October 23rd (Day One) Event Summary
Staring off the Integrative Dermatology Symposium, there were two inspiring panels focused on teamwork and inclusion. The speakers on the first panel discussed their personal experiences with integrative medicine as patients and practitioners. Kelly Batra gave her personal testimony on her struggles with atopic dermatitis (AD) and how working with integrative practitioners helped her achieve control of her severe AD. Then, Peter Lio MD and Olivia Friedman DACM LAc provided several examples on how working with different types of practitioners can be mutually beneficial as the gaps in each discipline can be filled in by one another. In doing so, this ultimately leads to providing the best treatment options and care to patients.
The speakers on the second panel spoke on the importance of inclusion of BIPOC and transgender individuals in healthcare with Michael Traub ND, Jennifer Ornelas MD, Djarra Sima ND, and Antía Itzel Gómez (medical student). They discussed the importance of culturally competent care and the shortcomings of the current medical system by sharing their own personal experiences with bias and their insights on how we can do better to provide a safe space for all patients. Some of the insights given were around the role of interpreters and the importance of speaking to the trans community without judgment or assumptions, and the need to understand a person culturally and not just at the skin level.
Overall, the theme of the day was all about community and working together to give patients the best care they deserve while being respectful of their race, ethnicity, culture, gender, identity, or sexual orientation.
Author: Maria Mas
October 24th (Day Two) Event Summary
Day 2 of the Integrative Dermatology Symposium was all about acne and rosacea! Jessica Sandhu opened up the day with an energizing yoga session followed by Dr. Raja Sivamani who highlighted the common gut microbiome changes that are seen in acne and rosacea patients and how specific probiotic supplementation has been shown to be efficacious by modulating the immune system and the local gut microbiome. Dr. Reena Rupani discussed novel topical botanicals that can be used to manage acne, such as vitex agnus castus, along with a host of adaptogens including rhodiola, ashwagandha and schisandra. She also introduced topical Clascoterone, the first topical anti-androgen product intended to decrease the skin’s oil production by competitively binding to the androgen receptors within the sebaceous gland.
After a brief exhibit hall break, naturopathic doctor Dr. Lauren Vreeland discussed acne as a metabolic syndrome and the research behind various dietary interventions that may improve acne and rosacea. The emphasis of this presentation was on improving dietary practices and treating gut dysbiosis for long-term healthy skin and a healthy body. Next, a well-rounded panel discussed different clinical approaches to the assessment and management of acne and rosacea. The panelist provided their unique insights from a conventional, naturopathic, ayurvedic and traditional Chinese medicine perspective. A second panel of integrative experts highlighted the latest trends in cosmeceuticals with anti-aging and anti-acne properties including bakuchiol, licorice and green tea extract, to name a few. Last, but not least, Dr. Heather Hammerstedt provided an in-depth overview of common intermittent fasting protocols that can be used to address hormonal dysregulation and serve to aid in weight loss, healthy skin aging and immune system regulation.
Author: Latoya Lewis
October 25th (Day Three) Event Summary
Day three kicked off with a Zumba session that warmed us all up for a day full of informative talks from experts in the field. Vivian Shi, MD began the morning with a talk covering the novel therapeutics available in atopic dermatitis while additionally covering the topics of dysbiosis, barrier dysfunction, immune dysregulation, and more. She delved into the ingredients of these new topical medications which include polyunsaturated fatty acids, palmitoylethanolamine, and even Roseomonas mucosa, which topically has shown efficacy in treating atopic dermatitis. Trevor Erickson, Dr. TCM, then, went over Chinese herbal medicine for the treatment of atopic dermatitis, emphasizing the importance of the unique individual and changing management as the patient responds to treatment. Through cases, he discussed the importance of considering systemic health when formulating the individualized three stage treatment plan, including a clearing herb formulation and a supplementary herb formulation each stage; one example described was Huang Lian Jie Du Tang. This talk was then followed by a discussion of atopic dermatitis cases by experts in the fields of traditional and nontraditional medicine, detailing the positives and negatives of various treatment options. The controversial studies regarding vitamin D supplementation among other additional treatment options were discussed.
