Treating Dermatological Conditions by Going Beyond the Skin

While the field of medical dermatology continues to grow in the US, there is also a growing demand for functional therapies to treat skin disorders. Holistic, or integrative, dermatology focuses on treating the human body as a whole and implementing lifestyle changes to enhance the treatment and prognosis of skin disease.¹ Patients may seek out a functional clinician for many reasons, including fear of adverse events from regularly prescribed therapeutics, or comorbities that could influence efficacy and adherence.

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Jodi Westfall, NP, runs Advanced Integrative Wellness in Cincinnati, Ohio. After a decade of working in traditional medical dermatology, she observed the effects of inflammation and autoimmune diseases in the skin, and found research and approaches that were not generally utilized in western medicine, and gradually changed her practice.

She spoke to Dermatology Times® about making that change, her treatment approaches, and how all patients can play a larger role in their own overall health and wellness. She discussed what she looks for in patients who do not see success from traditional therapies. “We look at a lot of food sensitivities; we do a lot of work with gastric permeability. Do you have a leaky gut? We do a lot more with hormones too, many will think testosterone is the problem. But generally, it's not the testosterone, it's your metabolites,” she stated.

Westfall said she also examines whether her patients are getting enough hydration, sleep and regular bowel movements. “Keeping it to the basics: you want to be hydrated, you don't want to be constipated and you want to sleep like a baby. And honestly, if we just had that I think the whole world would be a happier world,” she explained.

Transcript:

Dermatology Times®: How did you first discover functional dermatology?

Jodi Westfall, NP: I had a handful of failed Accutane folks that I did genetics on, and they all had issues with methylation. So, methylation being a carbon, three hydrogens, you know, when we just put them on active B vitamins, well, it made a big difference in their skin. So that was kind of my intro into thinking, there's a better way to do this. And with that, I found the Institute of Functional Medicine and I found the American Academy of Anti-Aging Medicine that helped me understand a little more physiology and other ways to do things.

Dermatology Times: How do you first assess a patient?

Westfall: Generally, we're going to do pretty comprehensive labs. So, I'm going to start with looking at doing a basic metabolic, which would tell us a ton. You know, where's your total protein? Where's your diet? How much carbohydrate you eat? How many inflammatory foods, most of us are sugar addicts. I mean, it's obviously nobody's alone. You know, you think that the lollipop at the bank, when you were 3...sugar addiction is 8 times more addictive than cocaine, and socially endorsed. It inflames us. So, we just address some of those pieces. We can do a lot of advanced testing, but I can we can go as basic or as complex as we want. And a lot of times, it's just going to be putting in basic amino acids, basic things to help you support you. A joke is, you come to me with a hole in the roof, and I give you a tarp. When you work from functional medicine, you know, that's great, we see the hole and give you a tarp for the minute, but you know what, we need to work on getting some rafters and shingles in place too.

Dermatology Times: What are some basic things everyone can do to better their health?

Westfall: There are 2 things. When you eat a collagen, it's broken down. And, you know, yeah, it breaks down into amino acids What's your most abundant amino acid in collagen? And what is collagen? It is the framework for your bones. Collagen is the spring in your skin, you know? But when you look at collagen, like glycine, glycine is also going to help to heal your gut. So you know, for a lot of us, if you look at how we're eating, most of us don't get enough protein. I mean, your hair is protein, your fingernails are protein, I mean, we're made of protein; So if there was anything I would suggest its simple things like a bone broth. If you look at bone broth, it is going to be super rich in glutamine. Glutamine helps to seal the junctions of the gut and is going to help you to have a healthier gut. It's in electrolytes.

Dermatology Times? How do you best combine traditional and functional medicines?

Westfall: I mean, I'm not afraid of writing spironolactone, et al. or whatever; I have no issue with that. But more often than not, I find that we don’t have to turn you red and peeling, and we will improve your mood and your energy, and you will just generally feel better. But some of it, is finding what your machine takes. I kind of joke, it is kind of like knowing gosh, I drive a diesel while I've been putting in regular my whole life. You know, so just being able to fine tune a little bit helps.

Transcript edited for clarity

Reference

1. Hu S, Anand P, Laughter M, et al. Holistic dermatology: An evidence-based review of modifiable lifestyle factor associations with dermatologic disorders. J Am Acad Dermatol. 2022 Apr;86(4):868-877. doi: 10.1016/j.jaad.2020.04.108.