Skin Flora

Skin flora
Skin flora, also called skin microbiota,

refers to microbiota (communities of
microorganisms) that reside on the skin,
typically human skin.
Depiction of the human body and bacteria that predominate
Many of them are bacteria of which there

are around 1,000 species upon human skin
from nineteen phyla.[1][2] Most are found in
the superficial layers of the epidermis and
the upper parts of hair follicles.
Skin flora is usually non-pathogenic, and

either commensal (are not harmful to their
host) or mutualistic (offer a benefit). The
benefits bacteria can offer include
preventing transient pathogenic organisms
from colonizing the skin surface, either by
competing for nutrients, secreting
chemicals against them, or stimulating the
skin's immune system.[3] However,
resident microbes can cause skin
diseases and enter the blood system,
creating life-threatening diseases,
particularly in immunosuppressed
people.[3]
A major non-human skin flora is

Batrachochytrium dendrobatidis, a chytrid
and non-hyphal zoosporic fungus that
causes chytridiomycosis, an infectious
disease thought to be responsible for the
decline in amphibian populations.[4]
Species variety
Bacteria
Scanning electron microscope image of Staphylococcus epidermidis one of roughly a thousand bacteria species present
on human skin. Though usually not pathogenic, it can cause skin infections and even life-threatening illnesses in those
that are immunocompromised.
The estimate of the number of species

present on skin bacteria has been radically
changed by the use of 16S ribosomal RNA
to identify bacterial species present on
skin samples direct from their genetic
material. Previously such identification
had depended upon microbiological
culture upon which many varieties of
bacteria did not grow and so were hidden
to science.[1]
Staphylococcus epidermidis and

Staphylococcus aureus were thought from
cultural based research to be dominant.
However 16S ribosomal RNA research
finds that while common, these species
make up only 5% of skin bacteria.[5]
However, skin variety provides a rich and
diverse habitat for bacteria. Most come
from four phyla: Actinomycetota (51.8%),
Bacillota (24.4%), Pseudomonadota
(16.5%), and Bacteroidota (6.3%).
Ecology of the 20 sites on the skin studied in the Human Microbiome Project
There are three main ecological areas:

sebaceous, moist, and dry.
Propionibacteria and Staphylococci species
were the main species in sebaceous
areas. In moist places on the body
Corynebacteria together with Staphylococci
dominate. In dry areas, there is a mixture
of species but Betaproteobacteria and
Flavobacteriales are dominant.
Ecologically, sebaceous areas had greater
species richness than moist and dry ones.
The areas with least similarity between
people in species were the spaces
between fingers, the spaces between toes,
axillae, and umbilical cord stump. Most
similarly were beside the nostril, nares
(inside the nostril), and on the back.[1]
Frequency of the best studied skin microbes[3]
Organism Observations Pathogenicity
Staphylococcus epidermidis Common occasionally pathogenic
Staphylococcus aureus Infrequent usually pathogenic
Staphylococcus warneri Infrequent occasionally pathogenic
Streptococcus pyogenes Infrequent usually pathogenic
Streptococcus mitis Frequent occasionally pathogenic
Cutibacterium acnes Frequent occasionally pathogenic
Corynebacterium spp. Frequent occasionally pathogenic
Acinetobacter johnsonii Frequent occasionally pathogenic
Pseudomonas aeruginosa Infrequent occasionally pathogenic
Fungal
A study of the area between toes in 100
young adults found 14 different genera of
fungi. These include yeasts such as
Candida albicans, Rhodotorula rubra,
Torulopsis and Trichosporon cutaneum,
dermatophytes (skin living fungi) such as
Microsporum gypseum, and Trichophyton
rubrum and nondermatophyte fungi
(opportunistic fungi that can live in skin)
such as Rhizopus stolonifer, Trichosporon
cutaneum, Fusarium, Scopulariopsis
brevicaulis, Curvularia, Alternaria alternata,
Paecilomyces, Aspergillus flavus and
Penicillium species.[6]
A study by the National Human Genome
Research Institute in Bethesda, Maryland,
researched the DNA of human skin fungi
at 14 different locations on the body.
These were the ear canal, between the
eyebrows, the back of the head, behind the
ear, the heel, toenails, between the toes,
forearm, back, groin, nostrils, chest, palm,
and the crook of the elbow. The study
showed a large fungal diversity across the
body, the richest habitat being the heel,
which hosts about 80 species of fungi. By
way of contrast, there are some 60
species in toenail clippings and 40
between the toes. Other rich areas are the
palm, forearm and inside the elbow, with
from 18 to 32 species. The head and the
trunk hosted between 2 and 10 each.[7]
Umbilical microbiome
The umbilicus, or navel, is an area of the

