Addressing The Root Cause of Skin Issues in Children and Teens

Episode Transcript

Dr. Nicole Beurkens:

Hi, everyone, welcome to the show. I’m Dr. Nicole. Today, we’ll be talking all about skin issues in children and teens and how those can be connected to other health problems and what we can do to address root causes. I find that many children struggle with conditions like eczema, or acne, or rosacea, or those types of things. They can be frustrating to resolve. I dealt with that both as a parent and also as a clinician. What many people don’t realize is that these kinds of skin related issues are connected to other kinds of health issues, and including mental health issues.

Same kinds of things that can cause problems on the skin can also contribute to issues in the brain. I find more often than not that kids that are coming into my clinic for developmental or mental health kinds of challenges also have one or more significant skin issues going on. To help us understand these connections and what we can do to effectively treat these issues, I’ve invited Dr. Raja Sivamani on the show today. Let me tell you a little bit about him. He’s a board-certified dermatologist and practices as an integrated dermatologist at Pacific Skin Institute.

He’s an Adjunct Associate Professor of Clinical Dermatology at the University of California Davis and Director of Clinical Research in the Clinical Trials Unit. He’s also an Adjunct Assistant Professor in the Department of Biological Sciences at the California State University, Sacramento, and an Associate Professor of Dermatology at California North State University, College of Medicine. He engages in clinical practice as well as both clinical and translational research that integrates bio-engineering, nutrition, cosmetics, and skin biology. Such an interesting combo, we’re going to ask him about that.

With training in both allopathic and Ayurvedic medicine, he takes an integrative approach to his patients and in his research. He’s published over 100-peer reviewed research manuscripts, 10 textbook chapters, and a textbook entitled Cosmeceuticals and Active Cosmetics, Third Edition with a passion for expanding the evidence and boundaries of integrative medicine for skincare. It is such a pleasure to have you on the show today. Welcome, Dr. Sivamani.

Dr. Raja Sivamani:

You’re so sweet. I’m super thrilled to be here. I love your podcast. I love what you’re doing with it. I’m also super jazzed to talk about skin any chance I get.

Dr. Nicole Beurkens:

Yeah, awesome. Skin for kids because, often, this is something that people aren’t talking about and it’s something that comes up often in my clinic work. Also, we’ve had lots of questions from listeners about these kinds of issues for their children. I’m excited to dive into it. I want to start with just give us a little background at how you came to be doing this integrative work that you’re doing because your educational and career path has taken some interesting twist. We’ve got the bioengineering, we’ve got the med school nutrition, the Ayurvedic medicine. How did all of that come to bring you to this point?

Dr. Raja Sivamani:

I think with all good things in life, you want to paint a picture that was super organized the whole way through, but you just let life come to you. I think that’s the first thing, is you just let life give you what’s going to give you and then you just go with it and not resist as much. In the very beginning, I just loved engineering when I was an undergrad. I thought this is really fun, get to really think through problems, get to understand what are the building blocks. I think that’s really what inspired me to go integrative, is understanding that there are building blocks to everything. Then when I went to medical school, we memorize so much.

I started thinking about, well, what are the building blocks that I need? I saw big holes in the building blocks. I saw a big hole in nutrition. I saw a big hole in thinking about mind, body. When we say nutrition, I mean you think about supplements, you think about herbs, you think about foods and what’s the right diet for me. When I started looking at all that, I started realizing, gosh, medical school is amazing, loved it. Went to UC Davis, absolutely loved it. I do have to say, felt like there was a big missing piece in there that I just didn’t get. I went to train in Ayurvedic medicine because I wanted to look at the person a bit more holistically, not just biochemical pathways and diseases.

I wanted to know, what’s the science of living well? Sometimes in medicine, it’s not a science of living. Well, it’s a science of how to get someone back towards what we considered healthier, early reactive medicine, as I call it, but if you’re thinking about preventative medicine. Then I went into Ayurvedic medicine. I’ve loved research, and putting those together has really given me, I think, some insight into how do you combine engineering, the building blocks, how do you take that, then build these bridges between alternative approaches like Ayurvedic medicine, and then, of course, conventional medicine. Nicole, you’re absolutely right, skin of children is a little different than skin of adults or skin of really older folks. It’s developing. It’s starting to what I say find its way to thrive. You have to help it come into its own.

Dr. Nicole Beurkens:

Yeah, awesome. People often don’t associate skin problems with other aspects of their health. It’s like, “oh, I’ve got this rash, or my child’s got these dry patches, or we’ve got these issues going on”. They tend to, like with lots of things in medicine, just look at it as an isolated issue. Oh, put some cream on it, make it go away type of thing. Really, the skin is a way of showing us other things that are going on. The skin can be a red flag for more root level issues happening. I’d love to have you talk about why it’s not just about what we’re seeing on the skin.

