January 14, 2025 • 22 mins
Discover how stress can take a toll on your skin with insights from our esteemed guest, Dr. Matt Zirwas, who has spent over two decades unraveling the mysteries of eczema. You’ll gain a new understanding of the powerful connection between stress and atopic dermatitis and why managing stress is crucial for skin health.
We also learn that the foods we eat can impact eczema by altering our gut microbiome. This episode challenges conventional wisdom, suggesting that the key might not be avoiding certain foods but rather nurturing a healthy gut with probiotics. From dietary considerations to cutting-edge treatment strategies you'll hear several ways eczema may be managed.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome to Dermot Trotter Don't Swear About Skin
Care where host Dr Shannon CTrotter, a board certified
dermatologist, sits down withfellow dermatologists and
skincare experts to separatefact from fiction and simplify
skincare.
Let's get started.
Speaker 2 (00:19):
Welcome to the Dermot Trotter, Don't Swear About Skin
Care podcast.
We've got another podcastthat's going to surely excite
you today as we talk a littlebit more about atopic dermatitis
and some things you probablydidn't know about how stress
impacts it and, of course,treatment.
I've got with me Dr Matt Zyrus.
You know well he's focused oneczema for the last 20 years of
his career, written a textbook,led sure to thousands of
(00:42):
dermatologists, over 200peer-reviewed published articles
.
So we've got an expert in thehouse to talk with us about this
topic.
So welcome to the show, DrZyrus.
Thank you, Dr Trotter.
So I know one thing that we allcomplain about in today's world
we're all stressed, you know,we're pulling our hair out,
we've overscheduled, overworkedand we all see it impact our
(01:03):
health.
Speaker 3 (01:09):
And a lot of people know how does this really affect
the skin, especially in regardsto atopic dermatitis?
Yep, so this is a reallyinteresting question.
So we first let me just say wedon't have fantastic
experimental data on this, butwe've got more than you would
think.
So I'm going to beextrapolating a little bit from
data looking at skin barrierfunction in stress.
(01:29):
But first let's go back for asecond and talk for a minute
about stress.
So when we talk about stressfrom a medical perspective and I
know you know this, but for thelisteners, really a stress
state primarily is a hormonaland neurological state.
So whenever you're under stress, you're releasing more hormones
like cortisol, norepinephrine,epinephrine, things like that,
(01:56):
and then you also have increasedautonomic nerve stimulation,
and so the physiologically Rightstimulation, and so the
physiologically right.
So the first thing is, wheneverwe talk about stress affecting
atopic derm, it is absolutelynothing like oh, it's in your
head or you think you feelitchier because you're anxious
or something.
No, that is not it at all.
(02:17):
It is the stress thatsignificantly affects your body
physiologically.
The analogy that I always givepeople to really hammer home the
idea that this isn't like inyour head is I often talk about
Pavlov's dogs, but in the humansense.
So I say, look so, think aboutit like this when you smell, if
(02:39):
you're hungry and you smell food, that is your favorite food.
When your mouth starts to water, that's all in your head, right
, because you smell the food,your brain knows that that's
going to relieve your hunger, soit's getting ready to eat and
your mouth starts to water.
Okay, great, now that you knowthat it's in your head, you
should be able to fix it right.
(02:59):
So next time you smell, you'rehungry and you smell something
really delicious, just fill yourmouth water.
No, you can't do that Right.
You cannot overcome your body'sautonomic nervous system and so
it's not all in people's heads.
So now to get into really whatthe data is.
So this has been looked at inboth what you would call
(03:21):
subacute stress and chronicstress.
And so for subacute stress,they looked at college students
and looked at skin barrierfunction how well your skin
protects you from theenvironment, which we know is
the fundamental problem ineczema.
How was your skin protect youfrom eczema?
They looked at that kind ofright whenever they got back
from a new, from a break.
(03:41):
So they were very, you know,college students unstressed, not
relaxed, how their skin barrierfunction was.
Then they looked at skinbarrier function during finals
week.
So subacute stress, dramaticchanges in skin barrier function
, reduced lipid production,probably related to steroids, to
the cortisol that your bodymakes naturally.
(04:02):
And then they also looked atchronic stress by looking
through people going throughcontentious divorces, and again
showed that stress dramaticallyaffects you know skin barrier
function and skin physiology.
Now also, I'm a firm believer.
So we know for sure, forexample, that sweat makes atopic
(04:25):
dermatitis worse and autonomicnervous function causes
increased sweating, and so weknow it's more than just the
physiologic effects on the skin.
So now the problem becomes okay, if you're somebody who has
atopic dermatitis, you alreadyknow well, if I get stressed it
makes me worse.
Ok, great, right.
(04:45):
So can I help?
Can I?
Is there something we can do?
Probably the only things that Iwould suggest and there are no
data to really back this up, butyou know the both
non-pharmacologic andpharmacologic approaches should
be helpful.
So there is some data showingthat hypnosis can be helpful in
atopic dermatitis.
(05:06):
If hypnosis is helpful, then wealso know that.
