The human skin microflora and disease

  • William C. Noble
Chapter

Abstract

The human skin is a complex habitat. It comprises areas that are relatively dry, such as the forearm, and others that are moist, such as the perineum and toewebs. Some areas have abundant lipid from sebaceous glands, such as the face, scalp and upper chest and back, while some, such as the axillae, also have secretions from specialized apocrine glands. Areas with many eccrine sweat glands may become highly saline as watery sweat induced by heat or exercise evaporates. On balance, an average adult has a total skin surface area of about 1.5 m2 with a pH of about 5.5 and a temperature between 30° and 37 °C with substantial local variations. The various skin secretions supply amino acids, metal ions, fatty acids, sugars and other nutrient materials although in dilute solution (Marples, 1965; Noble, 1981, 1993). It should therefore be no surprise that skin is inhabited by many different microorganisms, some of which may be fairly localized.

Keywords

Clinical Microbiology Nasal Carriage Propionibacterium Acne Eccrine Sweat Gland Normal Human Skin 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. Abe, T., Mayuzumi, J., Kikuchi, N. and Arai, S. (1980) Seasonal variations in skin temperature, skin pH, evaporative water loss and skin surface lipid values on human skin. Chemical Pharmaceutical Bulletin, 8, 387–392.CrossRefGoogle Scholar
  2. Aly, R., Shirley, C., Cunico, B. and Maibach, H. I. (1978) Effect of prolonged occlusion on the microbial flora, pH, carbon dioxide and transepidermal water loss on human skin. Journal of Investigative Dermatology, 71, 378–381.PubMedCrossRefGoogle Scholar
  3. Armstrong, R. W. and Wuerflein, R. D. (1996) Endocarditis due to Propionibacterium granulosum. Clinical Infectious Diseases, 23, 1178–1179.CrossRefGoogle Scholar
  4. Bandahaya, M. (1993) The distribution of Malassezia furfur and Malassezia pachydermatis on normal human skin. Southeast Asian Journal of Tropical Medicine and Public Health, 24, 343–346.Google Scholar
  5. Barton, L. L. and Friedman, A. D. (1987) Impetigo: a reassessment of etiology and therapy. Pediatric Dermatology, 4, 185–188.PubMedCrossRefGoogle Scholar
  6. Batson, J. H., Mukkamala, R., Byrd, R. P. Jr and Roy, T. M. (1996) Pulmonary abscess due to Corynebacterium striatum. Journal of the Tennessee Medical Association, 89, 115–116.Google Scholar
  7. Belsey, M. A. and LeBlanc, D. R. (1975) Skin infections and the epidemiology of diphtheria: acquisition and persistence of C. diphtheriae infection. American Journal of Epidemiology, 102, 179–184.PubMedGoogle Scholar
  8. Berger, S. A., Gorea, A., Stadler J. et al. (1984) Recurrent breast abscesses caused by Corynebacterium minutissimum. Journal of Clinical Microbiology, 20, 1219–1220.Google Scholar
  9. Berner, R., Pelz, K., Wilhelm, C. et al. (1997) Fatal sepsis caused by Corynebacterium amycolatum in a premature infant. Journal of Clinical Microbiology, 35, 1011–1012.PubMedGoogle Scholar
  10. Bibel, D. J., Bayles, C., Strauss, W. G. et al. (1983) Competitive adherence as a mechanism of bacterial interference. Canadian Journal of Microbiology, 29, 700–703.PubMedCrossRefGoogle Scholar
  11. Bradley, S. F. (1997) Methicillin-resistant Staphylococcus aureus in nursing homes. Epidemiology, prevention and management. Drugs and Aging, 10, 185–198.PubMedCrossRefGoogle Scholar
  12. Brazier, J. S. and Hall, V. (1993) Propionibacterium propionicum and infections of the lachrymal apparatus. Clinical Infectious Diseases 17 892–893.Google Scholar
  13. Brook, I. (1994) Infection caused by propionibacterium in children. Clinical Pediatrics, 33, 485–490.PubMedCrossRefGoogle Scholar
  14. Carr, D. L. and Kloos, W. E. (1977) Temporal study of the staphylococci and micrococci of normal infant skin. Applied and Environmental Microbiology, 34, 673–680.PubMedGoogle Scholar