Dr. Raja Sivamani:

I’m so happy you’re bringing this up. This is such an important point. Sometimes it is easy to say, oh, it’s a dry patch or stop itching. How many times have we heard this before, this poor child that has eczema and you say stop itching. Or even with acne, they say, oh, it’s just acne. The psychological consequences are so profound. This isn’t just, oh, about I’m feeling down. This is truly feeling left out socially or feeling like you’re not getting enough sleep and tired, and not doing well in school, and then losing confidence in yourself. For example, with eczema, eczema is not a problem with just a child, that’s the problem of everybody in the house.

If the child’s not sleeping, the mother and father are not sleeping, the siblings may not be sleeping, everyone is tired. Then they go to school, they don’t have that concentration level the same way that another child might. Yes, they are itching, but it’s not their fault. I think sometimes it’s easy to blame the child or something like that. The psychological impact of not getting good sleep, but also maybe kids make fun of them and then with really bad acne. Psychologically, that’s like the time of your life when you’re trying to be social. You’re developing socially into your early teens and mid-teens.

If you don’t have that confidence, the way you present yourself, yes, maybe for today you say, oh, it’s a little bit of acne. I’d never say that, by the way. I never say it’s a little bit of acne. What about tomorrow when you go for an interview when you’re an adult? All those habits that came from childhood persist. I think building those healthy habits early is probably the best preventative medicine or preventative approaches to wellness start as a child. Yes, the psychological impact is massive.

Dr. Nicole Beurkens:

We’ve got actually several really good studies on that, particularly as it relates to acne in preteens, teens, young adults showing the very profound psychological consequences of having these unresolved skin issues. You’re right. It’s connected to depression, anxiety, social isolation, just all of those things.

Dr. Raja Sivamani:

Absolutely.

Dr. Nicole Beurkens:

It is so important that we don’t just minimize that and say, oh, it’s not a big deal or oh, it’s not connected to anything else. It’s a really big part of kids’ physical and mental health.

Dr. Raja Sivamani:

The other thing is that it’s hidden sometimes because children don’t always tell you when they’re going through something that’s tough unless you specifically ask. I can’t tell you the number of times that I’ve had children bring things up and the mom and dad say, “Well, why didn’t you tell me about this?” I think we have to realize, children don’t see it as a duty to tell their parents sometimes if they’re feeling bad. Sometimes they hide it, because they don’t want to feel guilty that they’re going through it. I think it’s important to engage them in the conversation. They definitely are going to feel slight social isolation, or even overt social isolation, or some sense of confidence that they lose or whatnot. We have to engage them in that. I think it’s part of the treatment process, too.

Dr. Nicole Beurkens:

Yeah, absolutely. I love that you look at it in that full 360 degree whole person kind of way. It’s not just about what’s going on on the skin. Beneath that, and so we see these symptoms on the skin, we may have a child who’s got these really red, scaly, itchy, dry patches that won’t go away or we’ve got a kiddo who’s really struggling with acne or other kinds of things. We see that on the skin. Let’s talk about what’s going on beneath the surface there. What are the things that you think about when a child comes in with these issues? Yeah, I see the symptoms on their skin, but what do we need to be thinking about beneath the skin level?

Dr. Raja Sivamani:

Yeah, this is also a really important question because I think … Let’s start with the eczema as a first example. If you look at eczema, a lot of folks want to know what else is causing this, whether it’s internal or external. I think that’s where this beneath the skin part or deeper to the skin part is really important. Especially with eczema, there’s an environment outside of you and inside of you that plays a role, but then there’s also your internal tendencies. In Ayurveda, we call it tendencies in western medicine it’s kind of the genetics, but the epigenetics is what’s being actually expressed in your genes.

If you have a lot of family members that have eczema, you’re just going to have a higher risk because some of your genes are going to predispose you to having a skin barrier that’s not as good. Then comes the question of, well, what about food? What about the things that we’re eating? What about our bathing practices? I just want to touch upon a couple of these.

Dr. Nicole Beurkens:

Yeah, sure.

Dr. Raja Sivamani:

For one, when it comes to food, we know that by enlarge, usually food may play a role, but it’s not the overarching driving factor. I try to really be mindful to parents to not restrict all foods because you don’t want them to get malnourished. Malnourishment can be very insidious. It can take form and you might not realize it’s happening. Then eventually, you can be in a situation where say, “Oh my God, my child doesn’t get enough nutrition.” There are certain foods that we know that if you know it flares, and the best way to do is eliminate one food at a time, and the ones that are the bigger culprits are eggs and in many cases, dairy.

