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Jul 08 2014

Healing Skin by altering it’s pH & microbial (Malassezia) profile

skin_barrierSkin conditions such as Psoriasis, Eczema, atopic dermatitis, Dandruff, dry skin, Tinea Versicolor, Rosacea, Seborrhoeic dermatitis, Acne are in many cases thought to be caused by the fungus Malassezia.

Few people know this but natural healthy skin has a pH around 4. That is quite acidic and actually a good thing. Acidic pH helps maintain skin integrity and keeps beneficial flora attached to the skin and bad flora such as fungus away. (ref.)

Malassezia grows optimally in an environment when the pH is between 4 and 8. (ref.) Therefore it is critical the skin pH be around 4 or ideally slightly lower.

The use of soaps, water, creams and makeup on the skin can alter it’s pH considerably. Washing skin with soap and water may change the skin’s pH by up too 2 points making it more alkaline and it may take over 6 hours to return back to normal baseline. Many manufacturers know this and thus “pH balance” soaps, lotions and creams to make them more acidic. And in ignorant cases more alkaline, so it’s prudent to check.

Malassezia is a lipophilic yeast meaning it eats fats and oils to make itself grow. In a lab environment olive oil is used to enhance the growth of the fungus. (ref.

***Therefore many lotions, creams and oils used to hydrate and moisturize the skin will actually make the problem much worse despite offering temporary relief. Using most of them is like adding fuel to a fire!*** 

Most species of Malassezia consume fatty acids with a carbon chain length of 11 through 24.  (ref.)

Malassezia eczema carbon length skin

Therefore you want to check every single ingredient in a lotion/cream to make sure it is not within that range or else it will feed the Malassezia. For a list of oils (12-24) to avoid click here for a table.

Ointments that appear to be safe are:

  • Aquaphor is 41% petrolatum, which is composed of very long carbon chains of C25 to C30
  • Petroleum Jelly has carbon number mainly higher than 25 (ref.)
  • MCT oil has carbon chain lengths of 8-10

Another reason olive oil is a bad for example, is that it contains Tyrosol which has been found to be a quorum-sensing molecule that accelerates the growth of the fungus Candida albicans which shares many similarities with Malassezia. (ref 1) (ref 2

Even if the skin issue is not caused specifically by Malassezia, it may be caused by another bacteria. The following strategies will still be effective however minus the pharmaceutical antifungals. Bacteria also form biofilms, and the pH component is critical in mediating the entire skin microbiome.

Short Term Fix:

There are several strategies that can be used to kill the fungus and provide temporary relief. Keep in mind however it will grow back quickly unless the underlying environmental pH conditions skin are changed from the inside out.

1. Breakthrough Malassezia biofilm

Malassezia as it grows forms a biofilm around itself for protection purposes. Pharmaceutical antifungals can be used but often have limited impact and will need to be used for extended periods of time due to the very slow process of moving through the biofilm.

biofilm eczema  Malassezia

Biofilm on Skin

A faster strategy perhaps is to use biofilm busting compounds. Some possible compunds are:

  • Xylitol – reported by many people to be very effective, try this first
  • Candex formula applied topically (1 anecdote review here)
  • Chitinase because Malassezia cell wall is made up of chitn
  • Fibrin enzymes such as Serratiopeptidase and nattokinase may also work
  • Aloe Vera appears to also dissolve biofilms (reference needed)
  • Chitosan (source)
2. Kill the fungi
Pharmaceutical fungicides include:
  • Climbazole  *considered the best found in “Hegor 150”
  • Clotrimazole
  • Itraconazole
  • Ketoconazole, Piroctone Olamine, and Lotrimin Ultra
3. Create a temporary hostile (acidic) environment so it does not grow back
Acidifying the skin topically using Apple Cider vinegar has also helped many people. Other acidic compounds may work as well. Lactic Acid and urea are often used in creams specifically for eczema.
Sandalwood oil which contains the compound Farnesol may also be helpful. Farnesol is a quorum-sensing molecule which inhibits the growth of fungi such as Candida. There is some evidence to suggest that it works on Malassezia as well. 
  • Lactoferrin inhibits adhesion (ref.)

An ideal topical lotion might contain….