  15. Coyle, M. B., Leonard, R. B., Nowowiejski, D. J. et al. (1993) Evidence of multiple taxa within commercially available reference strains of Corynebacterium xerosis. Journal of Clinical Microbiology, 31, 1788–1793.Google Scholar
  16. Critchley, G. and Strachan, R. (1996) Postoperative subdural empyema caused by Propionibacterium acnes — a report of two cases. British Journal of Neurosurgery, 10, 321–323.PubMedCrossRefGoogle Scholar
  17. Cuny, C. and Witte, W. (1996) Typing of Staphylococcus aureus by PCR for DNA sequences flanked by transposon Tn916 target region and ribosomal binding site. Journal of Clinical Microbiology, 34, 1502–1505.PubMedGoogle Scholar
  18. Dancer, S. J. and Noble, W. C. (1991) Nasal, axillary and perineal carriage of Staphylococcus aureus among women: identification of strains producing epidermolytic toxin. Journal of Clinical Pathology, 44, 681–684.PubMedCrossRefGoogle Scholar
  19. Dancer, S. J., Simmons, N. A., Poston, S. M. and Noble, W. C. (1988) Outbreak of staphylococcal scalded skin syndrome among neonates. Journal of Infection, 16, 87–103.Google Scholar
  20. Davies, S. J., Ogg, C. S., Cameron, J. S. et al. (1989) Staphylococcus aureus nasal carriage, exit-site infection and catheter loss in patients treated with continuous ambulatory peritoneal dialysis (CAPD). Peritoneal Dialysis Bulletin, 9, 61–64.Google Scholar
  21. Esteban, J., Ramos, R. M., Jiminez-Castillo, P. and Soriano, F. (1995) Surgical wound infections due to Propionibacterium acnes: a study of 10 cases. Journal of Hospital Infection, 30, 229–232.PubMedCrossRefGoogle Scholar
  22. Estoppey, O., Rivier, G., Blane, C. H. et al. (1997) Propionibacterium avidum sacroiliitis and osteomyelitis. Revue du Rhumatisme (English edn), 64, 54–56.Google Scholar
  23. Etienne, J. and Eykyn, S. J. (1990) Increase in native valve endocarditis caused by coagulase-negative staphylococci: an Anglo-French clinical and microbiological study. British Heart Journal, 64, 381–384.Google Scholar
  24. Fan, S. T., Teoh-Chan, C. H., Lau, K. F. et al. (1988) Predictive value of surveillance skin and hub cultures in central venous catheter sepsis. Journal of Hospital Infection, 12, 191–198.PubMedCrossRefGoogle Scholar
  25. Funke, G., Stubbs, S., Pfyffer, G. E. et al. (1994) Characteristics of CDC group 3 and group 5 coryneform bacteria isolated from clinical specimens and assignment to the genus Dermabacter. Journal of Clinical Microbiology, 32, 1223–1228.Google Scholar
  26. Funke, G., von Graevenitz, A., Clarridge, J. E. III and Bernard, K. A. (1997) Clinical microbiology of coryneform bacteria. Clinical Microbiology Reviews, 10, 125–159.Google Scholar
  27. Goodacre, R. Howell, S. A., Noble W. C. and Neal, M. J. (1996) Sub-species discrimination, using pyrolysis mass spectrometry and self-organinising neural networks, of Propionibacterium acnes isolated from normal human skin. Zentralblatt far Bakteriologie. International Journal of Medical Microbiology, Virology, Parasitology and Infectious Diseases,284 501–515.Google Scholar
  28. Gower, D. B., Nixon, A. and Mallet, A. I. (1988) The significance of odorous steroids in axillary odour, in Perfumery: The Psychology and Biology of Fragrance, (eds S. van Toller and G. H. Dodd ), Chapman liuya Hall, London, pp. 47–85.Google Scholar
  29. Grimont, P. A. D. and Bouvet, P. J. M. (1991) Taxonomy of acinetobacter, in The Biology of Acinetobacter, (eds K. J. Towner, E. Bergogne-Berezin and C. A. Few-son ), Plenum Press, New York, pp. 25–36.Google Scholar
  30. Gruner, E., Steigerwalt, A. G., Hollis, D. G. et al. (1994) Recognition of Dermabacter hominis, formerly CDC fermentative coryneform group 3 and group 5, as a potential human pathogen. Journal of Clinical Microbiology, 32, 1918–1922.PubMedGoogle Scholar
  31. Gueho, E., Midgley, G. and Guillot, J. (1996) The genus Malassezia with description of four new species. Antonie van Leeuwenhoek, 69, 337–355.PubMedCrossRefGoogle Scholar
  32. Howell, S. A., Clayton, Y. M., Phan Q. G. and Noble, W. C. (1988) Tinea pedis: the relationship between symptoms, organisms and host characteristics. Microbial Ecology in Health and Disease, 1, 131–133.CrossRefGoogle Scholar
