What is Integrative Dermatology - Integrative Dermatology Symposium

What is Integrative Dermatology?

LearnSkin Virtual Guide

Integrative dermatology focuses on the whole person mind, body, and spirit—incorporating systems like Ayurveda,
Traditional Chinese Medicine (TCM), and Naturopathic Medicine (Naturopathy) with conventional treatments to address skin wellness through diet, mindfulness, and lifestyle management. Frequently, skin conditions have profound social, emotional, and psychological consequences for those afflicted. However, medical visits often focus on diagnosis and treatment without as much exploration of underlying psychosocial issues. As demand for integrative approaches increases, research continues to gain traction in the field. LearnSkin’s team of experts curates emerging evidence and novel therapies for you to use in the clinic immediately.

Integrative medicine offers additional holistic tools than conventional approaches. As patients seek a more whole-body and preventative approach to skin concerns like aging, acne control, atopic dermatitis, psoriasis, and hyperpigmentation,

integrative approaches will help dermatology practitioners address patients more completely.

Integrative clinicians will be best poised to provide their patients
with multiple treatment options to choose from.

"Complementary and Alternative medicine (CAM) in dermatology encompasses a wide variety of methods of diagnosis and treatment that either supplement or substitute for conventional dermatologic practice. — Fitzpatrick’s Dermatology in General Practice; 2007"

HOW MANY PEOPLE ARE USING COMPLEMENTARY

AND ALTERNATIVE MEDICINE (CAM)?

Dermatology patients, specifically, have been increasingly using complementary and alternative therapies. A review of seven surveys of dermatology patients revealedlifetime CAM use to be between2

40%

The odds are likely that a majority of patients
coming into your office have tried CAM
treatments, are currently using them, or are
interested in pursuing them.

Dermatology patients, specifically, have been increasingly using complementary and alternative therapies. A review of seven surveys of dermatology patients revealed lifetime CAM use to be between

35%-69%

The odds are likely that a majority of patients
coming into your office have tried CAM
treatments, are currently using them, or are
interested in pursuing them.

HOW DOES PRACTICING INTEGRATIVE MEDICINE

BENEFIT ME AS A PRACTITIONER?

Are you feeling burnt out, uninspired, and overwhelmed in practice? While exploring integrative medicine
options for your patients can enhance your practice and patient care, many individuals studying these
modalities will try them out for themselves and have their own new and exciting experiences.

Being an integrative practitioner brings back the “Art of Medicine.” You will be able to regain that creativity
and tailor treatment plans to each patient’s needs with a more holistic and individualized approach
compared to a “one size fits all” approach.

“I see primarily general dermatology, certainly a lot of eczema and psoriasis. What was cool about ISHS (LearnSkin’s Integrative Skin Health Series) was that they really covered a lot of what I typically see in the day to day and different options that I could offer to patients backed by lots of clinical data and research. So, it’s really been rewarding and I’ve seen the patients get really excited when they hear about an integrative option. It’s been cool to see those patients come back after a couple of months and see that it really does make a difference in their day to day lives seeing them improve. It’s been everything from plant based oils to talking about spearmint tea for acne or low dose naltrexone and things like that. There’s a huge push from the patient’s perspective to really want an integrative approach and so it’s been really rewarding to be able to offer that to them.”
— Joy Logothetis, PA (ISHS Alumnus)

“It’s a very energizing community. Going through these programs you will make amazing changes for yourself. I have made changes to my diet, to my exercise, to my exercise routine, to meditation, to the way I just treat myself and the way I think about my health in a different way.” “It’s one of the rare learning opportunities where you can implement it in your own life just as much as you can share it with your patients and make yourself healthier at the same time.”
— Steven Daveluy, MD (IDCP Alumnus)

Practising integrative medicine also allows you to collaborate with other like-minded professionals across
integrative medicine disciplines. It can help create a strong referral network and sense of connection within your local community.

