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Dr. Alban began the day by delivering a presentation on the role of Traditional Chinese Medicine (TCM) in achieving nutritional and skin balance. TCM aims to assist patients in transitioning from an unstable and unhealthy state to one of overall balanced well-being.
During his lecture, Dr. Alban explained the significance of flavors and temperatures of foods as per TCM principles. In TCM, different flavors and temperatures are prescribed for various conditions. For instance, cold substances are used to treat heat-related conditions, bitter substances are employed to address dampness, and acrid substances are utilized to tackle wind conditions. As an example, the acrid flavor of fresh ginger induces sweating and is beneficial in dispersing heat and wind, making it suitable for dermatological conditions like eczema.
In TCM, there are certain foods to avoid. Greasy and fried foods, as well as dairy products, can lead to the accumulation of dampness. Similarly, raw and cold foods tend to dampen the digestive fire.
Overall, Dr. Alban emphasized the importance of TCM in achieving a harmonious balance in nutrition and skin health, highlighting the specific dietary guidelines for different dermatological conditions within the framework of Traditional Chinese Medicine.
Lienna May, MS CNS LDN, discussed the connection between blood sugar and acne, highlighting the well-established link between glucose, acne, and insulin through IGF-1. Continuous glucose monitoring, which provides real-time data through a mobile app, was recommended for tracking and improving food that triggers blood sugar spikes and may therefore trigger acne. She surprised the audience by emphasizing how some seemingly healthy foods, such as acai bowls or oatmeal, can spike blood sugar. To optimize blood sugar and promote clear skin, May suggested a diet rich in leafy greens, high-fiber foods, balanced protein intake, and healthy fats containing omega-3 fatty acids. Meal sequencing, starting with proteins and transitioning to carbohydrates after vegetables and proteins, was proposed as an effective strategy for managing blood sugar levels.
Chef Kimber Dean and Raja Sivamani, MD MS AP, demonstrated the application of scientific principles in culinary practices. Dr. Sivamani highlighted the benefits of low glycemic diets for skin conditions and metabolic diseases. They showcased the substitution of potato chips with Kale chips, which have higher fiber and lower glycemic load. Attendees made their own chips following Chef Dean’s demonstration. They also presented an anti-inflammatory smoothie recipe adhering to paleo, grain-free, and vegan principles. Turmeric, cinnamon, and ginger enhanced the flavor of the banana-based smoothie.
The discussion then focused on hair loss and plant-based protein. Chef Dean showcased a recipe for Raw Vegan Brownie Bites enriched with organic chocolate protein powder, well-received by the audience. To wrap up, Chef Dean presented a one-day meal plan for individuals with HS and acne. The meals included Vanilla Chia Seed Pudding, mixed greens salad with lemon tahini dressing, spaghetti squash with basil cashew sauce, and chocolate mousse.
Dr. Daveluy initiated the panel session by discussing approaches to addressing recalcitrant acne and post-inflammatory hyperpigmentation while considering diet and nutrition. Asmi Sanghvi, MD, Joseph Alban, DAc MS Lac, and Lienna May, MS CNS LDN, stressed the importance of gradual behavioral modifications to enhance compliance and achieve long-term results. Shifting the focus to alopecia areata, our experts underscored the vital role of stress reduction through anti-inflammatory lifestyle changes, including the utilization of essential oils, acupuncture, and regular exercise to alleviate symptom severity. The panel further emphasized the significance of healing the gut microbiome by adopting a non-processed food diet for optimizing treatment responses in psoriasis. For individuals dealing with eczema, the identification of food sensitivities was highlighted as a potential strategy for better symptom management; this approach could reduce flare-ups and enhance treatment response.
Dr. Jason Hawkes, MD MS FAAD, emphasized the significant connection between microbiome disruption, known as dysbiosis, and the emergence of non-infectious inflammatory skin conditions like Hidradenitis Suppurativa, Atopic Dermatitis, and Psoriasis. He revealed how this relationship operates in a dual manner: dysbiosis can trigger flares and worsen these conditions, and conversely, disease flares and their treatment can contribute to dysbiosis. Dr. Hawkes also noted that JAK inhibitors may offer the most significant advantages in cases of concurrent skin and gastrointestinal inflammation, although their use does elevate the risk of infection development.
