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Gary Goldenberg, MD is an Assistant Clinical Professor of Dermatology, at the Icahn School of Medicine at Mount Sinai and the Medical Director of the Dermatology Faculty Practice at The Mount Sinai Medical Center in New York City.

Are lifestyle changes an important part of the treatment of skin diseases?

Absolutely. We approach common skin conditions by prescribing a therapy, whether a topical steroid, a biologic or acne medication, but I also discuss things that trigger the condition or worsen it, including stress. I often talk about meditation, massage, or yoga to reduce the stress that we know can lead to acne, premature wrinkles, or exacerbations of underlying skin diseases. It can be a double-edged sword as some of the things we do to reduce stress are unhealthy and further contribute to premature aging and skin disease, such as smoking and excessive alcohol intake. I counsel my patients on making healthier choices as well.

What about diet?

I talk about diet with almost every patient. With acne, there is evidence that skim milk is associated with acne more so than whole milk. I recommend organic dairy over non-organic products, especially in women who have hormonally mediated acne. Ingesting foods filled with hormones may throw off the normal hormonal balance, increase estrogen levels, and affect acne. Foods that are high on the glycemic index also tend to be proinflammatory, and can worsen acne, rosacea, eczema, or psoriasis.

How does the gut microbiome affect skin health?

The health of the gut mircobiome is important in acne, rosacea, psoriasis, and other skin diseases. Psoriasis patients who took probiotics saw improvements in their skin disease in one study. I recommend foods with live cultures like
Greek yogurt or kombucha or supplements to maximize gut health and improve skin.

Research has shown that psoriasis is more than skin deep. What about other skin diseases such as atopic dermatitis (AD) and rosacea?

It is looking more and more that way. We know that AD is linked to asthma and allergic rhinitis. I think we will discover more and more associations with time. There are also new AD medications in the pipeline that target systemic inflammation and, if approved, may change the way we think about and treat AD. A growing body of evidence suggests that rosacea may travel with respiratory diseases, gastroesophageal reflux disease and other gastrointestinal disorders, hypertension, metabolic disorders, and urogenital diseases. It will be interesting to see how this research bears out. It is certainly an exciting time to be practicing dermatology. n

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