“Working closely with other traditions has been both educational and incredibly empowering. I can’t master everything, but I don’t have to: I can refer patients to a trusted friend and colleague and then together we can make a strong therapeutic alliance.”
— Peter Lio, MD

“Working with other integrative practitioners helps provide a much broader and well-rounded treatment plan. It allows me to focus on what I am really good at knowing that my patients are getting the great comprehensive care.”
— Apple Bodemer, MD

“Integrative medicine is not just about bringing together different perspectives, as it also beautifully and practically integrates different practitioners, therapies, and practice modalities to improve our knowledge and ability to care for patients.”
— Raja Sivamani, MD MS AP

“I couldn’t be more excited about the community, it is so validating. In practice sometimes you feel like you’re the only one interested in exploring other things. Then you go through the programs and meet all these other people from around the country and around the world that are like-minded and interested like you. They still bring that scientific way of thinking about things, so you connect.”

“You get energized and excited to be able to talk together. Now we talk on our Facebook group. We have an integrative book club where we’re reading some different books that incorporate these different concepts and meetings where we can stay in touch.”
— Steven Daveluy, MD (IDCP Alumnus)

INTEGRATIVE MEDICINE

DISCIPLINES

Has a patient asked you about botanicals and supplements for their dermatological concerns, and you didn’t feel confident enough to provide an answer? Or have you ever had a patient ask you about acupuncture, but you weren’t confident about how to respond?

Integrative dermatology practitioners consciously push the boundaries of their knowledge to develop their philosophy. Ayurvedic treatments incorporate botanicals, oils, scrubs, masks, and massages to address everything from acne, psoriasis, and atopic dermatitis, to signs of aging. With the growing popularity of Ayurveda’s sister sciences, yoga and meditation, many patients have developed an appreciation for these treatments.

What is covered:

Ayurveda
Traditional Chinese Medicine (TCM)
Naturopathic Medicine (Naturopathy)
Nutrition
Mindfulness and Mind-Body Approaches
Conventional Medicine

Ayurveda

The 5,000-year-old tradition of medicine known as Ayurveda, meaning the science of life, is one of the oldest known systems of medicine. This ancient science identifies five elements found in nature (ether, air, fire, water, and earth) and bridges them to physiology and function in the skin and body. These elements have unique compositions in each person and allow for a personalized approach to the skin’s imbalances and treatment protocols. In Ayurveda, the practitioner examines the balance of the three physiological energies (doshas): Vata, Pitta, and Kapha.3 Ailments, including skin conditions, can present differently based on the specific imbalances of the doshas, and treatments are tailored to these specific imbalances.

List of Modalities:

Herbal formulas
Botanical oils
Lifestyle changes
Diet
Kansa Wand
Marma Point Facial Massage
Svedana
Shirodhara

Evidence for the use of Ayurveda in Dermatology

Sunder Vati for Acne

Have you had patients hesitant to take systemic medications for acne, such as isotretinoin or spironolactone? Did they ask about any natural remedies they could take for their acne? Were you able to provide them with any alternatives?

Sunder Vati is an Ayurvedic herbal formula studied in patients with acne. The formula was shown to significantly decrease the severity of inflammatory and non-inflammatory acne
lesions.3,4 From an Ayurvedic perspective, it is thought to balance Kapha and Pitta Ayurvedic
doshas which are thought to be out of balance in patients with acne.

This Ayurvedic formula contains the following 4 herbs:3,4

1 Kutaj

(Wrightia antidysenterica)

2 Amalaki

(Emblica officinalis)

3 Vidanga

(Embelia ribes)

4 Ginger

(Zingiber officinale)

1 Kutaj

(Wrightia antidysenterica)

2 Amalaki

(Emblica officinalis)

3 Vidanga

(Embelia ribes)

4 Ginger

(Zingiber officinale)

Click below to learn more about Ayurvedic perspectives and treatments in dermatology
with some LearnSkin articles and courses:

Integrative Skin Series: Finding the Right Approach to Treat Acne

Treating Atopic
Dermatitis with
Ayurveda

Ayurveda and the Microbiome

Ayurveda Summit: A More Personalized Approach to Health

Integrative Medicine Inclusive of Ayurveda

TRADITIONAL CHINESE MEDICINE

Traditional Chinese Medicine (TCM) dates back thousands of years. When incorporating TCM into dermatology, the skin care practitioner seeks to balance their patient’s Qi or energy. Diseases, including dermatological conditions, are said to reflect an imbalance in dual forces known as Yin and Yang.

Integrative clinicians who elevate their practice with TCM can
help address atopic dermatitis, rosacea, acne, topical steroid
withdrawal, dryness, and discoloration with a new lens. All of
these conditions are considered to be an imbalance of Qi.

