Day 1: Friday, September 30, 2022

Essential Guide to Food Allergies and Sensitivities in Dermatological Disease: Understanding the Key Role of the Microbiome

Faculty: Akil Palanisamy, MD

Dr. Akil Palanisamy started the day with a presentation about food-related skin reactions. He introduced the distinctions between food allergy, sensitivity, and intolerance, each of which depend on the antibody involved (IgG, IgE, and IgA) and differ in time course and severity of the reaction. Food allergies, which are mediated by IgE antibodies, trigger immediate reactions that occur within minutes. Food sensitivities, mediated by IgA or IgG antibodies, usually cause less severe reactions than food allergies but are still bothersome. The symptoms of food sensitivity include fatigue, joint pain, rashes, digestive symptoms, cognitive changes, and sinus congestion. Food sensitivity develops at any age, but unlike food allergies, they may resolve over time. They may be affected by the gut microbiota, intestinal permeability and the overall state of the immune system. Addressing these factors can have an impact on the severity of the sensitivity, as well as allow patients to resume eating foods they were sensitive to. Dr. Palanisamy also explained the role of bacteria in food reactions and the importance of the gut microbiome, which is essential in metabolism regulation, immunoprotection, digestion, and synthesis of vital nutrients. A healthy gut microbiome is associated with tolerance to a wide variety of foods. Additionally, overgrowth of potential pathogens in the microbiome can be associated with, or in some cases, even trigger food sensitivities. He emphasized the link between food sensitivity, systemic dermatological conditions, and the mind-body connection. He closed the session with several dietary encouragements to support the gut microbiome, such as incorporating a whole foods plant-based diet, vegetables, legumes, healthy fats, and lean proteins. He also recommended eating foods rich in prebiotic fiber, including Bifidobacteria, Akkermansia, and fermented foods.

Adding Ayurvedic Nutrition to Your Plate: An Integrative Approach to Acne

Faculty: Pushpa Soundararajan, RD, MBA, RDN, LDN, AP, CYI

Pushpa Soundarajan, RD, guided the attendees through Ayurvedic concepts of the dietary, lifestyle, psychological, and age-related causes of acne. She explained that acne is a result of disturbances in the mind-body and gut-skin connection as acne is not just a physical condition but one that can be triggered and aggravated by emotions and stress. Ayurvedic medicine attributes skin diseases to a predominantly “Pitta” imbalance, which also governs the metabolism in the body. When the gut is unhealthy and left untreated, this manifests in the form of skin disease. She described the ayurvedic types of acne, including “vataja, pittaja, kaphaja, and raktaja” which correlates to hyperkeratinization, inflammatory mediators in the blood, and excess sebum production. She encouraged including “pathya ahara” or “wholesome” foods into the diet, including bland foods (rice, oatmeal, applesauce), herbal teas (peppermint, dandelion, hibiscus), and fruit juices (aloe vera, pomegranate, coconut water) and limiting “apathya ahara” or “unwholesome” foods, such as fried, spicy, and fermented foods, as well as citrus, and excess salt. In addition, she encouraged daily routine, avoidance of incompatible foods, keeping a journal of foods that exacerbate acne, and following stress-reducing activities such as yoga, breath work, and oil massage to limit stress and improve digestion.

Is Tropism Dead? The Role of “Keystone” Pathogens and the Gateway Microbiomes in Health and Disease

Faculty: Mark Cannon, DDS

Dr. Mark Cannon highlighted the rich variety of the role and importance of the oral microbiome. The oral microbiome is known as a “gateway microbiome” because it adjusts quickly to environmental changes and influences the rest of the gastrointestinal tract. The oral microbiome is associated with varying systemic diseases, and dysbiosis of the oral microbiota can contribute to dysbiosis in the rest of the intestinal tract. A keystone pathogen is one that can compromise the integrity of the gateway microbiome by opening the barriers that protect the host. For example, Porphyromonas gingivalis is a classic keystone pathogen of the oral microbiome and can shift genomes in various strains to target host cells’ tight junctions and cause an immune response between cells. Xylitol can significantly inhibit the P. gingivalis-induced cytokines and nitric oxide production. Dr. Cannon promoted the use of prebiotics and probiotics in dental practice, with emphasis on the oral microbiome’s contribution to maintaining blood pressure control, blood sugar control, and reducing gluten sensitivity.

