Balancing Integrative and Conventional Approaches to Dermatologic Care

Peter Lio, MD

Integrative dermatology certainly has a place in the optimizing of care. However, some patients may desire to use only alternative treatments and distance themselves from the more conventional and pharmacologic medications. How the dermatologist responds can be crucial, not only for the desired treatment outcomes, but for their relationship with the patient.

In this second and final part of an interview with HCPLive®, Peter Lio, MD, Clinical Assistant Professor of Dermatology & Pediatrics, Northwestern University Feinberg School of Medicine, discussed the importance of balancing integrative approaches with conventional care. He also elaborated further on the reasons for why integrative medicine may appear to come more naturally for the field of dermatology.

HCPLive: Do you ever find yourself having conversations with patients regarding balancing conventional therapies with alternatives? I can imagine there might be some patients who are simply not looking to take a conventional route.

Lio: Honestly, I have. I find myself having that conversation every day. That conversation is very common, especially in my practice, which is sort of touted as being a place where integrative treatments happen.

Many patients come in and begin the discussion claiming they don't want any conventional medicine. And that's really tough, because it'd be like saying to a boxer, 'You can't use your right hand when you punch.' That's half of your game here. So, we do need to use both.

Sometimes I'll start patients on a very gentle approach, and I'll frame it as doing all of the gentler, more integrative approaches first. And then, as a rescue, if they're not doing great in the next weeks or months, we would then use some of the conventional therapies.

Patients would then say, 'Okay, I really like that, I'm on board.'

Whereas, if you say, 'We'll use this convetional therapy, and if you're better, we could try the namby pamby stuff that may not work,' that could ruffle the patient's feathers a bit.

So, if you spin it the other way, I think you can actually meet them halfway. Again, I think it actually can be a viable approach for many patients, too. We can reduce our reliance on more powerful medicines, but use them when we need them.

You mentioned before that you feel integrative approaches come naturally in dermatology. Certainly, in some ways, dermatology can be seen as a much more integrative field—versus, say, cardiology or rheumatology. Why do you think that is?

I'd like to think it's because the skin is right there. Everybody gets to see their skin, everybody likes to try things.

There is an ancient history of people trying stuff on their skin, from poultices, to different dressings, to different oils. And it's one of those fields where you have to be pretty comfortable with pretty much everybody being the expert.

When I walk into a room, everyone tells me, 'My cousin is really good at skin stuff.' And it turns out that she has a YouTube channel and makes her own home concoctions— and there's nothing wrong with that. But that's a little bit different than being a board-certified dermatologist. I mean, everyone has an opinion.

I often say, the antithesis of dermatology is ophthalmology. If something's wrong with your eye, nobody's messing with it. We would just say go see the eye doctor, and don't put anything in your eye. So, these kinds of diametrically opposed systems are fascinating.

As for hepatology, people can't access their liver, they don't know what's going on with it. So, it becomes this vague concept, whereas the skin is right there.