Reena N. Rupani - Integrative Dermatology: Practical Applications in Acne and Rosacea

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The Integrative Health movement continues to grow and develop in the United States and throughout the world. The National Institutes of Health/National Center for Complementary and Integrative Health notes that more than 30% of adults and some 12% of children utilize healing approaches outside of conventional medicine [1]. Driven partly by patients seeking holistic and personalized care, and partly by clinicians striving to incorporate mental, emotional, functional, spiritual, social, and community aspects of healing in step with conventional drug development pathways, there is undoubtedly an appeal of Integrative Health that enhances the connection between patient and providersomewhat of a harkening back to the village doctor who knew all of the individual stories.

The vast majority of our modern medicines stem from simpler and more natural beginnings, such as plants used by various world traditions for generations. Integrative Health offers the chance to look to these simpler, more elemental therapies for new ideas and approaches that, ironically, may one day be quite mainstream and may serve as valuable adjuncts to current allopathic standards of care.

As clinicians, we are sometimes painfully aware of the limitations of conventional medicine. Indeed, as Celsius once quipped: Satius est enim anceps auxilium experiri quam nullum or It is better to try a doubtful remedy than none at all [2]. Despite the best and most robust evidence, there are often scenarios where the data is lacking or the patient simply has not responded to what evidence-based literature deems best; there may be a need for adjunctive botanical or behavioral therapy to help mitigate adverse effects of standard care; perhaps the real or perceived side effects of a group of treatment options actually outweigh their potential therapeutic benefit, prompting a change of course; or, more fundamentally, a patient may benefit from a sense of agency which can come with addressing diet, discussing specific stressors, or even highlighting the simple concept of sleep hygiene.

In dermatology, we feel this equally or perhaps even more acutely than other medical fieldswe are mandated to treat a number of ill-defined and chronic inflammatory conditions, most of which have little chance of cure. We look forward to exploring the concept and applications of Integrative Dermatology with you, our colleagues and community, and hope that at the very least, the conversation is stimulating.

Integrative dermatology is as much a philosophy as it is a method; it looks to reverse causal factors rather than just stop symptoms. [1]

What better dermatologic illness to start the discussion of nutrition, stress, lifestyle, and role of supplements and botanical ingredients than acne? In this volume we focus on the treatment of Acneiform disorders, specifically acne vulgaris, with discussion too of rosacea. Assuming a target audience of skilled dermatologists, internists, pediatricians, and family medicine providers, standard medical approaches to acne are considered the foundation upon which our discussion of integrative therapies will rest.

The first part of the book (Chaps. ) begins with a discussion of the skin and gut microbiome as well as the use of oral supplements, including pre/probiotics, vitamins, minerals, and botanical ingredients.

Chapters will consider non-prescription topical botanical therapies and essential oils.

In Chap. , the somewhat novel (to dermatology) concept of Apitherapy is introduced, with consideration of naturally derived bee products, such as honey, propolis, and bee venom, and potential role in acne/rosacea therapy.

Chapter delves deeply into the hot topic of diet and acne/rosacea, including not only dairy and glycemic load, but also specific diet plans (Mediterranean, plant-based, low histamine) as well as anti-inflammatory dietary approaches.

Chapter discusses the important role of stress in acne and rosacea, and specific mindbody interventions that can significantly improve patient outcomes.

For those who are unfamiliar with the field of functional medicine, Chap. will introduce the core areas of Assimilation/Gastrointestinal, Immune, Energy, Detoxification, Cardiovascular/Lymphatic, Hormones/Neurotransmitter, and Musculoskeletal/Cellular Structure, and the connection between each of these areas and acne/rosacea.

The millenia-old system of Ayurvedic medicine, which originates from and is still practiced regularly in the Indian subcontinent, is defined in Chap. , with specific relevance to acne/rosacea therapy.

By turn, Chap. explores traditional Chinese medicine as a complete healing system, and how practitioners characterize and treat acne/rosacea within this framework.