PracticeUpdate Dermatology February 2019

EXPERT OPINION 20

Takeaways From the Inaugural Integrative Dermatology Symposium, October 2018 By InYoung Kim MD, PhD

In October 2018, the inaugural Integrative Dermatology Symposium was launched in Sacramento, California, where dermatologists, naturopathic doctors, ayurvedic practitioners, dietitians, basic scientists, and traditional Chinese medicine practitioners gathered to share evidence-based approaches to dermatologic conditions from their own respective fields. Here are some takeaways.

Integrative approach to eczema – Peter Lio MD • Moisturizing : Daily moisturization in the neonatal period may prevent development of atopic derma- titis (AD) and represents a cost-effective strategy to reduce its burden. • Bleach baths : Dilute bleach baths can improve symptoms by improving skin barrier function and reducing itch intensity (not due to effect on skin microbiome or Th2 inflammation). • Probiotics : AD is associated with decreased microbial diversity. The best evidence exists for recommending oral probiotics in mothers and infants for preventing development/reducing severity of AD. Topical probiotic therapy is in development. • Combination therapy : The “Aron regimen,” which employs daily application of a compounded anti- bacterial, low-potency steroid and moisturizer, can be effective in treating AD patients who have plateaued with standard therapies.

• “Non-medical” treatments : Convincing evidence for the use of sunflower oil, coconut oil, massage therapy, vitamin B12, L-histidine, acupuncture, tradi- tional Chinesemedicine, hypnosis, and biofeedback in improving AD symptoms were discussed. Prebiotics and probiotics in dermatology – Raja Sivamani MD • Atopic dermatitis (AD) : Oral consumption of probiotics and prebiotics may improve AD symp- tomatology, quality of life, and clinical severity, although high-level evidence is insufficient. Pro- biotic consumption during pregnancy may reduce risk of infantile AD in high-risk infants. • Acne : In a 12-week randomized study, a combina- tion of minocycline and probiotics ( acidophilus , L. delbrueckii ssp bulgaricus , B. bifidum ) was more effective than minocycline alone in the treatment of acne. • Psoriasis : Treatment with probiotics (infantis) for 8 weeks led to improvement in mild to moderate psoriasis and a decrease in plasma TNF-α and CRP. The effect of probiotic consumption on clin- ical improvement is not understood. Role of diet in skin aging – Rajani Katta MD • There are three main processes that lead to skin aging – oxidation, inflammation, and glycation – which may be reduced by the right foods.

" In traditional Chinese medicine, a person is considered a unique blend of five elements of qi, or life force energy – wood, fire, earth, metal, and water. Acupuncture focuses on bringing these elements into balance. "

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