149: How Staph Aureus Wrecks Your Skin w/ Dr. Julie Greenberg

Staph may not immediately come to mind when thinking about skin rash flares, but it can actually play a huge role! My guest today will break down how staph aureus can damage your skin.

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My guest today, Dr. Julie Greenberg, is a licensed ND who specializes in integrative dermatology.

She is the founder of the Center for Integrative Dermatology, a holistic dermatology clinic that approaches skin problems by finding and treating the root cause.

Dr. Greenberg hold degrees from Northwestern University, Stanford University and Bastyr University, and received advanced clinical training at the Dermatology Clinic at the University of Washington Medical School and at the Pediatric Dermatology Center at Seattle Children’s Hospital.

She is also the Program Chair of the Naturopathic & Integrative Dermatology series on LearnSkin.com, a learning platform for integrative health care professionals.

Join us as we talk about staph aureus: how it relates to eczema, how it can damage the skin, and much more.

Has staph aureus been found to be the cause of your skin rash? Let me know in the comments!

In this episode:

• What is the relationship between eczema and staph?
• Should the pH of the skin be acidic or alkaline?
• What is the relationship between staph and the nose?
• How does staph damage the skin?
• Can people with atopic dermatitis have staph aureus in the GI tract as well?

Quotes

“People are surprised to learn, the healthy place for skin is an acidic pH. And that is so important, and particularly as it relates to things like staph and other pathogens.” [4:59]

“People get misdiagnosed with eczema when it's actually malassezia, which is a yeast that causes dandruff.” [10:38]

Links

Find Dr. Greenberg online

Healthy Skin Show ep. 107: Symptoms Of A Staph Infection On Your Skin

Gut Dysbiosis and Its Role in Skin Disease: A LearnSkin course I co-authored

LearnSkin Naturopathic and Integrative Dermatology Series

149: How Staph Aureus Wrecks Your Skin w/ Dr. Julie Greenberg FULL TRANSCRIPT

Jennifer: Hi everyone. Welcome back. My guest today is someone whom I'm really excited to have on the show because she's just as much of a nerd about things as I am. And I'm hoping today that we can make this topic, which we're going to dive into, staph aureus, something that is both informative, but kind of fun. I think we should put on our curiosity caps today because, especially for people that are struggling with eczema, though to be fair, I have worked with clients to have psoriasis who have issues with staph infections. I think you're going to find this incredibly interesting.

Jennifer: My guest today is Dr. Julie Greenberg. She's a licensed naturopath who specializes in integrative dermatology. She is the founder of The Center for Integrative Dermatology, a holistic dermatology clinic that approaches skin problems by finding and treating the root cause. Dr. Greenberg holds degrees from Northwestern University, Stanford University and Bastyr University, and received advanced clinical training at The Dermatology Clinic at The University of Washington Medical School and at The Pediatric Dermatology Center at Seattle Children's Hospital. She is also the program chair of The Naturopathic and Integrative Dermatology Series on learnskin.com, a learning platform for integrative healthcare professionals. Thanks so much for being here, Dr. Greenberg.

Dr. Greenberg: Thanks so much for having me, Jen. You know I love The Healthy Skin Podcast, and I have listened to every single episode that's on it. And I just get excited when a new episode comes out, so thanks for having me.

Jennifer: I am excited because you are going to talk about a topic that nobody has talked about yet. And I find the whole staph aureus topic really fascinating. But when you approached me with this idea, I was like, “We have to talk about this,” because it's not just that staph is a bug that we have on our skin that we don't really want there. There's so much more around it that can impact skin health, and so I'm so glad you want to talk about this today with me.

Dr. Greenberg: Yeah. Staph is such a big player when it comes to skin disease. And we naturally think of it with things like atopic dermatitis, or if you have an infection, like a boil. But it can, like you said, be present, it can overlay psoriasis plaques. It can be involved with acne, rosacea, just lots of different presentations. But definitely close association between staph aureus and atopic dermatitis.