List of Modalities:

Acupuncture
Acupressure
Chinese herbal formulas
Moxibustion
Cupping
Gua Sha
Facial Rollers

Evidence for the use of
TCM in Dermatology:

Acupuncture and Acupressure
for Atopic Dermatitis

Do you have patients who can’t seem to break the itch-scratch cycle? Acupuncture and acupressure may be effective adjunctive tools to help these patients with this dilemma.

Ll 11

Acupuncture and acupressure have been studied and found to reduce pruritus and itching in individuals with atopic dermatitis and eczema.5–8

Specifically, applying pressure to the acupressure point LI 11, located on the lateral end of the transverse cubital crease, has been found to significantly reduce Visual Analogue Scale (VAS) and Eczema Area and Severity Index (EASI) lichenification scores in adult patients with atopic dermatitis.5 Pressure was applied to this point for 3 minutes three times per week for 4 weeks.5

From a TCM perspective, atopic dermatitis is a
disease involving excess dry and damp heat.8
Heat in TCM is synonymous with inflammation
in western terminology. The actions of LI 11 are
thought to clear heat and drain damp heat,
making it a great point to stimulate in patients
with AD.8

This treatment option is an affordable, quick
and easy way to help your atopic dermatitis
patients reduce their itch so their skin barrier
can heal.

Click below to learn more about TCM perspectives and treatments in
dermatology with LearnSkin articles and courses:

TCM for
Eczema

TCM Approach
to Eczema

Microbiome and
TCM Therapies

TCM Approach
to Nail Health

TCM for Eczema

TCM Approach to Eczema

Microbiome and
TCM Therapies

TCM Approach
to Nail Health

List of Modalities:

NATUROPATHIC MEDICINE

Naturopathic medicine incorporates practices that support the client’s overall health i.e., body, mind, and spirit. In addition to addressing the symptom, the naturopathic approach aims to thoroughly assess the root causes of disease states. The naturopathic approach will not only investigate the dermatological conditions a patient presents with but involves a thorough intake assessing the function of all of the organ systems. One of the key principles in naturopathic medicine is “doctor as teacher,” taking the time to educate patients on what is going on with their bodies and how treatments are thought to work.

Evidence for the use of Naturopathic
Medicine in Dermatology: Botanical
Medicine for Hair Loss

Have your patients been asking for more natural approaches to hair loss?

Botanicals such as rosemary oil and pumpkin seed oil are some options that may provide benefits to these patients.

Rosemary oil and pumpkin seed oil have both been studied to increase hair growth in individuals with androgenic alopecia.9–11 Rosemary oil applied topically, in patients with androgenic alopecia, was found to be just as effective as 2% minoxidil when compared over 3 and 6 months of use. Of note, the group assigned to the rosemary oil, experienced less
scalp itching as well.

Internally, 400 mg of pumpkin seed oil taken daily for 24 we was found to significantly increase hair growth when taken in men with androgenic alopecia.10 A 40% increase in mean hair count was observed after treatment.10 It is thought to have anti-androgen properties by blocking the 5-alpha reductase enzyme.

Another more recent study done in 2021, found 1 mL of pumpkin seed oil applied topically to females with female pattern hair loss daily, significantly increased upright regrowing hairs after 3 months of treatment.

Click below to learn more about Naturopathic Medicine perspectives and treatments in dermatology with LearnSkin articles and courses:

Overview of Philosophy and Approach
of Naturopathic Skin Therapies

Naturopathic and Integrative Dermatology Series

Wrinkles: Natural and Naturopathic Medicine Treatments

NUTRITION

Nutrition is the science of understanding nutrients in food, how the body utilizes nutrients for proper functioning, and the relationship between diet, health, and disease. Proper nutrition is the foundation for optimal growth and function. Analyzing and addressing a dermatology patient’s diet may have a positive impact on specific dermatological conditions, comorbidities, and overall health.

List of Modalities:

Click below to learn more about utilizing Nutrition in dermatology with LearnSkin articles and courses:

Nutrition and
Supplements Series

Diet and Herbs for
Dermatology: An
Integrative Approach Series

How Does Nutrition
Affect Acne?

