skin rash

Skin Microbiome and Eczema

Dr. Trevor Cates : Welcome to The Spa Dr. Podcast. I am Dr. Trevor Cates. Today we are talking about the skin microbiome and eczema. At least 32 million Americans are estimated to have eczema. I personally had eczema as a child and know how much this skin condition can impact your life. The itching, the embarrassing rashes kept me up all night. This is what led me on my path to help others with natural solutions for skin.

Whenever I hear about a natural option for people suffering with eczema, especially when it has some science and research behind it, I’m curious to learn more. So that’s why I asked today’s guests to come on The Spa Dr. Podcast. My guest today is Skyler Stein who holds an MBA from Harvard business school and a BA from Duke university and leads Gladskin USA. A biotech driven skincare brand. He has a really interesting story personally, that led him into the microbiome space, which he does share during the interview.

Dr. Trevor Cates : Also in the interview, we discuss the gut skin connection, all about the skin microbiome and Skylar shares some research in the skin microbiome space that has led to topical skin care to support people with eczema. Now we know that the inside out approach is important as well as what we put on our skin. So please enjoy this interview.

Dr. Trevor Cates : Skylar, welcome to the spa doctor podcast. It’s great to have you on.

Skyler Stein: Thank you for having me, Dr. Cates.

Dr. Trevor Cates : You have an interesting story. I would love for you to share what got you interested in one of my very favorite topics to talk about, which is the skin microbiome. You started with an MBA from Harvard and things took a turn and led you down the path to the microbiome space. So why don’t you tell everybody about your journey?

Skyler Stein: The story actually begins in my undergrad. When I was at Duke university, I started studying genomic sciences. I was really interested in science and how the implications for society of the new emerging genomic sciences ultimately shifted that focus to energy and the environment while I was at Duke because I saw so much of the systems were so unsustainable and they had to change and there was going to be so much opportunity to go along with that change.

I brought that major and focus in energy and the environment to my career after graduating, where I worked in finance, and investment banking and venture capital and private equity, really identifying new renewable energy and alternative technologies and commercializing them and bringing them to life. Then I decided to go back to Harvard to get my MBA. And about three weeks in, I started feeling really lousy.

I was fatigued. I couldn’t concentrate or focus. I was having trouble remembering words. I had been completely healthy my entire life. And I just knew I wasn’t feeling like myself. So I went to a number of different doctors, and after seeing about six doctors, someone tested me for Lyme disease and that came back positive. I took a medical leave from Harvard, moved back to San Diego where I’m from and started treatment. Treatment for Lyme disease involves lots of antibiotics. So I was essentially taking four to five antibiotics for four to five months straight, really not understanding the consequences or the collateral damage that that would cause.

I started researching more and more about the impacts that antibiotics have on the body and discovered the microbiome. This was back in 2014 and it was really when the microbiome space was really starting to take off. There were some really exciting studies that were coming out in mice and in humans showing that the microbiome affects everything from not just healthy digestion, but everything. There are links to many chronic conditions, neurodegenerative, obesity, mental health, really you name it. There is a new study coming out everyday showing the connection between the microbiome and those health conditions.

And I was completely fascinated by this. Luckily San Diego is a hub of microbiome research. There is the Craig Venter Institute. He is the guy who first sequence the human genome, and UCSD, which has developed a microbiome Institute with some of the leading researchers in the world there. I actually decided to do an end of one study on myself, tracking my microbiome weekly for a year. The results just fascinated me.

For those listening, I have this chart that shows weekly how the different types of bacteria changed through different medicines I was taking through different supplements I was taking through different diets and alternative treatments. I could over time correlate the health of my microbiome with how I was actually feeling. And it was such a light bulb for me.

I had read these studies and I thought this was fascinating, but when I really saw the data correlate to my own health, I decided this is really a space that I want to dedicate the next chapter of my career and my life to. I healed fully from the Lyme disease. I went back to Harvard and then I went to finish my MBA at Harvard and went to join Obvious Ventures, which is a venture capital fund started by some of the founders of Twitter.