  • Aloe Vera gel
  • MCT oil
  • Xylitol
  • Lactic Acid, Acetic Acid & Citric Acid
  • Climbazole
  • Sandalwood oil (source)
  • Niacinamide (B3), plus dl-panthenol (B6) and glycerin to improve skin barrier
  • have a pH of 3.5 – 4

Places to buy ingredients:

Long Term Fix:

The primary root cause of the above listed skin issues is in most cases the original use of antibiotics. Antibiotics even used once cause mass extinction on the gut biome level permanently altering the ecology which helps regulate many important functions in your body. Antiobiotics are targeted towards bacteria and in the vacuum created, often fungus take over. The goal here is to re-balance the gut biome to affect the skin. A person can affect dramatic change when using specific pre and pro biotic strategies as has been demonstrated recently with the wide use of Resistant Starch.

The most dominant variable governing skin pH appears to be lactic acid. (reference) The skin has what is called an “acid mantle” that protects against foreign invaders and helps maintain skin integrity.

So the goal here is to hopefully use the BEST pre and probiotics for increasing lactic acid in the body. This appears to be best done by supporting the growth of lactobacilli in the small intestine. Incidentally this is same strategy to use to combat Candida growth in the small intestine and in many cases it is probable that people have both internal and external fungal infections concurrently. Over growth of Malassezia on the skin is a good indicator of internal dysbiosis.

I have no idea if this strategy will increase lactic acid at the skin level, however blood pH is tightly regulated (7.35 – 7.45), so I am hoping lactic acid produced in the gut may transfer quickly to the skin if there is an adequate supply.

Many studies and anecdotes seem to suggest that pre & pro biotics can cure all manner of skin issues and I believe the lactobacilli producing lactic acid are the primary reason for this. The problem is results are often intermittent. For some people taking the probiotics alone appears to be good enough. However in more serious cases it is likely necessary to take a more aggressive approach especially if the problem is systemic. How aggressive a person may need to be I don’t know, it will be up to you to experiment.

How does skin become acidic? There appears to be several mechanisms.

  1. Lactic acid from microbes in the gut is taken up by blood and then released through the skin (hypothetical)
  2. Lactic acid byproduct from energy depletion in cells is excreted through sweat
  3. The conversion of phospholipids to fatty acids by enzymes in the skin (source)

The goal is to maximally produce acetic, lactic & propionic acid internally with the goal of having it secret through the skin. For a prebiotic I recommend using pectin. In prebiotic comparison studies it ferments all-around the best of many prebiotics with respect to lactic acid producing bacteria.

The prebiotic Larch Arabinogalactan has been shown to dramatically increase levels of Propionate. Propionic acid is known to be a very potent fungicide. It is used commercially to control fungi in stored grains and animal feed and has been tested specifically on Candida albicans for efficacy. (ref.)

Prebiotics recommended:
  • Apple Pectin, Acacia Senegal, Larch Arabinogalactan
Probiotics recommended:
  • L.Plantarum, Lactobacilli species

Acidifying Sweat:

Because tinea versicolor flares most frequently in hot climates when sweating is increased it is likely that the neutral pH of sweat is what is allowing the fungus on the skin to grow. Therefore by making the sweat more acidic it’s possible to perhaps eliminate malassezia. The following are some acids found in sweat that perhaps could be boosted with supplementation.

  • Pantothenic acid aka. Vitamin B5 – ph of 4.41; is water soluble  (also appears to help wound healing) (source)
  • Ascorbic acid aka. Vitamin C – ph of 4.10
  • Lactic acid
  • serine – ph of 2.21 as a carboxyl

Decreasing Sebaceous Gland activity – Psychological endocrine factor – a Bodynamic theory

It is well known that hormones (such as androgens aka. “male aggression energy”) affect SG activity. Therefore emotional stress and the physiological neural preferences could have an impact on localized skin issues. See my bodymap for further analysis. Muscles and fascia that are hypo-tonic signify areas of the body that are pyscho-emotionally inadequately brain-neural mapped in the limbic system. They are energetically under-resourced, and the lack of containment and function, likely results in undesirable leakage of said energy.