A Tour de Force of Atopic Dermatitis

Faculty: Peter Lio, MD

Dr. Peter Lio offered a well-rounded tour de force discussion on atopic dermatitis and the interplay of skin barrier, inflammation, microbiome, itch, and psyche. Dr. Lio explained the multidimensional burden of atopic dermatitis. The estimated cost of treating atopic dermatitis in the United States is over $4.3 billion annually. Eczema results in more sick days, reduced physical activity, skin pain, impaired sleep, more hospitalizations, and may contribute to depression, anxiety, and decreased sexuality. He explained the “eczema loop” which starts with barrier disruption and leads to dysbiosis, the inflammatory cascade, and itch, further damaging the skin barrier and perpetuating the cycle. He described the “five pillars of atopic dermatitis,” including skin barrier, psyche, inflammation, microbiome, and itch, which are important to consider when managing a patient with AD. Dr. Lio also discussed the role of elimination diets in AD. Avoidance of food may increase the risk of developing anaphylaxis. A retrospective review of 298 patients who avoided previously tolerated foods in an effort to treat eczema found, when the foods were reintroduced, 19% had symptoms of acute IgE reactions; of those, 30% classified as anaphylaxis. Instead of eliminating foods from the diet, Dr. Lio recommended maintaining a healthy, diverse diet. He highlighted the use of coconut oil, topical vitamin B12, oral hempseed oil, black tea, and acupuncture as part of an integrative eczema action plan, though ultimately emphasized that the optimal approach is a holistic patient-centered treatment plan.

Pediatric Atopic Dermatitis Update

Faculty: Lawrence Eichenfield, MD

Dr. Lawrence Eichenfield carried on with the topic of atopic dermatitis, this time focusing on pediatric and adolescent patients. There is a higher prevalence of atopic dermatitis in children, 10-20% compared to 2-10% in adults. Atopic dermatitis has a variable severity and course of disease with significant disease burden and comorbidities. Dr. Eichenfield emphasized that with the age of new systemic therapies, it is an incredible time for the field of atopic dermatitis. Since March of 2017, new systemic therapies and biologic agents have been approved and are currently in development. Examples of these include new topical therapies (tapinarof, roflumilast), oral JAK-inhibitors (ruxolitinib), and new indications for biologic agents down to 6 months of age. He discussed the comorbid mental health burden as well as the challenge of managing treatment expectations. He emphasized the importance of creating a plan for effective long term disease control. This care plan includes topical medications to restore the skin barrier, anti-inflammatory medications, bathing, and moisturization.

If You Don’t Know JAK, You Will Now: Overview and Update in Psoriasis

Faculty: Jason Ezra Hawkes, MD MS FAAD

The afternoon kicked off with Dr. Jason Hawkes, who spoke about the use of JAK inhibitors in psoriasis. Dr. Hawkes simplified the seemingly complicated JAK-STAT pathway by leading us through the extra- and intracellular signaling involved and highlighting the importance of specificity versus selectivity of treatments. With biologics, which act more extracellularly, there is higher specificity for the target inflammatory markers (ie, TNF, IL-17A, IL-23p19). This helps to limit unwanted side effects associated with interactions with “off-target” molecules. With JAK inhibitors and other therapies targeting smaller molecules, the inhibitor is selective for a specific isoform. The discussion then delved further into the TYK2 pathways and a new first-of-its-class medication aimed at targeting TYK2 enzymes in the treatment of patients with psoriasis. One major benefit of biologics like the TYK2 inhibitors is its broad effect on multiple cytokines while keeping to its specific target. For example, when TYK2
is blocked, it leads to a decrease in IL-23. This, in turn, reduces IL-17 which has been implicated in several cutaneous conditions. Dr. Hawkes’ discussion wrapped up with a few thoughtful clinical pearls and future research goals to further our understanding of targeted-therapies for psoriasis.

