Treating From Within: A Discussion with Dr. Elizabeth Geddes-Bruce 

YoungMD Connect Dermatology & Aesthetics recently hosted an informative session exploring the topic of integrative dermatology. The session was led by Dr. Elizabeth Geddes-Bruce, a board-certified and fellowship-trained dermatologist and dermatologic surgeon specializing in cosmetic and medical dermatology with a focus on integrative and preventive medicine. Dr. Geddes- Bruce practices at Westlake Dermatology in Austin, Texas. 

She opened the discussion by briefly discussing her journey in integrative dermatology, starting with how she became interested in the relationship between microbiome and skin health and then later attending the Learnskin Integrative Dermatology Symposium. She then completed the integrative dermatology certificate program, which she highly recommended to any dermatologist who is interested in learning more about this unique approach to dermatology. During the session, she discussed what integrative dermatology entails and clinical pearls for three common dermatologic conditions and aesthetics, and she finished by engaging in a Q&A session with attendees. 

WHY DOES IT MATTER? 

Increasing numbers of patients are interested in knowing the “root cause” of their skin conditions and pursuing alternative treatments that are more “natural.” There is an increasing emphasis on wellness, prevention, and collaboration with other practitioners of alternative medicine. 

WHAT IS IT? 

Integrative dermatology encompasses nutrition, lifestyle, stress, and other environmental factors. However, it does not involve abandoning our training or treating malignancy. Evidenced-based and personalized medicine remain paramount even when it comes to integrative dermatology, which does not replace standard of care. 

ACNE VULGARIS 

There is increasing evidence that skin and gut microbiome can play a role in acne pathogenesis. Deficiency in short-chained fatty acid has been found to be associated with acne as well. Limiting intake of meat, dairy, and refined sugar can be beneficial in improving acne. Supplements that may be beneficial include probiotics, pantothenic acid, chasteberry, myoinositol, dim, saw palmetto, soy, as well as glucose controlling herbs such as shardunika or vinegar. 

ROSACEA 

Skin microbiome with decrease in C. acne and decreased fecal microbiome diversity can be associated with rosacea. There is also some evidence that there may be a link between H. pylori infection and rosacea. Additionally, small intestinal bacterial overgrowth (due to poor motility, use of proton pump inhibitors, among other causes) may also play a role in triggering rosacea. Supplements and medications that may help with rosacea include rifaximin for SIBO, sulfur, fiber, omega 3, chamomile, green tea extract, and aloe vera. On the other hand, avoidance of alcohol, cinnamaldehyde, and capsaicin can be beneficial. 

HAND ECZEMA 

There are several topical and oral alternative therapeutics and approaches including topical oils (such as sunflower and coconut oils), black tea compresses, hypochlorous acid, L histidine, hempseed oil, vitamin D, probiotics (lactobacillus mix), as well as massage and meditation. 

AESTHETIC DERMATOLOGY 

Some evidence indicates that collagen supplements may improve skin health, even though much of the research is in animal studies. Oral consumption of almonds, soy, and pomegranate peel may help with rhytides. Supplements that may help with hyperpigmentation include soy, melatonin, pycnogenol, topical niacinamide, topical licorice, and carotenoids. Supplements that may play a role in photoprotection include polypodium leucotomos, vitamin E, beta-carotene, and polyphenols (including resveratrol and green tea). 

QUESTIONS FROM THE AUDIENCE 

Several additional clinical pearls were shared during the Q&A session. Dr. Geddes-Bruce said there is no specific blend of probiotics that she recommends because supplements are not regulated, though she does recommend a fish oil supplement from Nordic Naturals. She also recommends a collagen supplement from Vital Protein that is sold at Costco. Top discussion points for preventive measures in maintaining skin health can include Heliocare, sunscreen, vitamin D, and fiber. Discussion of integrative approaches may not be applicable to every patient, depending on time constraints and patient-specific factors. But such discussion does get easier as one gains more experience and trust is built with the patient. 

It was a pleasure to learn these invaluable clinical pearls from Dr. Geddes-Bruce as we navigate through the world of integrative dermatology, standing at the crossroad of multiple disciplines. After this informative session, we are now better equipped to counsel patients on alternative therapeutic approaches. More importantly, this would also enable us to establish a relationship of trust with patients who are seeking alternative treatment options as they turn to us as the true skin experts.