At Tarrytown Functional Medicine, we practice Integrative Dermatology, where we view the skin as a window to the health of the entire body. The health of the skin isn’t independent of the rest of the body, but in fact is a reflection of one’s general health. By observing the skin, we can assess many factors which effect the body’s state of health, including nutrition, toxicity, stress, accelerated aging, and exercise, or lack of it. The advantage we have in dermatology is that by observation of the skin, hair, and nails we can see changes in the inner conditions of the body.
In fact the skin is an indication of critical factors effecting internal health conditions. Some of these indicators include :INFLAMMATION, IMMUNE DEFICIENCIES, DEHYRATION/ DRYNESS, HAIR LOSS OR THINNING, SKIN PATTERNS/ RASHES, OUTBREAKS, WRINKLES AND AGE SPOTS. What do these indicators tell us and how can we approach the body more holistically without medicating away symptoms, only to leave behind chronic problems masked with drugs like antibiotics and steroid creams among others?
This approach appeals to those with intolerance to chemicals, who want to avoid pharmaceuticals, who have not responded to conventional therapies, or to those who simply want to treat their health problems, not just to cover them up.
Inflammation is a problem which shows up in the skin, but which can imply inflammation in the rest of the body. How do you know your skin is inflamed? The characteristics of inflammation are swelling, itching, pain, heat, and redness. If you have any or all of those issues, your skin is inflamed. What causes the skin to get inflamed?
Lets take an example of Atopic eczema. In this condition the skin gets dry, red, and itchy in patches. Most commonly the inner part of the elbows and knees, the neck and face, but almost any area of the skin can be affected.
The common approach to treating Atopic eczema is to give anti-inflammatory steroid creams, hydrating lotions, and anti-itching pills and creams. These interventions suppress the symptoms and the rash subsides while the creams are being used, but the rashes always come back because the cause has not been discovered or treated and chronic use of steroid creams can cause thinning of the skin and stretch marks, as well as adrenal fatigue.
WHAT IS THE CAUSE, WHICH WE SHOULD BE TREATING?
There are many causes, and they all work together to cause the condition. Atopic eczema is an allergic condition caused by an upset in the immune system where there is an imbalance in the antibody producing TH-2 (too much) and the cellular immunity TH-1 (too little). When the cellular immunity is impaired, people with eczema tend to get skin viruses such as warts and molluscum. The condition is often associated in patients or family members with inflammatory systemic problems such as asthma and/or allergies.
The causes of the immune deficiencies and inflammation can be food allergies, fatty acid (omega-3) deficiencies, and dysbiosis (inflammation in the digestive tract caused by bad bacteria and yeasts.) The skin is a barrier to the entrance of chemicals and microbes into the body, but in eczema, the barrier can be lost, causing the skin to dry out and crack. The skin that lines the bowel also must maintain a barrier between the bloodstream and the contents of the bowel (which is really the external environment).
Therefore, seeing eczema patches on the external skin can give us a clue to the health of the gut. When partially digested food particles pass through an inflamed, “leaky gut” into the blood stream, an immune response ensues, setting off this imbalance. Omega 3 fatty acids from fish or flax oil are anti-inflammatory. Eating too much meat, dairy, and refined grain products can cause too much inflammatory omega-6, setting up an inflammatory condition.
DEHYDRATION / DRYNESS
I see a lot of people with dry skin. When I mention that their skin is dry, I’m frequently told “yes, I know, I use lotion”. This misses the point, which is that if your skin is dry, the rest of your body’s internal environment is dry also. This means that discs and joints, which need to be hydrated in order to provide a good cushion, may be getting dry. Dehydrated discs and joints tend to be more frail and can crack more easily with trauma. When people are made aware of this obvious connection, they understand why the lotion is not the total answer. Getting the skin hydrated is more than just drinking more water and involves correcting deficiencies of fatty acids and certain vitamins.
Healthy hair requires a healthy, well-nourished body. There are many kinds of hair loss. We’ll define the three main types:
- Alopecia areata – is characterized by round spots of baldness in the scalp or other areas such as the eyebrows or even eyelashes. This is an inflammatory, auto-immune condition.
- Female pattern baldness – is seen in post-menopausal women, causing thinning of the scalp hair on the top and sides. It is caused by a hormone imbalance and genetic tendency.
