If you are suffering chronic itching — a common but difficult-to-treat symptom of an inflammatory skin condition — then you’ll want to read about my experience with diagnosing and treating Lexi.
Lexi is a 25-year-old woman who came to see me about a skin condition that was causing persistent itching. She was suffering with cellulitis on her face and eczema on her hands. (Cellulitis a common, potentially serious bacterial skin infection. With cellulitis, the affected skin appears swollen, red, and is typically warm to the touch and painful.) In Lexi’s case, she had been previously treated by another doctor with several rounds of topical steroids, oral steroids, and antibiotics.
She told me that, at first, the infections and skin cleared. But after a few short weeks, all of her symptoms reappeared. She said the skin on her hands was itchy, and the cellulitis on the side of her face was causing her to feel depressed and self-conscious.
The astonishing thing to me, was that her dermatologist continued to write prescriptions without actively seeking out the cause — the root cause. Lexi was never questioned about her environment at home or work or her stress levels, and her diet was only briefly discussed. And perhaps most shocking of all — no lab tests were ever ordered.
If this sounds familiar, you might be relieved to find out that skin conditions like Lexi’s — while often more than skin deep — can be effectively treated. In fact, you can start experiencing relief in a matter of days and be on your way with a treatment plan aimed at curing you in a matter of weeks.
Common Skin Conditions
Before we investigate the causes and cures for itchy skin conditions, let’s take a look at the most common diagnoses:
- Dermatitis comes from the Greek words “derma” meaning skin and “I” meaning inflammation. It’s the most common of the skin conditions and is usually triggered by an allergy or a sensitivity to one or more ingredients in personal care products such as shampoos, conditioners, and soaps. Other triggers include mold (from food or water-damaged buildings), dust mites, pet dander (from a dog or cat), wool, latex, mineral oils, and chemicals found in many foods and beverages.
- Eczema is a common form of dermatitis — essentially chronic inflammation of the skin. To put it simply: if the problem is acute, it’s usually diagnosed as dermatitis, and if it’s chronic it’s diagnosed as eczema. Symptoms include dry, cracked skin, which may blister and itch. Eczema commonly affects the skin folds of the arms, hands, or wrists, the backs of knees, or the face.
- Psoriasis comes from the Greek words “psora” meaning itch and “isis” meaning inflammation. It’s an autoimmune disorder that causes red, itchy, scaly patches most commonly on the knees, elbows, trunk, and scalp.
- Skin infections can be caused by a fungus, bacteria, or virus. Fungal infections include jock itch, athlete’s foot, and ringworm. Viruses include herpes, shingles, and warts. Bacterial infections may include infected eczema, cellulitis, impetigo, folliculitis, and skin-borne rashes characteristic of a tick-borne illness such as Lyme disease.
Treatment is usually focused on the symptoms of the condition. Doctors often prescribed steroids, antihistamines, antibiotics, or antifungals in pill form and/or as topical applications — creams or ointments. All of these can be effective for providing temporary symptomatic relief, and sometimes they’re successful in eliminating the root cause of the skin condition. However, in many instances, they simply don’t work, and in some cases, they cause side effects and other health issues.
The Functional Medicine Approach to Common Skin Conditions: Test First
Most of the skin conditions I treat are chronic, and most of the patients I see with these conditions have already seen their primary care physician and at least one dermatologist. They come to me because none of the conventional treatments they received provided the relief they expected or hoped for.
When conventional treatments fall short, it’s usually because they failed to address the root cause, often one or more of the following:
- Diet: Skin conditions can often be traced to a food sensitivity. The most common culprits are dairy, peanuts, soy, wheat/gluten, corn, and shellfish. Lab tests are available to identify which foods may be causing problems.
- Increased Intestinal Permeability/Leaky Gut: If your intestinal lining is damaged, undigested protein molecules may be passing through it into your bloodstream, triggering an immune response resulting in inflammation, which can affect any area of the body, including the skin. Increased intestinal permeability can cause eczema, psoriasis, or a bacterial, fungal, or viral infection that irritates the skin. In my practice, I use stool tests — including the GI Map — to look for hidden infections, gluten sensitivity, and leaky gut evidenced by the presence of a protein called zonulin, which is a biomarker of impaired gut barrier function.
