Latest / The Science of Skin / Dr. Peter Lio, well-known for his expertise in Integrative Dermatology, discusses complementary and alternative treatments and their role in treating dermatologic conditions.

Transcript

Dr. Peter Lio, well-known for his expertise in Integrative Dermatology, discusses complementary and alternative treatments and their role in treating dermatologic conditions. · The Science of Skin

• 0:08
  SPEAKER_00: Hi, I'm Dr.
• 0:09
  SPEAKER_00: Patty Ferris.
• 0:10
  SPEAKER_00: I'm a board certified dermatologist, and I'm your host for this episode of Skincare Confidential.
• 0:17
  SPEAKER_00: I could not be more delighted to have our guest today, which is Dr.
• 0:21
  SPEAKER_00: Peter Leo.
• 0:23
  SPEAKER_00: I'm going to tell you a little bit about Peter.
• 0:24
  SPEAKER_00: He's a clinical assistant professor of dermatology and pediatrics at Northwestern University.
• 0:30
  SPEAKER_00: He received his medical degree from Harvard Medical School and also did his dermatology training at Harvard.
• 0:36
  SPEAKER_00: And while at Harvard, he received formal training in acupuncture.
• 0:39
  SPEAKER_00: Dr.
• 0:39
  SPEAKER_00: Leo is the founding director of the Chicago Integrative Eczema Center and founding faculty member of the Integrative Dermatology Certificate Program.
• 0:48
  SPEAKER_00: He has over 200 publications and three textbooks, and he's on every podium at every meeting because everyone wants to hear from Peter Leo.
• 0:57
  SPEAKER_00: So bravo.
• 0:58
  SPEAKER_00: We're so excited you're here, Peter.
• 1:00
  SPEAKER_00: Thank you.
• 1:01
  SPEAKER_01: Thank you for having me.
• 1:02
  SPEAKER_01: You're too kind.
• 1:03
  SPEAKER_00: Well, that was all true, and I can't wait to talk to you.
• 1:08
  SPEAKER_00: So look, let's start with your own personal journey because I think everybody listening would love to know how did you get interested in integrative dermatology?
• 1:17
  SPEAKER_00: I mean, I know you were certified in acupuncture.
• 1:21
  SPEAKER_00: So obviously your interest was very early in our your medical career and your dermatology training, but just tell us all about that journey.
• 1:29
  SPEAKER_01: You know, I would say it goes back to when I was pretty little, I was always interested in fringe stuff, sometimes to the chagrin of my parents.
• 1:37
  SPEAKER_01: I loved UFOs and ghosts and, you know, cryptozoology, the Loch Nest monster.
• 1:42
  SPEAKER_01: I always liked that kind of stuff.
• 1:43
  SPEAKER_01: And so inevitably, when I got into medical school, I was quite drawn to those weird limnal areas, those fringes where questions would keep arising.
• 1:51
  SPEAKER_01: And I think a little bit of it is luck.
• 1:53
  SPEAKER_01: The timing was kind of perfect.
• 1:55
  SPEAKER_01: I was there when this sort of revolution for alternative and complimentary medicine was happening.
• 1:59
  SPEAKER_01: It was on the news.
• 2:00
  SPEAKER_01: There were all these people talking about it.
• 2:02
  SPEAKER_01: People were saying, you know, how do we use acupuncture?
• 2:04
  SPEAKER_01: Can it help?
• 2:05
  SPEAKER_01: What about these herbs?
• 2:06
  SPEAKER_01: And many times I would find that nobody seemed to know there wasn't a good answer.
• 2:10
  SPEAKER_01: So I was lucky that it was at the beginning of this and the answers were starting to come.
• 2:14
  SPEAKER_01: People were starting to do some science.
• 2:16
  SPEAKER_01: There was some research that was coming out, and it became kind of fun.
• 2:19
  SPEAKER_01: People would turn and say, hey, do you know anything about this?
• 2:21
  SPEAKER_01: You know, where how do we use Boris oil?
• 2:23
  SPEAKER_01: Where does this fit?
• 2:24
  SPEAKER_01: Can this actually do anything?
• 2:25
  SPEAKER_01: Or could it be dangerous?
• 2:26
  SPEAKER_01: You know, the other half of this is that sometimes these things are not totally benign.
• 2:30
  SPEAKER_01: So it was kind of fascinating.
• 2:31
  SPEAKER_01: And then I saw this opportunity to take formal acupuncture training after my residency, and I loved it.
• 2:37
  SPEAKER_01: It was incredibly eye-opening.
• 2:38
  SPEAKER_01: Two wonderful teachers, Kiko Matsumoto, David Euler.
• 2:41
  SPEAKER_01: They were just, they're great clinicians.
• 2:43
  SPEAKER_01: You know, they really are dedicated to their patients.
• 2:45
  SPEAKER_01: They're solving problems, they're thinking about things, they're learning and growing.
• 2:48
  SPEAKER_01: And I said, Wow, these are my people.