Jennifer: Yeah. And so with that said, what is the relationship between eczema and staph?

Dr. Greenberg: So as we know, I mean, eczema is a complicated, multifactorial disease. But as far as the skin barrier, that's one component of atopic dermatitis, is that we have a compromised skin barrier. And really, whenever I see patients who are having an eczema flare, I'm automatically thinking there's a staph aureus problem. Now there's kind of a range of the amount of staff that's on a skin. When there's a lot of staph, we call it a staph infection. And then you're looking at that crusting, oozing, really awful looking skin. And that's when people start to think, “Oh, maybe I have an infection.”

Dr. Greenberg: But even if you're not at that level, we can have colonization. Now colonization can be, you have it, if I cultured your skin or my skin, either of us could have staph aureus on our skin right now. But it might be at low enough levels that it's not causing a problem. And we have natural things on our skin that help fight it. So 20% of people out there, if you cultured them, you're going to find staph aureus, not a problem for them. Then when we look at people with atopic dermatitis and we culture them, they have much higher levels of colonization, both in terms of how many people are colonized and how much staph aureus is on the skin. And even then, when we look at lesional skin on eczema sufferers, it goes up even more.

Dr. Greenberg: So when I have a patient present to me with an eczema flare, I'm just already thinking there's a very, very high likelihood that staph is playing a problem with the skin barrier. And I know I need to address the staph. I don't even need to culture it. I know it's a problem. I see atopic derm flare, I think staph.

Jennifer: And pH is also important too with the skin. I mean, I've seen a lot of people that don't think that the pH of their skin is important. There's a lot of push out there online and holistic communities and wellness communities that everything in the body should be alkaline. What would you say to that?

Dr. Greenberg: Yeah. So the body has very specific pHs that it needs all over the body. Blood, for example, very tight regulation. It wants to be about 7.4, which is neutral. The skin, people are surprised to learn, the healthy place for skin is an acidic pH. And that is so important, and particularly as it relates to things like staph and other pathogens. So we have these great things on our skin called antimicrobial peptides. What it sounds like, they are things to fight microbes on the skin. And they can really only function in an acidic pH. And once the pH on our skin goes up, these guys are basically inactivated. So defensin is one of them. Defensin is, you want to talk about geeky, I think of it like a superhero. Right? And it deserves a cape and a big D on its chest. It's just on our skin and it's looking for bacteria and viruses and fungus. And sees it and, bam, it pokes holes in it and kills it. But it cannot function at a higher pH. And not only that, staph aureus loves a higher pH.

Dr. Greenberg: So we want skin, an ideal is four to five maybe for the pH. When staph gets up to 7.5, it's like, “Baby, I'm home. This is where I want to be.” And it just starts to grow and flourish. And then the things like defensin and those natural antimicrobial peptides, they can't function at that higher pH and fight it. So looking at and treating the skin pH is one of the main topical treatments that I use in treating atopic dermatitis flares. And to boot, it actually creates healthy skin, so people's skin will have less wrinkles. It will appear glowing and beautiful. It wants an acidic pH. It's super important.

Jennifer: Yeah. I cannot agree with you more, and especially too with all of the excessive body washing. I'm not saying you shouldn't shower, but there are some people that shower way too much. They wash their hands way too much. And that can increase the skin's pH as a result of the contact with water and soap, which is very alkaline. So we don't realize that it's not … I don't think that things are inherently bad. That's not the point. But that excessive exposure to certain things can actually create a situation where now your environment is now more favorable to staph. And so you mentioned something that I've heard from a few other practitioners about the nose, our nose. So what is the relationship between staph and the nose?

Dr. Greenberg: So I'm sure that many of your listeners, either patients themselves or practitioners, have the experience. They've treated staph infections. Right? The staph infection goes away. Yay, we've conquered it. And then before you know it, it is back with a vengeance. And it's like, “Oh, my gosh. How did this happen?” Well, staph aureus is sneaky. And the place that it likes to hide out and colonize are in the nose. Right? And so even if you take an antibiotic like a Doxycycline and you clean up the staph infection on the skin, it's really hard for it to get in the nose.