Dairy is a controversial one, because we don’t want people to necessarily take dairy off if it’s important for the child to grow or if they have some sort of a condition where they don’t have good growth. Because dairy is very good at building bones and building muscle and things. That being said, sometimes we want to think, oh, there’s this one food that’s going to be an end all be all. I think it’s really important to work with someone closely on that. I think nutrition is an important piece. The second thing, believe it or not, bathing habits make a huge difference. Or people don’t realize that body wash still counts as soap. They think body wash doesn’t count as soap.

Body wash is still a soap. It’s still washing your body and stripping things off. If you have a child that’s dealing with eczema, the more soap you use, maybe armpits and the private areas, go ahead and do that, but on the rest of the body when you use something like soap or a body wash, you still are stripping off their natural oils. As it is, one of the issues is that your natural oils are a little bit deficient when you have eczema. I try to tell people, be careful about how you bathe. Then, of course, if you have eczema and it’s a flare, we’ll talk about treatments. I think it’s important to look at the lifestyle habits that are there.

Because those are actually, believe or not, going to be the make or break between whether you’re going to have long-term control or if you’re going to continue to be fighting these flares over and over again. That’s one small example. Acne is another one. There we now know that with a lot of epidemiological studies, lot of studies that are looking at the connections between food and acne, if you have foods that are high in refined sugars, sodas, sweetened teas. By the way, teas are great, but if they’re sweetened, they tend to have a big sugar, low dairy. Believe it or not, nonfat and low fat is a bigger insulin spiker than full fat dairy.

Dairy, by enlarge, now we can see there’s a lot of connections there. I can’t believe I’m saying this, but I’ve teenage boys that are willing to restrict their diets and they come in and they tell me, “Oh my God, my skin’s getting better.” Of course, you put in the other treatments. I think it’s important to talk about the inside-out approach. It’s really important to bring in that role of nutrition too.

Dr. Nicole Beurkens:

Absolutely. I think that’s the piece that is often missed in the conversation. When I see patients, they come in, and some of them who’ve been struggling for years and years on all kinds of skin creams or medications or things. The parents will say, “Oh, nobody talked to us about what we’re eating.” I think the general point you’re making that’s really important for people to understand is that what we put in our bodies impacts us in every way. We talk a lot on this show about how the food that we put in kids impacts how their brain functions. Well, it impacts every part of our body too, including our skin, right?

Dr. Raja Sivamani:

Absolutely.

Dr. Nicole Beurkens:

Eating a lot of high sugar processed junky kinds of foods is going to impact our skin as well.

Dr. Raja Sivamani:

Yeah, there’s no question about that. The other aspect of treatment that I think is really important is the big bad boy for eczema that I think a lot of parents worry about is steroids. Steroids are actually very, very effective. I’ll tell you a small little thing. A lot of my colleagues know that I’m integrative. They’ll have a parent that says, “Oh, I don’t like steroids. I’m sending them to you, because I want to see if you have any alternative approaches.” Then I’ll see them, we’ll have the full conversation. In some cases, actually many cases, if they’re flared, I’ll put them on the steroids. My colleagues will say, “Oh, what did you end up doing?”

I’ll say, “Start them on steroids.” They said, “No, no. I thought they didn’t want steroids.” I tell them, “No, no. It’s not about not wanting steroids, it’s about having a full conversation, understanding where steroids fit into that treatment.” Because I think the big fear is, oh, my child is going to be on steroids forever, the steroid withdrawal. There’s ways to manage that so that you can include it as part of a holistic treatment plan. Same thing, with acne, you worry about antibiotics. It’s the same approach. Find a way to bring those antibiotics down, but tell parents what’s the context and why we’re using them. If there are alternatives, go towards that.

Dr. Nicole Beurkens:

I think you’re so right that often the resistance is simply that the recommendation of medications are not discussed in a broader context of and here’s all the other things. Parents feel like I just keep getting handed this prescription, but I don’t have any other tools and this is still a problem. They feel like they’re just putting a Band-Aid on it. When you talk about it as here’s the role these medications they’re going to play and here’s the other things that we can do on a foundational level to help with this, that makes a big difference for parents and for kids to understand how these things fit together.