• 2:49
  SPEAKER_01: This is what I want to do.
• 2:50
  SPEAKER_01: And sort of found this community of people that are interested in this.
• 2:53
  SPEAKER_01: And it just keeps growing and growing.
• 2:55
  SPEAKER_01: So it's been an incredible journey.
• 2:56
  SPEAKER_01: And I'd like to think we're, you know, in a way, we've only just begun.
• 2:59
  SPEAKER_00: Oh, I'm sure.
• 3:00
  SPEAKER_00: I I couldn't agree more.
• 3:01
  SPEAKER_00: So was were you in medical school or was that during a dermatology residency, during the residency training that you got the acupuncture um training?
• 3:10
  SPEAKER_01: Yes, right after residency.
• 3:11
  SPEAKER_01: In fact, yeah, I just finished up residency and then I spent a full year.
• 3:14
  SPEAKER_01: Well, I was seeing patients, you know, so during by day kind of doing my first year of being an attending, by night doing the course.
• 3:20
  SPEAKER_01: And then I kind of spent the second year being a bit of an apprentice and continuing to do it.
• 3:24
  SPEAKER_00: Oh, interesting.
• 3:24
  SPEAKER_00: So you had very extensive training.
• 3:26
  SPEAKER_00: I mean, I think one of the criticisms a lot of people have of CAM, and you know that I'm interested in CAM as well.
• 3:32
  SPEAKER_00: In fact, you and I met on a CAM, it was either a work group or a task force years ago.
• 3:37
  SPEAKER_00: But one of the criticisms that we often hear is that there just aren't enough studies.
• 3:41
  SPEAKER_00: There's not enough rigorous scientific evidence to back it up.
• 3:44
  SPEAKER_00: So speak to that a little bit.
• 3:46
  SPEAKER_00: And do you think that's changing now?
• 3:49
  SPEAKER_01: I definitely think you're right.
• 3:50
  SPEAKER_01: By and large, the area that we're focused on is even by definition, is going to have a lower level of evidence, or sometimes no evidence at all, than what we would put into the conventional canon of medicine.
• 4:00
  SPEAKER_01: I mean, I think we pride ourselves in practicing evidence-based medicine by saying, listen, hey, we know this is going to work because we have this double-blind randomized control trial.
• 4:10
  SPEAKER_01: It's been duplicated.
• 4:11
  SPEAKER_01: We understand it.
• 4:12
  SPEAKER_01: And ideally, I would even say the next level beyond just good evidence really is this precision medicine understanding.
• 4:18
  SPEAKER_01: We now understand the mechanism of disease.
• 4:19
  SPEAKER_01: We can isolate a gene and say, okay, this is the genetic malformation, this is the protein problem.
• 4:24
  SPEAKER_01: This is exactly mechanistically how it's working.
• 4:26
  SPEAKER_01: That's the highest level.
• 4:27
  SPEAKER_01: And we're there in some areas of medicine.
• 4:29
  SPEAKER_01: But you're right, for CAM, competent or alternative medicine or integrative approaches, we by definition don't have those things.
• 4:35
  SPEAKER_01: But there is this misconception, I think, that there's no data that, or that the data out there has shown that it's been debunked or disproven.
• 4:41
  SPEAKER_01: And a lot of times, once you start digging in, it's pretty amazing.
• 4:44
  SPEAKER_01: You'll find studies that are actually pretty good.
• 4:46
  SPEAKER_01: And some of the things that we do, I think, honestly can can rival and in sometimes even will, I think, can overshadow some of the things that we take for granted.
• 4:55
  SPEAKER_01: So, for example, you know, pediatric dermatology is about half my practice.
• 4:58
  SPEAKER_01: I'm focused on kids.
• 4:59
  SPEAKER_01: Most of the things I do in a daily basis really have very little evidence in kids.
• 5:03
  SPEAKER_01: And of course, we know many of the disorders we treat literally have zero FDA-approved medications.
• 5:08
  SPEAKER_01: So, you know, we can sort of get on our podium and say, look, it's so important to use evidence-based things.
• 5:14
  SPEAKER_01: But then the other half of our day, it's like oral like in plainest.
• 5:17
  SPEAKER_01: Uh, do you have any FDA-approved things?
• 5:19
  SPEAKER_01: No.
• 5:19
  SPEAKER_01: And the most of the studies are small.
• 5:20
  SPEAKER_01: They're, you know, so we're kind of used to that.
• 5:22
  SPEAKER_01: And I often think that really good clinicians, by, you know, sort of instinct, will go into these areas.
• 5:27
  SPEAKER_01: They're going to try to solve problems for their patients.
• 5:29
  SPEAKER_01: They're going to look and think outside of the box.
• 5:31
  SPEAKER_01: And to me, that's really exciting and attractive about dermatology in general.
• 5:34
  SPEAKER_01: And this is maybe even another extra scoop of that.
• 5:38
  SPEAKER_00: I think you're right about that.