Dr. Greenberg: And so it's just hiding out there, waiting, biding its time. And you're right, so using soaps, soaps can be a pH of up to 12. It's super alkaline, so it's waiting for that right environment. And it's right here, and then it just quickly comes out and colonizes the skin again. So absolutely, part of any treatment plan when you're dealing with staph, when you're dealing with eczema flares, you have to treat the colonization in the nose, or it's just a vicious cycle of, you clean it, it comes back, you clean it, it comes back. We want to get rid of it for good.

Jennifer: And so do you do a culture in the … Boy, look at me. I'm stumbling.

Dr. Greenberg: The nares.

Jennifer: In the nares, or in the nasal cavity, do you do a culture swab? Or how do you identify if staph is hiding there?

Dr. Greenberg: So again, you certainly can. You can do bacterial and fungal cultures in the nose. But again, I just know when I am looking at a patient with an eczema flare, it's a factor. And so we just go ahead and treat the nose. So there's a variety of botanicals. If you go to the dermatologist, they may prescribe something like a mupirocin ointment and antibacterial ointment to put up there. It can be effective, but then it can also not get it all. I, of course, being a naturopathic doctor, I like to use kind of more natural botanicals. And there's a lot of options. You can do colloidal silver sprays. They make nasal sprays. If you're looking for products, it might say vertical spray. That's an FDA labeling. So you'll look for nasal spray or vertical spray. Colloidal silver is good. And there's propolis sprays. There's other things that you can do. But yeah, you need to treat the nose. If a patient wants to do a culture, we can, but it's just an extra expense, so I rarely do that.

Jennifer: And what about if someone was to have a really bad flare around their eyes? Does that also kind of clue you? I've heard that sometimes if you have these recurrent really bad rashes around the eyes, that could be a sign that you want to take a look at what's going on in the nose.

Dr. Greenberg: Yeah. I mean, the eyes can be many things. I also see actually a lot of seb derm, seborrheic dermatitis that flares around the eyes. And people get misdiagnosed with eczema when it's actually malassezia, which is a yeast that causes dandruff. It likes sebum. So it depends, it can be either. But the good news is that a lot of these pathogens, so whether you're talking about malassezia or candida, so yeast and fungus, staph aureus, even herpes virus, they all want this really alkaline skin. And by using really beautiful, natural botanicals like aloe vera gel, hydrosols, even apple cider vinegar sprays, we lower the skin pH and we make it healthy against all pathogens. So again, you don't necessarily need to even culture the eyes and see what's going on. One thing that you can start doing is using these botanicals to lower the skin pH and make it a place that none of those pathogens can thrive or want to be.

Jennifer: Yeah. And so let's talk a little bit about the damage that staph does because it's not just its presence that's the problem. It causes a lot of damage. So how exactly does staph create the sort of train wreck on your skin?

Dr. Greenberg: Yeah. Staph has a lot of tools at its disposal for wreaking havoc on your skin. One thing that it does is it stimulates something called proteases. Proteases are enzymes that break down proteins on the skin. And specifically, staph aureus stimulates proteases that break down keratinocytes, so the skin cells. So first, it's breaking it down. It produces things called virulence factors, which it actually creates inflammatory cytokines. Cytokines are chemicals on your skin that cause inflammation. And with this chronic inflammation, your skin just can't heal. And again, now the pH is probably high, so the things like the defensins can't work. And so it just creates this whole environment where we can't fight it.

Dr. Greenberg: Then some strains of staph aureus produce things called toxins, like alpha toxin and beta toxins. And they are what they sound like. They are toxins. And they actually form these structures that poke holes in your skin.

Jennifer: Oh, my goodness.

Dr. Greenberg: Yeah. And so there's kind of a bigger problem. So obviously, if we've got holes in our skin, it's very hard for it to heal. But it also allows other things into the skin. It allows pathogens in, food proteins. And we know something, there's something called an atopic march, where people kind of start off with eczema, babies and kids, and then a lot of them will go on to develop food allergies and asthma. And we think that staph aureus has a big role to play in that with these toxins poking holes in the skin.