Psoriasis Panel

Moderator: Hadar Lev-Tov,MD, MAS

Panelists: Lakshi Aldredge, MSN, ANP-BC, DCNP, FAANP; Jason Ezra Hawkes, MD, MS FAAD; Joseph Alban, LAc, DAc

Dr. Lev-Tov facilitated an exciting case-based panel with licensed acupuncturist and traditional Chinese medicine (TCM) practitioner Dr. Joseph Alban, nurse practitioner Lakshi Aldredge, and board-certified dermatologist Dr. Jason Hawkes. The first case emphasized the mind-body connection in psoriasis by evaluating sleep, digestion, quality of life, patient age, psoriasis location and severity, and patient goals when developing a treatment plan. From a TCM perspective, Dr. Alban emphasized the importance of balance, especially between heat and cold, or a person’s qi (the energy in one’s body and how it moves). Lakshi Aldredge and Dr. Hawkes emphasized the importance of understanding where the patient is in their treatment journey in order to better navigate the “treatment landscape.” The discussion then shifted to a case of scalp psoriasis, in which the panelists agreed that treatment should address patient education to prevent scratching, treatment of itch (where acupuncture can be helpful according to Dr. Alban), and sleep aids. In harder-to-treat areas like the scalp, Dr. Hawkes suggested a more aggressive approach since hair can hinder the effectiveness of some therapies. Tying it back to the importance of sleep, Lakshi Aldredge suggested consideration of herbals or prescription medications to assist with sleep. Lastly, in a case of psoriasis of the genitals, the panelists discussed helping the patient feel comfortable during the skin exam of this sensitive region through communication, chaperone use, providing picture examples, allowing the patient to remain in undergarments, and utilizing anti-fungal shampoo in treating genital psoriasis.

The Hateful (Or Grateful) Eight – The Subcellular Processes That Belie All Chronic Disease

Faculty: Robert Lustig, MD

Dr. Robert Lustig captured the audience’s attention by discussing the hateful (or grateful) eight - glycation, oxidative stress, mitochondrial dysfunction, insulin resistance, membrane instability, inflammation, methylation, and autophagy - which are ultimately responsible for the development of all chronic metabolic diseases. Hypertension, type 2 diabetes, dyslipidemia, cardiovascular disease, cancer, dementia, and fatty liver disease have contributed to the declining life expectancy in the United States. Unfortunately, no treatments target the subcellular processes responsible for chronic metabolic diseases as there is no drug that can solely target the mitochondria. Currently, the available options for managing the symptoms are limited to undergoing surgery or taking medication. He also stated that certain markers used in predicting certain diseases such as cardiovascular diseases can be improved. Lowering low-density lipoprotein (LDL) via the use of statins can lower the risk of heart attack. He mentioned that lowering triglyceride levels would be more effective in reducing the risk of cardiovascular disease (CVD) compared to LDL cholesterol, as triglycerides are 50% more accurate in predicting the risk of heart attacks. Dr. Lustig emphasized that the hateful (or grateful) eight pathways are not “druggable” but are all “foodable.” Dietary changes including decreased consumption of processed foods high in sugar and low in fiber can help prevent and alleviate these subcellular pathologies and increase lifespan and overall well-being. He also explained that diet has a direct impact to the skin. He discussed how the glycation reaction releases reactive oxygen species, such as hydrogen peroxide, which can lead to crosslinking of collagen, inflammation, and can ultimately inhibit skin cell growth and wrinkles. Dr. Lustig’s discussion emphasized that real food consists of low sugar and high fiber to keep the tight junctions in the gut intact and thereby reducing glucose absorption in the gut level. In the words of Hippocrates, we are reminded to “let thy food be thy medicine.”