After a lunch break, Lawrence Eichenfield, MD described in detail the use of Dupixent for children aged 6-11 years with atopic dermatitis. After discussing the impact of atopic dermatitis on the patient as well as the caregiver, he went over the available clinical studies, emphasizing the efficacy, dosage, and safety profile. Finally, we moved to a case based approach to creating Ayurvedic herbal formulations in the clinic with Amy Branum, AHP, RH and Raja Sivamani, MD, MS, AP. The talk began with a overview of the three energies of Ayurveda – Kapha, Pitta, Vata – and, then, we went into how to create a formula with some common herbs such as turmeric, neem, manjistha and more, emphasizing the importance of the chief herb, the support herb, and a carrier herb. Overall, day three was a deep dive into atopic dermatitis, delving into the novel therapeutics available while also discussing various herbal medications and Ayurvedic formulations that can be efficacious in this complication skin condition.
Author: Karan Pandher.
October 26th (Day Four) Summary
The afternoon started with a mindfulness session led by Dr. Keira Barr where she helped ground all of the attendees to the present moment prior to starting the lectures. This was followed by a discussion by dermatologist Jennifer Soung, MD titled – Don’t Be Shy: Talking with Patients about Genital Psoriasis. Her discussion mostly focused on the importance of acknowledging that genital psoriasis is something most patients may not bring to their practitioner’s attention, despite its physical and emotional impact on quality of life. To combat this, better communication and history taking between clinician and patient is necessary to treating this impactful condition.
The night concluded with Joseph Alban MS LAc, an acupuncturist and Traditional Chinese Medicine (TCM) practitioner presenting a number of clinical trials and case studies to demonstrate the role of TCM in treating and managing psoriasis. Essentially, managing psoriasis with TCM depends on its pattern and symptoms. From there the right oral or topical herb can be chosen, as there is currently growing evidence in the literature on the use of both remedies.
In summary, today’s sessions explored topics in psoriasis that may not come up in a typical discussion on the condition. Together these presentations highlight not only the development of integrative approaches to treating psoriasis but also the importance of considering the full person when deciding on disease severity and treatment.
Author: Jordan Parker
October 27th (Day Five) Summary
Keira Barr, MD opened the day with a mindfulness session to help attendees slow down and allow their mind and body to focus on the moment. She explained that one of the best ways to tap into mindfulness is to focus on the five senses, allowing a person to be more grounded, turn off autopilot, and improve their engagement in life.
Jason Hawkes, MD MS then discussed the importance of the “whole-istic” view of treating psoriatic patients during the COVID-19 pandemic. In this discussion, Dr. Hawkes pointed out that while patients with psoriasis are understandably concerned about COVID when considering medications, there is presently no relationship to suggest that psoriasis patients have a higher risk for the development of COVID-19, and the AAD and NPF do not recommend discontinuation of psoriasis treatment, such as biologics, as prevention. His lecture was followed by a dynamic and integrative psoriasis panel with Lela Altman ND, Jason Hawkes, MD MS, Jennifer Soung MD, and Raja Sivamani, MD MS AP. The panel highlighted four cases of severe cutaneous psoriasis, scalp psoriasis, psoriasis in skin of color, and pediatric psoriasis. Dr. Sivamani noted the growing evidence for the correlation with cutaneous Malessezia globosa and Malessezia restricta in scalp psoriasis. Another area that the panel touched on was the affect that obesity can have on the presentation of psoriasis across all patient populations, urging counseling for better nutrition and weight loss as a way to improve psoriasis outcomes and the efficacy of medications.
The theme for this day was the importance of treating the patient as a whole and acknowledging that psoriasis is more than skin deep and can affect one’s systemic and mental health.
Author: Samantha Magana
October 28th (Day Six) Summary
The theme for the day was exploring the role of gut-health in Dermatology, from providing a basic understanding of SIBO to explaining how imbalances within the gut can impact various skin conditions.
Keira Barr MD started the evening with a mindfulness meditation practice. Focusing our attention on the breath, she urged us to stay in the moment and act with intention, not out of habit. That way, when future stressful situations arise, we can always choose to focus on our breathing for an instant reset.