Dr. Raja Sivamani:

Yeah, exactly. I think also letting parents know that there’s different intense. Western medicine is really good at getting things done quickly. If you have a bad flare, as much as we might want to address something like diet that might have a slow effect over time, the child sitting in front of you is miserable. You need to get them into a form where they feel confident that, hey, I’m getting better. Even the parents can feel a bit confident like, okay, now the symptoms getting better. I think you’re always managing what we call acute care with chronic management. It’s important to put those into perspective as you have the conversation with your doctor. Doctors should be looking at that too when they’re having the conversation with you as a patient.

Dr. Nicole Beurkens:

Absolutely. I want to touch on lifestyle factors. You talked about food, you talked about the bathing kinds of things. You and I have had previous conversations around other lifestyle issues like stress …

Dr. Raja Sivamani:

Oh my gosh, absolutely.

Dr. Nicole Beurkens:

… like getting enough movement, these kinds of things, which again people typically go, “Why are you talking to me about that? My kids got the skin issue going on.” What are some of the other lifestyle related things that you see that play into these kinds of chronic skin conditions that people have?

Dr. Raja Sivamani:

Oh my god, this is such a huge area. We generally are poor at being able to reflect upon our stress, I think, from a western society standpoint. Because it’s so easy to get caught up in the daily things that we have to do. Stress just builds up. Even for our children, they’re going through school. If you just take a child that maybe isn’t doing so well in school, it can snowball on the child. Because you didn’t get a good grade, now you have to study harder, but then studying harder puts more pressure, then you have to get a good grade. Then it can go back and forth.

If you have some ways to break that cycle and just spend time thinking about things like meditation or doing yoga together, or just doing something that takes your mind off of the stresses that are there, it’s huge. One thing that I do talk about to a lot of parents and patients is getting involved in yoga early and doing something together in that form. Or another option would be if you’re really thinking about meditation, they have these great apps now. I have no connection to any of these apps. I know some of them like Calm and Headspace, a lot folks find it’s a great way for the family to engage. Not just for you, but you can bring your child in.

How great is that if you could spend a couple minutes every day at the end of the day just saying, hey, let’s do this app together? It’s fun for them because it’s technology. It’s not so esoteric at that point, because you get to use whatever it is, your phone or something, an iPad or load up the app, and away you go. I think this mind body connection is so huge, and it does play a role. There’s no question. I appreciate you bringing that up too, Nicole, because this is such an area of need.

Dr. Nicole Beurkens:

Well, it is. We just see more and more kids and just families in general being so burdened by high levels of stress. We talk about that a lot from the psychological standpoint of things of how that reduces anxiety, gives kids better coping skills, helps with mood, sleep, all of that. I love that you’re talking about this too. Because it then registers for people that, oh, this time that we’re spending doing a little bit of yoga or some guided meditation or the Calm app or whatever. Huh, that also can help with my child’s physical issues like the skin problems they have going on. Say a little bit about why there’s a connection there because some parents might be listening and they’re going, how does doing some yoga or a breathing app or something with my kid, how would that have anything to do with their skin?

Dr. Raja Sivamani:

Well, first of all, I think when you think about stress, stress is going to impact cortisol levels in the body. We also know that the immune system plays a role in much of how you deal with inflammation. When you have stress, it sometimes will stimulate a higher inflammatory response in your body. The same person and this concept in Ayurveda is known as ojas, ojas is this concept of can you take on stress and how does your body respond to stress. We know that the more stress you get, the more you’re depleted, and the more you feel … Even in the western world, we have this very same concept.

The more and more stressful your life gets, you hit a point where you start to use the term burnout. When you start to burnout, it’s not just you mentally. Your body can do the same sort of thing where it’s not able to deal with inflammation as well or it starts to have hypersensitivity, meaning you have more itch than before, you have less sleep because stress impacts sleep. The less sleep you get, the rest rejuvenated your body is and a way we go into the cycle that’s not healthy at all. I think that’s where stress is a major impact. Here’s an example. This is an example that I like to give patients, whether they’re parents or even if they’re adults.

I had a patient that came in that was dealing with stress, and it was a really challenging situation with her eczema and just dry skin. I talked to her about putting on a moisturizer. Putting on a moisturizer shouldn’t feel like a chore. It shouldn’t feel like a self-love situation. In Ayurveda, we have this concept called self-Abhyanga, the concept is Abhyanga, which is massage and massage with oils. Now we know that there are a lot of natural oils that might be good options for when you’re moisturizing a child. We tell parents, even if they’re babies or little children, start early and get them to start incorporating the Abhyanga, which is massage onto themselves or even you do it for your child.