  33. Ingham, E., Holland, K. T., Gowland, G. and Cunliffe, W. J. (1983) Studies of the intracellular proteolytic activity produced by Propionibacterium acnes. Journal of Applied Bacteriology, 54, 263–271.CrossRefGoogle Scholar
  34. Iwantscheff, A., Kuhnen, E. and Brandis, H. (1985) Species distribution of coagulase-negative staphylococci isolated from clinical sources. Zentralblatt far Bakteriologie, Mikrobiologie, and Hygiene, Serie A, 260, 41–50.Google Scholar
  35. Jones, D. and Collins, M. D. (1988) Taxonomic studies on some human cutaneous coryneform bacteria: description of Dermabacter hominis gen. nov., sp. nov. FEMS Microbiology Letters, 51, 51–56.CrossRefGoogle Scholar
  36. Kaukoranta-Tolvanen, S. S., Sivonen, A., Kostiala, A. A. et al. (1995) Bacteremia caused by Brevibacterium species in an immunocompromised patient. European Journal of Clinical Microbiology and Infectious Diseases, 14, 801–804.CrossRefGoogle Scholar
  37. Kay, C. R. (1962) Sepsis in the home. British Medical Journal, i, 1048–1052.Google Scholar
  38. Khatib, R., Riederer, K. M., Clark, J. A. et al. (1995) Coagulase-negative staphylococci in multiple blood cultures: strain relatedness and determinants of samestrain bacteremia. Journal of Clinical Microbiology, 33, 816–820.PubMedGoogle Scholar
  39. Knols, B. G. J. (1996) On human odour, malaria mosquitoes, and Limburger cheese. Lancet, 348, 1322.PubMedCrossRefGoogle Scholar
  40. Leeming, J. P., Holland, K. T. and Cunliffe, W. J. (1988) The microbial colonization of inflamed acne vulgaris lesions. British Journal of Dermatology, 118, 203–208.Google Scholar
  41. Leonard, R. B., Nowowiejski, D. J., Warren, J. J. et al. (1994) Molecular evidence of person-to-person transmission of a pigmented strain of Corynebacterium striatum in intensive care units. Journal of Clinical Microbiology, 32, 164–169.Google Scholar
  42. Ludlam, H. A., Noble, W. C., Marples, R. R. et al. (1989) The epidemiology of peritonitis caused by coagulase-negative staphylococci in continuous ambulatory peritoneal dialysis. Journal of Medical Microbiology, 30, 167–174.PubMedCrossRefGoogle Scholar
  43. McBride, M. E., Ellner, K. M., Black, H. S. et al. (1993) A new Brevibacterium sp. isolated from infected genital hair of patients with white piedra. Journal of Medical Microbiology, 39, 255–261.PubMedCrossRefGoogle Scholar
  44. Magee, J. T., Burnett I. A., Hindmarsh, J. M. and Spencer, R. C. (1990) Micrococcus and Stomatococcus spp. from human infections. Journal of Hospital Infection, 16, 67–73.Google Scholar
  45. Marcon, M. J. and Powell, D. A. (1992) Human infections due to Malassezia spp. Clinical Microbiology Reviews, 5, 101–119.Google Scholar
  46. Marples, M. J. (1965) The Ecology of Human Skin, Charles C. Thomas, Springfield, IL.Google Scholar
  47. Massey, A., Mowbray, J. F. and Noble, W. C. (1978) Complement activation by Corynebacterium acnes. British Journal of Dermatology, 98, 583–584.CrossRefGoogle Scholar
  48. Matta, M. (1974) Carriage of Corynebacterium acnes in school children in relation to age and race. British Journal of Dermatology, 91, 557–561.PubMedCrossRefGoogle Scholar
  49. Moreno, F., Crisp, C., Jorgensen, J. H. and Patterson, J. E. (1995) Methicillinresistant Staphylococcus aureus as a community organism. Clinical Infectious Diseases, 21, 1308–1312.PubMedCrossRefGoogle Scholar
  50. Mukai, H., Kaneko, S., Saito, N. et al. (1997) Clinical significance of Malassezia furfur specific IgE antibody in atopic dermatitis. Arerugi — Japanese Journal of Allergology, 46, 26–33.Google Scholar
  51. Naidoo, J. (1984) Interspecific co-transfer of antibiotic resistance plasmids in staphylococci in vivo. Journal of Hygiene, Cambridge, 93, 59–66.Google Scholar
  52. Naidoo, J. and Noble, W. C. (1978) Transfer of gentamicin resistance between strains of Staphylococcus aureus on skin. Journal of General Microbiology, 107, 391–395.PubMedCrossRefGoogle Scholar
