Dermatologic thinking, and this well constructed evaluative structure, would benefit by including core variables that lead to seeking the probable etiology of the inflammatory attack, causing the specifically directed inflammatory and autoinflammatory skin condition.
Accurate evaluation of efficacy of the new JAK inhibitors for AA and other inflammatory skin disorders would benefit by including these omitted “integrative” core domain variables, to make sure that they do not distort outcomes positively or negatively. People with the worst digestive and dietary contributions to their AA might have less favorable results, distorting efficacy downward. Those making the best integrative attempt at control of their AA might have better results than with the drug alone, distorting efficacy results in the positive direction.
Determining underlying integrative treatments that decrease targeted and general inflammation in a patient has the potential of increasing overall efficacy of the total treatment regimen for inflammatory skin disorders. Dealing with the underlying issues would reduce the chance of tolerance to the drugs and the false sense of security from improvement without altering the underlying issues causing inflammation or autoimmunity.
The methodology that I have described and been using applies, with some disease specific modification and appropriate incorporation of conventional dermatologic methods to not only AA, but to almost all inflammatory skin conditions. Ideally, it requires a dermatologist skilled in these methods searching for patient specific triggers preceding disease onset or aggravation, and a patient able to follow and afford multiple dietary restrictions and incorporation of various supplements in the diet. Many parts of the inner work and transformation chapters in Radiant Skin from the Inside Out were written by my daughter Alicia Dattner. As a coach, she has helped me attune more to patients’ needs and feelings, and translate the science into concrete usable and inspiring information that invites them be excited to stick with new supplements, diet, and lifestyle protocols, to make life-changing shifts in their health.
Skilled coaching for the dermatologist can help them extend their capabilities, and skilled coaching of the patient can help them follow a protocol. Patient support in my practice was provided skilled coaches who worked with me. Due to the challenges of additional practitioner time required, additional holistic education required, and the time, motivation and resources required of patients, the pharmacologic treatments will remain predominant, with adjuvant help from holistic and integrative methods in some who need additional treatment efficacy.
Often, in my experience, success with this method for skin disorders clears other health issues as well, as if the skin disorder was just a symptom of the underlying issue. My intention is to add to Dermatology an evolving holistic strategy addressing probable underlying etiology that will help those who have failed or cannot take conventional dermatologic treatment for their AA or other inflammatory skin disease. Dermatologic indices and guidelines being created should include integrative and holistic core domains to be evaluated, and treated. Including holistic dermatology as a recognized subspecialty would reaffirm the comprehensiveness and scientific relevance of our specialty. Integrative education, research, and training would help the percentage of dermatologic patients successfully treated by increasing the number of dermatologists skilled in their appropriate application.
Accurate evaluation of efficacy of the new JAK inhibitors for AA and other inflammatory skin disorders would benefit by including these omitted “integrative” core domain variables, to make sure that they do not distort outcomes positively or negatively. People with the worst digestive and dietary contributions to their AA might have less favorable results, distorting efficacy downward. Those making the best integrative attempt at control of their AA might have better results than with the drug alone, distorting efficacy results in the positive direction.
Determining underlying integrative treatments that decrease targeted and general inflammation in a patient has the potential of increasing overall efficacy of the total treatment regimen for inflammatory skin disorders. Dealing with the underlying issues would reduce the chance of tolerance to the drugs and the false sense of security from improvement without altering the underlying issues causing inflammation or autoimmunity.
The methodology that I have described and been using applies, with some disease specific modification and appropriate incorporation of conventional dermatologic methods to not only AA, but to almost all inflammatory skin conditions. Ideally, it requires a dermatologist skilled in these methods searching for patient specific triggers preceding disease onset or aggravation, and a patient able to follow and afford multiple dietary restrictions and incorporation of various supplements in the diet. Many parts of the inner work and transformation chapters in Radiant Skin from the Inside Out were written by my daughter Alicia Dattner. As a coach, she has helped me attune more to patients’ needs and feelings, and translate the science into concrete usable and inspiring information that invites them be excited to stick with new supplements, diet, and lifestyle protocols, to make life-changing shifts in their health.
Skilled coaching for the dermatologist can help them extend their capabilities, and skilled coaching of the patient can help them follow a protocol. Patient support in my practice was provided skilled coaches who worked with me. Due to the challenges of additional practitioner time required, additional holistic education required, and the time, motivation and resources required of patients, the pharmacologic treatments will remain predominant, with adjuvant help from holistic and integrative methods in some who need additional treatment efficacy.