body that is rarely exposed to UV light,
soaps, or bodily secretions[8] (the navel
does not produce any secretions or oils)[9]
and because it is an almost undisturbed
community of bacteria[10] it is an excellent
part of the skin microbiome to study.[11]
The navel, or umbilicus is a moist
microbiome of the body[12] (with high
humidity and temperatures),[13] that
contains a large amount of bacteria,[14]
especially bacteria that favors moist
conditions such as Corynebacterium[15]
and Staphylococcus.[13]
The Belly Button Biodiversity Project

began at North Carolina State University in
early 2011 with two initial groups of 35
and 25 volunteers.[10] Volunteers were
given sterile cotton swabs and were asked
to insert the cotton swabs into their
navels, to turn the cotton swab around
three times and then return the cotton
swab to the researchers in a vial[16] that
contained a 0.5 ml 10% phosphate saline
buffer.[10] Researchers at North Carolina
State University, led by Jiri Hulcr,[17] then
grew the samples in a culture until the
bacterial colonies were large enough to be
photographed and then these pictures
were posted on the Belly Button
Biodiversity Project's website (volunteers
were given sample numbers so that they
could view their own samples online).[16]
These samples then were analyzed using
16S rDNA libraries so that strains that did
not grow well in cultures could be
identified.[10]
The researchers at North Carolina State

University discovered that while it was
difficult to predict every strain of bacteria
in the microbiome of the navel that they
could predict which strains would be
prevalent and which strains of bacteria
would be quite rare in the microbiome.[10]
It was found that the navel microbiomes
only contained a few prevalent types of
bacteria (Staphylococcus,
Corynebacterium, Actinobacteria,
Clostridiales, and Bacilli) and many
different types of rare bacteria.[10] Other
types of rare organisms were discovered
inside the navels of the volunteers
including three types of Archaea, two of
which were found in one volunteer who
claimed not to have bathed or showered
for many years.[10]
Staphylococcus and Corynebacterium were
among the most common types of
bacteria found in the navels of this
project's volunteers and these types of
bacteria have been found to be the most
common types of bacteria found on the
human skin in larger studies of the skin
microbiome[18] (of which the Belly Button
Biodiversity Project is a part).[10] (In these
larger studies it has been found that
females generally have more
Staphylococcus living in their skin
microbiomes[18] (usually Staphylococcus
epidermidis)[16] and that men have more
Corynebacterium living in their skin
microbiomes.)[18]
According to the Belly Button Biodiversity
Project[10] at North Carolina State
University, there are two types of
microorganisms found in the navel and
surrounding areas. Transient bacteria
(bacteria that does not reproduce)[12]
forms the majority of the organisms found
in the navel, and an estimated 1400
various strains were found in 95% of
participants of the study.[19]
The Belly Button Biodiversity Project is

ongoing and has now taken swabs from
over 500 people.[10] The project was
designed with the aim of countering that
misconception that bacteria are always
harmful to humans[20] and that humans
are at war with bacteria.[21] In actuality,
most strains of bacteria are harmless[13] if
not beneficial for the human body.[22]
Another of the project's goals is to foster
public interest in microbiology.[17] Working
in concert with the Human Microbiome
Project, the Belly Button Biodiversity
Project also studies the connections
between human microbiomes and the
factors of age, sex, ethnicity, location[17]
and overall health.[23]
Relationship to host
Skin microflora can be commensals,
mutualistic or pathogens. Often they can
be all three depending upon the strength
of the person's immune system.[3]
Research upon the immune system in the
gut and lungs has shown that microflora
aids immunity development: however such
research has only started upon whether
this is the case with the skin.[3]
Pseudomonas aeruginosa is an example of
a mutualistic bacterium that can turn into
a pathogen and cause disease: if it gains
entry into the circulatory system it can
result in infections in bone, joint,
gastrointestinal, and respiratory systems.
It can also cause dermatitis. However,
P. aeruginosa produces antimicrobial
substances such as pseudomonic acid
(that are exploited commercially such as
Mupirocin). This works against
staphylococcal and streptococcal
infections. P. aeruginosa also produces
substances that inhibit the growth of
fungus species such as Candida krusei,
Candida albicans, Torulopsis glabrata,
Saccharomyces cerevisiae and Aspergillus
fumigatus.[24] It can also inhibit the growth
of Helicobacter pylori.[25] So important is
its antimicrobial actions that it has been
noted that "removing P. aeruginosa from
the skin, through use of oral or topical
antibiotics, may inversely allow for
aberrant yeast colonization and
infection."[3]
Another aspect of bacteria is the