Probably we should know thatmeditation would be helpful.
I would imagine thatpharmacologic approaches, so
things like antidepressants andSSRIs may be helpful, although I
haven't seen any real dataabout that.
The one thing that we do havegood solid, pretty rock-solid
(05:28):
data on is melatonin, and so weknow that stress affects
circadian rhythms, can affectsleep, and when they've looked
at melatonin as a sleep aid, asa replacement for, say, benadryl
or hydroxyzine, actually foundthat sleep improved and atopic
dermatitis improved.
And so you know, getting goodsleep uh seems to be an
(05:51):
important thing as well.
But, right, if you're itchyit's pretty darn hard to sleep.
So, uh, but those would be.
I don't have a great answer forlike.
So, if something stressful isgoing on, do this, uh, but we
definitely know for sure thatstress makes atopic dermatitis
worse via direct effects onbarrier function, probably has
direct effects on immunefunction as well Not even
(06:14):
probably.
We know stress affects yourimmune function, but may push it
in a TH2 direction and thenthrough activating your
autonomic nervous system as wellno-transcript.
Speaker 2 (06:58):
The role of melatonin .
You know people want alternatesolutions to manage their skin.
What are some of thecomplimentary alternate
therapies that you like torecommend to patients and what's
the evidence that says itreally makes a difference?
Speaker 3 (07:12):
So fantastic question .
And let me tell you I am areally strong believer in the
effectiveness of what we wouldcall non-traditional therapies.
But the challenge becomes thereare so many non-traditional
therapies available.
How do you determine what areyou going to recommend?
And then it's not just okay ifit works, but it costs an
(07:35):
exorbitant amount $400 a monthin supplements or something, or
some really expensive bloodtesting or stool testing.
We know for sure that it'sreally, really going to be
helpful.
It's hard for me to recommendthat, so I stick to things that
number one we have really goodevidence for and number two,
that are cheap, and so weactually have several of those
things.
So first I mentioned melatonin.
(07:57):
We've got randomizeddouble-blind placebo-controlled
trials showing that melatoninhelps.
I don't recommend it veryfrequently, but it does help,
and that's because I'm typicallytaking care of people with
severe eczema who really needaggressive pharmacological
therapy, and that's going to getthem so much better that they
don't need something likemelatonin.
But for somebody with mild tomoderate atopic dermatitis, I
(08:20):
think melatonin can make a bigdifference.
I recommend five milligrams QHAat night.
If it's a kid, I recommend onemilligrams QHA at night.
If it's a kid, I recommend oneor three milligrams at night,
and again, we have randomized,double-blind, placebo-controlled
trials to support that.
Other things that I recommend tojust Now.
The next two things I recommendto everybody.
So the first is an oralceramide supplement.
(08:41):
So ceramides are the special,key component of your skin
barrier that helps seal water inand keep irritants out, things
that might trigger eczema.
And, believe it or not, we havemuch better data that taking
them by mouth helps your skinbarrier function Much better
(09:04):
data for that than we do forputting them on topically, and
so we have randomized, multiplerandomized, double-blind,
placebo-controlled trialsshowing that taking ceramides by
mouth improves barrier function.
The one in particular that Irecommend is from a company
called Life Extension.
You get it on Amazon.
It's about 16, 17 bucks a month.
It's from a company called LifeExtension.
(09:26):
I have no connection with them,I don't make anything from this
, but it is called LifeExtension Skin Restoring
Ceramides.
It's one small pill a day and Itell people give it about three
months to see if it's going tomake a big difference and the
way that I describe how that'sworking.
I tell people your skin issupposed to look like this and
nothing can get in or out.
(09:48):
Well, if you've got atopic derm, either genetically or from
long-term damage, fromenvironmental chemicals.
Your skin looks like this andhas these gaps in it.
They're letting things in toirritate you and letting water
out.
So your skin gets dry, so theceramide acts as a.
Water out, so your skin getsdry, so the ceramide acts as a.
(10:11):
It fills these gaps in andpeople get that idea.
So ceramides, then the next oneafter that, and then I recommend
everybody is a probiotic and wehave multiple studies showing
that particular probioticsdefinitely help, while as other
probiotics definitely do nothelp.
So there are certain strainsthat we need to get.
There are four in particular.
I can never remember the namesof the four, but the probiotic
(10:34):
that I recommend is called NOWN-O-W.
Can you get it on Amazon?
This one's about eight bucks amonth.
Now N-O-W is the brandProbiotic 10, meaning it has 10
strains of bacteria in it andthen they make different
strengths.
I recommend the 25 billion.
It's the most cost effective.
It costs about eight bucks amonth.
(10:54):
And what that one is doing.
We know that a big reason forthe atopic dermatitis epidemic
over the last 50 years has beenthe American diet and in
particular, the American dietupsets the natural healthy
microbiome, and a naturalhealthy microbiome is supposed
to be making substances thathelp calm your immune system and
(11:19):
keep it regulated, and so weneed to replace those natural
healthy bacteria with thisprobiotic.
