According to Davie, FL dermatologist Marianna Blyumin-Karasik, MD, blending the benefits of aesthetic, conventional and integrative medicine is, in her opinion, the ultimate treatment cocktail. Here, she walks us through how this treatment path has helped target the root of her patients’ skin challenges to improve their skin health, beauty and overall wellness.
What is integrative skin care?
“Practicing integrative medicine is a unique way to approach dermatology and its undergoing renaissance. In the past, physicians were so focused on the conventional approach to dermatology—whatever the clinical evidence for disease solution was, we would use that to help patients get better. At the time, alternative medicine approaches were frowned upon because they were vague and scarce in scientific backing. Over the last 10 years, the research in that arena has really expanded and there is more evidence coming out that a more holistic approach to skin care is significantly more beneficial to patients overall.
During my everyday dermatology practice, I see a variety of patients with cosmetic, medical and surgical skin concerns. What is fascinating to me is realizing how often their concerns overlap. For instance, a patient may start seeing me for acne and then reveal how much they are bothered by their blemishes and acne scars, which affects their appearance and self confidence, and that feeds into a negative emotional-stress loop. Another patient may come in for a skin check and, while I am evaluating for skin cancer, our conversation may veer toward skin care or laser therapy to repair photodamage or the emotional upheavals in their lives and how it impacts their self regard in the mirror.
My insight is that aesthetics, just like the other fields of medicine, is very much integrated with the physical and emotional wellbeing of my patients. So, approaching and caring for a patient as a whole was an ‘aha’ moment. I recognized that our skin, body, mind, emotions, perceptions, intentions, and behavior are so vitally interconnected. This is when I decided to delve deeper into my patients’ ‘why’ besides ‘what’ brings them to see me. The answers paved the way to more rewarding results and meaningful relationships.
Integrative skin care entails looking at the lifestyle of the patient—influences such as nutrition, sleep, activity level and stress levels—and determining whether those factors are having an effect on the skin. The reason why this is important is because a lot more patients are interested in how their bodies and mental health are affecting their skin, so they’re beginning to research and seek that type of approach to wellness.”
Has Covid made this approach to dermatology more important?
“Covid has made this approach to dermatology more important than ever because it has put more emphasis on finding the underlying causes for certain skin conditions as well as our mind-body-skin connection. At the breakout of Covid, a lot of my patients were experiencing worsening skin issues, be it acne, eczema or psoriasis. Since the beginning of the pandemic up until now, we’ve also been dealing with a lot of stress. So, the more anxious we become, the more our skin quality deteriorates. A lot of the time, people are blaming their bad skin on eating habits, ingredients in their makeup or environmental pollution, but in reality it’s a combination of everything, with the most significant impact being stress-induced inflammation. It’s a vicious cycle!”
How do you solve skin conditions using an integrative approach?
“I like to integrate discussions with my patients to find the origin of their stress and, sometimes, I even refer them to a therapist. Let’s go through the journey of a patient with maskne, for example. Besides the fact that this patient has pimples and friction-induced irritation, the microbes on their skin are in complete disarray because of the increased humidity and heat from the mask. For maskne, I often recommend hypochlorous acid—that’s the hero ingredient in my Stamina Cosmetics skin-care line—because it’s a powerful antimicrobial and calming ingredient. This product is mainly a part of my innovative approach to fighting acne, sensitive or stressed-out skin problems but the integrative approach would be to look at what else is going on.
Diving more into the lifestyle assessment, I often ask my patients, ‘What is it that you eat on a daily basis?’ We chat about diet because a diet full of dairy and high glycemic index is often connected with more acne breakouts. We also talk about if they’re using supplements, as supplements can improve acne. Of course, we also focus on stress. 90 percent of my patients have been stressed since the start of Covid and they need to learn how to handle it. So, we figure out the level of stress they’re under and, if it’s severe, I often guide them towards seeing a behavioral therapist. It usually entails several sessions with a professional who can teach them how to better manage their emotions and mental difficulties. In my opinion, if the severe stress can not be addressed, you’re going to be constantly breaking out, no matter what skin care is recommended. If the patients are just mildly stressed, I recommend certain ways to reduce the emotional pressures that are reflecting on their skin. My recommendations include using apps like Headpsace or Calm, which harness the powers of guided meditation, integrating exercise into their daily routines and writing in a gratitude journal weekly as a way to enhance positive mindset and offset stress.
Another uplifting technique that I recommend to many of my patients is a mindful integrative skin-care ritual. This is something I enjoy myself and therefore encourage my patients to try. Even if it’s a few minutes in the morning and night, try to relax and breathe while you’re doing your skin care. We can all benefit from the sensual and decompressing components that are playful and calming, which can balance out our stressful feelings. This can even be extended as a meditative experience with enhancing skin-care tools such as gua sha or skin rollers, as well as soothing candles, essential oils, incense, music, calming tea, etc. These small measures create a pleasing cocktail of soothing self-awareness. During this integrative skin-care practice, my patients may also notice the positive affirmations on Stamina Cosmetics’ products that are meant to better their mindset while the ingredients improve the grit and grace of their skin.”
How would you treat the patient who has skin issues that’s unrelated to stress?
“If the patient complains of symptoms such as stomach aches, bloating, gas or indigestion, that could be related to their acne or other skin condition due to possible disruption of gut health. Oftentimes, these patients are good candidates for probiotic supplements, as they help balance out the microbes in the gut, which will therefore improve your complexion. Klaire Labs Probiotics ($45) and SereneSkin make really nice organic and helpful probiotics.
On the other hand, I usually ask my female patients if they have a regular menstrual cycle. If it’s irregular and they have cystic breakouts around their jawline during their cycle, it’s typically due to hormonal disequilibrium. In this case, I refer my patients to an endocrinologist to help them treat their hormonal imbalance. But, if the hormone abnormality is not significant enough to show up in their blood work, then we discuss other options like DIM (Diindolylmethane) supplements that balance out the bad and good estrogen in women. We also recommend supplements such as Nutrafol Women Balance and Stress ($79/month) to women who have hair loss due to stress and hormonal fluctuations. They contain adaptogens such as ashwagandha and antioxidants that can reduce the impact of oxidative stress on the hair and skin.”
Do you still recommend in-office medical and cosmetic treatments?
“Of course! I treat my patients depending on their personal needs. At Precision Skin Institute, we coined this tailored patient-care approach as Precise Aesthetic Balance. Besides providing medical therapies and cultivating holistic care, I am also very passionate about aesthetic treatments. I am grateful to offer a wide range of cosmetic treatments that can help my patients look and feel better. This includes skin care, chemical peels, microneedling, lasers and energy devices as well as neuromodulators, fillers, threads, PRP and biostimulatory injectables. The synergy and transformative outcomes of these medical, cosmetic and alternative therapies is what makes Integrative skin care truly valuable.”