Nutrition and Dietary
Supplements for Acne
and Rosacea

Gut-Skin Connection: The
Role of Nutrition and the
Microbiome in Hidradenitis
Suppurativa

Evidence for the Use of
Nutrition and Supplements
for Hair Health

The Role of Nutrition,
Herbs, and Supplements
for Anti-Aging

Jump Start Guide to
Using Nutrition and
Supplements

The mTOR Pathway and
Acne: Linking Nutrition
to Biochemistry

Evidence for the use of Nutrition in Dermatology: Dietary Approaches to Acne

Have your patients ever asked you if their diet
impacts their acne?

Emerging research has displayed the role nutrition
plays in dermatological conditions, such as acne,
rosacea, and psoriasis. Specifically, there has
been a correlation between whey protein and
acne occurrence.

Whey protein consumption in adolescents and bodybuilders has been associated with the development and exacerbation of acne.12–18 After discontinuing whey protein, acne lesions have been found to clear as well.

Screening patients with acne (especially
adolescents, young adults, and athletes)
for whey consumption may be a simple, yet
worthwhile part of an initial intake to assess
potential causes and triggers for a patient’s
acne. Swapping whey protein for other forms of
protein such as pea, brown rice, or soy, may help
improve client’s acne and reduce breakouts.

On average, U.S. medical schools offer roughly 19.6 hours of nutrition education throughout the 4 years of training.

MINDFULNESS AND

MIND-BODY APPROACHES

Mindfulness is the practice of focusing one’s awareness on the present moment while calmly acknowledging and accepting one’s feelings, thoughts, and bodily sensations. It can be used as a therapeutic technique to help reduce stress and anxiety.

Mindfulness in dermatology can be a great adjunctive tool for patients experiencing conditions, that fall under the psychodermatology discipline, such as dermatillomania and trichotillomania. However, it can also be highly impactful for patients suffering from any skin condition including skin cancer, psoriasis, acne, hidradenitis suppurativa, and atopic dermatitis as well.

List of Modalities:

Meditation
Mindfulness-Based
Stress Reduction
Journaling
Counseling
Yoga
Breathwork

Meditation
Mindfulness-Based
Stress Reduction
Journaling
Counseling
Yoga
Breathwork

Evidence for the use of Mindfulness in Dermatology:
MBSR for Skin Cancer

Have you noticed an increasing number of your patients experiencing psychological distress due to their dermatological conditions?

The percentage of adults in the United States with symptoms of an anxiety or depressive disorder was found to be 41.5% in 2021.20 Specifically, the incidence of anxiety and depression among individuals with skin disorders was found to be over 25% in another survey study in 2004.21 Depression and anxiety are found to be most prevalent in those with skin cancer and psoriasis, followed by those with acne.

A pilot randomized controlled trial of an online self guided mindfulness-based program for patients diagnosed with melanoma (who have completed)

treatment for stage 2c or 3 melanoma) found the program to significantly reduce the severity of fear of cancer recurrence (FCR) compared to the control group.

Introducing mindfulness-based practices to patients with cancer may be a cost-effective way to help them cope with the emotional toll that cancer diagnosis and treatment may have on them and their families.

Click below to learn more about the mind-skin connection and mindfulness in dermatology with LearnSkin articles and courses:

Stress: Everything About
Skin Cancer We Were Never
Taught in Residency

Psoriasis Comorbidities:
Psoriatic Arthritis and
Mental Health Issues

Conscious Embodiment: 3
Integrative Steps for Skin
Cancer Management

Find Mental and Physical
Strength Through the Power
of Qigong

Hair Matters: Emotional
Aspects of Hair Loss

Eczema and
Emotional Toll

CONVENTIONAL

Conventional, or western medical approaches, treat symptoms and diseases using evidencebased interventions including pharmaceuticals, radiation, or surgery.24 Modern medicine aims to understand the pathology of disease in order to develop treatments and interventions that target specific biologic mechanisms contributing to disease states. Several advances have been made over the years to improve patient care with new treatments being developed at a rapid pace.

List of Modalities:

Evidence for new conventional treatments within dermatology: Encapsulated Benzoyl Peroxide for Acne and Rosacea

Did you know there is a new formulation of benzoyl peroxide studied for the treatment of acne and papulopustular rosacea?

While benzoyl peroxide and topical retinoids have been studied to improve acne and rosacea, they have also been found to cause local irritation, itching, burning, and stinging. Benzoyl peroxide and tretinoin encapsulated with a silica shell are released gradually when it contacts the skin and has been found to be better tolerated compared to unencapsulated benzoyl peroxide. Micronized benzoyl peroxide has enhanced bioavailability and is better at entering the pilosebaceous unit as well.