And really, where you go withthis one is if the patient says
that diet, you know I have toavoid certain things, or I flare
.
What should I be avoiding?
What should I not be avoiding?
It's not.
There's nothing they're goingto be able to figure out
(11:40):
long-term.
That is a avoid this.
What really is happening?
There are certain foods thatare going to cause relatively
acute changes in the microbiome,uh, and that then makes people
flare, and so you in which foodsit is going to change over time
.
So instead of of telling peopleto go see an allergist or avoid
(12:01):
certain foods, you're tryingelimination diet.
You put them on a probiotic,and that is helping to calm down
and regulate their immunesystem.
And then and again nowprobiotic, and that is helping
to calm down and regulate theirimmune system.
And then and again nowprobiotic.
10, 25 billion.
And then the third supplement orthe fourth.
So right, we got melatoninceramides, probiotic.
Then the fourth one that wehave randomized double-blind
placebo-controlled trials for ishigh omega-3 fish oil.
(12:23):
And there again we know theAmerican diet.
You have way too much omega-6,which is pro-inflammatory, and
not enough omega-3, which isanti-inflammatory.
And so we have people we haverandomized double-blown super
controlled trials it's at least500 milligrams a day of omega-3.
And really any.
Again I recommend from LifeExtension.
(12:44):
They make a super omega-3.
That's what I take personally.
Uh, I take actually all ofthese uh things personally, even
though I don't.
I don't take the ceramides, butI take the probiotic and the
fish oil.
Uh.
So the the life extension, uh,super omega-3.
And again we've got randomizeddouble black placebo controlled
trials supporting that.
(13:05):
Now I don't recommend the fishoil to everybody and that is
because the ceramide is onesmall capsule a day, the
probiotic is one small capsule aday and if you can't take a
capsule you can open it and pourit on food.
But the fish oil is four bigpills a day, so it can end up
becoming a lot for the fish oilin terms of how much you have to
(13:26):
take.
But those are the supplementsthat I recommend.
I don't recommend any topicals.
So you know, some people talkabout even primrose oil,
sunflower seed oil, things likethat.
Never seen any real data thatanything topically really makes
a difference.
But those are the oralsupplements that I recommend for
(13:49):
people with atopic derm.
So and again, the fish oil.
It's an anti-inflammatory, theprobiotic is to regulate the
immune system and the ceramidesare to help restore barrier
function.
And all things together I wouldsay that those supplements get
people 10 to 20 percent better.
(14:09):
Now it's actually more.
What I would say is it reducesthe severity of eczema by one to
two steps.
So if we put eczema on a 10point scale zero, you're perfect
.
Ten is the worst you couldpossibly imagine being.
If you're an eight, I think ittakes you to a six or seven.
So it's not like, oh, if you'vegot bad eczema takes you to a
six or a seven.
So it's not like, ooh, it's, ifyou've got bad eczema, you can
get better with the supplement.
(14:30):
No, but if you're a two or athree and I can take you to.
Or if you're a one, two orthree and I can take you to a
zero or one by getting you oneor two points better.
I have a lot of patients whodon't need to use any topicals
as long as they are using theoral supplements.
So they do make a difference.
(14:52):
They all have randomized,double-blind, super controlled
trials, and those are the threethat I know for sure have some
benefit.
Speaker 2 (15:01):
And if somebody wants to take those, as you mentioned
, better part of a more completetreatment regimen, which we'll
talk about another broadcast,but you mentioned, you know a
little bit of a concern which Ithink is important to bring up.
You know the food connection.
So when you have somebody comein it's like oh, this food is
definitely making me break out.
I need you to send me to anallergist.
How do you handle that?
(15:21):
Like what do you tell patients?
Like the real role, potentialfood allergies and their atopic
dermatitis, because I thinkpeople think it's much more of a
true cause than what it reallyis.
So, trying to dispel that mythand how we work with allergists,
but really it's more of acomplimentary approach.
Speaker 3 (15:37):
So I will talk about two different things here.
So I do think that there's arole for allergists in treating
some cases of atopic dermatitiswith allergy shots.
We have some data to back thatup.
But first to talk about how dowe talk about food allergy?
So the first thing we've gotdata that tells us that about
two out of three patients witheczema, food is a triggering
(16:01):
factor for them.
So it's not, you know I don'ttalk to because 10 years ago,
even five, three, probably threeto five years ago I was still
telling patients it's probably acoincidence, I know it seems
like every time you eat thatfood you get worse, but really
it's just that eczema kind ofgets better or worse on its own.
It's probably coincidental.
Patients hated that answer and,to be honest, I think that
(16:21):
answer was wrong answer and, tobe honest, I think that answer
was wrong.
So once I understood more aboutthe microbiome, now I will
proactively bring diet up,because it seems so that from
the patient perspective, if theybring diet up and then I give
them the answer I'm about togive, they often take it as like
I'm making something up just toplacate them, whereas if I
(16:45):
bring it up proactively, thenthey feel like, oh, this guy
knows what he's talking about.