It doesn’t take long with an oil. Ayurveda is a little brilliant. They figured out if you had something really sticky, it would take forever to put it on the body. If you use an oil, you can go faster. I think that’s a nice way to connect with your child, whether it’s sunflower seed oil, or coconut oil, or something that you can put on the child. If you do that, you start to make a bond that’s beyond just putting on a moisturizer. You’re actually touching the other person. I think that sense of touch is huge. As a child, if you start to see that touching your body is something that’s really normal in terms of … I’m talking about, obviously, in just arms and legs, we’re not going anywhere that’s inappropriate here.

Just doing that and getting them used to a routine of moisturizing and seeing how their arm feels, or the legs feels, or their hand feels, they get a better sense of self. That’s something that I don’t think we’ve explored so much in studies, but it’s there. I see a lot of my patients, when they start doing the self-Abhyanga approach, they have a better boost in their mood, they have a better boost in their sense of self. Also, moisturizing becomes a part of what we call therapeutic meditation yoga. It’s like a mental yoga for themselves. The stress really does have an impact to go back to what you’re saying. Then there are some ways, just have a way to bond around that.

Dr. Nicole Beurkens:

I love that, and such a powerful way to just strengthen the parent-child relationship too, which is so important for healthy minds, healthy bodies that those relational pieces and how maybe something that we might consider a chore of, oh, I got to get this stuff slathered on my …

Dr. Raja Sivamani:

Exactly.

Dr. Nicole Beurkens:

… kid after the bath. It’s like, oh, wait a minute, I can re-frame that into a few minutes of really meaningful bonding and interaction, calm my child, calm myself, and doing this, and really get a lot of mileage and a lot of ways out of such a basic thing.

Dr. Raja Sivamani:

Yeah, there’s no question. That bond, that parent-child bond, huge, huge, huge. We can’t underestimate that at all. That is so huge. The other part is it’s really fun to see them and follow up because you can see sometimes, especially when they’re smaller children, that their gears are going and they’re realizing that my skincare is also part of me. It’s not something that they then say, oh, I hate my skin for it. They realize there’s actually way to love their skin despite it.

Dr. Nicole Beurkens:

So fabulous. I’m thinking too that it helps kids to feel empowered and to feel like they have some control over their body, their health. It gives them something meaningful to do. I think when patients, whether they’re children or adults, feel a sense of empowerment in that way. That goes a long way to helping with treatment too.

Dr. Raja Sivamani:

Yeah. We have this sense even with the Instagram world now and just on TV. Everything is so perfect. Sometimes children see things and they realize, oh, everyone around me must be perfect. As we grow older, we start to realize, oh, wait a minute, that’s not the way the world works. We all have imperfections. Then you come into your own and realize, okay, I have to embrace this. Some of us get there sooner than others. Eventually, I think if you look at anyone that’s near the end of their life, they will tell you, “Gosh, life is just a bunch of turns. You just find your path and not everything is like a perfect carved Instagram story.”

I think it’s really important for children to realize that early, because I think it minimizes their psychological devastation that could occur, if they think everything has to be perfect, and they are imperfect. That’s the worst thing that you could do. Teaching them that, I think, really is the role of a physician too, is to let them know that, I hate to use imperfections, but I say, “Hey, your unique qualities are what makes you special.” Sometimes when they come in with a little weird mole, and they say, “What’s this?” I say, “Oh, it looks like you got kissed by an angel or something.”

Dr. Nicole Beurkens:

I love it.

Dr. Raja Sivamani:

This is different ways to put that together so that they see that it’s actually cool.

Dr. Nicole Beurkens:

Right. How we frame that stuff for kids in the language that we use makes a profound difference in how they see themselves and how they see those things, right?

Dr. Raja Sivamani:

Absolutely.

Dr. Nicole Beurkens:

I think that’s so important. I want to get into for a few minutes of your time at some of these root level issues, other things that contribute … Let’s touch on the issue of the microbiome as it relates to skin things. Because I think that there’s more out there about that, like a lot of our listeners are familiar with the gut microbiome, at balancing the microorganisms that live in our body and can support our health. What are your thoughts on the relationship of the gut microbiome to skin? I know that the skin also has its own microbiome. Many people might not be aware of that. Let’s touch on that a bit.

Dr. Raja Sivamani:

Yeah, this is probably one of the funnest areas for me to talk about because we do a lot of research in this area. We not only look at the skin microbiome, which by the way is super rich, lot of little niches as we say in environments, microenvironments, and then the gut microbiome. To start with the gut-skin connection, we already know there’s definitely a gut-skin connection because when you eat certain things, it does affect your skin. The microbiome is really interesting. We have a unique mix of ways that we can communicate with the rest of the body from the microbiome. Some small examples are things like short-chain fatty acids.