Dr. Song delivered a presentation on two novel nonsteroidal approaches to topical therapy for plaque psoriasis: VTAMA (Tapinarof) and Zoryve 0.3% cream (roflumilast). While topical corticosteroids are commonly used in dermatology, they have limitations due to their side effects and difficult use. Dr. Song compared the use of topical corticosteroids to using a sledgehammer, as they suppress the immune system Dr. Song compared them to a sledgehammer as they suppress the immune system and cause side effects like atrophy, striae, and rosacea/acne.
VTAMA (Tapinarof) is an aryl-hydrocarbon receptor agonist that targets tissue-resident memory T cells (TRM). It reduces Th17 cytokines, restores skin barrier function, and increases antioxidant activity through the Nrf2 pathway.
Zoryve 0.3% cream (roflumilast) is a next-generation phosphodiesterase-4 (PDE4) inhibitor. It effectively treats intertriginous plaques and is well-tolerated without propylene glycol. A foam formulation is expected in the future.
Dr. Song’s presentation highlighted these nonsteroidal options as potential alternatives to topical corticosteroids for plaque psoriasis, offering improved safety profiles.
Dr. Ammar Ahmed, MD, highlighted complementary treatment options for vitiligo, including vitamins, dietary components, amino acids, herbs, botanicals, sunlight, topical antioxidants, camouflage, and support groups. Although no definitive dietary data is available for vitiligo, the increased risk of metabolic syndrome and insulin resistance in patients suggests adopting a healthy, antioxidant-rich diet without excluding specific foods. In the herbal realm, ginkgo biloba and Polypodium leucotomos show promise, especially in enhancing phototherapy effects on the face. Black seed oil and Picrorhiza kurroa (kutki) have the potential for vitiligo, but more data is needed, as randomized controlled trials are lacking. Dr. Ahmed underscored the utmost importance of prioritizing patients’ quality of life.
Michelle Jeffries, DO IFMCP, discussed the influence of the circadian rhythm and clock genes on skin health. She began the discussion by elaborating on the various biological rhythms that mitigate bodily functions. She reviewed the cellular mechanisms of clock genes and elaborated on how the suprachiasmatic nucleus and other peripheral clocks regulate the sleep-wake cycle, peripheral tissues, feeding, fasting, and temperature. Notably, she emphasized that the disruption of the circadian rhythm has been associated with numerous negative health outcomes, including those of the skin. For example, she discussed how there is lower sebaceous gland activity, increased blood flow, decreased skin temperatures, increased transepidermal water loss, increased proliferation of keratinocytes, increased DNA damage repair, and increased inflammatory cytokines at night versus during the daytime. Furthermore, she noted that these changes align with the cortisol cycle and that the lower cortisol levels at night may contribute to the increased inflammation and itching seen in inflammatory/pruritic dermatoses. Overall, she advocated for the alignment of sleep cycles, skin care routines, and cortisol rhythms with clock genes to optimize overall health.
Dr. Jason Hawkes described the three primary immune responses are Type 1, Type 2, and Type 3. Type 2 is a T-cell-mediated disease and involves the cytokines IL-4,5,13 and 31. He noted that IL-4 alone promotes naïve T-cells into Th2 cells and that IL-4 and IL-13 promote KC hyperproliferation and class switching.
Next, he discussed that prurigo nodularis (PN) is a variable skin disease that has a lot of heterogeneity and is represented by raised, keratotic, pruritic, excoriated, or scarred papules and plaques. Often symmetric on the trunk and extremities due to repetitive trauma, PN lasts greater than 6 weeks and usually many months to years. He discussed the risk factors, including female gender, adult age, and skin of color. The pathophysiology of PN includes type 2 inflammation, epidermal barrier disruption/damage, pruritis, and neurosensitization.
He noted that biopsies are descriptive in nature but not pathognomonic. He then discussed treatments, such as the FDA-approved dupilumab and off-label treatments for PN, including gabapentin, TCAs, SSRIs, topical steroids, NbUVB, PUVA, and MTX. He then discussed the possible role of IL-31 blockade and that there were ongoing clinical studies in PN.
