Did the ancient Egyptians have skin microbiome dysbiosis? 

Bronze Age Egypt epitomised ‘structured hygiene’, a ritual of status and social separation with obsessive cleansing using natron, a cleanser, and other natural products that disrupted the skin’s microbial balance. 

The ancient Egyptians believed that cleanliness helped maintain the cosmic order. It was a part of social order, but went far beyond the evolving hygiene of other urbanisations.

Figure 01: From the tomb of Sennedjem, Valley of the Artisans, Deir el-Medina, Egypt. An artisan who lived during the reign of Pharaoh Ramesses II. It depicts family life, including personal grooming. 

Ancient Acne

We infer that the ancient Egyptians had skin ecosystem dysbiosis because acne appears in the archaeological record. Acne vulgaris effects 95% of people in highly industrialised societies today. Intriguingly acne is near absent for the few modern-era peoples that are semi-sedentary with low to no urbanisation.  

The first known mention of acne (“aku-t”) is for medical treatments written down 3,575 years ago in the Ebers Papyrus. Acne incidence was clearly sufficient for its inclusion in this medical text. Tomb goods of the adolescent Pharaoh Tutankhamun, amongst others, contained acne treatment products proposed in the Eber’s Papyrus.  

Given what’s known about ancient Egyptian practices its likely they suffered most forms of acnes, including acne vulgaris, contact, papulopustular, body and comedonal acne.

A High Class Problem

The 20 meter scroll of the Ebers Papyrus was written for 3-5% of the population who were high-status, the rest of ancient Egypt was lower class and didn’t read or write. 

The costs involved with  ‘structured hygiene’ suggests that acne prevalence was limited to high status individuals. Access to water and products for hygiene, particularly Natron, acted as a social border in ancient Egypt.

Hyper-Hygiene

Hygiene was used by the elite to differentiate themselves from the lower class, it signified spiritual purity. Cleanliness was linked to social success, access to worship, the petition for justice, acceptance and continuation into the next life - it was omnipresent and infinite. 

The elite enjoyed advanced water management systems, notably bathrooms, with specialist plaster surfaces for wet conditions, drainage and labour to provide a shower of jugged water, and drainage. Ten such have been identified at the Medinet Habu palace of Rameses III. 

Figure 02: Tell el-Amarna, Egypt (1924) excavations. Small house bathroom with specialised plaster walls and drainage (left, middle). Lustration (purification) slab with drainage (right) built some 3,378 to 3,361 years ago, before being abandoned after the death of the monotheist Pharaoh Akhenaten. 

Credit: Griffith, F. Ll. (1924). “Excavations at El-'Amarnah, 1923–24.” The Journal of Egyptian Archaeology, 10(1). 

According to Herodotus, the priestly class washed four times a day. This claim is plausible. A wall builder is mocked in the satirical text of ‘The Teaching of Khety’ (written some 3,925 years ago) for only washing once a day. This and other evidence going back 4,690 years reveals the higher-status ancient Egyptians were engaged in over-washing - or hyper-hygiene.  

The lower classes didn’t have bathrooms and public baths didn’t exist. They bathed in ponds, the many irrigation canals of the Nile or the river with the crocodiles - but they understood the sanctity of ‘structured hygiene. Their masters or priests wore white clothes and sandals, and they kept them clean. 

Natron Mania

Natron, a locally sourced sodium carbonate compound, was daily used as skin and mouth cleanser by the higher-classes. It came as an abrasive exfoliating powder that could be made into cleansing paste (called “mu-nu-hesmen”) with soap-like cleansing and anti-microbial effects. Like soap bars it was highly alkali (pH 9-11) and insulted the skin microbiome. 

The ancient Egyptian word "nṯrj" (natron) was linguistically in connected with purity, sanctity and the divine. The word "nṯr" means deity, to be or become divine. Cleanliness was a part of godliness - not next to it, per the Hebrew and Christian instruction. 

Figure 03: Dried salt water lake (background) much as Wadi El Natrun - the ancient Egyptians’ natron source – may have looked like prior to its mining denudation. Linen bag of natron from tomb goods of Pharaoh Tutankhamun some 3,350 years ago.

Credit: Bag of Natron from Tutankhamun's tomb. The Metropolitan Museum of Art, New York, USA. 