generation of body odor. Sweat is odorless
however several bacteria may consume it
and create byproducts which may be
considered putrid by humans (as in
contrast to flies, for example, that may find
them attractive/appealing).
Several
examples are:
Propionibacteria in adolescent and adult

sebaceous glands can turn its amino
acids into propionic acid.
Staphylococcus epidermidis creates
body odor by breaking sweat into
isovaleric acid (3-methyl butanoic
acid).[26]
Bacillus subtilis creates strong foot
odor.[27]
Skin defenses
Antimicrobial peptides
The skin creates antimicrobial peptides

such as cathelicidins that control the
proliferation of skin microbes.
Cathelicidins not only reduce microbe
numbers directly but also cause the
secretion of cytokine release which
induces inflammation, angiogenesis, and
reepithelialization. Conditions such as
atopic dermatitis have been linked to the
suppression in cathelicidin production.[28]
In rosacea abnormal processing of
cathelicidin cause inflammation. Psoriasis
has been linked to self-DNA created from
cathelicidin peptides that causes
autoinflammation. A major factor
controlling cathelicidin is vitamin D3.[29]
Acidity
The superficial layers of the skin are

naturally acidic (pH 4–4.5) due to lactic
acid in sweat and produced by skin
bacteria.[30] At this pH mutualistic flora
such as Staphylococci, Micrococci,
Corynebacterium and Propionibacteria
grow but not transient bacteria such as
Gram-negative bacteria like Escherichia
and Pseudomonas or Gram positive ones
such as Staphylococcus aureus.[30]
Another factor affecting the growth of
pathological bacteria is that the
antimicrobial substances secreted by the
skin are enhanced in acidic conditions.[30]
In alkaline conditions, bacteria cease to be
attached to the skin and are more readily
shed. It has been observed that the skin
also swells under alkaline conditions and
opens up allowing bacterial movement to
the surface.[30]
Immune system
If activated, the immune system in the skin

produces cell-mediated immunity against
microbes such as dermatophytes (skin
fungi).[31] One reaction is to increase
stratum corneum turnover and so shed the
fungus from the skin surface. Skin fungi
such as Trichophyton rubrum have evolved
to create substances that limit the
immune response to them.[31] The
shedding of skin is a general means to
control the buildup of flora upon the skin
surface.
Skin diseases
Microorganisms play a role in
noninfectious skin diseases such as
atopic dermatitis,[32] rosacea, psoriasis,[33]
and acne[34] Damaged skin can cause
nonpathogenic bacteria to become
pathogenic.[35] The diversity of species on
the skin is related to later development of
dermatitis.[36]
Acne vulgaris
Acne vulgaris is a common skin condition
characterised by excessive sebum
production by the pilosebaceous unit and
inflammation of the skin.[37] Affected
areas are typically colonised by
Propionibacterium acnes; a member of the
commensal microbiota even in those
without acne.[38] High populations of
P. acnes are linked to acne vulgaris
although only certain strains are strongly
associated with acne while others with
healthy skin. The relative population of
P. acnes is similar between those with
acne and those without.[37][38]
Current treatment includes topical and
systemic antibacterial drugs which result
in decreased P. acnes colonisation and/or
activity.[39] Potential probiotic treatment
includes the use of Staphylococcus
epidermidis to inhibit P. acnes growth.
S. epidermidis produces succinic acid
which has been shown to inhibit P. acnes
growth.[40] Lactobacillus plantarum has
also been shown to act as an anti-
inflammatory and improve antimicrobial
properties of the skin when applied
topically. It was also shown to be effective
in reducing acne lesion size.[41]
Atopic dermatitis
p
Individuals with atopic dermatitis have