Prurigo nodularis is a variable skin disease that has a lot of heterogeneity and is represented by raised, keratotic, pruritic, excoriated, or scarred papules and plaques. Often symmetric on trunk and extremities due to repetitive trauma. Duration often lasts greater than 6 weeks (usually many months). Risk factors include female gender, adult age, and skin of color. The pathophysiology of PN includes type 2 inflammation, epidermal barrier disruption/damage, pruritis, and neurosensitization. Biopsy is descriptive in nature but not pathognomonic. Biopsy presents with thickened acanthosis.
Off-label treatments for PN include gabapentin, TCAs, SSRIs, topical steroids, NbUVB, PUVA, and MTX. Dupilumab inhibits IL-4Ra (IL-4 and IL-13). Nemolizumab is an IL-31RA antagonist but leads to a paradoxical increase in Th2.
Raja Sivamani, MD MS AP, emphasized the importance of a functional approach to assessing gut health. He began the discussion with an overview of small and large intestine anatomy and physiology, highlighting that damage to the epithelial layer via a variety of factors can lead to a “leaky gut,” which contributes to inflammatory, metabolic, and systemic diseases. He discussed the use of lactulose-mannitol testing and zonulin as a biomarker for assessing permeability, suggesting that while there are pros and cons to both, the lactulose-mannitol ratio is the most validated measure of gut permeability. He noted that calprotectin may be helpful in detecting gut inflammation, such as in neutrophilic inflammatory conditions, however, it may not be as helpful in eosinophilic infiltration. He then moved into a gut microbiome discussion, emphasizing that certain species may be beneficial to maintaining gut homeostasis, such as short-chain fatty acid producers, while other species may be pathogenic, such as those associated with inflammatory disorders. He discussed the advantage of functional predictions by validating with metabolomic testing, and that there is a need for more validation going forward. He then went on to discuss different types of gut microbiome testing, emphasizing the pros and cons of different methodologies. Overall, he highlighted the role of gut health in patient’s wellbeing, discussed the various methods to assess gut health, and advocated for the expansion of validated functional gut microbiome assessments moving forward.
Raja Sivamani, MD MS AP, initiated the panel session. Katherine Varman, MD; Lakshi Alderdge, MSN ANP-BC DCNP FAANP; and Michael Traub, ND, reviewed several cases during this panel and emphasized the utility of functional gut testing for managing common inflammatory dermatoses. For patients with rosacea, they discussed the prevalence of SIBO in rosacea along with the various testing options. They also discussed treatment options for rosacea, including ivermectin, antibiotic therapy (rifaximin), herbal antibiotics, and the elemental diet. In general, the panel advised asking rosacea patients about gut symptoms which may reveal any underlying gastrointestinal triggers. For patients with atopic dermatitis, the panel suggested collecting a thorough medical history to identify any family history of atopy, frequency of flares, and precipitating factors. The panel also discussed utilizing systemic agents to quickly calm flare-ups, the implication of skin and gut dysbiosis in barrier function, and the goal of AD treatment, which is to build tolerance so that the body stops reacting to triggers. For psoriatic patients, the panel emphasized the role of diet and associated comorbidities. For example, the association of gluten sensitivity, IBD, metabolic diseases, and gut dysbiosis with psoriasis. The panel also discussed the utility of gut microbiome testing to identify pathogenic species and assess mucosal defense and suggested that specialized diets may help mitigate psoriasis.
Katie Varman, MD FAAD, discussed how supplements with photoprotective properties can be used for the prevention of photo-carcinogenesis. She began with a summary of innate defenses against photo-carcinogenesis, such as exogenous and endogenous antioxidants, melanin chromophores, cell cycle checkpoints/DNA repair, immunosurveillance, and more. She then elaborated on various food-based bioactive compounds that confer photoprotective effects. She discussed the importance of carotenoids for sun protection, as well as naturally occurring sources of carotenoids, including carrots, tomatoes, and kale. She discussed how polyphenols such as polypodium leucotomos, EGCG, pomegranate pine bark extract, isoflavones, spirulina, curcumin, silymarin, and almonds have antioxidant and anti-inflammatory effects that can mitigate photo-carcinogenesis. She also discussed how omega-3 fatty acids and micronutrients, including zinc, copper, manganese, folate, and niacinamide, also mitigate DNA repair and augment antioxidant defenses. Moreover, she discussed the role of the microbiome as a defense against UV-induced damage. She advocated for the use of supplements such as niacinamide, polypodium, leucotomos, omega-3 fatty acids, and carotenoids as a supportive measure for sun protection. Furthermore, she emphasized the role of a diverse diet with a variety of fruits and vegetables as well as sources of omega fatty acids. Finally, she advised caution with supplement dosing as high doses can have adverse effects.