- Toxicity: Toxins can build up in the body from pesticides, herbicides, plastics, tap water, heavy metals, mold from food and water-damaged buildings, mercury fillings, and medications. The body has several detox mechanisms and organs for breaking down and eliminating toxins. You’re probably aware of the role that the liver and kidneys play, but the body also detoxes through the skin — the largest organ of the human body. Itchy skin is a telltale sign that detox is needed.
- Stress: Stress alone can cause a person to break out in hives, so it’s no surprise that it can also contribute to other itchy skin conditions. Stress can also increase cortisol and weaken the immune response increasing susceptibility to infection.
A functional medicine approach to diagnosing and treating skin conditions considers all these factors and screens for them. Screening involves a physical examination, looking into your medical and family history, talking to you about your diet and lifestyle, and then ordering lab tests to gain additional insight about what’s going on in your body.
Lexi: The Rest of Her Story
When I met with Lexi, we quickly discovered that she had a history of irritable bowel syndrome (IBS) and had recently taken antibiotics for a sinus infection. (IBS is a group of symptoms that often occur together, including repeated pain in the abdomen and changes in bowel movements, diarrhea, and/or constipation.) In Lexi’s case, we did a test for yeast overgrowth in the digestive tract and found she was high in metabolites of yeast that come from Aspergillus and Penicillium — molds commonly found in food and in water-damaged buildings. They are ubiquitous in the environment, but generally don’t cause harm outdoors.
We were able to uncover three main causes of Lexi’s skin condition:
- Leaky gut associated with IBS
- Mold toxins coming from food or environment
- Antibiotic use, which caused dysbiosis (an imbalance in the community of microorganisms that inhabit the gut), resulting in immune system dysfunction
Lexi’s treatment consisted of topical use of tea tree oil mixed with coconut, supplements to heal a leaky gut including glutamine and aloe, and prebiotics and probiotics to restore balance to her gut microbiome. Her labs indicated an overgrowth of candida yeast, so we provided some natural antifungals. Within days, Lexi was experiencing relief, and in a matter of a few weeks, her skin was clearing.
Lexi’s story is only one example of how a skin condition can be treated with a functional medicine approach. It’s important to realize that even if two patients have identical symptoms, the cause(s) of those symptoms may be entirely different. Testing must be done to identify the root cause(s), so effective treatments can be selected.
Merely rubbing on creams or ointments — prescription or natural — or taking medications to calm the inflammation, won’t be effective until the root cause is identified and eliminated.
If you or a loved one are living with an undiagnosed or persistent skin condition for which you’ve had no relief, consider working with a functional medicine-trained doctor like myself. If you feel my approach may work for you, schedule an appointment today.
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About the Author: Dr. Matt Lewis, D.C., DACBN, CFMP®, specializes in diagnosing and treating the underlying causes of the symptoms related to chronic and unexplained illness through nutrition, lifestyle, chiropractic, and other natural approaches to whole-health healing in Tampa, Fla. Dr. Lewis has 20 years of experience practicing nutritional and holistic medicine. He earned his B.S. in Biology from Shenandoah University, his Doctorate in Chiropractic from Life University, his Diplomate status in Clinical Nutrition from the American Clinical Board of Nutrition, his CFMP® from Functional Medicine University, and his certification as a Digestive Health Specialist (DHS) through the Food Enzyme Institute. Dr. Lewis’ passion for health and wellness stems from his own personal experience. With a family history of autoimmune conditions and diabetes, and his own lab tests showing his genetic susceptibility to Hashimoto’s thyroiditis (autoimmune thyroid), he has learned how to restore his own health and vigor to prevent the onset of these and other illnesses and live an incredibly active life. Through this process, he acquired a deeper understanding of health and wellness, which he now offers his patients in Tampa.