Day 2: Saturday, October 1, 2022

Vitiligo: Impacts of Stress and the Latest Developments in Vitiligo

Faculty: Iltefat Hamzavi, MD

Dr. Ilfefat Hamzavi briefly reviewed the pathophysiology of vitiligo and mentioned labs to test in patients with vitiligo, such as TSH every 3 years. He also reviewed the different types, classifications, and presentations of vitiligo segmental versus non-segmental vitiligo. Dr Hamzavi also gave an overview of identifying unstable vitiligo which can present as Koebner-like lesions, confetti like lesions, and trichrome lesions. He shared valuable clinical pearls on treatment timelines and other integrative interventions to add to the clinician’s toolkit including the botanicals Ginkgo biloba, Polypodium leucotomos, and antioxidant rich foods like blueberries, blackberries, and red beans. Emphasis was placed on the impact of psychosocial components to vitiligo and counseling patients at regular intervals.

Rosacea: Emerging Technologies and Holistic Approaches

Faculty: Neal Bhatia, MD

Dr. Neal Bhatia discussed the multiple pathways of inflammation that contribute to the pathogenesis and presentation of rosacea and the role of common triggers. Dr. Bhatia described common rosacea triggers like UV light, spices, stress exercise, and heat, and tied them into ayurvedic principles. He reviewed current topical and oral therapies like antibiotics which positively impact the inflammatory cascade but have significant implications on the gut microbiome, including small intestine bacterial overgrowth (SIBO). He also discussed that skin texture, redness, and stinging can be targeted by various treatments for rosacea. He emphasized the potential of new treatments, such as UV therapy, tetracycline, ivermectin, benzoyl peroxide, and retinoids, which should be considered when generic options lose efficacy and tolerability.

SIBO and Rosacea

Faculty: Michael Traub, ND

Dr. Traub opened the talk discussing small intestinal bacterial overgrowth (SIBO), rosacea, and the gut-skin axis. He then reviewed foods and dietary habits that can exacerbate SIBO and symptoms of SIBO. He also gave a brief history of SIBO research and reviewed underlying risk factors to keep in mind when evaluating patients with SIBO. Cardinal symptoms of SIBO include abdominal pain, diarrhea, constipation, bloating, and flatulence. Additionally, there may be a connection between irritable bowel symptoms and SIBO, so addressing SIBO may provide relief for patients with irritable bowel symptoms. Food poisoning can be a risk factor for SIBO because the anti-cytolethal distending toxin b (Cdtb) antibiotics can lead to abnormal motility and an autoimmune state in the gut. Additionally, hypothyroidism can be a major risk factor for SIBO. For example, studies have found that H. pylori is found more prevalently in patients with rosacea when compared to control. He emphasized the importance of taking a thorough history in evaluating patients with SIBO. He then reviewed diagnostic options and reviewed multimodal options to treat this elusive disease including medications and lifestyle changes. Dr. Traub concluded with some key takeaways that went beyond the skin for clinicians to incorporate into their practice.

Acne and Rosacea Panel

Moderator: Raja Sivamani, MD, MS, AP

Panelists: Joseph Alban, LAc, DAc; Neal Bhatia, MD; Michael Traub, ND DHANP FABNO

The conference attendees regrouped after the morning break to a panel moderated by Dr. Sivamani who facilitated a case-based panel on acne and rosacea with dermatologist Dr. Neal Bhatia, Chinese medical practitioner Joseph Alban, and naturopath Michael Traub. They discussed a holistic treatment approach including diet changes, acupuncture, and cupping on a teenager with severe acne who failed doxycycline and isotretinoin. The next case was an adult with erythema, acne, and rosacea. The panel discussed reducing dampening foods based on Chinese medicine, use of topicals, and testing for possible SIBO. The last case discussed a young woman with hormonal acne and possible polycystic ovarian syndrome. The panel agreed that topical pumpkin seed oil, evaluation of birth control methods, spironolactone, and testing for insulin resistance and diabetes should all be considered for this patient.