Dr. Greenberg: It allows food proteins and pathogens like pollens and stuff from the air to get in and get presented to the immune system in a way they were never meant to. And then this causes the body to think suddenly, “Oh, this egg is a bad thing.” And suddenly, now we have a food allergy, whereas we never had one before. And they've done studies with mice where they've actually created food allergies in mice that never had them by basically poking holes in the skin and then layering egg protein over it. And suddenly, they had IGE food allergies several weeks down the line, where they never had it before.

Jennifer: Wow.

Dr. Greenberg: So staph aureus is really a bad guy. We really want to clean it up.

Jennifer: I try to remind people that staph is not just an atopic dermatitis issue. I have had the experience of working with psoriatic clients. And they've actually had problems with it. If you have skin issues in general, even if it's just a “dermatitis” because some people can't [inaudible 00:14:25], even though they've seen a number of dermatologists. Do you think it's worthwhile from your experience to always consider staph pretty much regardless of what type of chronic skin issue you might have?

Dr. Greenberg: I think it's always important to think that it could be playing a role just because it's so prevalent. Again, I mean, 20% of people out there, if you swab them, they will have staph aureus on their skin, and that's healthy skin. So once we start talking about skin that is not healthy and is compromised, you always have to be thinking about staph aureus as a potential factor. Again, I don't think that means that you necessarily need to go out and culture it, unless you've got a raging infection, and say you're going to get on an antibiotic, yeah, then that's a good idea. You want to know exactly what you're fighting before you get on an antibiotic. But using strategies like lowering the skin pH with botanicals or … And we didn't talk about coconut oil. I know you're not a huge fan of it, but there's a lot of studies that show that four weeks of using coconut oil twice a week can really help with eradicating staph. There are antibacterial components to coconut oil.

Dr. Greenberg: And I use coconut oil judiciously. I don't like it on the face because it's comedogenic. It can cause acne. And I don't like just coconut oil on the skin for months at a time because it can actually be drying. But it can be useful in helping to fight staph.

Jennifer: That's actually a really good point because I think a lot of times, we want to be black and … A lot of people want you to be black and white, like yes, or no, this is good, this is bad. But the truth of the matter is, I think where I've kind of come from with it is that we probably as a society have over assumed that coconut oil is the panacea of amazingness, which it is. But there's pros and cons to everything. And so maybe we need to take it a step back. And as you're saying, there are times and places where it can be really helpful. But you're not using it every day on end, slathering yourself head to toe with it.

Dr. Greenberg: Exactly.

Jennifer: And so I wanted to ask you a quick question, if you have any experience or any thoughts on if you have staph aureus on the skin, there's some really interesting research I've been reading recently about the incidence of people with atopic dermatitis having staph aureus in the GI tract as well. Any thoughts on that?

Dr. Greenberg: Absolutely. So as a naturopathic doctor, I do functional medicine testing, and of course looking at and treating the gut is a big component of how I treat the underlying root cause for a lot of skin conditions, including atopic dermatitis. So yeah, I've run a lot of stood tests, and it is certainly not uncommon to see an overgrowth of staph aureus on a stool test in atopic derm patients, very common. That's not always the case, but we know that there's a gut skin connection. And so it is definitely … I mean, part of my protocol for treating atopic dermatitis is also treating the gut. And again, it's helpful to have a stool test and see what's exactly in there. But I'm never surprised when I see staph aureus in the stool as overgrowth, and it happens all the time.

Jennifer: And so I think that's an important point to mention, is that we have these different microbiomes. And they communicate with one another. I think that's the easiest way to think about it. I don't know if we fully understand every which way that they communicate. I think we are learning, in a constant state of learning. I know one of the great resources we wanted to mention to everybody today, especially practitioners, is the Learn Skin platform, where there is going to be a lot of content that is releasing around helping people understand all of these different facets of looking at microbiome issues, looking at nutrient issues, and all sorts of things because education I think at this point is the key for us to be able to make a bigger impact in helping people overcome these issues.

