Introduction to Skin

Question 1

What do I need to know about skin?

Answer 1

• To briefly review the anatomy and physiology of the skin
• To consider the role of allergy and gastrointestinal dysfunction in the
  development of skin disorder
• To explore the conditions of eczema, seborrhoeic dermatitis, contact
  dermatitis, urticaria, and psoriasis.

Question 2

What is the basic skin anatomy?

Answer 2

Key facts:
* Three main layers – the avascular epidermis, the vascular and innervated dermis and the connective hypodermis
* Large area of tissue vulnerable to all external environmental factors and reactive to disturbances in the internal environment of the body
* Protection, sensation, thermoregulation and vitamin D synthesis are key functions of the skin, which is also an organ

Question 3

How can the skin become vulnerable?

Answer 3

• Irritation/ inflammation – eg contact with household and cosmetic products
• Pressure on protective mechanisms – sun exposure/ burns, environmental factors
• Immune dysfunction - particularly allergic response
• Systemic factors such as poor diet and disease

Protective measures. Areas we can impact –
* **Optimising diet **for reducing inflammation and allergens
* Careful selection of household and personal hygiene products to avoid irritants
* Application of adequate sun protection
* Minimise exposure to environmental factors e.g. swimming pool water, workplace chemicals, certain jewellery

Consider here the similarity with GIT vulnerability - this is also considered on the ‘outside’ of the body, exposed to external factors etc

Question 4

How can allergy impact the skin?

Answer 4

There are numerous factors that can trigger an allergic response with skin involvement, and it is important to remember that even without a diagnosed skin allergy, the atopic patient may be susceptible to reactive skin.

• Atopy – food or genetic, potential skin barrier defect leading to antigen entry
• Contact reaction - Non-allergic irritant or allergic….
• Histamine reaction - Infection, medication, stress….

Question 5

What is the link between gastrointestinal function and the skin?

Answer 5

In previous lessons we have considered the gut microbiome, and in the context of reactive skin the most important aspect perhaps is that of the defensive role of the microbiome – prevention of access to the systemic environment by antigens.

The skin is also one of the organs of excretion, along with the bowel, kidneys and lungs eg sweat

It is useful to consider that the skin may become reactive when there is excessive pressure of excretion being placed upon it – it could be seen as a ‘last resort’ channel, when the body is struggling to excrete optimally through more major channels.

Be wary of conflating suboptimal excretion with ‘toxicity’ – detoxing is a contentious concept. The body is capable of ‘detoxing’ itself, we may help support this through bitters etc

Question 6

What impact does the skin microbiome have on skin complaints?

Answer 6

• Consider the skin microbiome
• Consider the conditions of acne, rosacea, pityriasis versicolor, tinea, melanoma
• To explore some further herbal considerations for different skin conditions

Question 7

What is the skin microbiome?

Answer 7

• Called the cutaneous microflora or microbiota
• Second largest population of bacteria in the human body after the gut – 1 million bacteria per square centimetre, so healthy balance and environment for these is critical to maintain good skin health
• Look at Images showing two common residents of the skin, Staphylococcus aureus (left) and candida (right)
• Viruses, fungi and parasites are also present
• Skin is sterile in the womb and colonised during birth (vaginal bacteria from vaginal delivery, skin bacteria from caesarean section)
• Immune system and skin bacteria interplay contributes to development of skin conditions, potentially also systemic conditions though this is not a certainty

Question 8

What are some good herbs for skin?

Answer 8

Alterative
Depurative
Immune modulation,
Hormone balancing
Vulnerary
Astringent
Styptic (eg weepy leisons)
Anti-allergic
Anti-inflammatory

• Calendula off.,
• Iris versicolor,
• Hamamelis virginiana, - Witch hazel
• Echinacea spp.,
• Urtica dioica,
• Stellaria media - Chickweed