Lela Altman, ND then discussed Small Intestine Bacterial Overgrowth (SIBO). She reviewed ways to diagnose SIBO, including a jejunal aspirate and breath testing, with breath testing being preferred because it is less invasive and cheaper. Treatment options for SIBO were also discussed including antibiotics, herbs, and the elemental diet. The elemental diet is medical food consisting of pre-digested nutrients, which are easily absorbed to allow for gut rest and repair. It can be a difficult diet to adhere to and can come with risks, such as fungal overgrowth and weight loss, but for the right patient, it is a very good option.
The night ended with a lecture by Raja Sivamani, MD MS AP on emerging evidence in gut-skin health. He discussed the gut-skin axis and possible mechanisms by which the foods we eat are impacting our skin. He focused on the evidence for food triggers in acne, rosacea, psoriasis, and hidradenitis suppurativa. In some skin diseases, like psoriasis and hidradenitis suppurativa, he presented evidence for the role of food sensitivity testing.
Author: Alina Zufall
October 29 (Day Seven) Event Summary
Day 7 of IDS kicked off with a mindfulness meditation practice led by Keira Barr, MD. Focusing on being mindful of our body allows us to gain greater insight into sensations and emotions in the body we aren’t always aware of. She explains that this insight allows us to develop a deeper relationship with our bodies and find a sense of peace.
Heather Zwickey, PhD, then discussed the fascinating connection between the gut microbiome and skin. She emphasized that “postbiotics”, metabolites produced by microbiota in the gut, are important communicators in the body. For example, short-chain fatty acids produced by gut microbes can enter the bloodstream and interact with cells of the immune system. Additionally, gut microbiota will produce different metabolites in response to stress or changes in diet, enter the bloodstream, and affect the skin and its microbiome. What does this mean for clinicians? We can now measure microbiome metabolites and see what is missing in patients’ diets. For example, consuming more than 30 types of plants per week is associated with a higher abundance of microbial diversity. Oral probiotics can impact skin healing through the metabolite immune interface.
The evening closed with Jennifer Hsiao, MD, who discussed Hidradenitis suppurativa (HS) – a debilitating chronic skin condition that can be difficult to treat. Non-pharmacologic strategies including diet modification, micronutrient supplementation, and clothing selection can be integrated with conventional treatments to improve the severity of HS. Micronutrients like zinc gluconate or zinc picolinate 90mg daily (with added copper in a 10:1 zinc to copper ratio), vitamin D, and vitamin B12 have been shown to reduce the severity of HS. A Mediterranean diet that emphasizes vegetables, fruits, white meat and fish are recommended; avoid red meats, dairy, brewer’s yeast (alcohol) and sugar. Clothing selections should include absorbable and breathable loose-fitting fabrics like bamboo fiber and antimicrobial textiles. Undergarments like sports bras and boy shorts are recommended over tight fitting wire or lacy bras; loose boxer shorts are recommended over briefs for men. Finally, it is important to encourage smoking cessation, weight management, and early evaluation and referrals to mental health specialists if appropriate.
Author: Joelle Lee
October 30th (Day Eight) Event Summary
Day 8 of IDS was a focus on integrative approaches to aesthetics and scarring.
Keira Barr MD started off the night with a mindfulness session to give ourselves permission to re-connect with ourselves.
Shellie Goldstein LAc then took the attendees on a journey through a traditional Chinese medicine approach to acupuncture and aesthetics. She emphasized that many times the rest of the body must be addressed to achieve facial harmony. She discussed how acupuncture can be used in combination therapies with botulinum toxin, fillers, and with laser procedures.
Then, DeJarra Sims ND discussed natural approaches to ethnic skin and aging. She emphasized the need to treat from the inside and the outside and discussed the evidence behind vitamin E, vitamin C, rosehip oil, and jojoba oil among many other ingredients. She pointed out the need to supply the necessary and needed co-factors to support collagen synthesis. She summarized that an inside out approach is just as important as an outside in approach.
The night concluded with a networking event where Peter Lio MD and Raja Sivamani MD MS AP introduced the integrative toolkit. The attendees had a chance to more personally meet each other and talk in smaller groups. Overall, Day 8 left us with good learning, good connections, and an introduction to the integrative toolkit.
October 31st (Day Nine) Event Summary
Day 9 of the Integrative Dermatology Symposium included several sessions with key emphases on mindfulness and haircare.
Wahida Sharman began our day by gently awakening our bodies and minds with a grounded Pilates session that focused on the connection between core and breath. Throughout class, she emphasized the importance of listening to one’s body and provided variations of the postures, creating an accessible space for many levels of ability.