  53. Noble, W. C. (1981) Microbiology of Human Skin, Lloyd-Luke, London.Google Scholar
  54. Noble, W. C. (ed.) (1993) The Skin Microflora and Microbial Skin Disease, Cambridge University Press, Cambridge.Google Scholar
  55. Noble, W. C., Valkenburg, H. A. and Wolters, C. H. L. (1967) Carriage of Staphylococcus aureus in random samples of the normal population. Journal of Hygiene, Cambridge, 65, 567–573.Google Scholar
  56. Noble, W. C., Virani, Z. and Cree, R. G. A. (1992) Co-transfer of vancomycin and other resistance genes from Enterococcus faecalis NCTC12201 to Staphylococcus aureus. FEMS Microbiology Letters, 93, 195–198.CrossRefGoogle Scholar
  57. Noble, W. C., Rahman, M., Karadec, T. and Schwarz, S. (1996) Gentamicin resistance gene transfer from Enterococcus faecalis and E. faecium to Staphylococcus aureus, S. intermedius and S. hyicus. Veterinary Microbiology, 52, 143–152.CrossRefGoogle Scholar
  58. Nordstrom, K. M., McGinley, K. J. Cappriello, L. et al. (1987) Pitted keratolysis: the role of Micrococcus sedentarius. Archives of Dermatology,123 1320–1325.Google Scholar
  59. Papapetropoulos, M., Pappas, A., Papavassiliou, J. and Legakis, N. J. (1981) Distribution of coagulase-negative staphylococci in human infections. Journal of Hospital Infection, 2, 145–153.Google Scholar
  60. Pascual, C., Collins, M. D., Funke, G. and Pitcher, D. G. (1996) Phenotypic and genotypic characterisation of two brevibacterium strains from the human ear: description of Brevibacterium otitidis sp. nov. Medical Microbiology Letters, 5, 113–123.Google Scholar
  61. Pennie, R. A., Malik, A. S. and Wilcox, L. (1996) Misidentification of toxigenic Corynebacterium diphtheriae as a Corynebacterium species with low virulence in a child with endocarditis. Journal of Clinical Microbiology, 34, 1275–1276.PubMedGoogle Scholar
  62. Petts, D. N., Noble, W. C. and Howell, S. A. (1997) Potential for gene transfer among enterococci from a single patient and the possibility of confounding typing results. Journal of Clinical Microbiology, 35, 1722–1727.PubMedGoogle Scholar
  63. Pitcher, D. G. and Malnick, H. (1984) Identification of Brevibacterium from clinical sources. Journal of Clinical Pathology, 37, 1395–1398.PubMedCrossRefGoogle Scholar
  64. Polakoff, S., Richards, I. D. G., Parker M. T. and Lidwell, O. M. (1967) Nasal and skin carriage of Staphylococcus aureus by patients undergoing surgical operation. Journal of Hygiene, Cambridge, 65, 559–566.Google Scholar
  65. Refsahl, K. and Andersen, B. M. (1992) Clinically significant coagulase-negative staphylococci: identification and resistance patterns. Journal of Hospital Infection, 22, 19–31.PubMedCrossRefGoogle Scholar
  66. Reuther, J. W. A. and Noble, W. C. (1993) An ecological niche for Staphylococcus saprophyticus. Microbial Ecology in Health and Disease, 6, 209–212.CrossRefGoogle Scholar
  67. Saavedra, J. Rodriguez, J. N., Fernandez-Jurado, A. et al. (1996) A necrotic soft-tissue lesion due to Corynebacterium urealyticum in a neutropenic child. Clinical Infectious Diseases,22 851–852.Google Scholar
  68. Saint-Leger, D. Bague, A., Cohen, E. and Chivot, M. (1986) A possible role for squalene in the pathogenesis of acne I. In vitro study of squalene oxidation. British Journal of Dermatology,114 535–542.Google Scholar
  69. Saionji, K. and Shitara, M. (1992) Carrier state and comparative study of methicillin-resistant Staphylococcus aureus from the staff and patients. Japanese Journal of Clinical Medicine, 50, 998–1003.PubMedGoogle Scholar
  70. Schlievert, P. M. (1993) Role of superantigens in human disease. Journal of Infectious Diseases, 167, 997–1002.PubMedCrossRefGoogle Scholar
  71. Schmidt, A. (1997) Malassezia furfur: a fungus belonging to the physiological skin flora and its relevance in skin disorders. Cutis, 59, 21–24.Google Scholar
  72. Selwyn, S., Verma B. S. and Vaishnav, V. P. (1967) Factors in the bacterial colonization and infection of the human skin. Indian Journal of Medical Research, 55, 652–656.PubMedGoogle Scholar