Steve Daveluy, MD FAAD, discussed the impact of diet in the management of dermatological conditions. He began by discussing how TNF inhibitors may lead to weight gain but emphasized that the addition of a Mediterranean diet to TNFi therapy led to weight loss and reduced PASI scores to a greater extent than TNFi therapy alone. He also emphasized the role of high fiber/low red meat diets and omega-3 as complementary therapeutic modalities in the management of psoriasis. He went on to discuss the role of the gut microbiome in melanoma and suggested that diets high in fiber and probiotics can mitigate gut dysbiosis associated with mortality in melanoma. For patients with acne, he emphasized the association of hyperglycemia with acne severity and suggested that low-glycemic diets can improve acne, even alongside conventional treatments such as benzoyl peroxide. He discussed how whey protein, which is present in dairy, is a trigger for acne due to its influence on the mTORC pathway. Additionally, he advised omega-3 supplementation when on isotretinoin to reduce adverse effects such as dry lips and skin. Finally, he emphasized the benefits of adding vitamin D supplementation to field therapies for actinic keratoses. Overall, he advocated for the addition of several dietary modifications to enhance and treat a variety of dermatological conditions.
Dr. Anna Cabeca discussed cardiovascular disease and diabetes, specifically among menopausal women, and the influence of diet on health. Cardiac and metabolic health in Americans is alarmingly low. There is projected to be 700 million diabetics by the year 2045. Dr. Cabeca listed many of the hormonal symptoms of menopause that affect quality of life. She shared an inspiring personal story of overcoming early menopause.
Chronically acidic urine of a pH below 5.0 can be an indicator of certain pathologies, so adding an alkaline diet of mineral-rich foods can improve health. She spoke about the keto-alkaline concept as being revolutionary, bringing us into “energized enlightenment.” She also reviewed glucose to ketones nutrition and how it can influence lifestyle and the opportunities to manage without surgical interventions.
She stated how insulin and cortisol are important to our hormonal balance and didn’t forget everyone’s favorite oxytocin. Hormones can be negatively affected by stress, sleep, and disruptive chemicals. Intermittent fasting of 13 to 16 hours has been shown to have beneficial effects on metabolic health, and examples of individual patient outcomes were shared in this enlightening presentation.
This panel session was moderated by Dr. Daveluy and included panelists, Joseph Alban, DAc MS LAc; Stacy McClure, MD; and Emma Norton, ND, who expressed their ideas and expertise on approaches to maintain success in certain scenarios. Starting with a case study on a teenage boy with moderate-severe acne and speaking on the importance of getting to know your patient’s overall goals. Each panelist spoke on how to better minimize the side effects of antibiotic use in acne patients and recommended nutritional counseling for younger patients. A simple way to improve acne is by paying attention to our water, adding a water filter can make a difference. Another case was an adult with severe psoriasis who was about to start an IL17 inhibitor wanting to better understand his diet in relation to his flares and how to maintain a healthy diet with a busy schedule. The panelists all agreed you must be realistic with making dietary changes for someone who has a busy lifestyle. Options are to pull up a menu of places he likes and are available to him, and help him make better choices at those locations. Checking Vitamin D and maintaining optimal levels can better control their psoriasis as well. An interesting case of a child with eczema where the mother has questions on how to maintain therapy. When finding the right topical that a child can tolerate, it is better to start with samples so you and the mother can find something that is going to work. Other tips that were talked about were plain water baths and ointment afterward, washing clothing after buying new, and using oils such as coconut or sunflower seed oil. Another patient with hidradenitis suppurativa was discussed with more ways to help control the disease; starting a Mediterranean diet and watching for other comorbidities. Overall, the highlight in this discussion of an integrative approach to skin disease includes nutrition, as our gut microbiome and stress play huge roles. Stress was a key component in each case mentioned, having high amounts of stress can alter our skin microbiome and lead to a dysfunctional skin barrier. The panelists all agreed that managing stress was an important part of overall health and well-being.