He brought up food.
Most doctors tell me food's notan issue, so I will proactively
often bring up hey.
So about two-thirds of mypatients with eczema tell me
that food is a major trigger forthem, but they usually can
never pin it down to just one ortwo foods.
(17:06):
Does it a trigger for you?
And if they say no, then I'llstill be like, well, it might
become a trigger, so we're goingto, and if they say yes, then
it's much easier though.
So if they say yes, then I sayokay.
Now it's a really interestingthing, because we know that food
allergy never makes eczemaworse.
So now, food is definitelycausing your eczema to flare,
(17:27):
but it's not a food allergy.
Food allergies show up asstomach aches, abdominal pain,
maybe hives, like you know, ifyou ever know somebody who's
allergic to peanuts, like ifthey eat a peanut, they die
immediately.
That's what food allergy is.
Food allergy is never my eczemagets worse, so, but food is
definitely.
Food is definitely making myeczema gets worse, but food is
definitely making your eczemaworse.
(17:48):
It's not an allergy.
It's that food is reallyprocessed in your stomach and in
your intestines by the naturalhealthy bacteria that are
supposed to be there, and weknow that the American diet
things like food additives, foodpreservatives, emulsifiers,
antibiotics, hormones you knowall of those things in food are
(18:08):
upsetting the natural healthybacteria.
Then, once that happens,certain foods and which foods it
is will change over time,because the bacteria are always
changing will make that worseand make those bacteria even
more unhappy and then so thatcan make your eczema worse.
And so the key isn't to figureout which foods to avoid,
because it's changing all thetime.
You're going to you will noticesometimes you know, for a few
(18:31):
months, anytime I eat tomatoes Iget worse, and then suddenly
you can eat tomatoes just fine,but now anytime you eat corn you
get worse.
It's, it changes over time.
So it's not about finding thefoods to avoid, it's about
getting that natural bacteriahealthy again, and we're going
to fix that by having to startto take this probiotic Now.
(18:53):
Patients really appreciate that.
Now to talk about the role ofallergen immunotherapy, so
particularly for dust mites.
So we've got fairly goodevidence that doing
immunotherapy for dust mites forpeople who are highly allergic
to dust mites does seem or not.
Even people will often getsevere reactions from the shot,
(19:26):
either locally or they could geta systemic reaction where their
airway starts to close off.
They're like in the allergyoffice it's an emergency.
But if you've really gotsomebody, that you're somebody
who's really stuck and nothing'sworking for their eczema, it
can be very reasonable,especially for dustbite to get
tested and then, if you areallergic to dustbite, to get
(19:48):
treated for dustbite allergy.
But again, it is not easytreatment and then even if you
are able to get through theinitial few shots, which is
where you see most of those sideeffects, then you've got to be
going into the allergy officelike once a week, you know, for
a year essentially to get shots,and so it could be a real
challenge.
But in tough cases it can behelpful.
(20:10):
But that's about the only placethat I've really seen data or
clinically experienced thatallergy shots really helped.
Speaker 2 (20:20):
Well, that's great information.
I think that clarifies you knowa little bit of where patients
you know want to jump theallergy train quickly, which we
know.
A lot of people with eczemajust happen to have seasonal
allergies as well or allergiesto other things.
But the relevance to the eczemaor atopic dermatitis is part of
what the question is and wherewe can work with allergy to
figure that out if it'sworthwhile.
So we got some really goodsecrets and tips from you here
(20:41):
today and we're going to wrap upthe podcast because next time
we'll have you on to talk alittle bit more about the
pharmaceutical therapeutics thatare variable, you know,
available for patients.
Which one works, which one isbetter, which one do you think
is the right time for a patientto start on?
So we'll dive into that alittle bit deeper on our next
episode.
But I want to thank you, drZyrus, for all the information
today.
They got people thinking twiceand they stop in that supplement
(21:03):
aisle or maybe look online thatthey have alternatives to help
with their atopic dermatitis.
Speaker 3 (21:08):
And and the big thing with the uh, with the
supplements, I always tellpeople give it about three
months.
Uh, you know, get on all threeof them.
You know, if you're going to,if you're going to do it, at
least the two, the ceramides andthe probiotics, uh, and give
those at least three months.
And I'll even tell people giveit six because we know they're
good for you in general.
(21:29):
It's really just a matter of isit worth spending the $25 a
month to be on them, and I thinkyou can figure that out in
three to six months.
Speaker 2 (21:39):
Great tip.
Great tip.
And for those of our listenersthat want to find you, where can
they find you?
Online, available or everywhere?
Speaker 3 (21:48):
I stay under the radar.
They can find me on the DermotTrotter podcast.
I do no social media oranything else of my own, and so
I'm really not out thereanywhere.
Speaker 2 (22:06):
All right, we'll find him here on the Dermot Trotter
podcast and maybe we'll be ableto get him into one of our
future parodies or TikTok orInstagram videos.
We'll try, we'll try.
We'll introduce him.
I would love it.