Itch, Ouch, Breathe!! The Mind Body Approach to Pain and Itch

Faculty: Kathy Farah, MD, FAAFP

Dr. Kathy Farah kicked off the mindfulness lecture by leading the group through some collective deep breaths. Mind-body practices are techniques that can facilitate the interaction between the brain, mind, body, and behavior; they can affect emotional, mental, social, spiritual, and behavioral factors that in turn, can affect overall health. Mindfulness involves paying attention and making a conscious effort to be in the present moment. There are various breathing techniques that can foster mindfulness, including breath awareness, diaphragmatic breathing, square breathing, and five finger breathing. Mindfulness can be used to help decrease catastrophizing thoughts regarding atopic dermatitis-related itch. Dr. Farah led the group through an interactive guided imagery meditation. She wrapped up the talk by talking about the usefulness of mindfulness to help with eating.

Come on . . . Can Hypnosis Really Remove Warts?

Faculty: Steven Gurgevich, PhD

Dr. Steven Gurgevich continued the mindfulness lecture series by exploring the topic of hypnosis and its effect on warts. He explained the vital ingredients of hypnosis, including desire/motivation, belief, and expectation, and the importance of adjusting the view of the subconscious mind. Dr. Gurgevich emphasized the importance of shifting the consciousness from what you don’t want to what you want, and that the majority of your beliefs believe that it is possible to treat the disease. He discussed the two major hypnotic strategies, symptomatic and psychodynamic, which can treat and uncover the underlying causes of symptoms. Dr. Gurgevich mentioned several case examples in the symptomatic treatment in which his patients with warts successfully improved after using imaginative medicine with his patients and guiding their imagination through warding off their warts on their body. He also went over the psychodynamic approach in which a patient developed urticaria after the patient’s father died, discussing that there may be emotional conflicts that may be out of mind, but not out of body. He also stated that both strategies can be combined and used simultaneously. For hypnosis to work on patients, he mentioned that mastering words with patients, providing them with sleep hypnosis resources, and encouraging imaginations with positive expectations are crucial for hypnosis to be effective.

Coming Together Over Hair Loss- Strands of Wisdom From the Experts

Moderator: Apple Bodemer, MD

Panelists: DiAnne Davis, MD; Jason Ezra Hawkes, MD, MS

The panel worked through 3 unique challenges encountered in dermatology clinic related to hair loss: new ways of approaching people with hair loss, different types of hair loss, and tips to discuss with patients how to deal with hair loss. The first case was a young woman with a history of thinning of the eyebrows. Dr. Hawkes emphasized the importance of long appointments for hair loss patients to allow time for thorough history regarding the patient’s medical history and family history. Pregnancy, genetics, autoimmune diseases, and lifestyle can all contribute to hair loss. Dr. Davis added that eyebrow styling practices can also affect eyebrow hair loss, and it is important to gather that in the history to elucidate the hair loss. A hair tug test, nail pitting, scalp inflammation can all be useful physical exam findings. The panel then discussed alopecia areata, including associated conditions and treatment approaches.

The next case was a young female with a one-year history of asymptomatic diffuse shedding of scalp hair. Dr. Hawkes mentioned that hair loss can be an emotional conversation, and trying to confirm true diffuse hair loss versus regional hair loss can be helpful to diagnose these patients accurately. Additionally, Dr. Hawkes mentioned the importance of obtaining two scalp biopsies to uncover if the hair loss is diffuse or closer to the hairline. The panel then discussed chronic telogen effluvium and its common triggers, including emotional stressors, and physiologic stressors, such as thyroid abnormalities, iron deficiency, and rapid weight loss. Ferritin levels can be a helpful lab to obtain, as a low ferritin level even without iron deficiency can cause telogen effluvium.

The last case was a 36-year-old male with asymptomatic, slow thinning of the anterior hairline with bitemporal recession. Lichen planopilaris and androgenic alopecia should both be on the differential for a male with a similar presentation. Dr. Bodemer added that lichen planopilaris can be a diagnosis overlooked in males and it is important to keep this on the differential even with male patients. Interestingly, there is an associated increased cardiovascular risk associated with genetic patterned alopecia in men.