Sebum is a mixture of fats, and releasing to many be a sign of poor energetic emotional containment. Emotions as opposed to thoughts are denser energetically and are symbolized biochemically by fat, where thoughts could be biochemically symbolized by glucose. The skin ideally acts as a barrier to contain emotions. This is done psychologically by sensing into the body and feeling emotional energy bounded by the skin and contained by it. For some people this skill/neural map may need to be learned, and it’s possible this may have the effect of decreasing hormonal activity at the skin level and therefore SG activity reducing triglyceride leakage or unnecessary expulsion.

Acidity could also be symbolized by aggression energy, and a lack of containing and nurturing aggression energy could lead to an alkaline/more permeable skin barrier. Aggression is an important life force factor, one that too many people “leak out/expel” emotionally due to fearing it’s power, or bad beliefs around it. New neural maps will need to be created to harness the benefits of aggression psycho-somatically and hypo-tonic fascia and muscles need to be brought back online, in order to affect the endocrine-skin-barrier functional system.

 

Reference:

Additional Notes:

  • “It has been shown in vitro that glycine stimulates the fast growth of M. furfur, and when this amino acid is exhausted, yeast cells employ tryptophan as a nitrogen source, increasing the production of indolic metabolites.” (source)
  • “This was based on the observation that medium-chain fatty acids could delay the growth of the seven Malassezia species in vitro…” (source)
  • “This study shows the efficacy of an exogenous NO-releasing cream in treating tinea versicolor.” (source)
  • “The anatomical substrate of the epidermal barrier function, which is defective in atopic eczema, is the stratum corneum of the epidermis, a thin biological membrane that covers the whole body surface. It is made up of the keratinized, terminally differentiated epidermal keratinocytes of the interfollicular epidermis bound together by corneodesmosomes, filled with natural moisturizing factor and embedded in a lipidic matrix that is composed mainly of ceramides, cholesterol, fatty acids, and cholesterol esters. The natural moisturizing factor is formed by the degradation of fillagrin, comprising substances such as lactic acid, sodium pyrrolidone, carboxylic acid, urocanic acid, and urea. Decisive for the proper function of the stratum corneum is the maintenance of a pH gradient between its acidic outer and basic inner surfaces that motors many vital functions of this life-imperative biological membrane.”  (source)
  • “those authors pointed out, linoleic, oleic, and palmitic acids, which are potent growth stimulants of Malassezia species” (source)
  • “The use of acidic topical preparations containing alpha hydroxy acids, such as lactic and glycolic acid, for kereatolysis has proved effective in clinical practice. The treatment of atopic dermatitis is aided by their pH regulating properties.” (source)
  • “The effects of acetic acid (AA) and hydrochloric acid on S. aureus biofilm formation were evaluated in bullous impetigo and pemphigus foliaceus isolates and were both shown to decrease glycocalyx production. AA had a superior effect in reducing biofilm-associated S. aureus counts, indicating a specific effect of AA unrelated to low pH. In the clinical setting, AA 2.5% ointment was reported to reduce S. aureus counts in pemphigus foliaceus lesions…” (source)
  • Meta analysis of lactic acid bacteria as probiotics for the primary prevention of infantile eczema (source)
  • “The new antimicrobial hydrogel, made of 90 percent water, gloops together spontaneously when warmed to body temperature. It can bust through biofilms and kill a whole host of bacterial types, from small bugs like E. coli to large bugs like methicillin-resistant Staphylococcus aureus. The hydrogel is comprised of specially designed polymers, which are biodegradable and positively charged. When mixed with water and warmed up, the polymers self-assemble into chains, and the result is a thick gel.” (source)

Downloads:

References:

    • Mark

      When using Xylitol for acne do you eat it or use it topically?