Keira Barr MD then discussed the role of stress in skin health and aging. She highlighted the importance of emotional and spiritual well-being in physical health, leading with this impactful quote: “your skin is a reflection of your overall health and wellbeing. What shows up on it says a lot about how you are showing up in it”. Dr. Barr reviewed the skin’s response to hypothalamic-pituitary-adrenal axis activation, which is part of the stress response, and changes in sex hormone levels.
The following session was led by Julie Greenberg ND, and focused on the use of botanical medicine for dermatologic conditions. When considering botanicals in a regimen, Dr. Greenberg recommended that providers consider three key aspects: safety, evidence, and accessibility. She noted that while it can be difficult to find clinical trials on the efficacy of herbs in certain conditions, a search regarding the impacts of an herb on a specific pathophysiological aspect may yield more results, and used the example of pomegranate’s impact on the mTOR pathway involved in acne vulgaris.
Next, Apple Bodemer MD reviewed the role of supplements in hair health. Dr. Bodemer discussed the mechanisms of action, efficacy, and potential side effects of key vitamins, minerals, and supplements used in the promotion of hair vitality. She concluded her presentation with her approach to patients with hair loss: high quality diet that includes plant-based foods, adequate sleep, multivitamin, biotin (≤10 mg/day), vitamin D, and supplements if indicated. Dr. Bodemer’s lecture was complemented by an expert panel that dissected cases involving hair loss, which focused on the diagnosis and management of lichen planopilaris and alopecia areata.
Judith Hong MD, a Reiki master teacher, finished up the day with a workshop on mindfulness, meditation, and Reiki. Dr. Hong led us through breath work techniques, a sensation-based mindfulness practice, and a loving kindness meditation. She then introduced us to the concept of Reiki, an energy-based healing modality, and taught us ways we could practice it at home. Dr. Hong’s session was the perfect way to refocus us for the rest of our Saturday.
Written by Alyssa Becker
November 1st (Day Ten) Even Summary
Day 10 of the Integrative Dermatology Symposium included sessions which highlighted up-and-coming developments in integrative dermatology. The morning started off with a barre session led by Nikki Warren. The session was jam-packed with upbeat tunes and low-impact, high-intensity moves.
The first session of the day was hosted by Hadar Lev-Tov MD, who discussed how technology can play a role in dermatological care. He used real-life examples from his clinic such as the use of oily fish grafts to promote wound healing and treat pain. Additionally, he described a study that incorporated virtual reality to reduce pain during outpatient procedures. Additionally, he also explained the role that handheld ultrasound can play in identifying subclinical hidradenitis suppurativa lesions to start early treatment.
Apple Bodemer MD then discussed the role of low dose naltrexone (LDN) in dermatology, including lichen planopilaris and chronic pruritis. She expanded on the use of LDN as both a primary or adjunctive treatment for chronic inflammatory and autoimmune related dermatologic conditions. She reviewed various formulations, the side effect profile and dosing considerations.
The following session was led by Emma Norton ND, who elucidated the effect toxins can have on our skin. She explained various types and sources of toxins and their impact on our gut and skin microbiome. These environmental toxins can exacerbate conditions such as atopic dermatitis and acne vulgaris through pro-inflammatory and endocrine disrupting mechanisms.
Next, Peter Lio MD discussed the existing data and literature around the role of cannabinoids can play in dermatology. He pointed out the various phytocannabinoids and the potential areas for treatment in conditions such as acne and pruritis. He also explained the limitations in the current data and regulatory issues that may pose a barrier to their use in dermatology.
The lunch panel session with Jocelyn Strand ND, Marvin Singh MD, Lela Altman ND and moderated by Raja Sivamani MD MS AP discussed diagnosis and management of SIBO. They discussed testing modalities such as GI aspirate, glucose, lactulose, and antibody testing through a case-based conversation.
The day concluded with a workshop on reducing pain during procedures in dermatology hosted by Peter Lio MD. He began the talk with pain transmission theory, historical, and anecdotal examples of pain, fear, and attention which all culminate into distress. His talk addressed practical analgesic, anxiolytic, and distractive approaches to address each of these components and adequately reduce pain before procedures.
Written by Chairra Subramanyam