• 5:39
  SPEAKER_00: I think we push the boundaries a lot in dermatology.
• 5:41
  SPEAKER_00: So that makes a lot of sense.
• 5:43
  SPEAKER_00: What areas of dermatology, we're going to talk about eczema for sure, but what other areas of dermatology do you think we're making some inroads on with integrative approaches, acne, rosacea, some of these conditions that we treat, that our patients are looking for alternative treatments a lot of times?
• 5:59
  SPEAKER_01: They definitely aren't.
• 6:00
  SPEAKER_01: Thank you for bringing that up because that's the other piece.
• 6:02
  SPEAKER_01: I sometimes will talk to clinicians who hate this stuff and they're kind of rolling their eyes and they're saying, I don't really care about this.
• 6:07
  SPEAKER_01: Like I really want the science.
• 6:09
  SPEAKER_01: But I say, I hear you, but our patients really do.
• 6:12
  SPEAKER_01: They want to talk about it.
• 6:12
  SPEAKER_01: They're interested.
• 6:13
  SPEAKER_01: So at the very least, I think it's good to know a little bit about it, even if we can, again, help steer people away from areas where there's not good evidence or sometimes evidence of real harm or real danger.
• 6:22
  SPEAKER_01: But you're right.
• 6:23
  SPEAKER_01: I think all of the things that we focus on and we see frequently, you're going to see some alternative approaches to them.
• 6:29
  SPEAKER_01: I think the more obscure we get, the more difficult.
• 6:31
  SPEAKER_01: So, for example, we wrote a paper recently about the scarring alopecias.
• 6:35
  SPEAKER_01: And boy, I mean, we don't have many conventional things for this group of disorders that has a huge impact on our patients.
• 6:40
  SPEAKER_01: But when you get into alternative, then it's really the Wild West.
• 6:43
  SPEAKER_01: There's almost no good evidence for things there.
• 6:45
  SPEAKER_01: So almost everything is extrapolated.
• 6:47
  SPEAKER_01: We say, well, we think this is anti-inflammatory and in a similar condition, but it's really out there.
• 6:51
  SPEAKER_01: But when we get to the more common things, I think we do have good things.
• 6:54
  SPEAKER_00: I agree.
• 6:55
  SPEAKER_00: Do you use a lot of alternative treatments for your, say, pediatric acne patients?
• 7:01
  SPEAKER_01: I do.
• 7:02
  SPEAKER_01: I think, you know, for acne and rosacea, there are some things that are helpful.
• 7:05
  SPEAKER_01: And I'll be very, very clear here.
• 7:07
  SPEAKER_01: And of course, with my patients too.
• 7:09
  SPEAKER_01: First of all, I sort of present it as an option or an approach we can take.
• 7:12
  SPEAKER_01: Some of my patients come in and that's all they want.
• 7:14
  SPEAKER_01: Others come in and they're not that interested in these things.
• 7:17
  SPEAKER_01: Um, but I honestly will say with good faith, I don't think there's any situation where these are going to replace a conventional therapy.
• 7:24
  SPEAKER_01: These really are best thought of as sort of a complimentary piece.
• 7:27
  SPEAKER_01: We could say, listen, you have pretty bad acne.
• 7:29
  SPEAKER_01: You're, you may even need isotretinoin, right?
• 7:32
  SPEAKER_01: We have a lot of patients like this, but maybe they don't want to go there.
• 7:34
  SPEAKER_01: Or maybe it's one notch down and the real next step should be an oral antibiotic.
• 7:38
  SPEAKER_01: They're getting scarring, it's pretty widespread.
• 7:40
  SPEAKER_01: But they say, is there anything else?
• 7:41
  SPEAKER_01: And sometimes I think, yes, the answer could be we might be able to do something.
• 7:45
  SPEAKER_01: So maybe we're going to maximize our topicals.
• 7:46
  SPEAKER_01: We're going to use a good prescription retinoid.
• 7:48
  SPEAKER_01: We're going to maybe use a topical combination that has glindamycin, benzo peroxide, very conventional.
• 7:53
  SPEAKER_01: But then instead of adding on a tetracycline class antibiotic, maybe we can do something with some vitamins.
• 7:58
  SPEAKER_01: So there are two vitamins that actually have a reasonably, I think, convincing amount of evidence that they may help with acne.
• 8:05
  SPEAKER_01: And one of them is niacinamide.
• 8:06
  SPEAKER_01: Niacinamide's fascinating because it also seems to have a effect in preventing skin cancer, although more recent study showed it didn't do well in a transplant population, although it's interesting to think about how that population may be different.
• 8:18
  SPEAKER_01: But it seems to have an anti-inflammatory effect and decrease some of the inflammatory acne.
• 8:23
  SPEAKER_01: And then pantathenic acid is another vitamin that has been shown to help with comadonal acne.
• 8:28
  SPEAKER_01: So sometimes I'll have my patients take one of each of these supplements twice daily.
• 8:32
  SPEAKER_01: And what's great is these are very inexpensive.