Neal Barnard, MD, the keynote speaker and author of Your Body in Balance, finished off the day discussing the importance of a low-fat, plant-based diet and our health. Dr. Barnard walked us through multiple studies that covered how hormones can be altered by simple diet changes leading to excellent improvements. He shared inspiring facts about the life-altering changes made by diet in people living with diabetes, postmenopausal symptoms, menstrual pain, fertility issues, and breast cancer. He dived into the physiological role of hormones such as insulin and estrogen so we can better understand why these food choices influence each of these. Knowing how we can alter insulin function, we can not only help improve diabetic patients but sometimes eliminate it completely. He also emphasized the benefits of soy in our diet and the correlation between soybean intake and a decreased risk of breast cancer. With all this fascinating information, he also added tips on how to consume soybeans and tools on how to approach patients to help them begin their journey on a low-fat, plant-based diet.
Raja Sivamani, MD MS AP, facilitated this case-based panel session. Apple Bodemer, MD; Jonette Keri, MD PhD; and Michael Traub, ND, led an extensive conversation on how to develop integrative treatment regimens for acne and rosacea. They emphasized the importance of collecting a thorough medical history for rosacea patients in order to identify triggers that drive inflammation. The panel discussed various treatment options for rosacea, including conventional therapies such as isotretinoin and antibiotics, while also addressing various supplements, topicals, and dietary habits that may enhance treatment outcomes. For adult female acne, they discussed the importance of supplements (saw palmetto, maca root, silymarin, and pumpkin seed oil), and diet in patients unwilling to utilize conventional treatments. The panel discussed the use of myo-inositol, which has been shown to help with hormonal acne and is safe to use during pregnancy, and omega-3 supplements which can help mitigate adverse effects from isotretinoin. They also advocated for a high-fiber diet and foods that can cause beneficial hormonal shifts, such as whole soy foods. The panel also discussed the significant impact that acne can have on quality of life and reviewed the therapies available for post-inflammatory hyperpigmentation. For adult male acne, they emphasized the importance of sleep on testosterone fluctuations that drive acne and emphasized the importance of the maintenance period after isotretinoin treatment. Finally, they touched on the implications of using low-dose tretinoin to achieve similar efficacy while reducing adverse effects. Overall, the panel emphasized that the key to preventing recurrence is to address all the foundations of good health: stress, diet, sleep, and more.
Jonette Keri, PhD, delivered a presentation on new therapies for acne. One of the newer topical therapies clascoterone, a topical antiandrogen, that competes with DHT for binding to androgen receptors in sebaceous and hair glands. When speaking on this topical, Dr. Keri mentioned it didn’t work as well as she was expecting, although it was better than placebo, it was only slightly more effective. This shows us how complex acne can be. Another new topical therapy that was recently FDA approved is a triple-drug combination of a fixed dose of clindamycin phosphate 1.2%, benzoyl peroxide 3.1%, and adapalene 0.15 % gel. The studies done with this product showed improvement in self-perception, emotional, social, and acne symptoms.
Another alternative therapy she doesn’t want us to forget about is diet. She suggests a low glycemic load diet that has proven effective in acne patients. Supplements such as myo-inositol, which promotes the entry of glucose into the cell, and D-chiro inositol rule the conversion of glucose to glycogen. Both these inositols significantly improved PCOS patients’ acne scores.
Probiotics may be a therapeutic option or adjunct treatment, especially with antibiotics.
Dr. Keri highlighted the importance of a holistic approach, mental and social factors rather than the symptoms of illness only. Lastly, remember to give recommendations on a wash, moisturizer, and sunscreen for your acne patients.