That focuses on world positive investing. And I went there to focus on something similar to what I was doing in the energy space, but finding microbiome technologies and the opportunity to commercialize them. So while I was at Obvious Ventures, I spent all my time talking to as many researchers, academics, startups that were focused on microbiome sciences to improve human health.

As part of that process, I really focused on the skin microbiome space. There is a lot of work done in the gut microbiome. But there was less attention at the time on the skin microbiome. The science was clear that it is as important to our skin health as our gut microbiome is to the rest of our health. Through that process, I met the team at Gladskin, they are based in the Netherlands, near Amsterdam. I saw what they were doing.

They showed me their research. They showed me their results and they were leaps and bounds ahead of any other player who I had talked to in the States and decided to join them full time to bring that technology to the United States.

Dr. Trevor Cates : Fantastic. Thank you for sharing this. And thank you for sharing this slide. Before you close out of this, for those people that are watching the video, can you explain what exactly we are looking at here? What are the different colors and then it looks like you were taking antibiotics, then you took antifungals and then maybe did some travel. Is that what we’re seeing here?

Skyler Stein: Yes. I start at the beginning of this chart, you can see the first three bars. This is when I was on heavy antibiotics, essentially 80 to 90% of my entire microbiome was made up of one type of antibiotic resistant bacteria. When you are taking antibiotics over a long period of time you are naturally breeding more and more, and all that survives are the antibiotic resistant bacteria and they continue to thrive.

The type of bacteria is called Enterobacter which can cause lots of problems. And I was feeling it with my symptoms then. Through taking all the antibiotics, and by killing all the bacteria, it allowed the fungus that naturally lives in your gut in a healthy balance, it caused that to allow it to overgrow because the bacteria was not there to keep the fungus in check.

So you can see in the next chapter where it says antifungals, once we reduce the amount of the fungals, we could increase the amount of healthy bacteria back into my gut so it looks like a more naturally healthy balance over the next six months or so with the blue charts. That is essentially a healthy bacteria, different types of healthy bacteria that are starting to repopulate in my gut, to make me more healthy.

Fortunately around Thanksgiving. I took a family trip to Mexico, to Cabo, and drank the water. What was interesting is, it caused complete eradication of all the progress I had made over the prior six months and that same antibiotic resistant bacteria that had grown when I was taking all the antibiotics,it allowed that to really come back and thrive, which was fascinating.

My microbiome looked different actually going forward from the impact that Mexico had. I then saw an ayurvedic practitioner who prescribed me a three day cleanse of Kanji water. And I can tell more about what that is, but it’s essentially different ayurvedic spices with over cooked rice. I just drank the water from that for three days, and you can really see over those three days, this healthy bacteria coming back and repopulating.

It was essentially a way to selectively feed the healthy bacteria in your gut. And for me, this was such a turning point and the light bulb for me, that the microbiome really is the missing link between some alternative Eastern therapies in Western science. Now that we have the technologies to really measure what these alternative treatments and the effects they really have. It is a way to really quantify the impacts there.

Dr. Trevor Cates : Yeah, fantastic. The pink that we see in the graph there looks like it was present a little bit after the antifungals, and then it became much more prolific. What is that?

Skyler Stein: Yes. Those are called Bacteroides. It is generally healthy bacteria found in many people’s microbiomes, generally people who are healthy have a large portion of their microbiome, with Bacteroides type of bacteria. After that Kanji ayurvedic cleanse that I did, it became a permanent part of my microbiome going forward from that date. So even though I still wasn’t on it created an environment that made it healthy for that type of healthy bacteria to continue to grow.

Dr. Trevor Cates : Okay. Very cool. And then what kind of test was this that you did?

Skyler Stein: This is essentially a test where they sequence all of the bacteria that are in your microbiome. So it is called a 16s test. It allows you to look at the 16s gene on each of the bacteria, which gives you a good idea of the taxonomy of that gene.

Dr. Trevor Cates : Right. Okay. This is the gut microbiome, not the skin microbiome. I just want to clarify, and this also doesn’t include fungi. This is just the bacteria, not fungi. It would have been interesting to see what happened after the antifungals to the balance of those.