Often, in my experience, success with this method for skin disorders clears other health issues as well, as if the skin disorder was just a symptom of the underlying issue. My intention is to add to Dermatology an evolving holistic strategy addressing probable underlying etiology that will help those who have failed or cannot take conventional dermatologic treatment for their AA or other inflammatory skin disease. Dermatologic indices and guidelines being created should include integrative and holistic core domains to be evaluated, and treated. Including holistic dermatology as a recognized subspecialty would reaffirm the comprehensiveness and scientific relevance of our specialty. Integrative education, research, and training would help the percentage of dermatologic patients successfully treated by increasing the number of dermatologists skilled in their appropriate application.
DISCLOSURES
Dr. Dattner is the owner of HolisticDermatology.com.
REFERENCES
1. Dattner AM. Complementary and Alternative Medicine in Dermatology. Chap 241. In K Wolff, L Goldsmith, S Katz, B Gilchrest, AS Paller, D Leffell Dermatology in General Medicine. 8th ed. New York, NY: McGraw-Hill. 2012 (and previous editions)
2. Dattner AM. Herbal and complementary medicine in dermatology. Dermatol Clin. 2004 Jul;22(3):325-32, vii. doi: 10.1016/j.det.2004.03.005. PMID: 15207314
3. Brown DJ, Dattner AM. Phytotherapeutic approaches to common dermatologic conditions. Arch Dermatol. 1998 Nov;134(11):1401-4. doi: 10.1001/archderm.134.11.1401. PMID: 9828875
4. Dattner AM. Radiant Skin from the Inside Out: The Dermatologist’s Guide to Healing Your Skin Naturally. 2015 NY via Amazon books
5. Boehncke WH, Brembilla NC. Autoreactive T-lymphocytes in inflammatory skin diseases. Front Immunol. 2019 May 29;10:1198. doi: 10.3389/ fimmu.2019.01198. PMID: 31191553; PMCID: PMC6549194
6. Wall D, Meah N, York K, et al. A Global eDelphi exercise to identify core domains and domain items for the development of a global registry of alopecia areata disease severity and treatment safety (GRASS). JAMA Dermatol. 2021;157(4):439–448. doi:10.1001/jamadermatol.2020.5839
7. Dattner AM. Nutritional dermatology. Clin Dermatol. 1999 Jan- Feb;17(1):57-64. doi: 10.1016/s0738-081x(98)00051-0. PMID: 10089587
8. Dattner AM. Herbal and complementary medicine in dermatology. Dermatol Clin. 2004 Jul;22(3):325-32, vii. doi: 10.1016/j.det.2004.03.005. PMID: 15207314
9. de Oliveira GLV, Leite AZ, Higuchi BS, et al. Intestinal dysbiosis and probiotic applications in autoimmune diseases. Immunology. 2017 Sep;152(1):1- 12. doi: 10.1111/imm.12765. Epub 2017 Jun 29. PMID: 28556916; PMCID: PMC5543467
10. Rosenberg EW, Skinner RB Jr. Immunotherapy of alopecia areata with intralesional Candida antigen. Pediatr Dermatol. 2006 May-Jun;23(3):299. doi: 10.1111/j.1525-1470.2006.00240.x. PMID: 16780487.
11. Ali S, Ibrahim AM, El Sayed N. Candida antigen immunotherapy versus steroid in the treatment of alopecia areata. Dermatol Ther. 2021 Mar;34(2):e14802. doi: 10.1111/dth.14802. Epub 2021 Feb 7. PMID: 33496068
12. Xing L, Dai Z, Jabbari A, Cerise JE, Higgins CA, Gong W, de Jong A, Harel S, DeStefano GM, Rothman L, Singh P, Petukhova L, Mackay-Wiggan J, Christiano AM, Clynes R. Alopecia areata is driven by cytotoxic T lymphocytes and is reversed by JAK inhibition. Nat Med. 2014 Sep;20(9):1043-9
13. Levis WR, Dattner AM. Clonal priming of lymphocytes can measure human immune-response gene function. N Engl J Med. 1977 Oct 13;297(15):842-3. doi: 10.1056/NEJM197710132971521. PMID: 70753.
