Antigen, or self-transplantation antigen) requirement for response and reaction. Discovering that, we added individual molecular specificity needed for immune attack, which brought me the great revelation that specific foods and antigens could cause T-cell mediated diseases in individuals only if they had the required tissue type. The unique antigen recognized by lymphocytes for cross-reactive attack was a complex of unique self-characteristics in conjunction with the food derived, chemical, or microbial epitope component. And that, by classical immunologic thinking, was also modified by tissue type, route, and dose of exposure, presenter cell activity, tertiary folding, and chemical modification. That opened up a new understanding of how specific food, environment, and microorganisms could cause, for example, psoriasis in one individual, but not another. It opened my thinking to the viability and potential scientific validity of using alternative treatments, such as diet and supplements, for inflammatory skin disorders, and searching patient history for food, and environmental, microbial exposures that could stimulate attacks on specific tissues and cells involved in the skin disease. I also searched for and treated such factors as digestive and eliminative impairment, and emotional tagging that could be contributing to the inflammatory component of the disorder.
Searching for cross-reactive stimuli and targets is still a useful but under-applied conceptual approach today, not only for inflammatory skin and systemic disease, but also for new diseases such as the likely cross-reactive autoimmune sequelae of Covid known as “long Covid”, and has been part of my often-successful work with skin disease patients who also present with chronic fatigue syndrome. More funding and scientific attention should be paid to the work of the integrative medical community’s complex successes in this area. Many other modalities including metabolic, genetic, epigenetic, and microbiologic analysis have been added by this community.
Searching for causal factors, and using herbal, topical, and dietary measures were among the main methods of treating skin disorders before the advent of antibiotics and corticosteroids, in Western medical practice. The time has come for also including a holistic and integrative approach for evaluating and treating the underly causes of inflammatory skin disorders. This approach has matured with greater understanding of the mechanisms of immunology and physiology, the influx of perspectives from other healing systems, and the integration of these methods into dermatology and holistic/integrative medicine in general.
Inflammation mediated by reactive T-lymphocytes is a major causal factor in many skin disorders that involve redness, including eczema, acne, psoriasis, and auto immune conditions including lupus alopecia areata (AA).5 Dermatology has advanced dramatically in my lifetime with the advent of corticosteroids and other drugs to suppress inflammation, and antibiotics to control infections causing inflammation. More detailed understanding of the particular immune mechanisms underlying specific immune conditions has led to the development of immune process-inhibitory drugs such as the biologics, targeting key steps that lead to the inflammatory manifestations of these conditions.
Some of these drugs are so effective in initially eliminating the altered appearance caused by these conditions that addressing the underlying issues to prevent drug tolerance causing breakthrough of the condition is not even considered. This article argues that integrative and holistic parameters should be considered in evaluation of overall therapy for any inflammatory skin condition, offering more effective care to the population as well as to the individuals who either fail or refuse to use current dermatologic therapy. Just as we would not omit diet counselling to diabetics on antidiabetic drugs, or identifying and removing specific allergens in contact hypersensitivity, we should explore and include more complex integrative methods for treating the underlying causes of autoimmune and inflammatory skin conditions. Referrals should be made to specialists in this evolving field of dermatology, just as we refer to specialists for Mohs surgery or evaluating industrial contact dermatitis.
The article “A Global eDelphi Exercise to Identify Core Domains and Domain Items for the Development of a Global Registry of Alopecia Areata (AA) Disease Severity and Treatment Safety (GRASS)”6 presents a well thought out structure for comparison of AA evaluation variables in an attempt to standardize evaluation of causes, treatments, and results, compiled by an illustrious mix of stakeholders. It is important that this core list be expanded holistically, as it will be reused as a guiding template for other evaluative inflammatory skin disease frameworks such as TREAT for atopic dermatitis. While it mentions psychologic stress, limited environmental triggers, and diagnostically proven gluten sensitivity, and other triggers, as core domains, the registry is typical of conventional guidelines in that it leaves out important core integrative and holistic medicine domains involving the two crucial areas: etiopathogenesis and treatment.