Those are chemicals that are released by different bacteria. Typically, we think of them as being good for the body. There are good bacteria, as we say, “good bacteria” that are high producers of short-chain fatty acids that we think can then go through the bloodstream and then connect to the skin. Then this is just one chemical. There’s many different that we are still uncovering, but that can impact the skin. We find in some of our research that short-chain fatty acids can be anti-inflammatory to the skin. If there are ways that we can boost those bacteria in the gut, then we think that that might have a relationship. We are early.

We’re just figuring out how these bacteria shift and change. I also tell people, we’re not too early. Actually, we have tools that we can look at. Now the skin one is really, really interesting as well. I personally find the gut one fascinating, because it allows me to connect alternative medicine approaches with western research approaches so we can meld together Ayurveda concepts with western medicine. We are publishing a few articles on that right now. We published one on curcumin. We’re going to have one on Triphala, which is an herb that comes from Ayurvedic medicine, looking at how that shifts the gut. Now, the skin, oh my god, the skin is so rich.

They have so many crevices that you don’t even realize. Every hair follicle has what we call an invagination into the skin and it’s full of microbes in there as well. You have actually multiple environments. You have the environment that’s oxygen rich right on your skin, but then you have the areas that are within the hair follicle that might be a bit more oxygen poor what we call an anaerobic environment. You have different bacteria that live on your skin. Not only is it bacteria, you have yeast. We know that you have mites that live naturally. I don’t want anyone to get weirded out there like supernatural mites that live on you, believe it or not. They live symbiotically.

In some cases, they get out of balance. One example, with eczema, in eczema, when people flare and it was a really nice study done by Heidi Kong and Julie Segre at the NIH where they’ve tracked children with eczema before a flare and then when they got into a flare. Believe it or not, their diversity of bacteria on the skin shifted towards only having a dominance of a certain bacteria called Staphylococcus aureus, and that preceded the flare. Now, is that a chicken or the egg story? We don’t know. We know that some of these markers started shifting before the child started getting a breakout and eczema.

Then once the eczema was brought under control again, that Staphylococcus aureus dropped down. This is not an infection. This is just a colonization and an imbalance. We do know that there’s a susceptibility to Staph aureus in children with eczema. It’s very interesting that you can track this at the microbiome level and that there are other bacteria that may help to control the Staph aureus loads. We have natural bacteria that are good. Why does a bacteria shift out of balance? Why does it come back into balance when things get better? All questions that we’re trying to approach and understand, but it’s very interesting. Clearly, you have this community of bacteria, community of microorganisms that are controlling the inflammatory state of your skin and the state of your skin barrier to some extent.

Dr. Nicole Beurkens:

So fascinating. I think as you’re saying, we’re on the cusp of just starting to really understand these connections. It seems like this is the direction that research is moving to really understand and move beyond just what we’ve known and what we’ve done up until now. It’s like this is the next frontier of really understanding the mechanisms of how all this work.

Dr. Raja Sivamani:

Absolutely. This really is the next frontier. I think what we’re going to see now as we go along is, initially, we’ve been talking about the microbiome is what bacteria are present. I find that akin to saying who lives in a city. Now we know who lives there, but you don’t know if that person’s a lazy bum sitting and just watching something on TV, or are they out there doing something, or they’re doing something that’s good or doing something that’s negative. The next level is functional microbiome related analyses. We’re headed in that direction. We already have some of that now. Even us, we’ll be working on some of those studies to understand now that we know what bacteria are there, what are they doing and how can we figure that out? It’s not just bacteria, yeast, again, mites. There’s a whole community there. We need to know who’s doing what.

Dr. Nicole Beurkens:

Well, so that begs the question, because there’s probably many of our listeners are thinking, okay, if the gut microbiome, skin microbiome, if these microbiomes are related to this, then can we just give our kids some probiotics and will that help?

Dr. Raja Sivamani:

It’s a great question. We’re looking at that. One small example of where this may be interesting is there was a study that was done, small study that was done in acne. Now the study was done in adults. They compared it against an antibiotic that was given at half the normal dose. They found that in these two groups that the probiotic group that was given orally did just as well as the antibiotic group, which right then and there, you have to say, wait a minute, there’s clearly something more to these probiotics than what we had realized in terms of not only controlling what’s in the gut, but they may have effects outside of the gut.