14. Levis WR, Dattner AM. In vitro secondary response with specific antigens. Cell Immunol. 1979 Aug;46(1):219-21. doi: 10.1016/0008-8749(79)90262-4. PMID: 90556.
15. Bernheim JL. Clonal priming of lymphocytes and genetic determination of immune response. N Engl J Med. 1978 Mar 2;298(9):514-5. doi: 10.1056/ NEJM197803022980917. PMID: 622148.
16. Kurnick JT, Gr nvik KO, Wigzell H et al. Long term growth in vitro of human T cell blasts with maintenance of specificity and function. J Immunol. 1979;122:1255-60.
2. Dattner AM. Herbal and complementary medicine in dermatology. Dermatol Clin. 2004 Jul;22(3):325-32, vii. doi: 10.1016/j.det.2004.03.005. PMID: 15207314
3. Brown DJ, Dattner AM. Phytotherapeutic approaches to common dermatologic conditions. Arch Dermatol. 1998 Nov;134(11):1401-4. doi: 10.1001/archderm.134.11.1401. PMID: 9828875
4. Dattner AM. Radiant Skin from the Inside Out: The Dermatologist’s Guide to Healing Your Skin Naturally. 2015 NY via Amazon books
5. Boehncke WH, Brembilla NC. Autoreactive T-lymphocytes in inflammatory skin diseases. Front Immunol. 2019 May 29;10:1198. doi: 10.3389/ fimmu.2019.01198. PMID: 31191553; PMCID: PMC6549194
6. Wall D, Meah N, York K, et al. A Global eDelphi exercise to identify core domains and domain items for the development of a global registry of alopecia areata disease severity and treatment safety (GRASS). JAMA Dermatol. 2021;157(4):439–448. doi:10.1001/jamadermatol.2020.5839
7. Dattner AM. Nutritional dermatology. Clin Dermatol. 1999 Jan- Feb;17(1):57-64. doi: 10.1016/s0738-081x(98)00051-0. PMID: 10089587
8. Dattner AM. Herbal and complementary medicine in dermatology. Dermatol Clin. 2004 Jul;22(3):325-32, vii. doi: 10.1016/j.det.2004.03.005. PMID: 15207314
9. de Oliveira GLV, Leite AZ, Higuchi BS, et al. Intestinal dysbiosis and probiotic applications in autoimmune diseases. Immunology. 2017 Sep;152(1):1- 12. doi: 10.1111/imm.12765. Epub 2017 Jun 29. PMID: 28556916; PMCID: PMC5543467
10. Rosenberg EW, Skinner RB Jr. Immunotherapy of alopecia areata with intralesional Candida antigen. Pediatr Dermatol. 2006 May-Jun;23(3):299. doi: 10.1111/j.1525-1470.2006.00240.x. PMID: 16780487.
11. Ali S, Ibrahim AM, El Sayed N. Candida antigen immunotherapy versus steroid in the treatment of alopecia areata. Dermatol Ther. 2021 Mar;34(2):e14802. doi: 10.1111/dth.14802. Epub 2021 Feb 7. PMID: 33496068
12. Xing L, Dai Z, Jabbari A, Cerise JE, Higgins CA, Gong W, de Jong A, Harel S, DeStefano GM, Rothman L, Singh P, Petukhova L, Mackay-Wiggan J, Christiano AM, Clynes R. Alopecia areata is driven by cytotoxic T lymphocytes and is reversed by JAK inhibition. Nat Med. 2014 Sep;20(9):1043-9
13. Levis WR, Dattner AM. Clonal priming of lymphocytes can measure human immune-response gene function. N Engl J Med. 1977 Oct 13;297(15):842-3. doi: 10.1056/NEJM197710132971521. PMID: 70753.
14. Levis WR, Dattner AM. In vitro secondary response with specific antigens. Cell Immunol. 1979 Aug;46(1):219-21. doi: 10.1016/0008-8749(79)90262-4. PMID: 90556.
15. Bernheim JL. Clonal priming of lymphocytes and genetic determination of immune response. N Engl J Med. 1978 Mar 2;298(9):514-5. doi: 10.1056/ NEJM197803022980917. PMID: 622148.
16. Kurnick JT, Gr nvik KO, Wigzell H et al. Long term growth in vitro of human T cell blasts with maintenance of specificity and function. J Immunol. 1979;122:1255-60.