A randomized phase 2 dose-ranging study found that 1% and 5% encapsulated benzoyl peroxide gel significantly reduce papulopustular lesions in individuals with mild, moderate, and severe inflammatory lesions after once daily application over 12 weeks of use compared to the vehicle.

A randomized phase 2 dose-ranging study found that 1% and 5% encapsulated benzoyl peroxide gel significantly reAnother 12-week phase 2 multicenter, doubleblind, randomized, vehicle-controlled study found microencapsulated benzoyl peroxide and tretinoin to significantly reduce inflammatory and noninflammatory acne lesion counts in males and females with moderate to severe acne.26 Improvement occurred without an increase in adverse events or reduced skin tolerability.duce papulopustular lesions in individuals with mild, moderate, and severe inflammatory lesions after once daily application over 12 weeks of use compared to the vehicle.

Click below to learn more about new and emerging conventional dermatology treatments with LearnSkin articles and courses:

Get Up to Date with Acne and Rosacea: Emerging Technologies and Evidence

JAK Inhibitors Update for Atopic Dermatitis

Expanding the Toolkit: Advances in Moderate to Severe Atopic Dermatitis Series

New and Emerging Treatments for Androgenetic Alopecia

Emerging Therapies for AD and Co-Managing With Allied Healthcare Practitioners

New and Emerging Topical Treatments for Eczema

Newest Phytochemicals for Healthy Aging

Safety of Biologics: The Risk of Infection and Malignancy With Biologic Therapy

So Many Psoriasis Treatments: Considerations for Choosing a Specific Biologic Therapy

HOW TO INTEGRATE:

PUTTING IT ALL TOGETHER

Case Stem: A 17-year-old female presents to clinic with moderate to severe acne. You notice she has several inflammatory lesions along her cheeks and forehead, and she seems anxious and self-conscious about her appearance. She is currently on an oral birth control pill, is not taking any other medications, and has no known allergies but mentions she has sensitive skin.

Now that you’ve gotten a taste of some integrative treatment options, were you surprised to find the evidence-based research supporting these treatment options?

Do you feel more comfortable potentially introducing some of these modalities into practice? Do you feel like you need some more education and practical application to feel confident? If you do, then you’ve come to the right place.

It’s also important to understand that while research on integrative modalities is essential

and is growing each year, sometimes an integrative approach doesn’t always fit into the standard research model where there is one intervention targeting one disease mechanism. An integrative approach typically utilizes multiple interventions and takes a more whole-body, individualized-approach which is not possible to convey in a randomized controlled trial.

Engage in this introspective self-learning case example outlining an integrative approach to acne to gain a better understanding of how the integrative approach works.

WHAT ARE SOME OTHER QUESTIONS

YOU WOULD LIKE TO ASK THIS PATIENT?

An integrative practitioner will not only ask about the presentation and history of the specific condition itself, but they may also inquire more about this patient’s diet, stress levels, coping mechanisms, sleep quality and patterns, energy levels, and how their acne affects their self-esteem and social interactions, or other potentially related systems such as GI symptoms, etc.

Certain screening tools such as the GAD2 and PHQ2 can be used to assess anxiety and depression if
the patient seems at risk.

The patient can also be asked about their specific health goals and assessed for level of commitment
to improving their health.

ARE THERE ANY LABS YOU WOULD LIKE TO RUN

BEFORE PROCEEDING WITH TREATMENT OPTIONS?

Some integrative practitioners may want to utilize gut microbiome testing or assess hormone levels in patients with acne.

Upon further discussion, you find out the patient’s diet reflects a standard American diet and she is experiencing some GI symptoms, such as gas, bloating, and constipation. She is very stressed with school and rates her stress level at 9/10. She tells you her breakouts get worse when she is under a lot of stress and she does have a habit of popping her lesions and picking at her skin during these periods of high stress. She admits that her acne prevents her from going out and socializing because she is very self-conscious about her appearance. You ask her if she would be okay with answering some questions to screen for anxiety and depression and she agrees. She

answers yes to both questions in the GAD2 and PHQ2, so you proceed with the GAD7 and PHQ9. She scores a 13 on the GAD7 (indicating moderate anxiety) and a 7 on the PHQ9 (indicating mild depression). She says her anxiety and racing thoughts keep her up at night, so she gets very little sleep, sometimes only 4 hours. Due to the lack of sleep, she ends up feeling tired and has low energy levels throughout the day rated at 5/10.