Skyler Stein: Absolutely this is just focused on the bacteria, but you can see the impact of the antifungals, which don’t directly have impact on bacteria, but you can see indirectly what happened to the bacteria by taking them. It would have been fascinating to see the antifungal data as well. But I think this also paints a pretty clear picture of what was happening there.

Dr. Trevor Cates : Let’s talk more about the skin microbiome, because you were just talking a bit about the gut microbiome. Now I have talked to my audience some, they know that in my book, Clean Skin From Within, I talk about the skin microbiome and the gut microbiome, how it connects to it. Tell us a little bit about your understanding of the skin microbiome and what fascinates you so much about it.

Skyler Stein: Yes. It is widely known now that a healthy balance of bacteria in your gut is required to be healthy. I think most people in the U.S. understand probiotics and understand healthy balance in the gut, but there has been way less focus on the skin microbiome. When you tell people that your skin works the exact same way as your gut, and it also needs a healthy balance of bacteria in order to be healthy, it’s a light bulb that goes off, they are just so intuitive for so many people to really understand.

We have completely disregarded the skin microbiome. We have been taught that we are dirty and we need to scrub it clean and to essentially disinfect it every single day. And by doing that, we create an environment that is unhealthy. It is essentially like taking antibiotics for your gut every day. It doesn’t create an environment for those healthy bacteria to be able to thrive.

We also know that different parts of the body are colonized with different types of bacteria, depending on the environment that they are in. And actually, different people’s forehead to forehead is more common than my own forehead to the back of my knee. In terms of what the skin microbiome looks like there. More research is showing that there has been a connection between the skin microbiome, the types of bacteria that live on the skin and different types of skin, inflammatory skin conditions for a long time.

It was taught in medical school that the microbiome is really a reflection of what is happening of the disease on the skin. It is a symptom of what the cause is of the actual disease. There is more and more evidence coming out now that the skin microbiome is actually the cart pulling the horse where it is the imbalance in the skin microbiome. That is really the driving force that’s causing these different types of inflammatory skin conditions.

Dr. Trevor Cates : Yeah, absolutely. What you said about hygiene, I really want to emphasize that because I do think that for so long and still for many people, when someone has a skin problem like acne or eczema, psoriasis, dermatitis, a lot of these things people will think, Oh, that means my skin is dirty and I just need to clean it more. I need to use more cleansers and soaps and, and that’s actually further disturbing, disrupting, damaging the skin microbiome instead of moving in the right direction.

Skyler Stein: Oh, absolutely. If there is an invasive weed in the rainforest, instead of carefully weeding out the one problem, essentially what we are doing is we are burning the whole rainforest down and hoping that it comes back completely healthy and diverse. Because there is less flora and fauna and all those symbiotic relationships there, when you burn everything down, it really creates an environment for the bad pathogenic invasive species to take a hold without the protective species to keep them in check.

Dr. Trevor Cates : Right. Absolutely. Antibiotic resistance and all of that as well comes into play when we are using topical antibiotics or even oral antibiotics.

Skyler Stein: Yes, absolutely. Specifically within eczema or atopic dermatitis, which is a condition that affects about 30 million Americans up to 20% of children. There was an article put forth by Heidi Kong at the NIH that shows right before an eczema flare up happens, there is the signature microbiome imbalance that precedes it for the vast majority of people. And that it wasn’t until the microbiome healed, that then allowed the flair to resolve, which is a really fascinating piece of research that has caused many more skin microbiome researchers to dive deeper into really what’s happening here.

Dr. Trevor Cates : Yeah. I started going to some of the skin microbiome conferences a few years ago. We have been talking about the gut microbiome at Naturopathic medical school. I started learning about it there but the skin microbiome has been a little bit newer and certainly I became very interested in it. When I was going to the conferences, I realized there was so much we still don’t know, and that we are still learning about the skin microbiome and it is super complex.

I think a lot of times people are quick to jump to this assumption that the gut microbiome is going to be similar to the skin microbiome, at least the general public. So whatever is good for the gut microbiome must be good for the skin microbiome to put on topically. People are using products or bacteria that are in the gut on the skin, but that is not going to really help.

