Victoria Garcia-Albea (VGA): How did you get interested in integrative medicine?
Dr. Peter Lio (Dr. Lio): I have always been interested in fringe topics as I feel that that is where the most exciting discussion takes place! In medicine, while there is of course a great deal to digest in general, I've always been fascinated by the interface between what is known and accepted and what is just outside of that. I'm happy to say that in my 20-year career, I've seen an increased acceptance of integrative medicine and approaches, and that has been really heartening. When I first started, we created an alternative medicine interest group in medical school, and I confess that while most people were supportive, there was some open dissent back then from some who felt it was unseemly for Harvard Medical School to allow such a thing. But, I'm happy to say that most were supportive, and I continued to learn and explore this area. Right after residency, I took a wonderful year-long course called Structural Acupuncture for Physicians with Kiiko Matsumoto and David Euler. It was truly fantastic and opened my eyes to new ways of thinking about health and disease! Little by little I learned more and read more and wrote more about what I learned. Eventually, I came across the Integrative Dermatology Symposium, and I knew I was home! I have since worked with that group to create a longer program where we can explore lots of different integrative ideas in dermatology over many months and with teachers from all over the world!
VGA: Can you give our readers/viewers a couple of pearls or tips on incorporating integrative medicine into their daily practice?
Dr. Lio: I think the most important thing I've learned is that all good clinicians, even those who feel that they are not incorporating integrative medicine at all, actually do this to some degree! Simply talking with the patient, engaging in shared decision-making, and maybe customizing something a little bit to meet somebody's needs: that is really the beginning of this journey. Maybe it starts with someone who is allergic to propylene glycol, and so you help get a compounded version of a topical medication made for them without it. Already, we've left the domain of an FDA-approved conventional formulation, though it doesn't seem like a very big step. Maybe you incorporate vitamin D supplementation for a patient with eczema. The literature is sort of fuzzy here, with some studies supporting this and others not. Finally, perhaps you recommend that they see a hypnotherapist to help manage the stress component associated with their skin problem. There might not be any specific literature for lichen planopilaris and hypnotherapy, but the principles are clear, and the risks are very low. I think that just being open to some of the ideas is a great start. Many times, a patient comes in wanting to do something truly alternative to conventional therapy, and I listen, talk about it with them, and then we decide to pick the conventional medication instead because it is the right fit. Other times, however, I will talk about how we can add something to help support the skin in addition to conventional therapy, and--for the right patient--this can be inspiring. That enthusiasm is important, and not just from a mind-body perspective. When the patient is excited about the treatment, I think they are much more likely to follow through on using it, and that is something in and of itself.
VGA: Do you discuss integrative medicine with all of your patients? Are there any skin diseases that you find are less impacted by integrative medicine?
Dr. Lio: Not necessarily. I really try to read the room and get a sense of what they're looking for. Sometimes, they only want to go with alternatives, other times, they're not interested in that pathway at all. But I often pitch things as ideas when I think they might fit, and I'm totally comfortable letting the patient lead. My main career focus has been a topic dermatitis, and I think that there are tons of amazing opportunities there for integrative approaches. Outside of that, however, many inflammatory conditions I think can be approached in this way, even when there is sparse literature available. For some things, like skin cancer, I feel that the role here for integrative approaches is more supportive, and otherwise, it can be dangerous to try to treat skin cancer when we have such effective and definitive approaches like surgery. So part of the job is talking people out of certain therapies.
VGA: What are cost-effective ways for patients to incorporate natural products into their skincare routine for diseases like acne and eczema, which we frequently see?
Dr. Lio: Some of my favorite treatments for eczema include using black tea compresses to cool and soothe the skin, topical coconut oil, and topical vitamin B12 cream. These are things that I often incorporate, particularly in younger patients. For psoriasis, topical indigo naturalis cream, fish oil supplementation, and stress reduction all seem to be very helpful. For acne, oral supplementation with pantothenic acid and niacinamide can be helpful, as well as dietary changes such as avoiding dairy. But there are so many--that's why we had to develop a course!
VGA: Click here for more info about the Integrative Dermatology Symposium
VGA: Can integrative medicine play a role in infectious diseases we encounter in dermatology?
Dr. Lio: To some degree, yes. While I think it can be irresponsible to use something unproven for an actual infection, I would counter that for concepts like "dysbiosis," we don't really have any conventional medications. So, for trying to better understand the microbiome and support it- at this point at least- it's almost all integrative medicine. From probiotics to prebiotics, to postbiotics, to lifestyle and dietary alteration, I'm the first to admit that definitive answers are lacking but that what we do have clearly bleeds into integrative approaches.
VGA: Do you present different integrative medicine ideas for patients from different cultures/ethnicities?
Dr. Lio: I try to think broadly and continue to be surprised by just how diverse individuals can be in terms of thoughts and preferences. I love the idea that part of the magic happens when we open ourselves up to new ideas and learn from wisdom and traditions all over the world and throughout history.
Victoria Garcia-Albea, BSN, MSN, RN, PNP, DCNP, is a medical dermatology nurse practitioner at Lahey Clinic in Burlington, MA. She is the director of the Lahey Clinic Dermatology NP Training Program. She spends most of her free time with her husband and two school-aged boys and volunteers at her public library.
Peter Lio, MD, is a Clinical Assistant Professor of Dermatology & Pediatrics at Northwestern University. He received his medical degree from Harvard Medical School and his Dermatology training at Harvard. While at Harvard, he received formal training in acupuncture. Dr. Lio is the founding director of the Chicago Integrative Eczema Center and a founding faculty member of the Integrative Dermatology Certificate Program with over 400 publications and four textbooks, as well as his non-dermatology book, The Pizza Prescription.