• 8:34
  SPEAKER_01: You can get these, you know, for just honestly like$10 or$15 a month total.
• 8:38
  SPEAKER_01: And I've seen a dramatic improvement.
• 8:40
  SPEAKER_01: Patients that I was pretty convinced were going to need to go on an oral antibiotic now have actually been able to avoid that.
• 8:45
  SPEAKER_01: And then we can keep them in a good place without needing to go to that level.
• 8:49
  SPEAKER_01: So to me, that is sort of the that's my ultimate goal to use something that is very conventional and evidence-based, and maybe something a little bit outside of the box, but still have some evidence to help a patient get to where they want to go.
• 9:00
  SPEAKER_01: It doesn't always work.
• 9:01
  SPEAKER_01: Of course, you know, I have treatment failures or our situations where I say, Well, we tried.
• 9:04
  SPEAKER_01: But you know what's really neat sometimes when you fail, right?
• 9:07
  SPEAKER_01: But when you've tried, at least the patient might say, Golly, well, thank you for trying.
• 9:11
  SPEAKER_01: Now I am ready to take the antibiotic, or now I am ready to try isotretinoum because I feel like I gave a good, a good try before we went this direction.
• 9:18
  SPEAKER_00: Right.
• 9:18
  SPEAKER_00: And it's great to have some of these things also to get patients off of things like antibiotics.
• 9:23
  SPEAKER_00: Now we're trying to be such, you know, better stewards of our antibiotic resistance problems.
• 9:28
  SPEAKER_00: So it's good to have alternatives to give those patients.
• 9:31
  SPEAKER_00: Talk to us about the Chicago Integrative Eczema Center.
• 9:35
  SPEAKER_00: How did you start that?
• 9:37
  SPEAKER_00: What was the impetus for that?
• 9:38
  SPEAKER_00: And then, of course, we want to know all about the treatments that you're doing there that are cutting edge and different than what someone might get at another eczema center.
• 9:46
  SPEAKER_01: Thank you.
• 9:47
  SPEAKER_01: Yeah, so I think eczema probably more than anything else pushed me to focus on alternative approaches.
• 9:52
  SPEAKER_01: It was the disease that I kept just hitting my head against in residency and saying, why can't we do more for these patients?
• 9:58
  SPEAKER_01: There must be other approaches.
• 9:59
  SPEAKER_01: And of course, our patients are so unsatisfied.
• 10:01
  SPEAKER_01: And my wearing my other hat as a board member for the National Eczema Association, an amazing patient support organization, a nonprofit group.
• 10:08
  SPEAKER_01: You know, we hear all day long patients just feel so dismissed and unheard and just inadequately treated.
• 10:14
  SPEAKER_01: So I thought, gosh, is there some other approach to this?
• 10:16
  SPEAKER_01: And I think that's really what drove me to form the center, to be a little bit more holistic, to think outside of the box.
• 10:22
  SPEAKER_01: A big part of the agenda is really also a support group mechanism.
• 10:26
  SPEAKER_01: So we like patients to sit together.
• 10:28
  SPEAKER_01: I felt this terrible tension where I'd go from room to room to room, talking to these patients and families.
• 10:32
  SPEAKER_01: And it was crazy.
• 10:33
  SPEAKER_01: Each patient and family felt totally isolated.
• 10:35
  SPEAKER_01: They're like, I'm the only one who suffers from this.
• 10:37
  SPEAKER_01: I'm so alone.
• 10:38
  SPEAKER_01: No one understands me.
• 10:38
  SPEAKER_01: And I'd be like, no, wait, the last three patients in room, you know, room two and room four, they literally are in the same situation.
• 10:45
  SPEAKER_01: But obviously, you can't bring them together during a visit.
• 10:47
  SPEAKER_01: So I said, what if we met outside of clinic and did it?
• 10:50
  SPEAKER_01: And it's been incredible that way, too.
• 10:51
  SPEAKER_01: We've since the pandemic, we switched to an online format, but we used to do live meetings and they were wonderful.
• 10:56
  SPEAKER_01: And the online are even better in some ways because people come now from all over the country and even all over the world.
• 11:01
  SPEAKER_00: Wow.
• 11:01
  SPEAKER_00: And so what kind of treatments are you using, alternative treatments there?
• 11:05
  SPEAKER_00: I mean, are you using acupuncture?
• 11:07
  SPEAKER_00: Are you using other CAM treatments?
• 11:10
  SPEAKER_01: Absolutely.
• 11:11
  SPEAKER_01: So I would say, you know, we kind of have a huge array and I have kind of a large palette, for me at least in eczema atopic dermatitis, that's where I have the most treatments that I bring in, starting from maybe the simplest of simple things, like one of the things I've been obsessed with in the past couple of years is the black tea compress.
• 11:27
  SPEAKER_01: There was a wonderful paper actually from Germany.
• 11:29
  SPEAKER_01: It was a very conventional study.