Great Thanks, thanks again.
Speaker 1 (22:22):
Thanks for listening to Dermot Trotter.
For more about skincare, visitDermot Trottercom.
Don't forget to subscribe,leave a review and share this
podcast with anyone who needs alittle skincare sanity.
Until next time, stay skinsmart.
Welcome to Dermot Trotter Don't Swear About Skin
Care where host Dr Shannon CTrotter, a board certified
dermatologist, sits down withfellow dermatologists and
skincare experts to separatefact from fiction and simplify
skincare.
Let's get started.
Speaker 2 (00:19):
Welcome to the Dermot Trotter, Don't Swear About Skin
Care podcast.
We've got another podcastthat's going to surely excite
you today as we talk a littlebit more about atopic dermatitis
and some things you probablydidn't know about how stress
impacts it and, of course,treatment.
I've got with me Dr Matt Zyrus.
You know well he's focused oneczema for the last 20 years of
his career, written a textbook,led sure to thousands of
(00:42):
dermatologists, over 200peer-reviewed published articles
.
So we've got an expert in thehouse to talk with us about this
topic.
So welcome to the show, DrZyrus.
Thank you, Dr Trotter.
So I know one thing that we allcomplain about in today's world
we're all stressed, you know,we're pulling our hair out,
we've overscheduled, overworkedand we all see it impact our
(01:03):
health.
Speaker 3 (01:09):
And a lot of people know how does this really affect
the skin, especially in regardsto atopic dermatitis?
Yep, so this is a reallyinteresting question.
So we first let me just say wedon't have fantastic
experimental data on this, butwe've got more than you would
think.
So I'm going to beextrapolating a little bit from
data looking at skin barrierfunction in stress.
(01:29):
But first let's go back for asecond and talk for a minute
about stress.
So when we talk about stressfrom a medical perspective and I
know you know this, but for thelisteners, really a stress
state primarily is a hormonaland neurological state.
So whenever you're under stress, you're releasing more hormones
like cortisol, norepinephrine,epinephrine, things like that,
(01:56):
and then you also have increasedautonomic nerve stimulation,
and so the physiologically Rightstimulation, and so the
physiologically right.
So the first thing is, wheneverwe talk about stress affecting
atopic derm, it is absolutelynothing like oh, it's in your
head or you think you feelitchier because you're anxious
or something.
No, that is not it at all.
(02:17):
It is the stress thatsignificantly affects your body
physiologically.
The analogy that I always givepeople to really hammer home the
idea that this isn't like inyour head is I often talk about
Pavlov's dogs, but in the humansense.
So I say, look so, think aboutit like this when you smell, if
(02:39):
you're hungry and you smell food, that is your favorite food.
When your mouth starts to water, that's all in your head, right
, because you smell the food,your brain knows that that's
going to relieve your hunger, soit's getting ready to eat and
your mouth starts to water.
Okay, great, now that you knowthat it's in your head, you
should be able to fix it right.
(02:59):
So next time you smell, you'rehungry and you smell something
really delicious, just fill yourmouth water.
No, you can't do that Right.
You cannot overcome your body'sautonomic nervous system and so
it's not all in people's heads.
So now to get into really whatthe data is.
So this has been looked at inboth what you would call
(03:21):
subacute stress and chronicstress.
And so for subacute stress,they looked at college students
and looked at skin barrierfunction how well your skin
protects you from theenvironment, which we know is
the fundamental problem ineczema.
How was your skin protect youfrom eczema?
They looked at that kind ofright whenever they got back
from a new, from a break.
(03:41):
So they were very, you know,college students unstressed, not
relaxed, how their skin barrierfunction was.
Then they looked at skinbarrier function during finals
week.
So subacute stress, dramaticchanges in skin barrier function
, reduced lipid production,probably related to steroids, to
the cortisol that your bodymakes naturally.
(04:02):
And then they also looked atchronic stress by looking
through people going throughcontentious divorces, and again
showed that stress dramaticallyaffects you know skin barrier
function and skin physiology.
Now also, I'm a firm believer.
So we know for sure, forexample, that sweat makes atopic
(04:25):
dermatitis worse and autonomicnervous function causes
increased sweating, and so weknow it's more than just the
physiologic effects on the skin.
So now the problem becomes okay, if you're somebody who has
atopic dermatitis, you alreadyknow well, if I get stressed it
makes me worse.
Ok, great, right.
(04:45):
So can I help?
Can I?
Is there something we can do?
Probably the only things that Iwould suggest and there are no
data to really back this up, butyou know the both
non-pharmacologic andpharmacologic approaches should
be helpful.
So there is some data showingthat hypnosis can be helpful in
atopic dermatitis.
(05:06):
If hypnosis is helpful, then wealso know that.
Probably we should know thatmeditation would be helpful.
I would imagine thatpharmacologic approaches, so
things like antidepressants andSSRIs may be helpful, although I
haven't seen any real dataabout that.