Skyler Stein: Right. I think there are a lot of companies that, for example, will put lactobacillus yogurt extracts, which lactobacillus is really healthy bacteria for the gut, but doesn’t naturally exist or live on our skin. Not all probiotics are created equally. It is really important what exactly you are applying to your skin, especially depending on the problem that you are experiencing. It is definitely not a one size fit all. It is so complex and the more we are researching, the more we are learning, how much we don’t know about it.

Dr. Trevor Cates : Yeah. The challenges with the skin microbiome and using a topical on the skin, because I was so excited about initially, I thought, okay, well, I am going to do some research and start adding probiotics to my skincare products. It is not that simple because first of all, the bacteria are so different and they vary, like you said, from one person to the next, from one part of your body to the next, it varies so widely.

And then even if you identify an organism, how are you going to make sure that it stays alive in the topical in a way that is going to actually provide benefit rather than just being on the label. Then you also have to deal with the FDA regulations, of no live bacteria are supposed to be living in a skincare product. I realized, okay, this is way complicated. Maybe I need to take a step back here. It sounds like Gladskin is one of the few companies. There are a few emerging that are getting to the real science on this and figuring out some solutions for people. And especially, it looks like that is his focus on eczema on atopic dermatitis, right?

Skyler Stein: Absolutely. That is where we are starting. We see tremendous results with our Gladskin product for people with eczema. It is really about our view. It is about two things, keeping the bad pathogenic bacteria levels down as low as possible and keeping the healthy ones up. Sometimes just applying a probiotic will help with the healthy bacteria. But if there is a problem bacteria on your skin, that is really causing inflammation, that is really irritating things.

If you don’t get rid of that, you are not going to solve the problem. Gladskin uses what is called Endolysins technology and science. This has been available in Europe for about five years now. Gladskin has been sold there. We have helped hundreds of thousands of people in Europe with that technology. We just launched Gladskin into the U.S. in January. We are just getting started and really focusing on educating about why Endolysins are different and how it is really a different category and approach overall of treating it compared to anything else that is really available in the U.S.

Dr. Trevor Cates : Yeah. Amazing. Can you explain what is different about people with eczema, atopic dermatitis than everyone else?

Skyler Stein: Yes. So with people with atopic dermatitis, there is this particular species of bacteria called staph aureus, which is commonly known as staph. There is a difference between people who are colonized with it, meaning you have it on very low levels versus a full blown staph infection. Traditionally, it has been thought that as long as it doesn’t look like a classical infection, there is nothing you should really do about it.

Antibiotics should really be spared for the times that it’s a full blown infection. But what the research is showing now is that the vast majority over 80% of people with eczema are colonized with this bacteria. Even if it’s not at clinical levels where it is called an infection, but it can be causing inflammation all along the way. Previously doctors were only told to treat it if it was classified as an infection. Gladskin really focuses on balancing that skin microbiome at the core before things get out of control, even if it is not showing up as an infection.

Dr. Trevor Cates : Okay. Can you explain a little bit more about how this really helps, going a little bit deeper into how exactly this helps people with eczema?

Skyler Stein: Yes. The Heidi Kong article that I mentioned showed that the microbiome balance proceeds an eczema flare, and then the microbiome balance needs to heal before the flare can heal. Gladskin takes the approach of constantly monitoring and keeping that microbiome balanced. To reduce the likelihood of flares from happening and to help them to resolve quicker by really focusing on the microbiome first.

Dr. Trevor Cates : Okay, great. What are some of the other things that you guys have found with the skin microbiome in ways that help people with eczema?

Skyler Stein: Yeah. We found that the vast majority of skincare products in the U.S. are packed with preservatives. We think about preservatives as something to keep our product fresh so that it can stay on the shelf longer, so we can have a longer life, but preservatives are really broad spectrum antibiotics that kill bacteria. Every day that we are applying skincare products with preservatives, we are putting those broad spectrum antibiotics on our skin.

The preservatives are really important for the way most skincare products are produced because it helps keep the product safe. It helps keep consumers safe to make sure that there aren’t unhealthy problems causing bacteria inside the bottle, especially products that you kind of dip your fingers into every day. It is a way of keeping the product clean without infecting it every day.

