The Remarkable Life of the Skin: An Intimate Journey Across Our Largest Organ

We think you will enjoy Lymon’s exhaustive look at everything you always wondered about skin.

The Remarkable Life of Skin: An Intimate Journey Across Our Largest Organ

by Monty Lymon

Monty Lymon’s fascination with skin was prompted by his own experience with eczema.  While studying for his first medical school exam he says, “my face and neck became a dry itchy mess … – and eczema has shadowed me ever since.” Perhaps because he knows what it’s like to live with eczema, there are 23 references to atopic dermatitis in this 220-page book, including breakthrough research and the discussions of impact of bacteria, dust mites, stress, and diet.

After he chose dermatology as his specialty, he worked in a leading dermatology lab and won several national prizes in medical writing. For this book, he travelled the world collecting stories about how different cultures perceive and respond to our largest organ. Lymon moves from a detailed scientific overview of skin in his first five chapters to the more philosophical discussion of the cultural, psychological, and spiritual aspects of skin in his final chapters.

He sets the stage with an anatomy lesson on the layers and components of the skin. He conveys the sense of wonder that “this wafer-thin wall manages to keep your insides in and the treacherous outside out.” He marvels at the epidermis, our outermost layer of skin that is just a millimeter thick but constructed like a brickwork of keratinocytes, protein cells to create an impenetrable wall. Without this wall we would evaporate, like burn victims who require 20 liters of water a day to stay alive.

So, what happens when the protective epidermis can’t do its job? A landmark Scottish 2006 study found that roughly 50% of children with eczema have a genetic mutation that decreases the protein, filaggrin. Filaggrin keeps the interlocking brickwork of keratinocytes together and helps moisturize the epidermis. When it is missing it “creates cracks in the wall, letting microbes from the environment in and causing water to leak out.”  This was the first explanation of how genetic mutation affects the structure of the skin and may contribute to eczema. It may also explain why eczema is worse in the winter when less filaggrin is produced in the body.

Lymon turns next to the critters that are constant companions on our skin – “1000 different species of bacteria, not to mention fungi viruses and mites” that are crawling on our skin. Most bacteria are either harmless or neutral, but some like Staph aureus are pathogenic, and can cause inflammation and pain when the skin barrier is damaged by eczema. Frequent staph infections are the bane of children with eczema. Researchers are looking at ways to target the bacteria, like by making them more photosensitive and vulnerable to being killed by light.

It’s not only bacteria. Bugs can affect the skin of children with eczema.  Dust mites live on the thousands of dead skin cells we each shed every day. They produce a substance called phospholipase that breaks down fat molecules and stimulates the immune system causing itching and inflammation. (See this week’s blog on desensitizing children with dust mite “juice”).

It may also be possible that in our modern, uber clean societies we are not being exposed to enough infectious agents. Exposure to bacteria as young children may in fact help us develop an immune tolerance. When kids haven’t had a steady exposure to dirt and animals as our ancestors did, their unconditioned immune systems overreact, theoretically leading to high rates of eczema and allergies in the developed world.

We are just beginning to understand how food and the health of the skin are interrelated. But it’s complicated in a complex condition like eczema. One child benefits by removing dairy from the diet and many others do not. Food allergies can exacerbate eczema in a child, but no specific food seems to reduce the effect on eczema consistently. The research on vitamin D has been decidedly mixed with some studies showing benefit and others showing none. For now, there are seemingly no dietary or supplement wonder cures for eczema.

But we are learning more about allergies and how they develop in kids with eczema. In the ground-breaking 2015 LEAP study, researchers found that exposing kids to peanuts, eggs, and other potentially allergic foods early in life by mouth, prevented most serious allergies. But they also found that kids with eczema could acquire allergies by simply being exposed through their damaged skin. By exposing kids to food by mouth very early (in the first few months of life), before they were exposed through their skin, they could reduce food allergies significantly.

How about prebiotics and probiotics to modify the gut biome? Kids with eczema have lower gut biodiversity and low levels of good bacteria. A recent study has shown that giving them probiotics - a mixture of Lactobacilli and Bifidobacteria does improve eczema symptoms. Combining prebiotics (elements that support bacterial growth) plus probiotics for eight weeks reduced the symptoms of eczema in children aged one and older in a 2016 study.

What role does stress play in eczema? A substantial one. A sleepless, itching, uncomfortable child is under stress. Cortisol is the hormone that can helps react to stress, but the constant release of cortisol increases both immune response and inflammation. Stress causes the nerves to react, creating their own brand of inflammation. And stress changes the skin's own immune system, increasing the T helper 2 cells leading to (you guessed it) redness, inflammation and itching.

In this review, we have emphasized what Lymon has to say about eczema because that is GPER’s focus. But the rest of the book is a fascinating read about every aspect of the skin.

How is skin affected by sunlight (and computer screens)?

How does our skin age and can we do anything about it?

How are itching and pain related?

Why can’t we tickle ourselves?

How does skin help us with amazingly complex everyday tasks like finding our keys in our pocket without the benefit of sight, holding them without dropping them and then inserting them into a keyhole?

Why is skin one of the greatest determinants of prejudice?

Why does every culture tattoo skin to tell a story?

How does the concept of skin affect us physically and psychologically?

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