The one thing that we do havegood solid, pretty rock-solid
(05:28):
data on is melatonin, and so weknow that stress affects
circadian rhythms, can affectsleep, and when they've looked
at melatonin as a sleep aid, asa replacement for, say, benadryl
or hydroxyzine, actually foundthat sleep improved and atopic
dermatitis improved.
And so you know, getting goodsleep uh seems to be an
(05:51):
important thing as well.
But, right, if you're itchyit's pretty darn hard to sleep.
So, uh, but those would be.
I don't have a great answer forlike.
So, if something stressful isgoing on, do this, uh, but we
definitely know for sure thatstress makes atopic dermatitis
worse via direct effects onbarrier function, probably has
direct effects on immunefunction as well Not even
(06:14):
probably.
We know stress affects yourimmune function, but may push it
in a TH2 direction and thenthrough activating your
autonomic nervous system as wellno-transcript.
Speaker 2 (06:58):
The role of melatonin .
You know people want alternatesolutions to manage their skin.
What are some of thecomplimentary alternate
therapies that you like torecommend to patients and what's
the evidence that says itreally makes a difference?
Speaker 3 (07:12):
So fantastic question .
And let me tell you I am areally strong believer in the
effectiveness of what we wouldcall non-traditional therapies.
But the challenge becomes thereare so many non-traditional
therapies available.
How do you determine what areyou going to recommend?
And then it's not just okay ifit works, but it costs an
(07:35):
exorbitant amount $400 a monthin supplements or something, or
some really expensive bloodtesting or stool testing.
We know for sure that it'sreally, really going to be
helpful.
It's hard for me to recommendthat, so I stick to things that
number one we have really goodevidence for and number two,
that are cheap, and so weactually have several of those
things.
So first I mentioned melatonin.
(07:57):
We've got randomizeddouble-blind placebo-controlled
trials showing that melatoninhelps.
I don't recommend it veryfrequently, but it does help,
and that's because I'm typicallytaking care of people with
severe eczema who really needaggressive pharmacological
therapy, and that's going to getthem so much better that they
don't need something likemelatonin.
But for somebody with mild tomoderate atopic dermatitis, I
(08:20):
think melatonin can make a bigdifference.
I recommend five milligrams QHAat night.
If it's a kid, I recommend onemilligrams QHA at night.
If it's a kid, I recommend oneor three milligrams at night,
and again, we have randomized,double-blind, placebo-controlled
trials to support that.
Other things that I recommend tojust Now.
The next two things I recommendto everybody.
So the first is an oralceramide supplement.
(08:41):
So ceramides are the special,key component of your skin
barrier that helps seal water inand keep irritants out, things
that might trigger eczema.
And, believe it or not, we havemuch better data that taking
them by mouth helps your skinbarrier function Much better
(09:04):
data for that than we do forputting them on topically, and
so we have randomized, multiplerandomized, double-blind,
placebo-controlled trialsshowing that taking ceramides by
mouth improves barrier function.
The one in particular that Irecommend is from a company
called Life Extension.
You get it on Amazon.
It's about 16, 17 bucks a month.
It's from a company called LifeExtension.
(09:26):
I have no connection with them,I don't make anything from this
, but it is called LifeExtension Skin Restoring
Ceramides.
It's one small pill a day and Itell people give it about three
months to see if it's going tomake a big difference and the
way that I describe how that'sworking.
I tell people your skin issupposed to look like this and
nothing can get in or out.
(09:48):
Well, if you've got atopic derm, either genetically or from
long-term damage, fromenvironmental chemicals.
Your skin looks like this andhas these gaps in it.
They're letting things in toirritate you and letting water
out.
So your skin gets dry, so theceramide acts as a.
Water out, so your skin getsdry, so the ceramide acts as a.
(10:11):
It fills these gaps in andpeople get that idea.
So ceramides, then the next oneafter that, and then I recommend
everybody is a probiotic and wehave multiple studies showing
that particular probioticsdefinitely help, while as other
probiotics definitely do nothelp.
So there are certain strainsthat we need to get.
There are four in particular.
I can never remember the namesof the four, but the probiotic
(10:34):
that I recommend is called NOWN-O-W.
Can you get it on Amazon?
This one's about eight bucks amonth.
Now N-O-W is the brandProbiotic 10, meaning it has 10
strains of bacteria in it andthen they make different
strengths.
I recommend the 25 billion.
It's the most cost effective.
It costs about eight bucks amonth.
(10:54):
And what that one is doing.
We know that a big reason forthe atopic dermatitis epidemic
over the last 50 years has beenthe American diet and in
particular, the American dietupsets the natural healthy
microbiome, and a naturalhealthy microbiome is supposed
to be making substances thathelp calm your immune system and
(11:19):
keep it regulated, and so weneed to replace those natural
healthy bacteria with thisprobiotic.
And really, where you go withthis one is if the patient says
that diet, you know I have toavoid certain things, or I flare
.
What should I be avoiding?
What should I not be avoiding?
It's not.
There's nothing they're goingto be able to figure out
(11:40):
long-term.
That is a avoid this.