      • mhikl

        Mark, this is the first article I have been able to find on Xylitol and eczema or any skin problems. This week I decided to try Xylitol on my own (not finding anything about it regarding eczema anywhere) and it has been amazing. I do not know if it would also work for acne, but it does for sure work for sinusitis and now it appears it works on my eczema.
        Xylitol dissolves phlegm, and therefore cleans passages. It may do the same on your skin. I am now ten years completely free from sinusitis, colds and flues as I spray my nasal passages, inner ears, eyes, eyebrows (killed itch immediately where nothing else ever worked—eyebrow itch attacks one in their later years). For head orifices: 5 TBS Xylitol + 1 C water; warm to dissolve. I use it from a Dollar Store 250ml (1 cup) spray bottle. Use daily, or throughout the day might be better.
        Yesterday I bathed, soaked, scrubbed my eczema sores off my arms and legs. (One is not supposed to do this). They bled and I continued to rinse them off until the bleeding stopped. Then I applied my heavy solution of Xylitol in the shower, letting the skin mostly dry, and then re-applying. I did this at least three times. Took a while. I left the Xylitol on my skin.
        The different pains from some awful sores were gone, for the first time ever, when I got out of the shower. That evening there was a little pain in a few sores, but very little compared to before. Most of them did not itch, hurt, sting, have any negative sensation at all.
        This morning my legs and arms looked much better. There seemed to be less pain in the few sores that had any pain.
        This morning I soaked my legs in the solution, applying, let dry, re-applying, etc. And then, whist wet, I wrapped them in cellophane wrap, still covered in Xylitol solution, and pulled on long elastic knee socks to hold the wraps in place. Tonight I shall take them off, re-apply the Xylitol solution, let them dry and then sleep without the socks or cellophane.
        It looks like a miracle to me.
        I hope you can will the Xylitol on your acne. Don’t be in a hurry. See if it works. The sticky feeling subsides as the Xylitol dries.
        Xylitol appears to starve viruses and maybe bacteria, or so it is claimed.
        Namaste and care,
        mhikil

        • John Sorensen

          Excellent article my friend. Great work.

        • gsaas

          Mhikil,
          Can you give an update on your experience using Xylitol topically for AD?

        • Guest

          Xylitol is not benign however. It messed up the gut microbiome and is strongly associated with developing kidney stones and other oxalate issues.

          https://www.ncbi.nlm.nih.gov/pubmed/3744193

          “The administration of fructose, xylitol or sorbitol was associated with
          the greatest renal deposition of calcium oxalate, and glucose was
          associated with by far the least.”

    • One of the best articles on dermatitis I’ve ever read!

      • Natashacbk

        I agree. It’s an excellent article.

    • Arkajit Aich

      nice article

    • JB Z

      TY JonZ, surperb article & website, I’m fighting Malassezia so I appreciate greatly.

    • Carol

      This is the most brilliant article I’ve seen regarding yeast. Thanks for your extensive research and curation of this information. Malassezia is the most strikingly common yeast no one’s ever heard of. Think of all the folks who think “I just have really dry skin”, and slather themselves with yeast-feeding oils commonly found in most lotions (oils in that 11-24 carbon range as you pointed out: mineral oil, cocoa butter, shea butter, stearic acid, etc.). Thank you for citing that important study! I wanted to add:
      *Derman ointment works well & it’s cheap. Composed of
      decylenic acid (a shorter-chain derivative of castor oil) and zinc
      decylenate. Unless your infection is on the scalp or under nails, try
      this before bringing out the big guns (the “azoles”).
      *You mentioned the enzyme-based product Candex. I wonder if the enzymes bromelain (from pineapple) and papain (from papaya) would help topically?
      *In addition to xylitol, sorbitol and erythritol also break down yeast cell walls (PMID 18778883). Many folks have one of these in their pantry already (e.g Truvia). Sugars are being tested against bacterial biofilms, too.
      *UV Radiation may work synergistically with your topical treatment of choice. Zinc oxide and titanium dioxide are photocatalysts that help sunlight do its disinfection (PMID 26239879). Scientists are “rediscovering” UV radiation as a “novel” disinfectant (ha ha).
      In this age of antibiotic resistance, scientists are investigating all manner of biofilm busters, and some of these may have relevance for fungi as well: peptides, nanoparticles such as those found in clay minerals and in terpenes, ultrasound (“sonication”), phototherapy, etc. The good news is that yeast are found even in healthy skin, so we don’t have to obsess over total eradication . . .Thanks for advice on improving our skin barrier! Improving our immune function through exercise, good sleep and a clean whole-food diet should help as well.

    • curtis gandolph

      So would be using MCT oil a better alternative to cocount oil when it comes to the putting it on my skin after showering?

      • GestaltReality

        Yes, most likely.