When they put them together, it was synergistic. We’re going to be doing a study on probiotics and acne that’s coming up. We’ll see what we find. Then also not only there, if you look even at the level of eczema, there was a small study where there was a topical probiotic that was put on the skin, a topical bacteria, and they found that that was helpful in restoring balance to the skin. We’re starting to understand that probiotics is not just a buzzword, that there are some science behind it. Now, probiotics aren’t all created equally. There seems to be some science there.

If you can either temporarily shift what the balance of your skin is or the Holy Grail, is there a way that you can do that more permanently? This is where food comes into play. Because the foods that you eat probably do control the kind of bacteria that grow in your gut. Then what about the food that we put on our skin? Well, we have a name for that. It’s called moisturizers and topical skin therapies. That’s going to be the next frontier, is understanding what we put on our skin matter. Just to speak to that, we’re about to do a study right now looking at things like parabens and phthalates.

If a moisturizer contains them, does that shift the microbiome more than if a cream didn’t contain them? Because we want to look at what is the science there. What about preservatives that we put in our skincare? Stay tuned. It’s going to be over the courses next upcoming year or two. We’ll have some more research that we’re doing on this.

Dr. Nicole Beurkens:

Awesome. Can’t wait to see that. That does beg the question then that I had meant to ask earlier when you’re talking about things like eczema, are there things that people should be looking to avoid? It’s complicated for all of us. I’ve been there for myself looking at the aisles of products for my son who has struggled with eczema over the years. Parents come in and they’re like, okay, so I’m standing there at the store, I’m looking online, and there’s 60 different kinds of moisturizers, some of them even labeled for eczema or those kinds of things. What are some of the things that you feel like parents can be looking for either that may be better or worse product wise to use on their children?

Dr. Raja Sivamani:

This is another really great question because I think when it comes to products, it really comes down to the ingredients that you’re using and what those ingredients do. In fact, we’re approaching this. We have a web site called Dermveda, that’s D-E-R-M-V-E-D-A, where we’re taking a deep dive into ingredients and how ingredients do make a difference. Also, it depends on your skin type. If you have really oily skin or you have dry skin, that’s going to be very different. The way you respond is going to be different. By the way, we have skin typing on there too. It’s all totally just free. The thing about eczema is that your skin already has this propensity to be dry.

If you use ingredients that are heavy emulsifiers, and there are a few drying agents that sometimes in soaps you can see things like sodium lauryl sulfate, and if you have emulsifiers that just … Emulsifiers are found in thin creams. Lotions that are really thin, really easy to put on the skin. The problem is when they’re laden with emulsifiers, they pull the natural oils out of your skin into the emulsified layer. Then when you shower, there goes all the stuff that was supposed to be in your skin. This whole notion of being addicted to your moisturizer comes up. I think it’s important to find good humectants. Humectants are things that help you grab on to water.

The classic one is glycerin and things that are occlusives. The occlusives that are used conventionally are things like petrolatum. By the way, while petrolatum is supposed to be a purified version of petrolatum. It’s less aggravating and tends to go on the skin much nicer. White petrolatum isn’t just a color, it actually has a meaning to it on purity. Or if you have Shea butter, coconut oil. There’s so many alternatives if you look at the western versus maybe the oil-based or eastern approaches, but anything that’s occlusive. Those two are really important, a humectant that helps you hold on to water and then occlusive so that you help bolster the skin barrier so you don’t lose as much water through the skin as easily.

Both of those together I think are important. I talk to parents about this. It’s really important. Also, when you put the moisturizer on, it’s important to put it on no matter which product you use, get it on within three minutes of bathing. I personally have no issue with the child bathing every day. I know there’s a lot of controversy. Do you bathe every day or not? I don’t have a problem with it as long as you get a good moisturizer on right afterwards. Believe it or not, you start evaporating off the skin. The water starts evaporating off the skin very quickly after a bath. They’ve done studies.

Dr. Eichenfield has done some of these studies from the University of California, San Diego, where if you don’t get a moisturizer on quickly, you start evaporating to a point where you’ve lost a lot of the water in your skin that you don’t get that benefit. I tell people, usually, a minute to two minutes as soon as you get out, pat dry and get that moisturizer on is the first thing that you do.

Dr. Nicole Beurkens:

What I hear you saying is that the ingredients are important and that you gave a really helpful list of things that we can look for. Does it also make sense then for us to look at these labels on these products that the more things they have in them and the more chemicals and fragrance and all that that those are maybe better to steer away from?