Sasha Hu, MD, emphasized the enduring human preoccupation with anti-aging throughout history, from ancient anti-wrinkle remedies documented on papyrus to Greek researchers’ exploration of age-fighting foods. In the modern context, the aging industry has become a staggering $19.9 billion business in the US, prompting a crucial question: What truly delivers results? Driven by evidence-based research, certain ingredients stand out as effective anti-aging agents. Alpha hydroxy acids such as lactic, glycolic, citric, and malic acid show promise, but should be used in caution in conjunction with retinoids. Antioxidants like niacinamide, with its skin repair and sebum regulation benefits, and vitamin C, renowned for countering UV-induced damage and collagen synthesis, are highly regarded. Topical retinoids remain the gold standard in addressing aging concerns, with bakuchiol presenting as an effective retinol alternative. The intriguing Polypodium leucomotos is gaining more attention in the industry for both its anti-aging properties in addition to well-known photoprotective effect. What remains an important take-home point is understanding that not all evidence out there is equal, and it is important to keep a critical mind when going over data, so best patient care can be achieved.
Apple Bodemer, MD, opened the presentation by highlighting common patient concerns about hair health, including different types of hair loss. Dr. Bodemer discussed emerging therapies for alopecia areata, androgenic alopecia, and scarring alopecia. The session began with relaxation exercises such as diaphragmatic breathing and pursed lip exhales. Dr. Bodemer explained the structure of the hair follicle and the hair growth cycle, focusing on the WNT pathway and the role of JAK inhibitors. Androgenetic alopecia, a genetic patterned hair loss, was the main topic of discussion. It can be reversible in its early stages but becomes terminal and irreversible in later stages. Finasteride, a 5-alpha reductase inhibitor, is commonly used to treat androgenetic alopecia but may cause sexual and mood-related side effects. Alternative options include botanical 5-alpha reductase inhibitors like pumpkin seed oil, green tea, and American ginseng. Minoxidil, available in topical and oral forms, is another popular treatment with mechanisms such as vasodilation and interference with androgen receptors. Oral minoxidil may have side effects like edema and irregular heartbeats. Topical prostaglandins like bimatoprost and latanoprost, as well as Valproic acid, have shown potential in hair loss treatment. JAK inhibitors, including botanical examples like garlic and curcumin, have shown promise in treating alopecia areata. Diet and lifestyle also play a role in hair loss, with a Mediterranean diet rich in vegetables and herbs promoting hair health, while excessive consumption of sugary beverages may contribute to hair loss.
In this session, Hadar Lev-Tov, MD MAS, discussed the pathophysiology of Hidradenitis Suppurativa (HS), emerging medical and surgical therapies, and nutritional recommendations.
HS is a chronic inflammatory condition characterized by the recurrence of inflammatory nodules and abscesses, often resulting in extensive scarring. The exact cause of HS is not yet fully understood. However, it is believed to be a result of blocked hair follicles. Genetic predisposition, environmental factors like bacterial presence in the hair follicle, and hormonal imbalances are thought to contribute to the development of HS.
HS is clinically graded using various classification systems to assess the severity and extent of the disease. One commonly used grading system is the Hurley staging system, which categorizes HS into three stages.
Adalimumab and infliximab, TNF-alpha inhibitors, have shown promise in clinical trials for HS treatment. Secukinumab, bimekizumab, and biologics targeting IL-17A have also shown potential. Povorcitinib, an oral Janus kinase inhibitor, and clascoterone, a topical androgen receptor inhibitor, are being explored as treatments for HS.
Surgical interventions can be considered for the management of Hidradenitis Suppurativa (HS) in cases where medical treatments alone are insufficient. Nutrition-wise, the Mediterranean diet may be beneficial, while supplementation with zinc and vitamin D are common strategies in HS management.
Dr. Natalie Gustafson, PharmD, discussed a variety of oral and topical agents that can be compounded to combat aging. She opened the talk with a review of metformin and its beneficial effects on multiple aspects of health, including cardiovascular health and anti-aging benefits. She emphasized that metformin seems to have a dose-dependent effect on lifespan, but more research is necessary. She also discussed the safety profile and dosing of metformin and advised the use of the extended-release version. She then reviewed various pharmaceutical and non-pharmaceutical topical anti-aging agents as well as methods for compounding these agents to reduce adverse effects and achieve optimal results. Notably, she stressed the importance of identifying the form of vitamin C being used in compounds to prevent degradation and oxidation. Finally, she discussed the evidence for oral photoprotective supplements that can be used in combination with conventional sun-protective measures.
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