• 11:31
  SPEAKER_01: And in fact, if I would have blocked out that they were actually using tea, like black, literally black tea that you drink, if I would have blacked that out and put instead, you know, this is drug X, I think you could be convinced that it's really a drug study.
• 11:41
  SPEAKER_01: They have a facial easy score and they have the investigator global assessment.
• 11:45
  SPEAKER_01: They have all these beautiful things, and they showed how just in a few days there was a dramatic improvement in facial atopic dermatitis.
• 11:51
  SPEAKER_01: And also they they included patients that had a contact dermatitis.
• 11:54
  SPEAKER_01: So this has been a game changer for me, where we just have them brew up some black tea.
• 11:59
  SPEAKER_01: And the ideally, the way that they've described it in the paper is you make your first cup and then you either drink that or pitch that one, and you're going to do the second steeping.
• 12:06
  SPEAKER_01: So it's a little bit weaker, a little bit of a milder preparation.
• 12:08
  SPEAKER_01: I have my patients keep it in the refrigerator.
• 12:10
  SPEAKER_01: I don't want anyone to be burned.
• 12:12
  SPEAKER_01: So they keep it in the fridge.
• 12:14
  SPEAKER_01: Exactly.
• 12:14
  SPEAKER_01: And that's all they do.
• 12:15
  SPEAKER_01: They take that cool compress with a with a cloth and they do that a few times a day.
• 12:19
  SPEAKER_01: Dramatic.
• 12:20
  SPEAKER_01: So that's something you can you can integrate with all sorts of things.
• 12:22
  SPEAKER_00: Was this a controlled study?
• 12:25
  SPEAKER_01: Uh in this study, they didn't do a proper control in this one.
• 12:29
  SPEAKER_01: It was more of a descriptive case series, but really remarkable for these patients.
• 12:33
  SPEAKER_00: So what is in the black tea compress?
• 12:36
  SPEAKER_01: It's hard to know.
• 12:37
  SPEAKER_01: You know, is it the tannic acid that acidifies and strengths, right?
• 12:41
  SPEAKER_01: Does it strengthen the acid mantle?
• 12:42
  SPEAKER_01: Is it the caffeine, which may have some immunomodulatory effects?
• 12:45
  SPEAKER_01: Is it something else?
• 12:46
  SPEAKER_01: You know, tea is kind of these plants are complex.
• 12:48
  SPEAKER_01: These botanicals are amazing.
• 12:49
  SPEAKER_01: So is it you can do that?
• 12:50
  SPEAKER_01: So many phytonutrients in there.
• 12:53
  SPEAKER_01: Exactly.
• 12:54
  SPEAKER_00: That's an that's really interesting.
• 12:57
  SPEAKER_00: Um, talk to me about nutraceuticals a little bit.
• 13:00
  SPEAKER_00: Um, we talked a little bit about the acne, but what do you do in terms of eczema patients?
• 13:05
  SPEAKER_00: Do you have any nutraceuticals that you go to?
• 13:07
  SPEAKER_00: Or nutritional?
• 13:08
  SPEAKER_00: I mean, nutrition is such a huge part of atopic dermatitis.
• 13:12
  SPEAKER_00: So sort of address that as well.
• 13:14
  SPEAKER_01: Absolutely.
• 13:15
  SPEAKER_01: And it's probably the single biggest question I get is you know, what is the role of food?
• 13:18
  SPEAKER_01: So many patients will really focus on their diet, and sometimes dangerously so.
• 13:22
  SPEAKER_01: We've had these families where the kids are failing to thrive because they they keep excluding different foods, and the poor kids, you know, they're eating goat milk and and and rocks.
• 13:30
  SPEAKER_01: I don't know what they're eating.
• 13:31
  SPEAKER_01: They're they're yeah.
• 13:32
  SPEAKER_01: And so you worry about this.
• 13:33
  SPEAKER_01: But typically what I do is I kind of emphasize healthy diet.
• 13:36
  SPEAKER_01: I want people trying to minimize processed foods.
• 13:38
  SPEAKER_01: I try to avoid things like emulsifiers.
• 13:40
  SPEAKER_01: There's some some evidence now that some of the emulsifiers and foods are actually quite bad for the gut lining.
• 13:46
  SPEAKER_01: You know, we know these epithelial barriers are very sensitive.
• 13:48
  SPEAKER_01: And so the foods that we eat can actually have an effect on the lining, which then affects the microbiome, which then can affect all of these distal things, right?
• 13:56
  SPEAKER_01: This barrier hypothesis.
• 13:57
  SPEAKER_01: Uh, I think vitamin D is one of these fascinating, I even have like a whole lecture about it because it's sort of a roller coaster ride.
• 14:04
  SPEAKER_01: Vitamin D, first question, is low vitamin D associated with atopic dermatitis?
• 14:09
  SPEAKER_01: Well, it depends.
• 14:09
  SPEAKER_01: Some studies show yes, there is a correlation.
• 14:11
  SPEAKER_01: Others show, eh, we didn't see it in this group.