Dr. Raja Sivamani:

Yeah, this is a great point too. Fragrances, that’s one of those that you want to try to avoid. Now, will it aggravate every single person? No, not necessarily. We tried to be mindful of the fact that when you have really dry skin, you also tend to have skin that gets inflamed more easily, something has a ton of fragrances. By the way, essential oils unfortunately go into that same category too, have a lot of essential oils, those are fragrances. They are nature’s fragrances. If you say that’s natural, yes, they’re natural in the herb, but they’re usually not naturally pulled out then put into a product. I think essential oils have a lot of healing properties.

Dr. Raja Sivamani:

I don’t want to across the board say that they’re bad, but realize that they are. They have potential to be allergenic. If you’re using a product and it seems to still be aggravating and you look at the label and it has a bunch of essential oils, that’s another culprit. Then there’s always preservatives in there that I think you have to be careful of. Sometimes they can be hidden preservatives, even if they’re fragrance free. Sometimes if they’re fragrance free and they have essential oils, they may still have a fragrance in there. It’s something to watch out for. Yes, you are right. If there’s a ton of ingredients in there and many of them are fragrances or many of them are essential oils, maybe okay for some of us that don’t have really dry skin. If you have dry and sensitive skin, might want to steer clear.

Dr. Nicole Beurkens:

Super helpful tips. I love that you mentioned your Dermveda website. I was hoping that we could throw that out there, because I think it’s a great resource for people. Anybody listening can go there and …

Dr. Raja Sivamani:

Absolutely.

Dr. Nicole Beurkens:

… there’s the information that they get, skin types, they can find different products. You make recommendations on there.

Dr. Raja Sivamani:

Yeah. What we do there is it’s really all about the skin typing and then ingredient science. If you go there and you take the quiz, it’s a pretty short quiz that we do and we build in mind body in there, you’ll get a really detailed look at what is your skin type. We break it really down in two. We’ve taken Ayurvedic medicine, traditional Chinese medicine and melded it into the western science. We have the skin typing that’s a little bit beyond just oily, dry, combination sensitive. We actually go a little bit deeper, because some of these other traditions go deeper into how your skin is unique. That’s the key. All of us have unique skin.

If you go to a big website that’s going to give you recommendations on products so that you can purchase a product and you just look for five stars on there, how do you know the person on the other end had the same skin type as you? You don’t. None of us would ever take financial advice from someone that was broke, for example. Why would you take skin advice from someone that has super dry skin if you have oily skin? Same sort of a deal. Then what we do on there is we actually analyze ingredients and then we can tell you if the product is compatible to you or not. We stay pretty agnostic. The idea is that you go in there and help us build that database too. Because pretty soon, what we’re going to have, Nicole, is the ability for people to take a photo of the ingredient label and we’ll read the label for you, and then return back how that matches to your skin type.

Dr. Nicole Beurkens:

Awesome.

Dr. Raja Sivamani:

It’s all meant to just build this database so that we can make better decisions and eventually, hopefully we can get manufacturers to be mindful of many different skin types out there.

Dr. Nicole Beurkens:

Such an important project. Again, coming from you and your team who are physicians, and scientists, and researchers in this, that is just a resource that is helping people now and it’s going to just go on to help so many more people. I’m so excited that you’re doing that. We’ll have the link for that in the show notes too. Is that the best place for people to go? Any other websites or things that you have out there that we could point people too to find out more about what you’re doing?

Dr. Raja Sivamani:

That’s so sweet. Thanks for bringing that up. Well, what I was going to say is this is really a bridge of everything that I’ve done in my life up until now. It bridges in engineering. It brings in clinical care, brings in dermatology. The other website that we’re building is called Jiva factory, J-I-V-A. Jiva just means vitality, and factories just the idea that all of us can get there. There’s a way to get there. It’s all about wellness. We’ll be building that website up. You’ll hear more and more about it. We’ve got a preview of the website that’s up right now. Really, we’ll be building it out to talk more about our own podcast that we’re going to be releasing, which is the holistic health podcast. That’s what we’ll be up to. It’s really just a wellness, engineering, dermatology and a better you.

Dr. Nicole Beurkens:

Such a fabulous combination. I can’t think of a better person to be bringing all those things together. I really appreciate you for spending the time with us today. This has been an incredibly helpful conversation. I know our listeners will find it really valuable. Thank you.

Dr. Raja Sivamani:

No, thank you so much. I have to say, Nicole, every time I talk to you, it’s super fun. I think what you’re doing is super amazing. I just want to say to the listeners, what an awesome show that you’ve got put together here. I loved being here.

Dr. Nicole Beurkens:

Thank you so much. Thanks to all of you for listening today. We’ll see you next time on the next episode of the Better Behavior Show.