What really is happening?
There are certain foods thatare going to cause relatively
acute changes in the microbiome,uh, and that then makes people
flare, and so you in which foodsit is going to change over time
.
So instead of of telling peopleto go see an allergist or avoid
(12:01):
certain foods, you're tryingelimination diet.
You put them on a probiotic,and that is helping to calm down
and regulate their immunesystem.
And then and again nowprobiotic, and that is helping
to calm down and regulate theirimmune system.
And then and again nowprobiotic.
10, 25 billion.
And then the third supplement orthe fourth.
So right, we got melatoninceramides, probiotic.
Then the fourth one that wehave randomized double-blind
placebo-controlled trials for ishigh omega-3 fish oil.
(12:23):
And there again we know theAmerican diet.
You have way too much omega-6,which is pro-inflammatory, and
not enough omega-3, which isanti-inflammatory.
And so we have people we haverandomized double-blown super
controlled trials it's at least500 milligrams a day of omega-3.
And really any.
Again I recommend from LifeExtension.
(12:44):
They make a super omega-3.
That's what I take personally.
Uh, I take actually all ofthese uh things personally, even
though I don't.
I don't take the ceramides, butI take the probiotic and the
fish oil.
Uh.
So the the life extension, uh,super omega-3.
And again we've got randomizeddouble black placebo controlled
trials supporting that.
(13:05):
Now I don't recommend the fishoil to everybody and that is
because the ceramide is onesmall capsule a day, the
probiotic is one small capsule aday and if you can't take a
capsule you can open it and pourit on food.
But the fish oil is four bigpills a day, so it can end up
becoming a lot for the fish oilin terms of how much you have to
(13:26):
take.
But those are the supplementsthat I recommend.
I don't recommend any topicals.
So you know, some people talkabout even primrose oil,
sunflower seed oil, things likethat.
Never seen any real data thatanything topically really makes
a difference.
But those are the oralsupplements that I recommend for
(13:49):
people with atopic derm.
So and again, the fish oil.
It's an anti-inflammatory, theprobiotic is to regulate the
immune system and the ceramidesare to help restore barrier
function.
And all things together I wouldsay that those supplements get
people 10 to 20 percent better.
(14:09):
Now it's actually more.
What I would say is it reducesthe severity of eczema by one to
two steps.
So if we put eczema on a 10point scale zero, you're perfect
.
Ten is the worst you couldpossibly imagine being.
If you're an eight, I think ittakes you to a six or seven.
So it's not like, oh, if you'vegot bad eczema takes you to a
six or a seven.
So it's not like, ooh, it's, ifyou've got bad eczema, you can
get better with the supplement.
(14:30):
No, but if you're a two or athree and I can take you to.
Or if you're a one, two orthree and I can take you to a
zero or one by getting you oneor two points better.
I have a lot of patients whodon't need to use any topicals
as long as they are using theoral supplements.
So they do make a difference.
(14:52):
They all have randomized,double-blind, super controlled
trials, and those are the threethat I know for sure have some
benefit.
Speaker 2 (15:01):
And if somebody wants to take those, as you mentioned
, better part of a more completetreatment regimen, which we'll
talk about another broadcast,but you mentioned, you know a
little bit of a concern which Ithink is important to bring up.
You know the food connection.
So when you have somebody comein it's like oh, this food is
definitely making me break out.
I need you to send me to anallergist.
How do you handle that?
(15:21):
Like what do you tell patients?
Like the real role, potentialfood allergies and their atopic
dermatitis, because I thinkpeople think it's much more of a
true cause than what it reallyis.
So, trying to dispel that mythand how we work with allergists,
but really it's more of acomplimentary approach.
Speaker 3 (15:37):
So I will talk about two different things here.
So I do think that there's arole for allergists in treating
some cases of atopic dermatitiswith allergy shots.
We have some data to back thatup.
But first to talk about how dowe talk about food allergy?
So the first thing we've gotdata that tells us that about
two out of three patients witheczema, food is a triggering
(16:01):
factor for them.
So it's not, you know I don'ttalk to because 10 years ago,
even five, three, probably threeto five years ago I was still
telling patients it's probably acoincidence, I know it seems
like every time you eat thatfood you get worse, but really
it's just that eczema kind ofgets better or worse on its own.
It's probably coincidental.
Patients hated that answer and,to be honest, I think that
(16:21):
answer was wrong answer and, tobe honest, I think that answer
was wrong.
So once I understood more aboutthe microbiome, now I will
proactively bring diet up,because it seems so that from
the patient perspective, if theybring diet up and then I give
them the answer I'm about togive, they often take it as like
I'm making something up just toplacate them, whereas if I
(16:45):
bring it up proactively, thenthey feel like, oh, this guy
knows what he's talking about.
He brought up food.
Most doctors tell me food's notan issue, so I will proactively
often bring up hey.
So about two-thirds of mypatients with eczema tell me
that food is a major trigger forthem, but they usually can
never pin it down to just one ortwo foods.
(17:06):
Does it a trigger for you?
