying it.
He then wrote a prescription for a skin cream called Elidel® and told me to apply it daily. I was then escorted to the front desk to pay my bill and make another appointment. If the office visit, not counting the 30 minutes I sat in the waiting room thumbing through old magazines, was longer than ten minutes I’d be shocked.
I went straight to the pharmacy and had my prescription filled. When I arrived home, I eagerly took it out of the bag only to be presented with a black box warning label.
For those of you who don’t know what this is, it’s an FDA warning outlined in a heavy black border that alerts consumers to potentially serious side effects of the medication they’re about to use. And what were the possible side effects of this stuff prescribed by a dermatologist less than six degrees of separation from Michael Jackson? Well, let me reprint the warning directly from the drug manufacturer’s website:
“Prolonged systemic use of calcineurin inhibitors for sustained immunosuppression in animal studies and transplant patients following systemic administration has been associated with an increased risk of infections, lymphomas, and skin malignancies. These risks are associated with the intensity and duration of immunosuppression.
Based on this information and the mechanism of action, there is a concern about a potential risk with the use of topical calcineurin inhibitors, including ELIDEL Cream. While a causal relationship has not been established, rare cases of skin malignancy and lymphoma have been reported in patients treated with topical calcineurin inhibitors, including ELIDEL Cream.”
Immune suppression and cancer! Whoopee! And all for just $80? What a bargain!
But damn it, I’d just blown a couple of hundred bucks seeing this doctor and paying for this expensive cream to stop now. Plus, I had no other options. So yes folks I applied it to my skin until this, and another refill were exhausted.
The redness did fade, although never completely. I subsequently decided I didn’t want to risk the side-effects of using this stuff for the sake of vanity so I stopped.
At this point I decided to see a dermatologist through my HMO instead. After two months, I was finally able to snag an appointment. No mention of Michael Jackson was made during this exam. I’m guessing this doc attended a less prestigious medical school.
This time I was told I didn’t have eczema, but rosacea. OK, I thought, what does that mean and how do I get rid of it? Sorry to say, he had no suggestions other than to recommend another brand of moisturizer with a greenish tint that helped hide the rash. Sigh.
By this time I was well done with dermatologists. However, the medical profession was not done with me because not too long after this, my digestive complaints overtook my life. That involved seeing more doctors who after examining me every which way, (yet failing to screen for SIBO), pronounced me a newly minted member of the burgeoning IBS club. The rest, as they say, is history.
Now, I’m sure you’re wondering what the hell this story has to do with gut flora. Well, in my case, everything. You see, after resolving my digestive issues, my skin also improved.
There is a connection between skin health and gut flora. That connection is receiving more attention in research papers such as this one.
A recently published randomized, placebo-controlled Japanese study offers further confirmation. (1) This study is intriguing in that it was conducted in a population free from skin disorders.
These researchers wanted to see if administering probiotics and prebiotics to a group of healthy Japanese women would have any effect upon their skin health. They suspected it might as an informal survey of 600 Japanese women conducted in 2007 by this same group found an association between abnormal bowel movements and skin dryness.
In this study, forty female volunteers ranging in age between 23 to 75 were randomly assigned into two groups. One group was given fermented milk containing Bifidobacterium breve, Lactobacillus lactis and Streptoccocus thermophilus. This fermented beverage also contained the prebiotic galacto-oligosaccharide (GOS). Natural sources of GOS are found in human breast milk.
The milk given to the placebo group was the same in taste and texture, but only contained lactic acid, ascetic acid and dextrin.
The trial lasted two months. The first month was a pre-administration period and during this time all women were instructed to refrain from consuming probiotics and prebiotics from supplements or food. At the start of the second month, women were randomized to either group.
Hydration levels were measured daily during the intervention phase. Skin cells from the outermost layer of each woman were collected and analyzed.
Urine and blood samples were also taken to measure levels of phenols. Phenols are chemical compounds produced by a range of plants and organisms, including bacteria.
Previous in vitro and animal research has discovered that phenols produced by certain gut pathogens negatively impact skin cells. (2) Bacteria that produce these phenols include members of the gram-negative Enterobacteriaceae family: Salmonella, Escherichia coli, Yersinia pestis, Klebsiella, Proteus, Enterobacter, Serratia, Citrobacter and Shigella. Other produces of phenols include Clostridium and Staphylococcus.
The women’s cathepsin L-like activity was also assessed. Cathepsins are enzymes that degrade protein, and this particular cathepsin works on skin collagen. Higher activity is associated with healthier skin as it encourages turnover.
This illustrates hydration levels in both groups of women before and during administration of the fermented and non-fermented milk.
Now, I need to explain the dramatic decrease in hydration in the placebo group. This study began in October and lasted through December. During this period, humidity levels decline in Tokyo as is true in many places when winter settles in. The loss of skin moisture was a normal result of less humid weather.
However, note that the group fed the probiotic/prebiotic milk didn’t suffer a comparable decline. They maintained levels that were close to those seen during the pre-administration period.
While there was no statistically significant increase in capthepsin L-like activity in the placebo group, there was in the probiotic/prebiotic group.
Here, the first illustration charts serum phenol levels. In the placebo group, there was no change, however, this was not the case with the probiotic/prebiotic group. Their levels were found to be significantly lower both against their pre-administration testing and the placebo group.
A similar finding was noted in urine phenol levels, although there was no statistically significant difference between the active and placebo group once the intervention began.
Now, what could be the mechanism of action here? Well, the increase in beneficial gut flora would certainly reduce colonies of phenol-producing gut pathogens for one.
Another mode of action involves strengthening of gut wall barrier function. Bifidobacteria ferments prebiotics into the short-chain fatty acid butyrate. Butyrate in turn, feeds colonic cells keeping them healthy. Healthy gut cells are far better able to prevent toxic bacterial metabolites from reaching systemic circulation.
Now there are two limitations to this study, namely that it was very small and lasted only two months. It’s intriguing to be sure, but larger and longer-lasting placebo-controlled trials would have to be conducted to verify these preliminary results.
If these findings about phenol levels hold up to further scrutiny, this could revolutionize how dermatologists diagnose and treat skin disorders, although do nothing about celebrity name dropping. Given what I’ve covered in this blog about how endotoxemia affects every major organ of the body, it’s certainly not much of a stretch to believe that disordered gut flora does the same to our skin.