Dr. Greenberg: Absolutely. I mean, we have at least 1000 different species of bacteria on our skin. And that doesn't include all of the fungal and yeast species and viruses. There's a whole world living on our skin. And we're starting to pay a lot more attention to it. It think the gut microbiome has gained a lot of traction over the past few years. And just now are we thinking about the skin microbiome. And absolutely, they're connected. We don't know all the ways because there are definitely different bacteria on the skin than occur in the gut. But they speak to each other. They're connected. And our skin microbiome, the health of our skin microbiome is just as important to the health of our skin as our gut microbiome is to our internal health. And there's a fascinating study that shows basically, I mean, to speak to staph aureus is an even bigger problem with atopic derm, that right before someone gets a flare, we want high microbial diversity on our skin, of obviously the good ones, and staph aureus to be low or nonexistent.

Dr. Greenberg: And the study showed that right before a flare, for some reason, the diversity of the microbiome plummets. And at the same time, staph aureus shoots up. And we're not sure why that happens. We're not sure if this is a function of PH, where again, if somebody's maybe soaping and not … The skin isn't able to recover, and so all of those bacteria that need an acidic skin PH die off, and then staph is like, “Ooh, this is my chance. Here I go.” But basically, you don't get the eczema flares until the microbial diversity plummets and the staph colonization increases. And now conversely, you don't get resolution of the eczema until the staph aureus population decreases and the microbial diversity increases again. So it's even more important why we really need to pay attention to skin PH and the microbiome of the skin. It is the foundations for health of the skin.

Jennifer: Yeah. And it's super important. And I want to make sure that people can connect with you because you're a fantastic resource and you have so much information, that even just having this conversation, I feel a little, I'm nerding out. I love it so much. I hope all the listeners are … I know the listeners love this kind of stuff because we've done enough of these shows at this point to know they really love diving into answering these deeper questions. But they can find you at integrativedermatologycenter.com. Check out your practice. And tell us a little bit about your practice.

Dr. Greenberg: Yeah. So I'm physically based in Los Angeles, but I see patients throughout California and Washington via telehealth. And for patients in other states or other countries, I can't treat them directly, but I can work with their licensed healthcare practitioners to help improve and implement treatment plans for them. And I'm always available to answer questions, so people can feel free to submit questions or ping me on my site, and I'm happy to respond to them.

Jennifer: Yeah. And because you're doing such fantastic work too over at learnskin.com, all of this amazing information to put out, and we're going to start that I think June 25th. Correct?

Dr. Greenberg: Yes. Yes. We have a series of 25, 20 courses that really do a deep dive into all of this kind of stuff, like the underlying root cause of skin disease. And you have coauthored a really important article called Gut Dysbiosis and Skin Health that I think people are going to just … Their minds are going to be blown. And it's what the integrative and what these kinds of communities have been talking about for years. But it shows all the published research in one place, like all the gut dysfunction. What is happening in atopic dermatitis in the gut? What is happening in the gut with psoriasis?

Dr. Greenberg: You guys have just done a fantastic job of laying out the research that is just unbelievable on how much gut dysfunction contributes to these chronic skin diseases and just further that you can put a steroid cream on atopic dermatitis, or you can try to treat a psoriasis plaque, but you're just not getting to the underlying root cause unless you're looking at the gut. And I think this course will be free for a while, so if people want to go check out your excellent work, they can go to learnskin.com, and it's just fantastic information.

Jennifer: Yeah. Well, thank you too for the opportunity. I appreciate the time and energy that you're putting into creating resources like this along with Learn Skin. I just love being a part of it. So I want to thank you, first of all, for putting together this idea to have this conversation here on the Healthy Skin Show, and the time that you took today to share all this great information. I know people are going to love it.

Dr. Greenberg: Absolutely. Thanks so much for having me.