Day 3: Sunday, October 2, 2022

The Plant Hunter: Botanicals and the Future of Skin Health

Faculty: Cassandra Quave, PhD

Dr. Cassandra Quave led an extensive conversation about botanicals and their impact on skin health. She reviewed botanical mechanisms of action on inflammatory skin disease. Many botanicals can affect the skin by regenerative, anti-inflammatory, antimicrobial, antioxidant, and angiogenic properties. She then showed examples of botanicals used in traditional medicine for skin health. For example, salicylic acid can be sourced from willow, wintergreen, and sweet birth. These botanicals containing salicylic acid have been used historically as a chemical exfoliant for calluses and corns, acne, and warts. Lastly, she discussed the influence of natural plant products on the skin microbiota. The gut-skin connection plays an important role in mediation of inflammatory skin disease as well as the skin microbiome. Her talk concluded that botanicals in our food or topically on the skin can play an important role in mediation of inflammatory skin disease. She emphasized the importance of discussing botanical use with patients and their use in various forms such as supplements, cosmeceuticals, and personal care products. Dr. Quave also highlighted that medicinal plants may not be safe for all patients. Botanical products can sometimes cause skin reactions like allergic contact dermatitis.

Facelift, Filler, or Acupuncture?

Faculty: Sandra Chiu, LAc, MSTCM

Sandra Chiu, a licensed acupuncturist and Chinese medicine specialist, started her lecture by showcasing remarkable results of facial cosmetic acupuncture (FCA) on the jaw, neck, and face. The results included tightening and plumping of the face, improvement in skin complexion, and a more youthful face shape. Facial gua sha, cupping, and infrared heat massage can be used to supplement FCA. From an acupuncturist’s perspective, she discussed how the body’s blood flow and circulation improves with FCA and can release and decrease muscular tension while slimming the lower face. These effects are beyond skin deep– it can also affect posture, the nervous system, and an individual’s vitality. She concluded her presentation by encouraging the integration of FCA in cosmetic dermatology, highlighting how each method might enhance the other when used together. Cosmetic dermatology might be another option for patients looking for a more holistic or noninvasive alternative to filler or surgical facelifts.

It’s All in Your Head - Office-Based Procedures to Help Your Hidradenitis Suppurativa Patients

Faculty: Hadar Lev-Tov, MD, MAS

Dr. Lev-Tov opened his presentation by emphasizing the importance of a holistic approach to Hidradenitis Suppurativa (HS). Treatment of HS should be multimodal and often requires surgical procedures to optimize the treatment plan in select patients. Dr Lev-Tov briefly summarized the benefits of the deroofing procedure which is performed with tumescent infiltration for sustained effect and surgical probes for tunnel mapping. The technique results in lower recurrence rates and improved patient comfort as compared to classic wide excision and closure. He displayed a patient case with rapid disease progression and posed that biofilm formation within lesions could be driving the rapid progression seen. He went on to describe the Lev-Tov procedure, which aims to resolve HS tunnels without deroofing and instead uses anti-biofilm gels after creating an exit with a punch tool. This technique, in his experience, has demonstrated successful local resolution of the disease. Dr Lev-Tov emphasized the importance of listening to patients and their lived experiences, as HS is a devastating disease and can have effects that extend beyond the skin.

Hidradenitis Suppurativa Panel: How to Make HS Management a Delight

Moderator: Hadar Lev-Tov, MD, MAS

Panelists: Brindley Brooks; Steven Daveluy, MD

The audience took part in a panel discussion about HS management, led by Dr. Lev-Tov and featuring the HS-savvy dermatologist, Dr. Steven Daveluy, and HS patient, Brindley Brooks. Dr. Lev-Tov walked the audience through the HS patient experience in his conversation with Ms. Brooks. Ms. Brooks discussed the lifestyle modifications and challenges facing patients with HS. She opened up about her lived experiences as a patient with HS, including the inter-family relationships and the personal emotional impact of the disease. Dr. Daveluy introduced his approach to the HS patient interview and management. He recommends covering topics such as diet, topical benzoyl wash, medical therapy, timing, and more. He also emphasized the importance of listening to patients’ lived experiences and the importance of healthcare providers to create a safe environment in their clinics as their patients share more about their struggles. Dr. Lev-Tov concluded the presentation with cases of HS to spark conversation regarding the treatment of patients, both mind and body, in the setting of severe disease.