shown an increase in populations of
Staphylococcus aureus in both lesional and
nonlesional skin.[38] Atopic dermatitis
flares are associated with low bacterial
diversity due to colonisation by S. aureus
and following standard treatment,
bacterial diversity has been seen to
increase.
Current treatments include combinations

of topical or systemic antibiotics,
corticosteroids, and diluted bleach
baths.[42] Potential probiotic treatments
include using the commensal skin
bacteria, S. epidermidis, to inhibit S. aureus
growth. During atopic dermatitis flares,
population levels of S. epidermidis has
been shown to increase as an attempt to
control S. aureus populations.[38][42]
Low gut microbial diversity in babies has

been associated with an increased risk of
atopic dermatitis.[43] Infants with atopic
eczema have low levels of Bacteroides and
high levels of Bacillota. Bacteroides have
anti-inflammatory properties which are
essential against dermatitis.[43] (See gut
microbiota)
Psoriasis vulgaris
Psoriasis vulgaris typically affects drier
skin sites such as elbows and knees. Dry
areas of the skin tend to have high
microbial diversity and fewer populations
than sebaceous sites.[39] A study using
swab sampling techniques show areas
rich in Bacillota (mainly Streptococcus and
Staphylococcus) and Actinomycetota
(mainly Corynebacterium and
Propionibacterium) are associated with
psoriasis.[44] While another study using
biopsies associate increased levels of
Bacillota and Actinomycetota with healthy
skin.[45] However most studies show that
individuals affected by psoriasis have a
lower microbial diversity in the affected
areas.
Treatments for psoriasis include topical

agents, phototherapy, and systemic
agents.[46] Current research on the skin
microbiota's role in psoriasis is
inconsistent therefore there are no
potential probiotic treatments.
Rosacea
Rosacea is typically connected to

sebaceous sites of the skin. The skin mite
Demodex folliculorum produce lipases that
allow them to use sebum as a source of
food therefore they have a high affinity for
sebaceous skin sites. Although it is a part
of the commensal skin microbiota,
patients affected with rosacea show an
increase in D. folliculorum compared to
healthy individuals, suggesting
pathogenicity.[47]
Bacillus oleronius, a Demodex associated

microbe, is not typically found in the
commensal skin microbiota but initiates
inflammatory pathways whose starting
mechanism is similar to rosacea
patients.[38] Populations of S. epidermidis
have also been isolated from pustules of
rosacea patients. However it is possible
that they were moved by Demodex to areas
that favour growth as Demodex has shown
to transport bacteria around the face.[48]
Current treatments include topical and oral

antibiotics and laser therapy.[49] As current
research has yet to show a clear
mechanism for Demodex influence in
rosacea, there are no potential probiotic
treatments.
Clinical
Infected devices
Skin microbes are a potential source of

infected medical devices such as
catheters.[50]
Hygiene
The human skin is host to numerous
bacterial and fungal species, some of
which are known to be harmful, some
known to be beneficial and the vast
majority unresearched. The use of
bactericidal and fungicidal soaps will
inevitably lead to bacterial and fungal
populations which are resistant to the
chemicals employed (see drug
resistance).
Contagion
Skin flora do not readily pass between
people: 30 seconds of moderate friction
and dry hand contact results in a transfer
of only 0.07% of natural hand flora from
naked with a greater percentage from
gloves.[51]
Removal
The most effective (60–80% reduction)

antimicrobial washing is with ethanol,
isopropanol, and n-propanol. Viruses are
most affected by high (95%)
concentrations of ethanol, while bacteria
are more affected by n-propanol.[52]
Unmedicated soaps are not very effective
as illustrated by the following data. Health
care workers washed their hands once in
nonmedicated liquid soap for 30 seconds.
The students/technicians for 20 times.[53]
Skin flora upon two hospital groups in colony-forming units per ml.
group and hand skin condition unwashed washed
Health care workers healthy 3.47 3.15
Health care workers damaged 3.33 3.29
Students/technicians healthy 4.39 3.54
Students/technicians damaged 4.58 4.43
An important use of hand washing is to

prevent the transmission of antibiotic
resistant skin flora that cause hospital-
acquired infections such as methicillin-
resistant Staphylococcus aureus. While
such flora have become antibiotic
resistant due to antibiotics there is no
evidence that recommended antiseptics or
disinfectants selects for antibiotic-
resistant organisms when used in hand
washing.[54] However, many strains of
organisms are resistant to some of the
substances used in antibacterial soaps
such as triclosan.[54]
One survey of bar soaps in dentist clinics

