Viewpoints on Integrative Dermatology, Part 2

With conventional medicine, we have a lot of what we need, but not everything. As alternative and complementary therapies are becoming more mainstream, they are being integrated with conventional medicine. The options are opening up more rapidly than I could have ever imagined when I first became interested in integrative medicine over 20 years ago. Right before I graduated from medical school at the University of Iowa in 2002, I took a month-long elective that was an introduction to integrative medicine, including aromatherapy, massage therapy, hypnosis, biofeedback, and acupuncture. It was the first of its kind in the College of Medicine and the only course offered. Now, the University of Iowa Medical School has an entire curriculum.

Although as far as I know I am the only one in my department at Wake Forest School of Medicine referring patients for alternative treatments such as acupuncture and hypnosis, integrative dermatology is a blossoming field. In part 1 of this series, Dr Lio imparted his wealth of knowledge about integrative approaches from both an academic and private practice perspective. In this article, I will share my experiences with integrative dermatology within a strictly academic environment for those interested in learning more about what these therapies have to off er our patients.

Is There Evidence for Integrative Dermatology?

There is evidence, but not as much as is available for subjects such as cancer and cardiovascular disease, for example. Although there has been a paucity of studies in dermatology, the body of evidence is finally growing based on studies that have been done correctly with a decent number of participants. Some of the more exciting studies involve mind-body therapies. There is good evidence for hypnosis in some skin-picking diseases, which is what I use as a therapy for some of my patients. Acupuncture also has a lot of great data, not just for dermatology, but for local and general anesthesia, pain, and migraines as well.

Are There Harms to Integrative Approaches?

The potential for harm exists in any kind of approach, whether it is a conventional or alternative treatment. There are alternative treatments such as massage therapy that are not likely to be harmful at all. But then there are practices that can be downright dangerous such as people ingesting colloidal silver. With the rise of social media, especially younger people who are on TikTok, Instagram, Facebook, and other sites, patients see things on their feed. What can grow my hair? What can make my nails stronger? Often, I must battle misinformation because what is on these sites is not regulated. Sometimes, patients get argumentative with me when I tell them what they want to try does not make sense. And then there are the patients who have tried something they saw on TikTok, and it has gone wrong.

Recently, I had a patient with psoriasis who had tried many different treatments but would never fully try anything because she was impatient. She had read on Instagram or TikTok that you can rub pure oregano oil on all your psoriasis plaques, and they will go away. So, she did. Essential oils are never good applied directly to the skin, and oregano oil is a known contact allergen. The patient came in with severe contact dermatitis. She had large bullae everywhere, on her face, in her ears, on her elbows and knees, and even on her buttocks. She was miserable and begging for something conventional. I gave her oral and topical steroids and had a close follow up with her. Within 2 weeks, she was back to normal with normal psoriasis plaques, and she asked me if we could try an injectable biologic again.

With integrative approaches, shared decision-making is key. They need to be talked about with and guided by a dermatologist, and obviously not just, “I saw it on TikTok, I am going to try it.”

What Are Some of the Integrative Treatments to Consider?

I am not a medical acupuncturist or hypnotist, but I have colleagues who are. I have a few medical acupuncturists and now 2 medical hypnotists to whom I regularly send patients if my patient is on that page. I use both these modalities for skin picking and trichotillomania. I have numerous patients with skin picking, and several of my colleagues send people to me for extra help with it. I have patients who are on conventional therapy for skin picking but they want something in addition, and I have patients who do not want to use anything conventional but they cannot stop picking.

I also use hypnosis for warts, which is something I just started doing after I went to the Integrative Dermatology Symposium this fall. Dr Steven Gurgevich from the University of Arizona gave a talk about using hypnosis to help clear warts in the pediatric population. I have already had 5 success stories of referrals for medical hypnosis in children with warts. I had a “blow my mind” moment when Dr Gurgevich spoke about this at the meeting. He guides children through a journey using the power of the mind to stimulate the body's immune system. He has them picture the wart on their hand, and it is a boat that he names. As the boat travels, it loses this part and that part until it disintegrates into the ocean. And then the pieces wash up on the shore, and they pick them up and throw them in the trash. Hypnosis for smoking cessation has a huge bank of data; for warts, Dr Gurgevich noted that we do not know how it works, but it is safe.

How Can I Best Discuss Integrative Approaches?

A lot of the patients I see, especially those referred to me by colleagues and private practice practitioners in the community, are interested in either an addition to their conventional treatment or they want nothing to do with conventional medicine and they want something else. In fact, I get more pushback from patients about topical steroids. If a patient asks if there is something else they can do that is not a medication and I sense they might be open to it, I will discuss integrative approaches such as acupuncture and hypnosis. I give them a brief overview and if they seem interested, I put in a referral.

I like to roll with people. Whether they come in with their own ideas or no idea, I try to meet them where they are. I get to know my patients. What is their life like? What is their lifestyle? Because certain things are not going to fly with certain people. I like to be with the person. Let's see this together. Let's try this. Always my goal for patients is that I do not want their treatment to be ineffective and I certainly do not want it to harm them. I like to make plans with my patient knowing we are in this together, checking in to see where they are at, and regrouping if needed.

What Does the Future Hold for Integrative Treatments in Dermatology?

I think the future will be exciting. We are going to have more data published and interested clinicians will initiate new studies. I am hoping to see some studies of head-to-head conventional vs alternative therapy for diseases we deal with frequently, such as psoriasis and atopic dermatitis. The medical community in general, and in all specialties, is much more open than it used to be and that translates into good things to come.

Disclosure: The author reports no relevant financial relationships.

Viewpoints on Integrative Dermatology, Part 1 Read Here!

Recommended Reading

• Birch S, Hammerschlag R, Trinh K, Zaslawski C. The non-specific effects of acupuncture treatment: when and how to control for them. Clin Acupunct Oriental Med. 2002;3(1):20-25.
• Gustafson C, Taylor SL, Feldman SR. Usage of complementary and alternative medicine for management of skin disease. J Dermatolog Treat. 2011;22(5):306-308. doi:10.3109/09546634.2011.619459
• Kaiser P, Kohen DP, Brown ML, Kajander RL, Barnes AJ. Integrating pediatric hypnosis with complementary modalities: clinical perspectives on personalized treatment. Children (Basel). 2018;5(8):108. doi:10.3390/children5080108
• Parvizi MM, Salami MH, Moini Jazani A, Javaheri R, Jaladat AM, Handjani F. Complementary and integrative remedies in the treatment of chronic pruritus: a review of clinical trials. J Cosmet Dermatol. 2022;21(11):5360-5369. doi:10.1111/jocd.15094
• Schi  E, Gurgevich S, Caspi O. Potential synergism between hypnosis and acupuncture—is the whole more than the sum of its parts? Evid Based Complement Alternat Med. 2007;4(2):233-240. doi: 0.1093/ecam/nel069