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The Bacterial Flora of the Skin1

1952; Elsevier BV; Volume: 18; Issue: 3 Linguagem: Inglês

10.1038/jid.1952.21

1523-1747

Donald M. Pillsbury, Gerbert Rebell, Sue Kaneda, Margaret de Saint Phalle,

Autoimmune Bullous Skin Diseases

In spite of rapid improvement during the past decade of methods of dealing with superficial infections of the skin, many aspects of the general problem of chronic bacterial infections remain poorly understood. Although much has been written concerning the mechanisms by which the normal healthy skin disposes of undesirable microorganisms, there are important components of the phenomenon of which are still not clearly defined. The probable and possible mechanisms involved have been summarized recently by Stuart-Harris (23) and by Burtenshaw (3). Certain older hypotheses relating to changes in the bacterial flora of the skin surface would appear to require re-examination as to their validity. The importance of a normal balance in the numbers and types of bacteria and fungi present on the skin surface, i.e. the maintenance of a healthy bacterial ecology, is manifest. Moreover, with the development of agents which are highly specific in their effects upon some strains of bacteria, without any effects upon other strains or upon fungi, the occasional deleterious results of disturbance of a possible delicate balance between bacteria themselves, or between bacteria and fungi, is becoming increasingly significant clinically. As is immediately obvious from the titles of many papers dealing with the bacterial flora of the skin, in which the terms degerming and self-disinfection recur often, it would seem possible that disproportional emphasis may have been placed upon the mechanisms by which the skin wards off bacteria, with relative neglect of the precise mechanisms by which the skin becomes a fertile soil for the growth of certain strains. To give a rather homely analogy, if a physician whose training had been in methods of preventing the growth of bacteria were to survey a piece of land in respect to its ability to support the growth of wheat, his instincts would paradoxically tend to make him proceed first to a consideration of what factors in the soil prevented the germination and growth of the wheat. The farmer, whose training and instincts are in the direction of making plants grow, would immediately consider the soil in terms of the mechanisms through which the soil might support the growth of wheat. In considering factors relating to the bacterial flora of the human skin, it might be well for investigators to emu-