• 14:13
  SPEAKER_01: The second bigger question is does vitamin D supplementation help?
• 14:17
  SPEAKER_01: And again, you'll see some studies say yes, it does.
• 14:19
  SPEAKER_01: Others say it doesn't really seem to help.
• 14:20
  SPEAKER_01: There aren't any studies, to my knowledge, that show it hurts, though.
• 14:23
  SPEAKER_01: That's important.
• 14:24
  SPEAKER_01: But I think that this is a situation where there's a group of people that actually are sensitive to vitamin D and we just don't know how to pick them out.
• 14:30
  SPEAKER_01: So a little bit of the luck of the draw, when you pick a study, you either get patients who they're going to respond to or they're not.
• 14:36
  SPEAKER_01: But I truly recommend it for almost all of my patients.
• 14:38
  SPEAKER_01: I think that vitamin D supplementation helps a group of them.
• 14:41
  SPEAKER_01: And because I can't pick who that is, and because it's pretty safe, I let that go and I think that's helpful.
• 14:45
  SPEAKER_01: I also think that oral probiotics are helpful.
• 14:47
  SPEAKER_01: It's the same kind of story where some studies show yes, some studies show no, and there are many, many unanswered questions.
• 14:52
  SPEAKER_01: But I like to pick a mixed probiotic that, again, is not too expensive because part of the hidden story about alternative approaches is that it can be extremely expensive for the patient.
• 15:01
  SPEAKER_01: By definition, these aren't covered by insurance.
• 15:03
  SPEAKER_01: So I try to be very mindful of the cost.
• 15:05
  SPEAKER_01: But those are a couple of the things that I really like.
• 15:07
  SPEAKER_01: Uh, there's also been a study that I really shaped my practice where they had patients take hemp seed oil.
• 15:13
  SPEAKER_01: So actually take it by mouth.
• 15:15
  SPEAKER_01: And they actually showed quite an impressive improvement in atopic derms.
• 15:18
  SPEAKER_01: So for the older kids and adults, I will often have them try that.
• 15:21
  SPEAKER_00: Wow, those are some interesting approaches.
• 15:24
  SPEAKER_00: Talk about um, you're so well-versed in the skin barrier.
• 15:28
  SPEAKER_00: So we have to talk a little bit about what are some of your favorite, maybe more alternative topicals to use for barrier function, improving barrier function, eczema patients, and other patients as well.
• 15:41
  SPEAKER_01: Yes, you know I love this, and and the Science of Skin Care Summit is my favorite.
• 15:45
  SPEAKER_01: I felt like a kid in a candy shop just hearing everybody talk about it in a way that honestly, I, you know, it was the highest level I've ever heard.
• 15:51
  SPEAKER_01: It was like, you know, playing amateur tennis and then going to a professional match.
• 15:54
  SPEAKER_01: It was incredible.
• 15:55
  SPEAKER_00: It was a lot of fun.
• 15:56
  SPEAKER_01: But yes, some of the things, right?
• 15:58
  SPEAKER_01: Some of the things that we can do from an integrative standpoint, I think are fascinating.
• 16:03
  SPEAKER_01: One of them is I'm a huge fan of sunflower oil.
• 16:06
  SPEAKER_01: So I think sunflower oil, and Larry Eichenfield put a paper out years ago.
• 16:10
  SPEAKER_01: I think it was, I mean, relatively speaking, he's written so much, but it was sort of a throwaway paper because when I told him about it, he was like, oh yeah, I guess I did write that.
• 16:17
  SPEAKER_01: But it really does seem to have an effect on barrier directly, but it seems to stimulate natural ceramide production.
• 16:22
  SPEAKER_01: So this is kind of a neat way to solve that problem.
• 16:24
  SPEAKER_01: I mean, you still you can might use you know ceramides from the outside, externally applied, but this helps boost endogenous ceramides.
• 16:31
  SPEAKER_01: I'm also a very good thing.
• 16:32
  SPEAKER_00: It's very interesting.
• 16:33
  SPEAKER_00: Is that a sensitizer?
• 16:35
  SPEAKER_00: Sunflower.
• 16:36
  SPEAKER_01: Very rarely.
• 16:37
  SPEAKER_01: So it's a it's a key point.
• 16:39
  SPEAKER_01: And sometimes when I'm talking to allergists, they get nervous about that, right?
• 16:42
  SPEAKER_01: Allergists are saying, wait a minute, we don't want to put foods on the skin, right?
• 16:45
  SPEAKER_01: That's what you keep saying.
• 16:46
  SPEAKER_01: You're you don't want to transcutaneously sensitize them to foods.
• 16:49
  SPEAKER_01: But it turns out some are very high risk, some are low.
• 16:51
  SPEAKER_01: And we think sunflower and coconut are relatively low risk.
• 16:53
  SPEAKER_00: No, tell me about coconut.
• 16:55
  SPEAKER_00: You like it as well, or you how do you use the two?