Those preservatives can be really irritating for people. It is a similar line of thinking right now with COVID and everybody is constantly washing their hands, constantly disinfecting their hands and more and more people are seeing their skins are getting more sensitive. There are more eczema type flare ups from the overuse of those products. All those products are doing is killing the skin microbiome, which otherwise keeps your hands healthy.

It is really the awareness of it and the importance of the skin microbiome is becoming more and more obvious to people. So long story long answer to your question, but it’s about using products that both can preserve the healthy bacteria that naturally are growing on your skin and minimizing the pathogenic bad problem causing bacteria.

Dr. Trevor Cates : Great. What is some of the research you have done? You can make claims on the product. So obviously you have done some research on this.

Skyler Stein: Yes, we have done a lot of research. Mike Rios, the biotech company that developed this is a hundred person, biotech company in Europe. We have done a tremendous amount of research. There was a double blinded placebo controlled trial in Europe with Gladskin and it showed that there was roughly 80% reduction in reported flare ups compared to the product that did not have the Gladskin technology inside of it.

Dr. Trevor Cates : Wow. It is great to see that. I had eczema as a child and my daughter started developing it too when she was younger and once it starts and you get that flare up, it just gets harder to manage. And it’s nice to know that there are things to help with calming it down. I know with my daughter, for a while, she was starting to get it on her hands. What we realized is that at school, the soaps that they use in the dispensers was really irritating her skin.

The more she would use it, the worse her eczema would get. It started to get better over the weekend when she was home, then she would go back to school and it would come back. I actually had my pharmacy compound a natural hand-wash for her. She started using that instead and took it to school with her and used it and that helped. Of course she also has a gluten sensitivity, and so if she eats any gluten at all, she gets a flare up of eczema.

That was another thing that we had to work on from the inside out and helping her gut microbiome. I definitely know it is challenging if people are looking for options besides topical steroids and the conventional treatment, which can calm the flare up initially, but it is not a long term solution. And it’s certainly not the best solution either. If you can find other things to help soothe the skin, support the skin microbiome, it’s certainly a healthier approach. And it is certainly more of a Naturopathic approach from my perspective of helping support the body to heal itself. The body is very wise when just given the right tools, it can recreate balance and good health.

Skyler Stein: Absolutely. Eczema is a chronic skin condition. And so we need tools and medicines that align with the chronic nature of the condition. Steroids are fantastic over a two week period, but it is really a bandaid for the two week period without getting to the root of what’s really driving the disease.

Dr. Trevor Cates : Skyler it has been so interesting having you on, and I love your personal story. Thank you for sharing your personal story at the beginning, and what led you to Gladskin and all of the research and things that they are doing there. Tell everyone where they can find you learn more about the solutions that you all have.

Skyler Stein: Yes. You can come check us out at gladskin.com. You can purchase the product directly from there. If it doesn’t work for any reason, we offer a no questions asked guarantee to make sure that everybody is happy. Thank you so much for having me on the show.

Dr. Trevor Cates : Yeah, absolutely. Thanks for coming on.

Dr. Trevor Cates : I hope you enjoyed this interview today with Skyler Stein. And if you’d like to have more information about Gladskin, you can go to thespadr.com, go to the podcast page with their interview and you’ll find the information there. They have generously offered a discount for people who would like to try out the products and I don’t make any commissions. I don’t make any money from the sale of this product. I have no association with this product. I just heard about it, thought it was very interesting. I love hearing things that people are doing innovatively, especially in the skin microbiome space, because it’s so near and dear to my passions. So while you are at thespadr.com, I encourage you to join the spa doctor family. So you don’t miss any of our upcoming shows and information. You can also take the skin quiz to find out what messages your skin might be trying to tell you about your health, including the skin microbiome, and how much that might be playing a role in the health of your skin. You can go to theskinquiz.com to take that online quiz. Also, I invite you to join The Spa Dr. on social media. We are on Instagram, Facebook, YouTube, Twitter, and Pinterest. And I’ll see you next time on The Spa Dr. Podcast.