Insights From Derm Week: Alternative and Complementary Dermatology

In this feature Dermatology Week video, Dr Peter Lio discusses what his session, "Alternative and Complementary Dermatology: Educating Patients," will cover during the meeting.

Peter Lio, MD, FAAD, is clinical assistant professor of dermatology and pediatrics at Feinberg School of Medicine at Northwestern University in Chicago, IL.

Transcript:

In your experience, why do many patients seek care beyond traditional therapies?

Dr Lio: I think there are 3 kind of root causes for why patients will look outside of the conventional medical canon for different therapies. Number 1 is when I think they feel that our treatments are not really getting to the fundamental root cause of the problem. And they're more of a sort of a bandage type approach or just symptomatic. And the truth is, that does apply to a lot of the things that we do. I wish I could just figure out exactly what's causing atopic dermatitis or exactly what's causing psoriasis, but we really don't know, right? We think these are complex, multifaceted diseases, so we can't do that. So, I think they feel defeated sometimes and disappointed that we can't give them a clear treatment.

And the second is when our treatments actually have the potential or have actual side effects. And I meet a lot of patients who've had a bad experience, or they've been injured with an adverse event from a medication, and they're concerned. They don't want to keep going down that. And although I think in general our medicines are pretty safe, we literally published reports of the percentage of people that have adverse reactions, including some of those are severe. So, I think patients get nervous about that.

And then finally, I think it is just the way that we conceptualize the disease. I think patients often feel sort of unfulfilled in the way that we talk about it and when you look outside of Western traditions, the language they use is kind of different and they often do make it, I think, more digestible. You know, if I ask you, is diet a causative aspect of acne or what is the role of diet in acne? It's confusing, right? For many years, the party line was there really any connection. Now, I think we really agree, dairy products for at least some people. make a difference, high glycemic foods and so on. So, we now have started to change it, but we don't really give it in a very simple way.

We still talk about acne as a complex multifactorial disease again. Whereas if you say, if you're, you know, in a different tradition, you might say something like, ah, this is due to liver, young excess or something simple like this is just due to guts. This is leaky gut. Patients’ kind of like that. So, for better or for worse, it may not be true or correct in the deepest sense, but I think those are 3 reasons that push people to go outside.

What kind of “alternative” treatments will your session cover how they could impact dermatologic conditions?

Dr Lio:I think, you know, we really try to take a broad approach with this. And of course, I often joke that if we're saying evidence -based medicine is sort of the gold standard, which I think it is, it's the best we have right now.

And that is a small subset, but everything non -evidence -based medicine is one way to define alternative treatments, and that is literally infinite, right? It's any possible thing at any time anyway. So, I can't know all of that.

In fact, the number 1 thing that I say to patients when they ask me about something is, I don't know. I can look it up and I can see, but most of the things that we talk about really don't have a lot of evidence. And so, I really cling to the things that have some evidence. I would argue by definition, it will not appease the most stringent critics, because otherwise, it would be an accident for the conventional canon, right? That's how you get into the conventional canon. There are many things we don't fully understand how they work, but we understand there's enough data to say, "Look, this has great evidence." Most of the things I deal with are liminal. They're on that delicate border.

But I really do like to see some evidence of efficacy clinically, not just in a lab setting, because we also know that any botanical you take has some anti -inflammatory, some antibacterial properties that really doesn't mean that it's going to have a clinical effect. It's particularly in those types of domains. So, we really want clinical evidence, we need some sense that it's safe, and it has to be practical. So, there are many treatments that are just too difficult to mean if it's going to another part of the world and soaking in special waters. It may help, it'd be great, but most of our patients can't do that, and they certainly can't do that regularly.

How can physicians use complementary treatments alongside more traditional ones in their practice?

Dr Lio: And that question really is the whole of my, my career--that's what I'm devoting everything towards. How do we bring the best of these traditions together to create this integrative approach? And the answer is it's really hard and it takes constant effort and constant refinement of this. But I think the biggest thing my take home point and really what is, I think, underpinning my whole approach here, the hidden agenda, if you will, and now it's not hidden.

The unhidden agenda, is just that if we think about it, if we talk about it, if we're not completely going to just totally put it out of mind from the very beginning and not going to dismiss all of these different approaches, if we can just think about them a little bit, I think we will go a long way to connecting with patients. So many times, I'll talk about some of the alternative approaches, but then I might go back and say, "You know, but you're pretty severe, and I'm worried that these are not going to happen, thank you very much, to be enough. Would you consider using a conventional therapy?”, and many times the patients, who apparently didn't want to use those from the beginning say, okay, I'm okay with you because they know I'm serious and I'm thinking about these things and we're really trying to consider them all. I'm not just dismissing them from the very get -go and I guess that's really the secret. But ultimately, it's also continuing on the journey.

Part of our goal is to get people interested so that we can have some answers. If, if borage oil doesn't help, then I really want to know that. You know, right now, for example, with that, the Cochrane Review says it doesn't, but there are a couple of really compelling papers that show that it did.

So, what's the truth here? I don't know. I mean, you know, people are not the result of weighing a couple of big studies, right? We need to go to the next level, which I would argue is precision medicine or personalized medicine, really being able to say, "In this individual, we understand it so well that we can do this." And I think that many botanicals and more natural products could certainly play a role in that domain.

What else would you like to share with your colleagues regarding your spring 2024 Derm Week session?

Dr Lio: I just would like to share that there is something in here for everybody. You know, it really affects every aspect of dermatology and even for the skeptical people that feel like they don't do anything like this. I would argue that almost every good clinician to some extent faces situations where we don't have great evidence. If you're treating lichen planopilaris, we have very limited evidence. We don't have any FDA -approved drugs, so you're often thinking outside of the box.

And I guess the question is, what is your comfort zone? Maybe you're only comfortable thinking outside of the box to a certain degree, but my goal is at least think. It's not dangerous necessarily to think.

It can be, maybe, dangerous in a good way, but to think even further outside of that box so that we can consider a larger universe of possibility because I truly believe if our goal is to help the patient, which it is, right? It's not to be right. I'm not trying to prove anybody wrong. It's to get the patient better than I am willing to go as far as we have to go to get them better.

And we have to be careful with that, of course, but I think that should be really one of our driving motivational factors.