• 16:58
  SPEAKER_01: I love it.
• 16:59
  SPEAKER_01: I love coconut.
• 17:00
  SPEAKER_01: So coconut's fascinating because it contains these things called monolaurins, which seem to have a powerful antibacterial effect, particularly against Staph aureus, which is one of the bad actors in atopic derm.
• 17:11
  SPEAKER_01: And it's incredibly elegant.
• 17:12
  SPEAKER_01: It kind of melts at skin temperature.
• 17:14
  SPEAKER_01: And I love the fact that, again, it's a very, very rare sensitizer, non-zero.
• 17:18
  SPEAKER_01: So for the allergists who might, you know, they they'll get their hackles up, I will never say that this can't cause trouble.
• 17:23
  SPEAKER_01: These things, they can cause trouble, but so can cocamidal propyl betane, and so can, you know, MCI.
• 17:28
  SPEAKER_01: And so, you know, it's it's it's a real thing.
• 17:30
  SPEAKER_01: It's not, it's not something magical.
• 17:32
  SPEAKER_01: But boy, can it help.
• 17:33
  SPEAKER_01: So my favorite is we actually have we have a wonderful, uh, he's actually a perfumist here in Chicago, and he does different types of aromatherapy things and gets wonderful oil.
• 17:42
  SPEAKER_01: So he makes for our patients a combination of sunflower oil, coconut oil, and kind of a jojoba oil base.
• 17:49
  SPEAKER_01: And it's this wonderful, kind of silky feeling oil that they can use.
• 17:53
  SPEAKER_01: And you kind of get the best of a few different worlds.
• 17:55
  SPEAKER_01: Very inexpensive.
• 17:56
  SPEAKER_01: We use food grade oils, and I think that's amazing.
• 17:58
  SPEAKER_01: But you can also just for patients who can't get that, we just have them pick up, you know, there are so many nice, inexpensive, very, very well-rated oils that you can get online.
• 18:06
  SPEAKER_01: And I think that's a wonderful adjunct.
• 18:08
  SPEAKER_01: That's not going to replace something that's not a topical steroid replacement, but boy, can it really help, especially for patients who are very dry.
• 18:14
  SPEAKER_00: Wow.
• 18:14
  SPEAKER_00: What a formulation.
• 18:15
  SPEAKER_00: That sounds amazing.
• 18:17
  SPEAKER_00: What do you do?
• 18:17
  SPEAKER_00: Do you do anything else like for, you know, atopic dermatitis is such a stressful disease.
• 18:23
  SPEAKER_00: The whole family's under stress.
• 18:24
  SPEAKER_00: People are sleepless.
• 18:26
  SPEAKER_00: Do you do any sort of relaxation techniques or meditation?
• 18:29
  SPEAKER_00: Yes, I'm sure you do.
• 18:31
  SPEAKER_01: Absolutely.
• 18:32
  SPEAKER_01: And I love it.
• 18:32
  SPEAKER_01: You know, in fact, uh, I work with a close colleague here in Chicago who is a hypnotherapist, and it's an incredibly interesting approach.
• 18:40
  SPEAKER_01: You know, a lot of the families, I think there's a huge psychological burden to this disease.
• 18:43
  SPEAKER_01: You know, we know there's a lot of anxiety, a lot of depression.
• 18:45
  SPEAKER_01: And some patients can kind of blanch if you mention, you know, I'd like you to see a mental health practitioner to help with this, uh, sometimes.
• 18:51
  SPEAKER_01: Sometimes they're open to it.
• 18:52
  SPEAKER_01: But but I've had patients and families who say, Are you saying I'm crazy?
• 18:55
  SPEAKER_01: Are you saying it's in my head?
• 18:55
  SPEAKER_01: And I'm like, gosh, no, I'm not saying that at all.
• 18:57
  SPEAKER_01: I'm just saying the disease takes a huge burden.
• 18:59
  SPEAKER_01: But something fascinating about hypnotherapy is that I think it's sort of another approach to this whole idea.
• 19:04
  SPEAKER_01: Now, the person who I'm sending to is also a therapist, so she can do a bit of both.
• 19:08
  SPEAKER_01: But I love the fact that we can use hypnosis as a relaxation technique.
• 19:12
  SPEAKER_01: It helps with sleep, it helps calm down some of the itch behavior, because we'll see a behavioral piece when they get stretched, they'll start scratching, sometimes even when they're not itchy.
• 19:20
  SPEAKER_01: And I also love there's a something called, there are a couple different cognitive behavioral approaches, but uh, but there are these approaches that can replace a habit.
• 19:28
  SPEAKER_01: So habit reversal therapy, uh, which is really interesting.
• 19:32
  SPEAKER_01: And there are these techniques.
• 19:33
  SPEAKER_01: In fact, I'm working right now with a, with a neat student.
• 19:35
  SPEAKER_01: We're trying to put together a series of resources to help patients do this on their own and find people that can help them do these things because I agree, this behavioral mental piece is sort of a very big unmet need for our patients.