  73. Singh, G. (1973) Heat, humidity and pyodermas. Dermatologica, 147, 342–347.PubMedCrossRefGoogle Scholar
  74. Singh, G., Marples, R. R. and Kligman, A. M. (1971) Experimental Staphylococcus aureus infection in humans. Journal of Investigative Dermatology, 57, 149–162.PubMedCrossRefGoogle Scholar
  75. Stackebrandt, E., Koch, C., Gvosdiak, O. and Schumann, P. (1995) Taxonomic dissection of the genus Micrococcus: Kocuria gen. nov., Nesterkonia gen. nov., Kytococcus gen. nov., Dermacoccus gen. nov. and Micrococcus Cohn 1872 gen. emend. International Journal of Systematic Bacteriology, 45, 682–692.PubMedCrossRefGoogle Scholar
  76. Stoll, T., Stucki, G., Bruhlmann, P. et al. (1996) Infection of a total knee joint prosthesis by Peptostreptococcus micros and Propionibacterium acnes in an elderly RA patient: implant salvage with longterm antibiotics and needle aspiration/ irrigation. Clinical Rheumatology 15, 399–402.PubMedCrossRefGoogle Scholar
  77. Strange, P., Skov, L., Lisby, S. et al. (1996) Staphylococcal enterotoxin B applied on intact normal and intact atopic skin induces dermatitis. Archives of Dermatology, 132, 27–33.PubMedCrossRefGoogle Scholar
  78. Stubbs, E., Pegler, M., Vickery A. and Harbour, C. (1994) Nasal carriage of Staphylococcus aureus in Australian (preclinical and clinical) medical students. Journal of Hospital Infection, 27, 127–134.PubMedCrossRefGoogle Scholar
  79. Tenover, F. C., Arbeit, R., Archer, G. et al. (1994) Comparison of traditional and molecular methods of typing isolates of Staphylococcus aureus. Journal of Clinical Microbiology, 32, 407–415.Google Scholar
  80. Townsend, D. E., den Hollander, L., Bolton, S. and Grubb, W. B. (1986) Clinical isolates of staphylococci conjugate on contact with dry absorbent surfaces. Medical Journal of Australia, 144, 166.PubMedGoogle Scholar
  81. Tucker, S. B., Rogers, R. S. III, Winkelmann, R. K. et al. (1980) Inflammation in acne vulgaris: leukocyte attraction and cytotoxicity by comedonal material. Journal of Investigative Dermatology, 74, 21–25.PubMedCrossRefGoogle Scholar
  82. Vandenesch, F., Etienne, J., Reverdy, M. E. and Eykyn, S. J. (1993) Endocarditis due to Staphylococcus lugdunensis: report of 11 cases and review. Clinical Infectious Diseases, 17, 871–876.PubMedCrossRefGoogle Scholar
  83. Vowels, B. R., Yang, S. and Leyden, J. J. (1995) Induction of proinflammatory cytokines by a soluble factor of Propionibacterium acnes: implications for chronic inflammatory acne. Infection and Immunity, 63, 3158–3165.PubMedGoogle Scholar
  84. Webster, G. F., Leyden, J. J., Norman, M. E. and Nilsson, U. R. (1978) Complement activation in acne vulgaris: in vitro studies with Propionibacterium acnes and Propionibacterium granulosum. Infection and Immunity, 22, 523–529.Google Scholar
  85. Welbel, S. F., McNeil, M. M., Pramanik, A. et al. (1994) Nosocomial Malassezia pachydermatis bloodstream infections in a neonatal intensive care unit. Pediatric Infectious Disease Journal, 13, 104–108.PubMedCrossRefGoogle Scholar
  86. Weller, T. M. A., McLardy Smith, P. and Crook, D. W. (1994) Corynebacterium jeikeium osteomyelitis following total hip joint replacement. Journal of Infection, 29, 113–114.Google Scholar
  87. Wenzel, R. P. and Perl, T. M. (1995) The significance of nasal carriage of Staphylococcus aureus and the incidence of postoperative wound infection. Journal of Hospital Infection, 31, 13–24.PubMedCrossRefGoogle Scholar
  88. Woodgyer, A. J., Baxter, M., Rush-Munro, F. M. et al. (1985) Isolation of Dermatophilus congolensis from two New Zealand cases of pitted keratolysis. Australasian Journal of Dermatology, 26, 29–35.PubMedCrossRefGoogle Scholar
  89. Yu, V. L., Goetz, A., Wagener, M. et al. (1986) Staphylococcus aureus nasal carriage and infection in patients on hemodialysis. New England Journal of Medicine, 315, 91–96.Google Scholar

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  • William C. Noble

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