Stressed Out About Hair - The Role of Stress in Hair Loss

Faculty: Apple Bodemer, MD

The following session continued with a discussion about hair and stress. Dr. Apple Bodemer started with an analysis of cortisol and stress and how it contributes to several biochemical pathways that impact hair growth. Hair loss can also cause stress, making the cause of hair loss challenging to identify at times. Cortisol fluctuates significantly over the day, with it peaking about one hour upon waking. It can also be found to travel from the blood to the hair follicle and is preserved into the developing hair shaft. It was found in mouse models that corticosterone can regulate hair follicle stem cells, and an absence of this is associated with follicular stem cells entering more regenerative cycles. Stress also suppresses expression of the Gas6 gene within the dermal papilla in a reversible fashion. Stress also decreases sex hormones both acutely and chronically. Elevated estrogen is associated with increased telogen:anagen ratio, induction of catagen, which causes follicular regression, and slowing of hair growth. However, cortisol has anti-inflammatory properties and regulates the immune system when it is within normal limits, and it is the elevated cortisol that can promote a pro-inflammatory state. Dr. Bodemer also discussed the importance of addressing depression and the negative social implications surrounding hair loss.

Ethnic Hairstyles and What they mean for Dermatologists

Faculty: DiAnne Davis, MD

Dr. Davis discussed different curl types and different hair practices in ethnic populations. Understanding of high-risk hairstyling habits is essential when developing an assessment and treatment plan for various scalp conditions. The Andre walker hair typing system classifies hair curl type by the hair’s natural condition when wet without products as well as the diameter of the curl pattern. Classification of the curl pattern is helpful in understanding which product formulation will be most compatible with a patient’s hair and most efficacious in reaching the scalp. For example, a type 2 hair curl pattern may benefit more from an oil or cream than a curlier hair pattern. Dr. Davis also debunked myths surrounding hair types. For example, the type 4 hair pattern is the most fragile hair type, although some think its tightly coiled texture makes it stronger. Some curlier hair types can also experience shrinkage, a term describing when the hair appears shorter in its natural form and is much longer when it is straightened. Dr. Davis then discussed the differences between natural hair and straightened hair. Understanding hair types and styles is necessary to ensure that scalp treatments can reach and penetrate the scalp and do not get absorbed by the hair instead. Braided hair styles are also popular and can be safe when they are kept in for less than 6 weeks. Another low-traction style is called the 2-strand twist, which can then be worn as a twist out. Dr. Davis mentions that being able to fit a pencil underneath the start of the braid near the scalp is an easy way to ensure there is not too much traction on the hair. Manipulation of the frontal hairline with gel and toothbrush can also cause traction alopecia. Clip-in weaves are a safer option because they do not use a nylon thread sewn near the scalp, which can cause excessive friction. Dermatology practitioners should work alongside hair stylists in the community to help patients with ethnic hair. Lastly, ethnic hairstyles also come with discrimination in the workplace. Therefore, it is important that dermatology providers empower their patients’ hairstyles, which can have significant cultural roots. The CROWN act was recently created to help prevent race-based hair discrimination, denial of employment and educational opportunities due to hair textures and hair styles.


The 2022 Integrative Dermatology Symposium brought together integrative practitioners from around the country to discuss the latest advances in integrative medicine and dermatology. The symposium invigorated attendees to incorporate a multidisciplinary approach to their dermatology practices. Although the field of integrative dermatology is expanding quickly, there remains space for additional high-quality research to help inform clinical practice.