• 19:46
  SPEAKER_00: Yeah, and and a lot of pain.
• 19:48
  SPEAKER_00: Well, when you were talking about replacing the behavior, I was thinking about the facticial acne patients who, you know, the pickers, and that's one of the hardest things to treat.
• 19:57
  SPEAKER_00: And I was very lucky to have a hypnotist here in New Orleans who treated a lot of patients for me over the years.
• 20:02
  SPEAKER_00: He's gone now, but boy, that was very helpful for those patients because that just needs behavior modification.
• 20:09
  SPEAKER_00: Um, you know, it's it's a very difficult problem to treat.
• 20:13
  SPEAKER_00: Uh, I don't want the time to get away from me because we're getting close.
• 20:16
  SPEAKER_00: I want you to talk about the integrative dermatology certificate program and how you started that and what kind of things you do there.
• 20:23
  SPEAKER_00: Because I'm sure there's a lot of people listening who, after hearing this, are going to be like, I want to learn those things that Dr.
• 20:28
  SPEAKER_00: Leo's using.
• 20:30
  SPEAKER_01: Well, thank you.
• 20:31
  SPEAKER_01: Yes.
• 20:31
  SPEAKER_01: And and I'll tell you, so I've been interested in this for now more than a decade, been kind of focused on this.
• 20:36
  SPEAKER_01: And I'll give lectures sometimes at the academy meeting or at different different conferences.
• 20:40
  SPEAKER_01: And many times people will come up and say, that was good, but I need more.
• 20:44
  SPEAKER_01: Like, where do we go for more?
• 20:45
  SPEAKER_01: And the truth is, there wasn't that many things.
• 20:47
  SPEAKER_01: We have some books out there, we have some other resources, but Raja Sivimani, who's a good friend and a wonderful integrative Durham as well, and Apple Bodimer, she's up in Wisconsin, incredibly just thoughtful, creative.
• 20:59
  SPEAKER_01: Also studied with Andrew Weil down in Arizona.
• 21:01
  SPEAKER_01: We said, what if we put together a little course?
• 21:04
  SPEAKER_01: You know, we we're not, we can't, we're not gonna, it's not a true graduate program.
• 21:08
  SPEAKER_01: It's certainly not a fellowship, but what if we put together everything and got great guest speakers and made a curriculum and we spent about a year building it?
• 21:15
  SPEAKER_01: Uh there are many, many lectures.
• 21:17
  SPEAKER_01: I think I counted, I give something like 60 lectures through the time.
• 21:20
  SPEAKER_01: It's like crazy.
• 21:22
  SPEAKER_01: Um, and we have all these guest speakers and we have resources and papers, anyways.
• 21:25
  SPEAKER_01: And we thought we'll offer it to dermatologists and maybe we'll get like five or 10 people.
• 21:29
  SPEAKER_01: It'll be amazing.
• 21:30
  SPEAKER_01: Well, in the first year, we had more than 30 people sign up.
• 21:33
  SPEAKER_01: And now we've completed the third year.
• 21:35
  SPEAKER_01: And it's been every year more exciting, more interesting.
• 21:37
  SPEAKER_01: It develops, we refine it, we keep updating things.
• 21:40
  SPEAKER_01: It's been a great journey.
• 21:40
  SPEAKER_01: And I will say the feedback we've gotten from the people who've participated is that they love it, that it's been something I didn't expect is that it's been something that can help them deal with burnout and kind of reignite their passion for dermatology and taking care of patients, which is really cool.
• 21:54
  SPEAKER_01: The secret part, the selfish part, right?
• 21:56
  SPEAKER_01: And the selfish part for me is that we are now building the community that I've always dreamed of because now we have these people who know a lot about integrative medicine, that have their own interests, that are now contributing, learning, writing.
• 22:05
  SPEAKER_01: And it's just amazing.
• 22:06
  SPEAKER_01: We've built this community.
• 22:08
  SPEAKER_01: So I just love it.
• 22:08
  SPEAKER_01: I feel like now I'm part of a community and I just feel lucky that I got to help build it.
• 22:12
  SPEAKER_00: That's a fantastic story and a great end for us.
• 22:15
  SPEAKER_00: Listen, I can't thank you enough for being with us.
• 22:18
  SPEAKER_00: Um I I'll tell you the funniest thing that Ted Lane said when I said, you know, I'm interviewing Peter this week.
• 22:24
  SPEAKER_00: He's like, oh, I hate that because you're gonna have so much fun.
• 22:28
  SPEAKER_00: Because he loves you, you know that.
• 22:30
  SPEAKER_00: And we both we both thank you so much for your contribution for the Science of Skin Care Summit.
• 22:34
  SPEAKER_00: Can't wait for this year.
• 22:35
  SPEAKER_00: And um again, thanks for sharing your expertise with our listeners today.
• 22:40
  SPEAKER_01: Thank you for having me.
• 22:42
  SPEAKER_01: It's a pleasure.