As a commodity natron was central to social access, status, religious purity and death. It was used for mummification desiccation and as additive to castor oil for smokeless lamps enabling the creation of tomb art without soot damage. Ovid’s “‘Treatments for the Female Face” lists a facial balm using 101.16 grams (4 ounces) of natron, which gives an insight into ancient higher-status cosmetic usage 

Access to Natron depended on affordability. Physical currency didn’t exist in ancient Egypt instead there was a barter system with measure based on deben, a 90 gram weight of copper. Labourers, at the bottom of the social hierarchy, got paid 10-11  deben of grain a day and 2 jugs of light ale, that was safer to drink than water. 

90 grams of natron cost 1 to 3 deben weight of bartered food. For the lower classes natron was accessible but likely reserved for religious festivals and medicaments - not daily hygiene. The ancient Egyptians even had a word for a small amount, associated with lower classes - “nhi” - which means “a little of natron”. 

Moisturisation Addiction

Bathing 1 to 4 times a day with high alkali natron paste would efficiently strip the skin of its natural moisturising factors (NMF) beyond the transient water effect. Skin is going to get dry, particularly in an arid strong sun environment. 

The skincare solution was for elite Egyptians to moisturise their entire bodies with oils perfumed with frankincense, myrrh, and sometimes they added natron. 

Putting an oil dressing on their bodies would have had effects other than moisturisation.  Firstly, the oil would have slowed natural NMF output from their skin, as completely sealed their skin would be reacting to a 100% relative humidity environment not the 40% of Luxor. 

Occlusive skincare would have made the elite dependent on moisturisers, just like modern users are addicted. As a stay-on product the oil additives are anti-microbial which would have constantly stripped away the skin microbiome.

Soap Moisturisation?

Commentators on ancient Egyptian hygiene state that they didn’t use soap. It’s correct as soap wasn’t purposed for washing. Instead, natron was divine and preferred. 

It was well known how to combine natron with oils or fats to create a soap, and also features in the Ebers Papyrus. Soap was used as an antimicrobial topical medicament for broken skin. However, another form of soap was as a moisturiser. 

Add 13.4% natron to a fat (or oil) moisturiser and you have saponification and soap. It’s very doubtful that the ancient Egyptians used this much natron if used as a ‘purifying’ moisturiser additive. However, even used at lower levels it would still be a non-foaming weak soap with a contributory skin dysbiosis impact. 

What the ancient Egyptians put in such hygiene associated products was deliberate. They synthesised cosmetic pigments, and the wet methods used means they had a knowledge of pH control and buffering.  It’s advanced chemistry. 

What they’d have been unaware of was the biology of the skin microbiome and its effect on skin health. We’re just catching up ourselves.

Diabetes Diet

None of these hygiene practices were helped by diet. Analysis of mummies reveals the elite had high glycaemic load and acquired the modern disease of Type-2 diabetes, that’s strongly linked with dysbiosis with a 49% loss of skin microbiome diversity.

Hygiene’s Health Irony

Perhaps the wall builder has the last laugh washing in the biodiversity-rich waters from the Nile. It’s unlikely that his skin was prone to dysbiosis, he couldn’t afford access to the damage risks of ancient Egyptian ‘structured hygiene’. 

This inferred level of low skin dysbiosis in the lower classes is suggestively supported by a 2003 study of 3 Egyptian rural villages. Acne affected only 5.37% of individuals, a staggering low prevalence for modern times.

What’s Changed?

What’s changed since the days of the Pharaohs is the level of access to and number of potential hazards that can effect skin dysbiosis and result in a health condition. 

Modern urbanised life includes; low to no daily contact with any nature; exposure to built environments; pollution; untreated human waste in (UK)) natural bathing areas; antibiotics; anti-microbial surfaces; the commodity-hygiene of washing agents; skincare; cosmetics; preservatives; disinfectants; detergents, recycled chlorinated water, non-food etc. 

The ancient Egyptian’s hyper-hygiene practices parallel modern over-cleansing and other presentation behaviours, and this isn’t simply mirrored in fads like ‘everything shower’, ‘skin flooding’ or ‘slugging’. It’s deeply rooted into basic modern practices. 

This reveals urbanisation’s enduring links between social behaviours, skin ecosystem diversity loss, dysbiosis and skin health. In ancient Egypt ‘structured hygiene’ was a high-status problem, now everyone has the same problem.