Skin Bacteria, Infections, and Lupus Flares

Skin Bacteria, Infections, and Lupus Flares: What’s the Relationship?

Lupus disrupts the microbes on the skin and makes people with lupus more vulnerable to skin infections, which can cause flares.

We are not alone in our bodies: an entire world of microorganisms lives on our skin and inside our bodies. 

These microorganisms protect the body from infection by either crowding out invading pathogens or making the environment deadly to the invaders. These microbes also produce substances like vitamins, and help the body modulate the immune response. 

These ecosystems, called the microbiome, affect everything from weight to energy levels. They also affect autoimmune diseases such as systemic lupus erythematosus (SLE), an autoimmune disease that affects every organ system in the body. This includes the skin, the largest organ in the body, responsible for sensing the world around us and protecting us from the outside world. Lupus with skin manifestations is called cutaneous lupus erythematosus (CLE,) and you can read more about it here. 

Not only can we not live without our microscopic tenants, but they have evolved specifically to live with us. The microbiome is so complex that we are only scratching the surface (pun intended) of what this thriving part of our world is actually doing and how we can use it. Many people are now aware of how their gut microbiome affects them, and how they can support it with probiotics and diet. 

But what about the microorganisms that live on your skin?

The Skin Microbiome and Flares

The microbiome on our skin is responsible for blocking out bacteria, and also for body odor. In fact, body odor can be a good indicator that something is amiss in the skin’s ecosystem.  Hygiene and cosmetics, as well as the environment, hormone levels, medications, and the overall health of a person effect the microbiome. Ethnicity also seems to affect the microbiome, but the exact reason for this is unknown (possibly due to food or environment differences.) 

SLE causes changes in the structure of the skin that makes it easier for Staphylococcus aureus to colonize the skin there. Much like the leaky gut phenomenon broken down barriers in the skin let bacteria and bacteria byproducts into parts of the body it would otherwise not go. This can cause the body to develop targets and reactions to those byproducts and attack them, leading to inflammation and, as a result, increased lupus symptoms.

You can read more about the incredible skin microbiome here.

Bacteria involved with a healthy, well-regulated immune response include several species of lactobacillus bacteria. How they might calm inflammation is unclear, but a balanced microbiome, in the gut and on the skin, is clearly important. How bacteria cause autoimmune disease is often related to them having proteins similar to the body. When the immune system targets them, it also targets the body.

Skin Infections, Flares, and the Microbiome

People with lupus are more vulnerable to infections. Infections push the immune system into higher levels of activity, which, even as it attacks the bacteria, also drives up lupus symptoms. This causes a feedback loop of lupus symptoms making conditions more friendly for these bacteria, and then becoming more severe due to the infections of these bacteria.

Skin infections can show up as:

• Boils, raised, swollen pockets of pus
• Impetigo, a crusty rash with blisters that can be passed from person to person
• Cellulitis, which is redness, swelling, and sores on the surfaceof the skin from a deeper skin infection
• Ringworm, an itchy rash with ring-like spots. It’s caused by fungus like athlete’s foot, not worms.
• Eczema, a rash that causes itchiness and dry, scaly skin.

Rashes are a common symptom of lupus, so it’s important to keep an eye on them. 

Most bacterial skin infections are caused by bacteria in the Staphylococcus and Streptococcus families and can be treated with most antibiotics. Viruses like herpes and also certain fungi can cause skin infection, too. Ironically, the reason that an invasion of staphylococcus can cause a flare and get a foothold on the skin is because the immune system does its job: it recognizes the invader, but also causes it to ‘stick’ to the skin and break down some of the barriers between the skin cells and outside world. This makes it easier for staph to live on the skin and trigger the immune system even further. 

Skin infection is so common that the increased presence of Staphylococcus bacteria is sometimes used a way to confirm a diagnosis of lupus. Staphylococcus aureus was found in a study to occur in the noses of 21.4% of people with lupus (18 out of a population of 84) which was similar to  the frequency it occurs in people who do not have lupus. Staph seems to be highly associated with severe lupus, including lupus nephritis.

Some researchers are looking into how they can target Staph and other members of the skin microbiome for treatments

Other species of bacteria that are associated with lupus include E. Gallinarum and Ruminococcus gnavus. Salmonella and Escherichia coli are also known contributors to lupus and very dangerous diseases.

Antibiotics and Lupus Flares

So, can antibiotics reduce flares? If the flare trigger is the presence of bacteria like staphylococcus, yes. Lotions change the microbiome of the skin, making it more or less pleasant and livable for certain microbes over others.

According to a study in a mouse model mimicking Sjogren syndrome, an autoimmune disease that often occurs alongside lupus, changes in the bacteria on the skin can trigger autoimmune flares. In this case, the mice, who develop dermatitis due to a genetic mutation, had more Staphylococcus aureus on their skin than normal, non-modified mice. Antibiotics reduced the S. aureus on their skin and reduced the autoimmune dermatitis in the mice. Re-introducing S. aureus to the mice led to worsened autoimmune symptoms, including renal (kidney) disease, a common complication of systemic lupus.

The infection does not cause autoimmune disease, but it does exacerbate vulnerabilities that were already there, and may trigger the onset of lupus.

Keeping Your Skin Microbiome Healthy

Watch what cosmetics or skin-related makeup, lotions, deodorants, medications, or creams you use. Anything you put on your skin can affect the microbiome there, for good or ill. In addition, cosmetics or lotions that you are allergic can also trigger lupus flares. There are not really probiotics for the skin like there are for the gut but finding a lotion that works for you can help. Moisturizing can help keep the skin from cracking and breaking, reducing sores and lesions and preventing infection.

People with lupus are more sensitive to UV light and need extra protection from the sun to prevent flares and damage to their skin. This can be done with protective clothing or sunscreen. It’s advised to use mineral sunscreens, not chemical sunscreens. The reason given is because the chemicals can affect hormones and cause flares, but mineral sunscreens might have better effects on the skin microbiome.

Regular handwashing and keeping surfaces clean (especially those that make contact with sweat and skin) can reduce risks of skin infections. It’s important to find a balance of cleaning, however, because while cleaning your skin can reduce irritation and infection, it can also damage the skin if you do it too much.

A balanced diet full of antioxidants, including vitamin C (from citrus fruits,) and lycopene (abundant in tomatoes,) vitamin e (found in almonds and sunflower seeds) and omega 3 fatty acids (Fish, sunflower seed oil, walnut oil) is very good for the skin.

Staying hydrated can help keep the skin healthy, though usually if there are skin symptoms they are not in the areas that will benefit from drinking water. Pat attention to how your skin reacts to moisture in the air. Lotions and creams will work very well to protect and heal the skin but staying hydrated has many benefits.

Take care of your skin and the microbes on it, and it will take care of you.