found they all had their own flora and on
average from two to five different genera
of microorganisms with those used most
more likely to have more species
varieties.[55] Another survey of bar soaps
in public toilets found even more flora.[56]
Another study found that very dry soaps
are not infected while all are that rest in
pools of water.[57] However, research upon
soap that was specially infected found
that soap flora do not transmit to the
hands.[58]
Damaged skin
Washing skin repeatedly can damage the

protective external layer and cause
transepidermal loss of water. This can be
seen in roughness characterized by
scaling and dryness, itchiness, dermatitis
provoked by microorganisms and
allergens penetrating the corneal layer and
redness. Wearing gloves can cause further
problems since it produces a humid
environment favoring the growth of
microbes and also contains irritants such
as latex and talcum powder.[59]
Hand washing can damage skin because

the stratum corneum top layer of skin
consists of 15 to 20 layers of keratin disks,
corneocytes, each of which is each
surrounded by a thin film of skin lipids
which can be removed by alcohols and
detergents.[60]
Damaged skin defined by extensive

cracking of skin surface, widespread
reddening or occasional bleeding has also
been found to be more frequently
colonized by Staphylococcus hominis and
these were more likely to be methicillin
resistant.[59] Though not related to greater
antibiotic resistance, damaged skin was
also more like to be colonized by
Staphylococcus aureus, gram-negative
bacteria, Enterococci and Candida.[59]
Comparison with other flora

The skin flora is different from that of the
gut which is predominantly Bacillota and
Bacteroidota.[61] There is also low level of
variation between people that is not found
in gut studies.[5] Both gut and skin flora
however lack the diversity found in soil
flora.[1]
See also
Biology
portal
Medicine
portal
Bacterial disease
Body odor
Gut flora
Human flora
Human microbiome project
Medical microbiology
Microbial ecology
Microflora
Oral microbiology
Skin
Vaginal flora
Zeaspora
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External links
Wikispecies has information related to
Microbiota.
Cellulitis Skin Infection (https://web.arch
ive.org/web/20110623011743/http://cel
lulitistreatmentnow.com/)
Human microbiome project (https://we
b.archive.org/web/20101210013519/htt
p://nihroadmap.nih.gov/hmp/)
Todar's Online Textbook of Bacteriology
(http://textbookofbacteriology.net/inde
x.html)
Hygiene of the Skin: When Is Clean Too
Clean? (https://wwwnc.cdc.gov/eid/arti
cle/7/2/70-0225_article)
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Skin flora, also called skin microbiota,

Many of them are bacteria of which there

Skin flora is usually non-pathogenic, and

A major non-human skin flora is

The estimate of the number of species

Staphylococcus epidermidis and

There are three main ecological areas:

Staphylococcus epidermidis Common occasionally pathogenic

Staphylococcus aureus Infrequent usually pathogenic

Staphylococcus warneri Infrequent occasionally pathogenic

Streptococcus pyogenes Infrequent usually pathogenic

Streptococcus mitis Frequent occasionally pathogenic

Cutibacterium acnes Frequent occasionally pathogenic

Corynebacterium spp. Frequent occasionally pathogenic

Acinetobacter johnsonii Frequent occasionally pathogenic

Pseudomonas aeruginosa Infrequent occasionally pathogenic

The umbilicus, or navel, is an area of the

The Belly Button Biodiversity Project

The researchers at North Carolina State

The Belly Button Biodiversity Project is

Another aspect of bacteria is the

Propionibacteria in adolescent and adult

The skin creates antimicrobial peptides

The superficial layers of the skin are

If activated, the immune system in the skin

Individuals with atopic dermatitis have

Current treatments include combinations

Low gut microbial diversity in babies has

Treatments for psoriasis include topical

Rosacea is typically connected to

Bacillus oleronius, a Demodex associated

Current treatments include topical and oral

Skin microbes are a potential source of

The most effective (60–80% reduction)

Health care workers healthy 3.47 3.15

Health care workers damaged 3.33 3.29

Students/technicians healthy 4.39 3.54

Students/technicians damaged 4.58 4.43

An important use of hand washing is to

One survey of bar soaps in dentist clinics

Washing skin repeatedly can damage the

Hand washing can damage skin because

Damaged skin defined by extensive

Comparison with other flora

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This page was last edited on 12 June 2023, at

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