Skin Health / Events
Dr. Akil Palanisamy discussed food-related skin reactions, where he introduced the distinctions between food allergy, sensitivity, and intolerance, with a focus on the role of bacteria in food reactions. He emphasized the link between food sensitivity and systemic dermatological conditions as well as the mind-body connection. He closed the session with several dietary encouragements, such as the incorporation of bifidobacteria, akkermansia, and fermented foods into the diet.
Pushpa Soundarajan, RD, guided attendees through Ayurvedic concepts of the dietary, lifestyle, psychological, and age related influences on acne. She encouraged daily routine, the awareness of incompatible foods, and following stress-reducing activities such as yoga, breath work, and oil massage.
Dr. Mark Cannon, DDS, highlighted the rich variety of role and importance in the oral microbiome. He promoted prebiotics and probiotics in dental practice, with emphasis on the oral microbiome’s contribution to overall health with examples on its influence on maintaining blood pressure control, blood sugar control, and reducing gluten sensitivity.
Dr. Peter Lio offered a well-rounded tour de force discussion on atopic dermatitis, and the interplay of the skin barrier, inflammation, microbiome, itch, and psyche. He described how a breakdown in the skin barrier of the skin in atopic dermatitis may lead to “leaky skin” that may set up food sensitivities and allergies rather than the other way around. He highlighted the use of coconut oil, topical vitamin B12, black tea, and acupuncture as part of an integrative eczema action plan. He emphasized that the optimal approach is a holistic patient-centered treatment plan.
Dr. Lawrence Eichenfield carried on with the topic of atopic dermatitis, focusing on pediatric and adolescent patients. He discussed the comorbid mental health burden and the challenge of managing treatment expectations. His discussion spotlighted the evidence of emerging medications and the importance of topical medications in restoring the skin barrier.
The afternoon started with Dr. Jason Hawkes, who talked to us about using JAK inhibitors in psoriasis. Dr. Hawkes simplified the seemingly complicated JAK-STAT pathway by leading us through the extra- and intracellular signaling involved and highlighting the importance of specificity versus selectivity of treatments. The discussion then delved further into TYK2 pathways and a new first-of-its-class medication targeting TYK2 enzymes in treating patients with psoriasis. Dr. Hawkes’ discussion wrapped up a few thoughtful clinical pearls and future research goals to further our understanding of targeted therapies for psoriasis.
Dr. Lev-Tov facilitated an exciting case-based panel with traditional Chinese practitioner Joseph Alban, nurse practitioner Lakshmi Aldredge, and dermatologist Dr. Jason Hawkes. The first case emphasized the mind-body connection in psoriasis by evaluating sleep, digestion, quality of life, patient’s age, psoriasis location, and patient goals when developing a treatment plan. The discussion then shifted to a case of scalp psoriasis. The panelists agreed that treatment should address patient education to prevent scratching, treatment of itching (acupuncture can be helpful), and sleep aids. Lastly, in the case of psoriasis of the genitals, the panelists discussed helping patients feel comfortable during the skin exam of this sensitive region.
Dr. Robert Lustig captured the audience’s attention by discussing the hateful (or grateful) eight – glycation, oxidative stress, mitochondrial dysfunction, insulin resistance, membrane instability, inflammation, methylation, and autophagy – which are ultimately responsible for the development of all chronic metabolic diseases. Hypertension, type 2 diabetes, dyslipidemia, cardiovascular disease, cancer, dementia, and fatty liver disease have contributed to the declining life expectancy in the United States. Unfortunately, no treatments target the subcellular processes responsible for chronic metabolic disease; there are only medications that mitigate the symptoms. Dietary changes, including decreased consumption of processed foods (high sugar, low fiber), can help prevent and alleviate these subcellular pathologies.
Dr. Hamzavi, MD, briefly reviewed the pathophysiology of vitiligo and mentioned labs to test in patients with vitiligo, such as TSH. He also reviewed the different types, classifications, and presentations of vitiligo (segmental and non-segmental). He shared valuable clinical pearls on treatment timelines and other integrative interventions to add to the clinician’s toolkit including the botanicals Ginkgo biloba, Polypodium leucotomos, and antioxidant-rich foods like blueberries, blackberries, and red beans. Emphasis was placed on the impact of psychosocial components on vitiligo and counseling patients at regular intervals.
Dr. Neal Bhatia discussed the multiple pathways of inflammation that contribute to the pathogenesis and presentation of rosacea and the role of common triggers. He reviewed current topical and oral therapies like antibiotics which positively impact the inflammatory cascade but have significant implications on the gut microbiome, including small intestine bacterial overgrowth (SIBO). He emphasized the potential of new treatments, such as UV therapy, tetracycline, ivermectin, benzoyl peroxide, and retinoids, which should be considered when generic options lose efficacy and tolerability.
Dr. Traub opened the talk by discussing SIBO, rosacea, and the gut-skin axis. He then reviewed foods and dietary habits that can exacerbate SIBO and the symptoms of SIBO. He also gave a brief history of SIBO research and examined underlying risk factors to keep in mind when evaluating patients with SIBO. He emphasized the importance of taking a thorough history in assessing patients with SIBO. He then reviewed diagnostic and multimodal options to treat this elusive disease, including medications and lifestyle changes. Dr. Traub concluded with some key takeaways beyond the skin for clinicians to incorporate into their practice.