        • curtis gandolph

          Thanks for the quick reply! what do you suggest for a facial soap? and the other question I had is does consuming oils such as coconut oil, and olive does it have the same effect internally? or should I cut them out of my diet all together? I really appreciate your help

          • GestaltReality

            I don’t have a recommendation on soap. Consuming oils, is most likely to be fine. I would only avoid large quantities of olive oil if a candida infection was suspected.

            • curtis gandolph

              thanks again! I really appreciate it

    • peter wallace

      Very Good article, i’ve had this condition since i was 18 (33 now) although its not as bad as it used to be i’ve still never got rid of it, the only time it gets better is during the summer when i can get some sun, do you know if the sun stops the malassezia growth? i’ve tried everything ACV,Steriod creams,Aveeno,Sea salt water and mud masks. Coconut oil seemed to work for a while and made my skin alot smoother but i noticed it started to spread my Seb Derm to other areas of my face so i stopped using it. i’m very suprised that with the amount of people that seem to have this condition no one has come up with a sure fire ‘cure’.

    • Annie

      Do they mean xylitol the sweetener? If so how do you use that on your face?

    • Karim Naufal

      Thank you from the bottom of my heart for this extremely enlightening info. I have search the web for year to understand my condition, facial seborrheic dermatitis, that appeared at age 20 when I was in emotional distress living alone for the first time for my university studies. Everything you wrote makes so much sense and gives me hope again.

    • Andrei Volokitin

      amazing

    • Re Gsah

      Great article. But I couldn’t understand the psychological part very well. Is it saying that a person with seborrheic dermatitis should learn to contain their emotions and to nurture agression?

      • GestaltReality

        Yes, that is just my hypothesis. Further research would need to be conducted, and the activation of individual specific muscles and fascia would likely be different from person to person. A sensi-motor/psychological protocol would thus need to be individualized.

    • Julia

      Thank you for an informed article – I was recently diagnosed with SD but I think I have had it for a very long time, with flaky skin between eyebrows and upper lip and I just thought it was dry skin as it did not bother me too much. But last year this condition just went mad with red inflamed and flaky skin above and between eyebrows, stretching over the sides of the nose and upper lip include top of they eyelids – not a great look. So I started off with the GP’s diagnosis and they gave me Daktacort which helped a bit but the inflammation came back so started using hydrocortisone creams which worked but as soon as I stopped the condition flared up again, now looking at alternatives and recently came across a website “Skindrone” that also talked about not applying topical oils to the skin as this creates a feeding ground. Over the last 5 weeks I have not been applying any oils to my skin other than an Aveeno moisturiser which has only liquid petroleum and dimenthicone and emolients and using the salt bath routine. All was going really well so decided to start using my oils again, major disaster within days I had a flare up – so it looks like that plant oils with their fatty acid profile is a no go area for me now.

      This is very depressing (I have my own skincare range) that I cannot use my own creams as they contain plant oils. I use Niacinamide (Vit B3) in my day cream – it is an excellent ingredient (reduces redness, increases hydration and also forms a barrier on the skin) however, for Vitamin B3 to be stable it needs to be in a PH of 5.5 to 6, if the ph drops as suggested in the ariticle the Niacinamide will convert to Niacin which can result it redness and inflammation on the skin. So I would like to know from the author where their reference came from in relation to using Niacinamide at a PH 3.5 – 4.

      I am about to make a cream using some of the suggested ingredients above, using Mineral Oils in place of plants oils, and I also like the idea of using Xyitol too – would anyone know how much I could use % in a cream.
      Thanks

    • Elliot Archuleta

      I’m fairly confused with this article. I’ve suffered with this problem for ten years now. I am 25. I took accutane three times (awful, I know) and I’m convinced that exacerbated the problem. I’ve done my own research, reading hundreds of articles like this and forums, trying to find a common denominator. Since nothing any dermatologist has prescribed in the last decade has worked, I’m thinking the only way to at least keep this semi contained is to change my diet. I truly don’t really have any idea what I’m doing. From what I’ve read, cutting out all processed foods, and refined sugars is what seems to help people. I need to fully understand malassezia is to understand what feeds it and what will starve it. I know nothing about pH levels, but this article is saying to keep your pH level between 1-4, and from what little I’ve read about pH levels, that’s not good for your longterm health. Not only that, but it goes against everything I’ve read regarding food consumption. I’m truly at a loss here, and am wondering if anyone can give me insight to this. I went on a diet last year for a couple months and I feel like my skin cleared up pretty well. I ate mostly fruits and vegetables, cheated rarely, and noticed a difference. But my skin got significantly worse when autumn came around last year and has been bad ever since. I started doing the diet again but I haven’t seen any changes. Would love some feedback.

