Root Causes of Eczema: bacterial imbalances

case study eczema Mar 20, 2020
Eczema and skin rashes are not just one trigger, but often a “perfect storm” of many triggers. 
Today, let’s talk about bacterial overgrowths. 
Bacterial overgrowths are kind of like weeds in a lawn. There are many situations that allow weed overgrowth and too many of them shift your lawn (or microbiome) from looking lush and beautiful to looking, well, weedy. 
The same thing can happen as a root cause of eczema. Again, there are usually a few co-factors, like digestive inadequacies or the skin acting as an organ of elimination, but an overgrowth of “weeds” or opportunistic bacteria is a common root cause I see in practice. 
Let’s take the case of Eli: 

Case Study: Eli’s eczema flares
Eli’s eczema had an interesting pattern. A couple of days before he got common cold symptoms, his skin would start flaring. When we saw his stool test, there was no denying his eczema was definitely rooted in gut imbalances—Staphylococcus aureus, Streptococcus, and many others. After a few weeks on a plan to correct bacterial imbalances, we finally started to see Eli’s skin looking clear, and his mood and sleep improved. His skin flared once more due to a respiratory illness while we worked on correcting his gut balance. Because the “bad” bacteria so significantly outweighed the good bacteria when he had a short-term illness, he still had a more mild flare even though he had been moving in the right direction. Once his immune system caught up and the cold or acute infection moved on, we were able to finish rebalancing his gut for long- term, clear skin. 

Something I want to point out about addressing “weeds” in the microbiome is that when you pull weeds, take care to replenish the “lawn” by feeding the healthy grass and replanting in empty areas. Otherwise, weeds grow back. You could make a case that simply ripping out large weedy sections of the lawn can make things look worse if you don’t replant and nourish new grass. 
While weed or opportunistic bacteria overgrowth is a common problem in the microbiome, another suboptimal situation I sometimes see when looking at the microbiome is a lack of any grass or weeds—or bacteria in general. Now testing certainly has it’s limitations and no test looks at every bacteria in the microbiome, but there are a few things we can infer when we see a deficit of good bacteria in the microbiome: 
  1. Is there opportunistic or pathogenic bacteria or “weeds” so significantly overgrown it’s suppressing good bacteria? 
  2. Is there a history or recent history of significant antibiotics or other herbs or medications that might alter gut microbiota (i.e. reflux medication)? 
  3. How is the diet? Is it rich in a variety of colored fruits, vegetables and fiber sources to feed bacteria? 
What if someone has a skin rash but no apparent digestive symptoms? 
Well first, let’s qualify that: 
+ Any gas or flatulence at any time of day besides around bowel movements? Extra points for stinky gas. 
+ Any bloating or abdomen distention throughout the day? 
+ Any indigestion, heartburn or reflux? How about burping? 
+ Any issues with sleep? (Which can be related to gut health) 
+ Any seasonal allergies or “period problems?” 
+ How often do you have a bowel movement? (1-3 times per day is normal, usually banana-like consistency)
+ Do you have an urgency to use the bathroom after meals? Or do you ever notice greasy stool? 
+ How about throat clearing or stuffy nose that is chronic? 
+ Achy muscles or joints that never get better or seem to rotate? 
I could go on. All of these are common symptoms that show up when there are gut-related imbalances. 
Not all gut tests are created equal. They measure different markers with a different sensitivity for accuracy. This is why it is important to be a great detective on health history, symptoms and changes. 
Stool tests often also give us useful information about markers of intestinal health, digestive enzyme status, indications of intestinal permeability and front line immune status or secretory IgA. 
The big picture of these results gives us a starting place for the right interventions to target the root causes of eczema that are stemming from the microbiome. 
More importantly, someone’s own account of what makes the skin better, worse, the history of the skin rash and how he or she is feeling is better than any testing and a critical part of an overall success plan for resolving eczema long term. 

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