We regrouped after the morning break to Dr. Sivamani, who facilitated a case-based panel on acne and rosacea with dermatologist Dr. Neal Bhatia, Chinese medical practitioner Joseph Alban, and naturopath Michael Traub. They discussed a holistic treatment approach, including diet changes, acupuncture, and cupping on a teenager with severe acne who failed doxycycline and isotretinoin. The following case was an adult with erythema and acne, and rosacea. The panel discussed reducing dampening foods based on Chinese medicine, use of topicals, and testing for possible SIBO. The last case concerns a young woman with hormonal acne and possible PCOS. The panel agreed that topical pumpkin seed oil, evaluation of birth control methods, spironolactone, and testing for insulin resistance and diabetes should all be considered for this patient.
Dr. Farah kicked off the mindfulness lecture by leading the group through some collective deep breaths. She then shared some tips to utilize mindfulness in reducing itch by reviewing the available clinical trial literature on the topic. Dr. Farah led the group through an interactive guided imagery meditation. She wrapped up the talk by talking about the usefulness of mindfulness to help with eating.
Dr. Steven Gurgevich continued the mindfulness lecture series by exploring the topic of hypnosis and its effect on warts. He explained the vital ingredients of hypnosis, including desire/motivation, belief, and expectation, and the importance of adjusting the view of the subconscious mind. He discussed the two major hypnotic strategies, symptomatic and psychodynamic, which can treat and uncover the underlying causes of symptoms.
After the afternoon break, the Mindfulness Panel, which included Dr. Apple Bodemer, MD, Dr. Keira Barr, MD, and Steven Gurgevich, PhD, addressed the importance of mindfulness techniques in improving the dermatological conditions and quality of life of patients. They discussed the use of psychotherapy with immunotherapy in patients with alopecia universalises, the use of meditation audio tapes before/during phototherapy treatment, as well as the importance of addressing the parents’ stress as well in cases of pediatric eczema, which can ultimately affect the child’s quality of life and resilience in dealing with their skin condition.
What a fantastic way to wrap up day two with Dr. Andrew Weil, a world-renowned leader in integrative medicine. He emphasized that the body has a natural and intrinsic ability to restore itself and that the mind and body are delicately intertwined. Dr. Weil highlighted the importance of treating the whole person (body, mind, and spirit) and considering all aspects of their lifestyle.
Dr. Cassandra Quave, PhD led an extensive conversation about botanicals and their impact on skin health. Her talk concluded that botanicals in our food or topically on the skin could be essential in mediating inflammatory skin disease. Additionally, she highlighted that not all medicinal plants are safe for all patients, which can result in skin reactions like contact dermatitis.
Sandra Chui, a licensed acupuncturist and Chinese medicine specialist, started her discussion by showcasing remarkable jaw, neck, and face tightening and plumping achieved with facial cosmetic acupuncture (FCA). She provided unique insight into the body’s’ blood flow and overall circulation improvement with FCA. She emphasized it’s beyond the skin’s benefit on posture, nervous system, and vitality of the whole body. She ended her talk by encouraging the integration of FCA in cosmetic dermatology, highlighting how each method might enhance the other when used in synchrony.
Dr. Lev-Tov enthusiastically began his Hidradenitis Suppurativa (HS)-centered presentation by emphasizing the importance of a holistic approach to this disease and the need for surgical procedures to optimize the treatment plan in select patients. He went over the benefits of deroofing procedure, performed with tumescent infiltration for sustained effect and surgical probes for tunnel mapping, discussing the lower recurrence rates and improved patient comfort compared to classic wide excision and closure. He showcased a patient who suffered from rapid disease progression and asked if biofilm formation within lesions could be driving the rapid progression seen. He described the Lev-Tov procedure, which aims to resolve HS tunnels without deroofing but uses anti-biofilm gels after creating an exit with a punch tool. He demonstrated successful local resolution of the disease with this approach.
Up next, the audience participated in a panel discussion about HS management, led by Dr. Lev-Tov and featuring the HS-savvy dermatologist Dr. Steven Daveluy and HS Advocate and Leader of HS Connect, Brindley Brooks. Dr. Lev-Tov walked the audience through the HS patient experience in his conversation with Ms. Brooks. She exposed the lifestyle modifications and challenges facing patients with HS, including inter-family relationships and feelings of blame and stress in the disease. Dr. Daveluy introduced his approach to the HS patient interview and management, covering diet, topical benzoyl wash, medical therapy, timing, and more. Dr. Lev-Tov closed the presentation with cases of HS to spark conversation regarding treating patients, both mind and body, in the setting of severe disease.
The following session continued with a discussion about hair and stress. Dr. Apple Bodemer started by analyzing cortisol and stress and how it contributes to several biochemical pathways that impact hair growth. She also discussed the importance of addressing depression and hair loss’s negative social implications.
Dr. Apple Bodemer kicked off the last session of IDS 2022 with a hair loss panel, introducing Dr. DiAnne Davis and Dr. Jason Ezra Hawkes. The panelists walked through several cases of hair loss, guiding audience members through stages of diagnosis and options of therapy. Audience members engaged with the panelists, asking questions far-ranging in nature, including topics in the various diagnostic testing and co-morbid conditions associated with hair loss.
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