      • jenna

        You seem to have some for your information confused. I’m going to try and help you however be warned I’m terrible at explaining, also i’d love to tell you about what has helped me in my journey with acne. The article does not state that you need to keep you pH around 1-4, the article states that your SKIN loves a pH of around 4. A pH of 1-3 is much too acidic and would probably burn your skin. A pH of 4 is ideal because it’s the pH that the good bacteria on your skin loves and will help to get rid of the bad bacteria or fungus’s etc. A lot of face washes companies on the market know this however there still are face washes on the market that have a higher ph. I have a link to a list of popular face washes and there pH

        http://www.dianayvonne.com/content/pHcleansers.pdf

        You can also buy pH test strips if you want to test products at home. I get mine off amazon here’s a link to the ones I get

        https://www.amazon.ca/Haobase-Range-Strips-Litmus-Testing/dp/B0181SWWMG/ref=sr_1_1?ie=UTF8&qid=1490638466&sr=8-1&keywords=ph+strips

        About a month ago I started washing my face with distilled water with a ½ tsp of apple cider vinegar (which brought the water down to a pH of around 4 or 5), using my regular face wash (arbonne calm gentle daily face wash). My skin is loving the lower ph., I find my skin looks more vibrant after washing and has less redness. Also my acne is considerably better.

        From my understanding you are referring to the alkaline diet trend. I don’t really know too much about this diet. for myself I have found that I look and feel the healthiest when I am eating lots of fruits and vegetables, drinking 7-8 glasses of water, staying away from caffeine (except green tea), eating less simple carbs and more complex carbs, eating whole proteins (I eat a lot of fish salmon and herring mostly, some tuna), less sugar, taking probiotics or eating them. I’m actually gluten and diary free as well. I found cutting dairy from my diet to be a huge help with acne.

        My skin did improve following a healthy eating plan but I don’t know if can say that it’s because the foods have a high ph(aka alkaline). I think there are a lot of different factors that can influence your health when it comes to the food you eat. Could be that a lot of the foods on the pH diet are anti-inflammatory, and acne is said to be an inflammatory skin disease.

        A couple of the reasons why I eat fish for my protein sources is because fish is high in omega 3 EPA and DHA. EPA is an anti-inflammatory, which is good for any inflammatory disease ie. Acne. And the DHA is good for people with low dopamine, such as those with ADHD (like myself).

        You said your skin got worse in autumn, did anything stressful happen during that time? Maybe starting school again, new job, relationship. Stress can be a big contributor to acne. The reason behind this is that stress increases cortisol. A natural way to lower cortisol is to take vitamin C or learn how to handle your stress better. Take up yoga, meditate, etc. another reason your skin may have gotten worse in autumn is that there is less sunlight in the fall (although that depends on where you live). If you get less sunlight your vitamin D levels may drop. Here is a link to a scientific journal of why Vitamin D is important for you skin

        http://www.sciencedirect.com/science/article/pii/S209012321400023X

        One thing I would like to share with you that has helped me the most with my acne, and if you are going to follow any of my advice this is the part you need to listen to. Take l-lysine. L-lysine has exponentially helped my acne. Literally within the first day! I take about 500mg a day and it seems to be enough for me. There isn’t much information on the internet about lysine when it comes to acne. I’ll give you a link of where I had heard it from

        https://www.youtube.com/watch?v=I0B7RXCp47k

        At about 12:40 this YouTuber talks about l-lysine and her theories for why it works. I’m not too sure about her other information. I don’t know if I believe in the whole face mapping thing but it’s worth a listen.

        Anyways if you have any questions don’t hesitate to ask. I went over a lot of stuff but also skipped a lot too. Hope I helped a little.