In this feature video, Dr Peter Lio discussed holistic treatments for conditions like atopic dermatitis (AD) and alopecia areata (AA) prior to his session, "A Holistic Approach to Diagnosing & Treating AD and AA in Adolescent and Adults, Including Addressing Unique Psychological Aspects in Patients & Families", presented at the 26th Mount Sinai Symposium. 

Peter Lio, MD, FAAD, is a clinical assistant professor of dermatology and pediatrics at the Feinberg School of Medicine at Northwestern University in Chicago, IL. He is also a member of the Clinical Advisory Committee of the National Eczema Association.

Transcript:
What are the typical holistic approaches that are used to treat AD and AA?
Dr Peter Lio: There are so many approaches that we can use, and the truth is that part of the definition of a holistic treatment in 1 definition is that there's not enough evidence to put it in the mainstream. Right? Because, arguably, anything that has enough evidence, then that would be conventional, wouldn't be unconventional, but many different things. So, for atopic dermatitis, we could go on a long time, And that includes things like some of the botanical oils, coconut oil, sunflower oil. I'm also a big fan of oral hemp seed oil.

There was a wonderful paper out of Germany a couple years ago talking using black tea, just plain old black tea as a compress, a cooling compress on the face. I love that. The literature on vitamin D I think is compelling. If you look at it, it's actually seems like there's a subgroup of patients that respond. So, these are some of the things that we can incorporate.

They're almost never going to replace the mainstream conventional therapies, but they often can be an adjunct, and they're usually very safe and very accessible. For alopecia areata, it's maybe a little less well developed. Areata has, you know, very few treatments. Just in the last couple of years, we finally got some FDA approved treatments after many, many years of doing everything off label. But couple of things that I think are worth thinking about, we know there's an association again between alopecia areata and low vitamin d levels.

So, there may be a role for vitamin D there, and I often do recommend that. Because again, I think there's probably a just a general immune sort of modulating effect of vitamin D. I think if we're low in D, then we can see more immune issues. So, I think that can be nice. Also, vitamin B12 and folate.

There are some studies that suggest these might be able to, again, affect the progression of alopecia areata. One of my favorite ones for alopecia areata is actually around zinc. So, there's some data that, again, low zinc may affect this. Now these are not great studies, but they're compelling enough that you wonder, maybe there is a connection between this. We certainly know in other types of hair loss like telogen effluvium, there can be zinc connection as well in probably not everybody, but there may be something for some patients, which is kind of interesting.

Can you describe what psychological aspects are associated with treating AD and AA whether it’s a holistic or a different approach?
Dr Peter Lio: There are a lot of psychological aspects for both these conditions, of course, not only do they cause distress in patients, you know, with AD, you're you have visual lesions, you're itchy, you're uncomfortable, you're not sleeping well, it's terrible. For AA, people see it. They're concerned about it. The stress levels huge. And, of course, we know that stress also has an immunomodulator effect, a negative one. It drives inflammation.

So, we want to help people deal with the burden of disease. We want to help support them. That's huge. We also know that if we can help reduce their stress and they're kind of concerned and have anxiety about it. That actually may help the outcome. So, I think this is important. One of the things that I think can help is things like hypnosis or hypnotherapy. I'll have patients see a hypnotherapist because I it's not necessary for the disease itself, but it's for all of the aligned issues and stress. And I think that's why you will see sometimes an effect on itch and potentially even on hair loss of the hypnosis. Another thing that I like is one of my favorite treatments to use for alopecia areata is a mixture of aromatherapy oils.

So, it's a bunch of essential oils that are mixed. It has things like, oh, it's got thyme. It's got lavender, rosemary, Atlantic cedar. It's kind of been studied. It was in a wonderful paper in the archives of dermatology that's now been renamed to JAMA Dermatology, so very mainstream back in 1998. And they had these patients massage this mixture into their scalp at night daily for 3 months, and they actually showed that there was a significant improvement in patients who use this compared to the control group that just used carrier oil. Now here's where this connects with the psychological aspect. One of my patients got full hair regrowth on this. And, again, that's not saying that that was the whole sole cause. We know there's a many patient get better on their own. But after he had full regrowth, I said, “you're good now, you don't have to use oil anymore.” And he said, “No. No. I love it.”

So, tell me why. He said, because it helps me go to sleep at night. It relaxes me. And I realized, you know, this is one of those points. It was a relaxing ritual. So, again, maybe the essential oils have an effect. I think we have a little bit of evidence they do. They compared it against the control, but maybe part of it is the ritual and the nighttime routine that actually helped him, and he continues to do that. It helps him sleep. How wonderful, right? What a win-win for a few dollars in a very relatively safe--is it perfectly safe? No. Can you have problems with certain aroma, you therapy and essential oils? Absolutely. They could be allergic. That can cause trouble, so, but generally speaking, compared to something like, you know, a powerful systemic medication, these are going to be safer.

How are families impacted by patients treated for AD and AA?
Dr Peter Lio: I think the families suffer a lot, and sometimes we don't give them enough attention and focus because the patients were focused on. But, you know, they carry that burden with them, so the family has carried the burden with atopic dermatitis.

The sleep burden is real, and sometimes the whole family is not sleeping well. For alopecia areata, I think the family feels sometimes shame, and they feel this helplessness. There's like we've asked a bunch of people what we could do. Nothing seems to be working. Maybe they're not ready for a very powerful medicine or maybe they even tried one and failed, But they're not there.

We know that even our best treatments, they certainly don't get everybody perfectly there. So, I think there's a lot of burden for this. And, of course, you know, people spend a lot of money and time on their appearance. And if you're missing your hair, I mean, a guy like myself, it's easier. I don't mind being bald, but I'm in a very specific area and spot in my life where I can do that. If you're, you know, a 12-year-old, this is a big deal. This is going to have huge ramifications. And, no matter your age, I think depending on what you want. It's a limitation. Right? It's a limitation for people.

What else would you share with your colleagues regarding your session at the Mt Sinai Symposium?
Dr Peter Lio: Just that this is supposed to be part of the discussion. I get I take umbrage a little bit when people get all anti holistic or alternative things. And there can be a little bit of that, you know, kind of the villagers with the pitchforks, and we're not trying to replace anything. It's part of a huge group of amazing speakers and amazing ideas and new technologies, and this is a little corner of it.

I think that it's nice to even know about it. I often say, even if you hate this stuff, it's good to learn a little bit about it because at the very least, you could tell a patient, “You know, I heard about it. It might have some effect, probably not much. Why don't we stick with this if you're not comfortable with it?” Or You might say, “You know what? This maybe does have a little evidence. You can add that on. That's not going to hurt anything. We could try it.”

And I think sometimes just that acknowledgement, just that acceptance as opposed to either just kind of violent angry dismissal of the whole thing. It's a bunch of baloney. Get out of my office. Like, I don't think that helps anybody. You know?

And I don't think most people imagine themselves doing that, but I know patients sometimes feel that way. They feel dismissed or kind of even talked down to, like, that they were idiots for thinking about it, and I don't think that's fair either. So, I like the idea of at least engaging a little bit, and I think that makes us better even if we find that it's not the correct answer for most patients or maybe even for any patient. But I think that doing the exercise is worthwhile, and patients say, “You know what? Thank you for at least learning about that. Thank you for exploring it.” That's part of our job too.