A Note From Our Dermatologist, Dr. Clay-Ramsey on Skin Microbiome Health & pH Balance

We are so excited to welcome Dr. Tiffany Clay-Ramsey, a board-certified dermatologist, to our Pulse panel of experts. The skin is the largest organ in the human body and it is our first line of defense against harmful biological and environmental factors. It is believed that skin health is a key indicator of a person’s overall health and wellness.  

Who is Dr. Tiffany Clay-Ramsey? 

Dr. Clay-Ramsey loves helping others, indulging in self-care and is always thinking about her next meal. She’s a board-certified dermatologist, boy-mom (twice over), devoted wife, sister and daughter.  

She was born in New Jersey, grew up in Atlanta, but left to pursue education in medicine, which led her to live in some very cool cities. She returned to Atlanta in 2015 to begin working as a private practice dermatologist where she sees patients of all ages and practices medical, cosmetic and surgical dermatology.  

 What inspired you to study medicine and become a dermatologist? 

As a preteen I always had dreams of becoming an OBGYN so I could deliver babies, but I soon realized I don’t really like hospitals or big messes! My introduction to dermatology came as a child when I had a severe scalp fungal infection that led to short term hair loss. As a teen I experienced very mild acne, and later in college I developed eczema from the stress of dealing with Hurricane Katrina during my senior year of college in New Orleans. After many personal experiences with dermatological disorders, I learned more about the field and loved how diverse it was.  

Do you have any specialties or passions in dermatology? 

I’m most passionate about sun protection and sunscreen education as well as treating humans with skin of color. It is a common misbelief that sunscreen is only needed at the beach, so my goal is for everyone within my reach to begin wearing it daily on their exposed areas not only for skin cancer prevention but for the anti-aging benefits of less discoloration and fewer wrinkles. Secondly, underrepresented populations with skin diseases often have more severe cases and are not offered the best or strongest treatments for their conditions. My goal is to listen to these patients and give them options and opportunities to have clear(er) skin and to feel great about their skin. 

How do disparities in health show up in your field of dermatology? 

Disparities in the field of dermatology include access to care and limited education on skin of color. I often see patients who have had severe conditions like eczema or acne for decades but never had the opportunity to have it treated by a dermatologist. This may be because they didn’t have insurance or couldn’t afford care, they didn’t know a dermatologist was the correct specialist to treat them properly or they didn’t have a dermatologist in their geographic area. Additionally, dermatology textbooks and dermatology clinical trials are very limited in the representation of skin of color populations. Limited education on skin of color in the dermatology field can sometimes lead to misdiagnoses for humans who do have access. I encourage anyone who is on their wellness journey to advocate for themselves while meeting with their Dermatologist to ensure that the diagnoses and treatment is accurate. 

What do you wish more people knew about skin health? 

I wish people knew that it doesn’t take much to take good care of your skin. You don’t need the most expensive products on the market, and you don’t need a 10-step routine if you can’t keep up with it. I always recommend simple staples to use daily, including a gentle cleanser, moisturizer and sunscreen for the face each day. Let’s not forget the body. Body care includes what you do in the shower, so if you use products that are harsh and dry in the shower this can translate to how your body feels throughout the rest of the day. 

 Can you explain the connection between the skin’s pH and the skin microbiome? 

The skin's pH and microbiome are closely knit. The microbiome includes various microbes on our skin, including bacteria, fungi and viruses, that form the first defense of our immune system by preventing pathogens from entering the skin. In a healthy adult the microbiome remains unchanged unless disruptions in the skin’s pH occur due to dermatologic diseases or topical products applied. The optimal pH of the skin is acidic (pH <5.5) and at this pH the species of microbes are those that aide in protecting the skin are more prevalent. PH is an indicator of the environment of the skin while the microbiome is the group of living organisms in the environment. 

 What happens when the microbiome is out of balance? 

An out of balance microbiome or dysbiosis may be reflected by skin disorders that are related to increases in specific microbes thought to cause or worsen specific skin conditions. A few of these conditions include seborrheic dermatitis, eczema or atopic dermatitis and acne. For example, Staphylococcus aureus is found in higher numbers on the affected patches of skin versus normal appearing skin in the same individual with eczema.  

How can our community improve their skin health? 

My top 3 habits to improve skin health include: 

1. Seeing a dermatologist at least once a year to address your skin issues or to have a “mole check” to ensure you don’t have abnormal growths 
2. Avoid unhealthy habits that have poor effects on the skin such as tanning and smoking tobacco 
3. Skin care doesn’t stop at your face, so be sure to moisturize and be kind to the rest of your skin from the neck-down   

Is there a skin myth you would like to debunk? 

My favorite debunked skin myth is that sunscreen isn’t needed daily. If it is “daytime” you should be wearing it on your face and neck at least. Ultraviolet rays as well as blue light, aka visible light (from our screened devices), can cause our skin to become discolored and to age faster. So yes, unless you reside in a cave somewhere, you should apply your sunscreen each day. 

Resources: 

Byrd, A., Belkaid, Y. & Segre, J. The human skin microbiome. Nat Rev Microbiol 16, 143-155 (2018) 

Hülpüsch, C., Tremmel, K. et al. Skin pH-dependent Staphylococcus aureus abundance as predictor for increasing atopic dermatitis severity. Allergy. 75, 2888-2898 (2020) 

Ellis, S., et al. The skin and gut microbiome and its role in common dermatologic conditions. Microorganisms. 7, 550 (2019)