- Telogen effluvium – is a sudden loss of hair due to a stress, surgery or anesthesia, a low or high thyroid hormone level, low protein weight loss diet, medication, or sudden changes in hormone status (such as stopping birth control pills, or going into a natural post-partum state).
These are all treatable by addressing the inflammation, the hormone imbalance, and the nutrition.
Inflammation, as we mentioned above, is addressed with attention to fatty acid balance, dysbiosis, avoidance of food allergens, and attention to nutritional deficiencies, vitamins, minerals, and amino acids.
The hair requires an adequate supply of amino acids (the building blocks of proteins) particularly sulfur containing amino acids such as cysteine, to make the keratin, which is the main protein in hair. It also needs the right fatty acids to keep the hair from drying and cracking off. The hair is one of the first places that one can see nutritional deficiencies.
If a person has constant acne outbreaks, the standard of care is to give antibiotics. This suppresses the symptoms but when the patient stops the antibiotic, the problem returns because the cause has not been addressed. In addition to being ineffective in the long run, systemic antibiotics wipe out the natural flora of the bowel and skin, setting the person up for more virulent bacteria to prevail.
Acne may be exacerbated by underlying hormonal imbalances. In my experience, acne patients consume more sugar, dairy, and coffee than others without acne and these foods contribute to the hormonal imbalances, which underlie acne. Sugar raises insulin levels, which increase androgens and cause metabolic syndrome, which we know is associated with acne. Dairy contains high levels of the cow’s own progesterone hormones and has added growth hormone. Several recent studies have implicated milk consumption, especially skim milk, with acne. Women who drank 2 or more servings of skim milk every day were 44% more likely to have developed severe acne.  Caffeine increases sebum production, and sebum can get stuck in a plugged follicle and become a medium on which bacteria grow. Certain vitamin and fatty acid deficiencies can contribute to the follicular plugging.
Medications are often necessary initially to get a skin problem under control but a diet and supplement plan should be given at the same time to prevent future outbreaks or the need for more medication in the future.
 Journal of the American Academy of Dermatology. Feb. 2005
Age spots and wrinkles on the skin can indicate excessive ultraviolet (sunlight) exposure, leading to breakdown of the elastic tissue and the cross-links in the collagen strands. It can also indicate a state of accelerated aging in general, which could be due to factors such as smoking, free radical damage due to antioxidant deficiency, loss of hormones (estrogen and testosterone), toxic exposures, poor diet, fatty acid deficiencies, and lack of sleep.
Vitamins C and E, coenzyme Q-10, L-carnitine, alpha-lipoic acid and the mineral selenium are the cornerstones of anti-aging supplementation along with a diet rich in antioxidant fruits and vegetables. Beta carotene is nature’s sun blocker and it’s important to eat lots of leafy green vegetables to get this nutrient naturally to protect the skin and eyes from ultraviolet damage.
NUTRITIONAL TESTING TO HELP DIAGNOSE AND TREAT SKIN DISEASES
Nutritional testing is often very useful to pinpoint nutritional deficiencies or imbalances in the body.
But dermatology patients are sometimes resistant to nutritional testing. They are used to the standard of care, where they are examined in a cursory fashion and after 5 minutes, a diagnosis is pronounced. If there is any doubt, a biopsy is performed which gives the ultimate answer as to what medicine or surgery will be prescribed.
In the case of skin cancer or skin infections, medications and surgery are necessary but what about all the rest of the chronic skin conditions that people suffer with for years, and for which medications have been given, with temporary relief followed by side effects and a return of the problem.
These are conditions such as:
- Urticaria (hives)
- Acne vulgaris
- Acne rosacea
- Alopecia areata (round spots of baldness)
- Aphthous ulcers (sores in the mouth)
- Dry skin and dry mouth
- Discoid Lupus (an autoimmune skin Lupus)
- Morphia (a kind of localized scleroderma or skin thickening in patches)
- Seborrheic dermatitis (dandruff on the scalp, face, or body)
- Vitiligo (depigmented patches of skin)
Standard dermatology has symptomatic treatment for these condition such as antibiotics, steroids, ultraviolet light, and heavier guns such as retinoids, antimalarials, and biologics but nutritional testing is the only way to look at the terrain of the body and treat the underlying causes of these illnesses. As we mentioned above, conditions such as inflammation, dehydration, and oxidative stress affect the skin and can be due to food allergies, poor bowel terrain, toxic exposures, or nutrient deficiencies.
We also depend on nutritional testing to tell us what you need.