Two different methodologies need to be properly represented in this approach to dermatologic evaluation and treatment. They offer a bridgeable dichotomy in the philosophic understanding and treatment of AA and other inflammatory skin disorders.
The first and predominant mainstream methodology, based on the premise that AA patients have similar causes because they have the same disease, is treatment that inhibits the inflammatory process that is involved in AA or other autoimmune or allergic skin disorders. It is based on the premise that we can determine the final mechanistic pathway,
Searching for cross-reactive stimuli and targets is still a useful but under-applied conceptual approach today, not only for inflammatory skin and systemic disease, but also for new diseases such as the likely cross-reactive autoimmune sequelae of Covid known as “long Covid”, and has been part of my often-successful work with skin disease patients who also present with chronic fatigue syndrome. More funding and scientific attention should be paid to the work of the integrative medical community’s complex successes in this area. Many other modalities including metabolic, genetic, epigenetic, and microbiologic analysis have been added by this community.
Searching for causal factors, and using herbal, topical, and dietary measures were among the main methods of treating skin disorders before the advent of antibiotics and corticosteroids, in Western medical practice. The time has come for also including a holistic and integrative approach for evaluating and treating the underly causes of inflammatory skin disorders. This approach has matured with greater understanding of the mechanisms of immunology and physiology, the influx of perspectives from other healing systems, and the integration of these methods into dermatology and holistic/integrative medicine in general.
Inflammation mediated by reactive T-lymphocytes is a major causal factor in many skin disorders that involve redness, including eczema, acne, psoriasis, and auto immune conditions including lupus alopecia areata (AA).5 Dermatology has advanced dramatically in my lifetime with the advent of corticosteroids and other drugs to suppress inflammation, and antibiotics to control infections causing inflammation. More detailed understanding of the particular immune mechanisms underlying specific immune conditions has led to the development of immune process-inhibitory drugs such as the biologics, targeting key steps that lead to the inflammatory manifestations of these conditions.
Some of these drugs are so effective in initially eliminating the altered appearance caused by these conditions that addressing the underlying issues to prevent drug tolerance causing breakthrough of the condition is not even considered. This article argues that integrative and holistic parameters should be considered in evaluation of overall therapy for any inflammatory skin condition, offering more effective care to the population as well as to the individuals who either fail or refuse to use current dermatologic therapy. Just as we would not omit diet counselling to diabetics on antidiabetic drugs, or identifying and removing specific allergens in contact hypersensitivity, we should explore and include more complex integrative methods for treating the underlying causes of autoimmune and inflammatory skin conditions. Referrals should be made to specialists in this evolving field of dermatology, just as we refer to specialists for Mohs surgery or evaluating industrial contact dermatitis.
The article “A Global eDelphi Exercise to Identify Core Domains and Domain Items for the Development of a Global Registry of Alopecia Areata (AA) Disease Severity and Treatment Safety (GRASS)”6 presents a well thought out structure for comparison of AA evaluation variables in an attempt to standardize evaluation of causes, treatments, and results, compiled by an illustrious mix of stakeholders. It is important that this core list be expanded holistically, as it will be reused as a guiding template for other evaluative inflammatory skin disease frameworks such as TREAT for atopic dermatitis. While it mentions psychologic stress, limited environmental triggers, and diagnostically proven gluten sensitivity, and other triggers, as core domains, the registry is typical of conventional guidelines in that it leaves out important core integrative and holistic medicine domains involving the two crucial areas: etiopathogenesis and treatment.
Two different methodologies need to be properly represented in this approach to dermatologic evaluation and treatment. They offer a bridgeable dichotomy in the philosophic understanding and treatment of AA and other inflammatory skin disorders.
The first and predominant mainstream methodology, based on the premise that AA patients have similar causes because they have the same disease, is treatment that inhibits the inflammatory process that is involved in AA or other autoimmune or allergic skin disorders. It is based on the premise that we can determine the final mechanistic pathway,