She tells you she can’t afford to do gut testing, but is open to any integrative treatment options. However, she does not want to go on oral isotretinoin unless it is the only option left for her. She is highly motivated to clear her acne and states she is willing to do whatever it takes.

Given this additional information, what are some integrative and holistic treatment
options you start to consider for this patient?

As we can see, the effect this patient’s acne has on her is more than just skin deep. Addressing both
her physical symptoms as well as her mental-emotional state will be key to reducing her stress,
improving her overall health, and in turn will help improve her skin.

Integrative practitioners, such as naturopathic doctors, utilize the therapeutic order to take a stepwise approach when making treatment plans. The therapeutic order focuses on reducing “obstacles
to cure,” starting with the least invasive treatment modalities first if appropriate.

Therapeutic Order
of Naturopathic Medicine

AN INTEGRATIVE PRACTITIONER MAY CONSIDER AND
OFFER THE FOLLOWING OPTIONS TO THIS PATIENT

AN INTEGRATIVE PRACTITIONER MAY CONSIDER AND OFFER THE FOLLOWING OPTIONS TO THIS PATIENT

Acne Lesions

Recommendation

Topical application of pumpkin seed oil, topical bakuchiol oil, or topical encapsulated benzoyl peroxide and tretinoin once daily.

(Giving informed consent on each option and letting the patient be involved in deciding which they want to choose or try first.)

Reasoning

Topical pumpkin seed oil has anti-inflammatory and antiandrogenic properties as it acts on the DHT pathway. Backuchiol is an Ayurvedic extract that acts similarly to retinoids and has been found to reduce acne lesion counts without causing increased irritation or redness, same with topical encapsulated benzoyl peroxide and tretinoin. Since the patient noted she has sensitive skin, these are all viable options to consider. Even though the patient mentioned she has no known allergies, the practitioner may still want to advise to do a small patch test of any topicals before applying all over the face, especially with some botanicals.

GI Symptoms (Gas, Bloating, Constipation)

Diet diary *Diet diaries may be triggering for individuals who struggle with eating disorders or have had a history of eating disorders, and should be avoided in these patients. It is important to be mindful of this and
screen for eating disorders before asking a patient to complete a diet diary.

Reasoning

Having the patient fill out a diet diary for at least 1-2 weeks will provide significant insight into their eating habits and nutrient consumption. When giving a patient a diet diary, it’s important to stress for them to log specific products, quantities, and ingredients they are consuming alongside any symptoms they experience throughout the day. This includes fluid intake as well.

It is helpful to have a diet diary that logs food intake and symptoms to see if there are any correlations or patterns indicating certain GI concerns, such as increased intestinal permeability (leaky gut) or small intestinal bacterial overgrowth (SIBO). Both can be linked to skin conditions, such as acne or rosacea. If the patient’s diet diary indicated more of a leaky gut picture, starting with l-glutamine might be preferred before starting a probiotic.

A diet diary might help you identify acne triggers such as whey protein. It’s also helpful to start with a diet diary before making any dietary recommendations so you can recognize the patient’s dietary preferences, and make easy swaps for any foods or meals that should be avoided and replace them with healthier options.

Sleep Quality, Anxiety, Racing Thoughts

Recommendation 1

Education on sleep hygiene

Reasoning

Since the patient described having poor sleep quality, this is another important area to address in the first step of the therapeutic order, “Establish the foundation for optimal health.” So many biological processes and cellular repairs occur when sleeping. To help the body heal, no matter what bodily system is experiencing disease, it is key to ensure the patient is getting adequate amounts of sleep to also address the second step on the therapeutic order “Stimulate self-healing.”

Sleep hygiene entails educating the patient on avoiding screens (phones, computers, TVs) at least 1-2 hours before bed, making sure the bed is comfortable, avoiding large meals and caffeine before bed, and creating a relaxing bedtime routine – potentially incorporating aromatherapy, etc.