And if they say no, then I'llstill be like, well, it might
become a trigger, so we're goingto, and if they say yes, then
it's much easier though.
So if they say yes, then I sayokay.
Now it's a really interestingthing, because we know that food
allergy never makes eczemaworse.
So now, food is definitelycausing your eczema to flare,
(17:27):
but it's not a food allergy.
Food allergies show up asstomach aches, abdominal pain,
maybe hives, like you know, ifyou ever know somebody who's
allergic to peanuts, like ifthey eat a peanut, they die
immediately.
That's what food allergy is.
Food allergy is never my eczemagets worse, so, but food is
definitely.
Food is definitely making myeczema gets worse, but food is
definitely making your eczemaworse.
(17:48):
It's not an allergy.
It's that food is reallyprocessed in your stomach and in
your intestines by the naturalhealthy bacteria that are
supposed to be there, and weknow that the American diet
things like food additives, foodpreservatives, emulsifiers,
antibiotics, hormones you knowall of those things in food are
(18:08):
upsetting the natural healthybacteria.
Then, once that happens,certain foods and which foods it
is will change over time,because the bacteria are always
changing will make that worseand make those bacteria even
more unhappy and then so thatcan make your eczema worse.
And so the key isn't to figureout which foods to avoid,
because it's changing all thetime.
You're going to you will noticesometimes you know, for a few
(18:31):
months, anytime I eat tomatoes Iget worse, and then suddenly
you can eat tomatoes just fine,but now anytime you eat corn you
get worse.
It's, it changes over time.
So it's not about finding thefoods to avoid, it's about
getting that natural bacteriahealthy again, and we're going
to fix that by having to startto take this probiotic Now.
(18:53):
Patients really appreciate that.
Now to talk about the role ofallergen immunotherapy, so
particularly for dust mites.
So we've got fairly goodevidence that doing
immunotherapy for dust mites forpeople who are highly allergic
to dust mites does seem or not.
Even people will often getsevere reactions from the shot,
(19:26):
either locally or they could geta systemic reaction where their
airway starts to close off.
They're like in the allergyoffice it's an emergency.
But if you've really gotsomebody, that you're somebody
who's really stuck and nothing'sworking for their eczema, it
can be very reasonable,especially for dustbite to get
tested and then, if you areallergic to dustbite, to get
(19:48):
treated for dustbite allergy.
But again, it is not easytreatment and then even if you
are able to get through theinitial few shots, which is
where you see most of those sideeffects, then you've got to be
going into the allergy officelike once a week, you know, for
a year essentially to get shots,and so it could be a real
challenge.
But in tough cases it can behelpful.
(20:10):
But that's about the only placethat I've really seen data or
clinically experienced thatallergy shots really helped.
Speaker 2 (20:20):
Well, that's great information.
I think that clarifies you knowa little bit of where patients
you know want to jump theallergy train quickly, which we
know.
A lot of people with eczemajust happen to have seasonal
allergies as well or allergiesto other things.
But the relevance to the eczemaor atopic dermatitis is part of
what the question is and wherewe can work with allergy to
figure that out if it'sworthwhile.
So we got some really goodsecrets and tips from you here
(20:41):
today and we're going to wrap upthe podcast because next time
we'll have you on to talk alittle bit more about the
pharmaceutical therapeutics thatare variable, you know,
available for patients.
Which one works, which one isbetter, which one do you think
is the right time for a patientto start on?
So we'll dive into that alittle bit deeper on our next
episode.
But I want to thank you, drZyrus, for all the information
today.
They got people thinking twiceand they stop in that supplement
(21:03):
aisle or maybe look online thatthey have alternatives to help
with their atopic dermatitis.
Speaker 3 (21:08):
And and the big thing with the uh, with the
supplements, I always tellpeople give it about three
months.
Uh, you know, get on all threeof them.
You know, if you're going to,if you're going to do it, at
least the two, the ceramides andthe probiotics, uh, and give
those at least three months.
And I'll even tell people giveit six because we know they're
good for you in general.
(21:29):
It's really just a matter of isit worth spending the $25 a
month to be on them, and I thinkyou can figure that out in
three to six months.
Speaker 2 (21:39):
Great tip.
Great tip.
And for those of our listenersthat want to find you, where can
they find you?
Online, available or everywhere?
Speaker 3 (21:48):
I stay under the radar.
They can find me on the DermotTrotter podcast.
I do no social media oranything else of my own, and so
I'm really not out thereanywhere.
Speaker 2 (22:06):
All right, we'll find him here on the Dermot Trotter
podcast and maybe we'll be ableto get him into one of our
future parodies or TikTok orInstagram videos.
We'll try, we'll try.
We'll introduce him.
I would love it.
Great Thanks, thanks again.
Speaker 1 (22:22):
Thanks for listening to Dermot Trotter.
For more about skincare, visitDermot Trottercom.
Don't forget to subscribe,leave a review and share this
podcast with anyone who needs alittle skincare sanity.
Until next time, stay skinsmart.
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