Dr. Peter Lio discusses complementary approaches to skin disease treatment, including risks, benefits, and evidence.
Peter Lio, MD, Clinical Assistant Professor, Dermatology and Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Ill.
“One of the things we talked about was how so many patients are interested in alternative and complementary approaches to treatment,” said Peter Lio, MD, who presented “Integrative Skincare” at the Science of Skincare Symposium in Austin, Texas.
“Some clinicians love this and are interested in it. Obviously, we have a whole group of people that we are cultivating and learning from and learning with. The American Academy of Dermatology has an expert resource group in integrative dermatology. I’m one of the chairs….”
Admittedly, there are clinicians who may not be interested in the idea or practice of integrative dermatology. But patients care and are interested, said Dr. Lio.
“[So] even if you don’t care about it, I think it’s important still to learn a little bit of something because our patients are going to ask. They’re going to want to talk about it.”
In fact, there is some compelling evidence that some integrative treatments can help, he said.
Risks and Benefits
American astronomer Carl Sagan always insisted, “Extraordinary claims require extraordinary evidence,” said Dr. Lio.
“You can’t make a ridiculous sounding claim without having something to back it up because everyone will say, ‘Well, that doesn’t make any sense.’”
According to Dr. Lio, many integrative and alternative approaches are not that extraordinary and depend on your point of view.
“So if you’re in the world of botanical treatments and natural treatments, then you realize [that] actually things work like this, and they’re not so ridiculous.”
For clinicians who aren’t in that world, there are studies that can back up some of these claims, making them, perhaps, worth a try, especially given the minimal associated risk factors, he said.
That said, natural treatments are not risk free, he said.
“We know any kind of a treatment has potential for downside, side effects, and these do too—contact dermatitis, irritation, and other things, of course. But relatively speaking, compared to, for example, a powerful systemic immunosuppressant, the side effect profile of using the botanical oil is pretty darn different.”
Another benefit? Natural treatments are easily accessible, said Dr. Lio.
“And we can also put it in the calculation of our matrix of accessibility. If there’s something I can go get at the grocery store as a natural food product, now that’s a little bit different than having to do 16 prior authorizations and a peer-to-peer review to get the $40,000 per year+ medicine covered.”
Adjunct Status
Importantly, natural treatments are not replacements for clinical ones, said Dr. Lio.
“We’re not saying you’re not going to use a topical steroid and instead use this. In general, they don’t have that kind of power. Most of the more natural treatments are definitionally ‘milder.’”
But you can use them as adjuncts to support skin disease treatment.
“Again, this is the concept of ‘integration.’ We’re going to pull the best from all these different areas and put together a package that I think not only is delightful for patients—which, of course, we know is part of the healing process and part of what’s going to help them use those treatments—but I really do think we can gain benefit and that’s really what I’m here for. I’m trying to make myself obsolete. I want to get people better so they can go about their day, and I don’t want them to be obsessing about their skin and worrying about it all the time.”
What Works?
There are many alternative products that can be used as part of skin disease treatment, said Dr. Lio. Summaries of the evidence can be found in a textbook he co-edited called the Handbook of Integrative Dermatology: An Evidence-Based Approach.1
“And we have a journal we started a couple of years ago called The Journal of Integrative Dermatology, where we really focus on getting these kinds of studies and papers and reviews all in one place. …I’ve written a number of updates there trying to keep [it all] state of the art.”
Commonly used products for atopic dermatitis include coconut oil, topical vitamin B12, and oral vitamin D, he said.
“I use a lot of coconut oil in my practice because it seems to be anti-microbial and helps us rebalance that microbiome, which is fantastic. I use a lot of topical vitamin B12.”
Several studies have shown that topical B12 has anti-inflammatory benefits on eczema, said Dr. Lio. Notably, oral B12 does not have the same effect.
“I’m a big fan of using vitamin D supplementation. That literature is fascinating because there’s a lot of mixed evidence, but…there’s a subgroup of patients who really does respond well to vitamin D.”
Studies have also shown that probiotics can help when certain strains or mixtures of strains are used, he said.
“…for psoriasis I really like indigo naturalis. I have a special formulation of indigo made in a really nice moisturizer base and the evidence on that is quite striking.”
Garlic has been shown to aid in wart treatment, said Dr. Lio.
“…there’s, again, literature on this both using actual garlic and even a garlic extract. So there’s pretty good science behind these things. They’re not totally conjectural.”
Reference:
- Lio PA, Patel T, Peters NT, and Kasprowicz S. Handbook of Integrative Dermatology: An Evidence-Based Approach. Springer International Publishing Switzerland; 2015.