Recommendation 2

Journaling at night

Reasoning

Since the patient described having racing thoughts at night, one simple suggestion to make is to have the patient write down all of their racing thoughts before bed to try to release them from their mind. Sometimes this is helpful for patients and for others it is not. It’s important to check in at each visit to see how the patient responds to any recommendation and if they are able to be compliant.

Recommendation 3

Daily guided meditation and/or sharing resources on Mindfulness-Based Stress Reduction (MBSR) programs she can enroll in.

Reasoning

Sleep and anxiety are closely related. Mindfulness activities such as meditation and MBSR programs may help the patient have more compassion for herself , reducing the racing thoughts contributing to her unhealthy sleep patterns. Introducing some mindfulness techniques may also provide the patient with some additional coping mechanisms to relax and reduce anxious behaviors she displays, such as skin picking.

Recommendation 4

Acupressure on acupuncture point Yin Tang

Reasoning

The acupuncture point “Yin Tang” is known in TCM philosophy to calm the mind and improve sleep. The point is located at the exact midpoint between the two eyebrows. Firm pressure can be applied and the point can be massaged for 5 seconds or so and can be repeated throughout the day. Acupressure is a very simple and free recommendation to make that may help provide some stress relief for patients.

If patients are interested in TCM, referring to a reputable TCM practitioner and working together as a team to treat a patient is always an option as well.

YinTang

Calms the mind
Improves Sleep
Reduces Congestion

It’s important to remember that integrative practitioners will likely not recommend the same exact protocol for every patient that presents with the same or similar conditions. This is where the “art of medicine” comes into play and considerations based on patient preference, history, access to treatment, budget, culture, and current health status are important to take note of when developing individualized treatment plans.

As you can see, the first visit recommendations primarily focus on “Establishing the foundation for optimal health,” but still incorporate some options to start addressing the client’s immediate concerns. The physical and mental pieces go hand in hand. As the patient experiences improvement of acne lesions, she will likely experience increased self-esteem and reduced anxiety as well. Providing the patient with something that will provide symptom relief while simultaneously working on restoring the basic foundations for health will make them feel motivated to continue working toward their health goals.

As an integrative practitioner, the next steps you might take in this case would be to develop an appropriate diet plan and potentially incorporate other supplements or probiotics to address gut-health-based on the patient’s diet diary. It’s becoming more and more important to address gut health in skin conditions as more research has emerged showing how closely the two systems are connected. Re-evaluating the patient’s response and compliance to the treatment plan at each visit will also guide any changes to the treatment plan moving forward.

A NOTE FROM OUR DIRECTORS

Integrative Dermatology is the practice of combining standard and conventional approaches in dermatology with various complementary modalities. Since this field is emerging, we at LearnSkin wanted to create educational resources introducing healthcare practitioners to modalities not typically covered in conventional medical schools. LearnSkin teaches you how to develop an insideout and outside-in approach to skin health.

You’ll learn new concepts from Ayurveda, Traditional Chinese Medicine (TCM), Naturopathic Medicine, and more. We teamed up with some of the most noted experts to create educational content that sets a new standard for healthcare.

We are a community of like-minded professionals on a mission to spread awareness and education in the field of integrative dermatology to help expand your toolkit and enhance patient care. We have a variety of Integrative Dermatology resources available including our LearnSkin Podcast, LearnSkin Master Classes, LearnSkin CME Programs, Certificate Programs (IDCP, ISHS, IECP), and Integrative Dermatology Symposium/Integrative Esthetician Track, to help support your individual learning goals. We hope to see you in an upcoming program soon!

Maria Mas

Medical Education Director

Raja Sivamani

Scientific Editor

REFERENCES

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States. J Altern Complement Med. 2014;20(5):392-398. doi:10.1089/acm.2013.0327
3. Treating Acne With An Integrative Approach To Skin | LearnSkin. Accessed August 28, 2022. https://www.learnskin.com/
articles/integrative-skin-series-finding-the-right-approach-to-treat-acne
4. Paranjpe P, Kulkarni PH. Comparative efficacy of four Ayurvedic formulations in the treatment of acne vulgaris: a
double-blind randomised placebo-controlled clinical evaluation. J Ethnopharmacol. 1995;49(3):127-132. doi:10.1016/03788741(95)01309-1
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dermatitis: a pilot trial. Acupunct Med J Br Med Acupunct Soc. 2012;30(1):8-11. doi:10.1136/acupmed-2011-010088
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