A Naturopathic Approach to Healthy Skin

Skin health reflects whole body health. Its appearance can have profound effects on one’s psychological well-being while also serving as an indicator of the body’s internal health status and physiological resiliency. Skin complaints such as acne, aging, eczema, and rosacea are some of the most common and recurring presentations in clinical practice, and in 2013 an estimated 85 million Americans (or 1 in 4 individuals of all ages) were seen by a physician for at least one skin disease.₁ Most conventional approaches to skin health involve the use of topical and/or oral medications, which offer temporary relief from symptoms quite successfully; however, exacerbations and recurrence upon their withdrawal can often occur. In these cases, and many others, a holistic, preventative approach to skin health and healthy aging can help minimize the need for more invasive therapies and/or potentially harmful interventions while serving the health of the body as a whole.

The Integumentary System

Though only a few millimeters thick, the skin provides the body with a fundamental first layer of defense, providing protection against pathogens as well as physical, environmental, and sensory stressors. Additionally, it can impart valuable information regarding potential health concerns and systemic imbalances, especially in relation to inflammation, immunity, and the body’s adaptive and detoxification capabilities. Like any other bodily organ, the integumentary system consists of a collection of tissues with similar and specialized functions (e.g., skin, hair, nails, and exocrine glands) which communicate with and respond to signals from other body systems including endocrine, nervous, immune, and digestive.

Gut-Skin Connection

Multiple studies have linked gastrointestinal health to skin health, particularly for inflammatory skin conditions like acne, eczema, and psoriasis.₂ Both organs share functional similarities, serving as primary interfaces with the external environment and being essential to the maintenance of physiologic homeostasis. The gut and the skin are also both densely vascularized and richly innervated, having important immune and neuroendocrine roles.₃ Additionally, the intestinal microbiota facilitates both local and cutaneous inflammatory responses.₄ Evidence appears to demonstrate a bidirectional relationship between the skin and the gut, whereby in cases of intestinal dysbiosis and disrupted gut barrier integrity, this connection can result in a positive feedback cycle of metabolic inflammation.₅

Addressing inflammation within the gastrointestinal tract includes:

1. Healing disturbed intestinal barriers
2. Promoting beneficial gut microbiota and their metabolites
3. Identifying and avoiding food allergies and sensitivities to help reduce inflammatory immune responses, thus allowing the skin and the mucosal linings of the gastrointestinal tract to heal

Modulation of the microbiome with probiotics and prebiotics (synbiotics) can be incredibly beneficial in the prevention and/or treatment of many inflammatory skin diseases along with demulcent and anti-inflammatory herbs and foods, which have the potential to influence both gastrointestinal and cutaneous immune defense mechanisms.

Herbal Support

Herbs can play a vital role in supporting skin health, and multiple studies have shown positive results with either equal or superior benefits compared to conventional therapies for a variety of skin disorders when used topically or internally.6 Tissue healing involves the development of new circulation followed by the laying down of new connective tissue, and medicinal herbs are notably rich in various phytochemicals with key therapeutic actions related to these processes including:

• Controlling inflammation and oxidative stress
• Slowing down collagen degradation
• Improving microcirculation
• Improving tissue detoxification
• Decreasing edema and improving lymphatic drainage

Gotu kola (Centella asiatica) has been used traditionally in Ayurvedic medicine to support moisture balance and provide overall nourishment to the skin. Its leaves are rich in triterpenes (mainly asiaticoside, asiatic acid, and madecassic acid) which have been shown to act upon fibroblasts to improves the synthesis and maturation of collagen and stimulate collagen remodeling while improving microcirculation and decreasing endothelial cell damage._7,8 Both oral and topical administration of Gotu kola extract have been shown to produce more rapid skin growth and a higher rate of wound healing when compared to controls in animal models.₉

Grapeseed (Vitis vinifera) is rich with oligomeric procyanidins (OPCs) which also have several key actions related to improved stabilization of connective tissues. In vitro and in vivo studies demonstrate its ability to support connective tissue by protecting collagen and elastin within the walls of the microvasculature and facilitating the formation of collagen microfibrils and collagen crosslinking._10,11 Ginkgo (Ginkgo biloba) is another herb with therapeutic properties associated with tissue healing. Known for centuries as a powerful plant antioxidant, recent research suggests it to be a Nrf2-activator, in addition to supporting microvascular development and improving circulation in the arteries, veins, and capillaries._12,13

In addition to promoting tissue healing, supporting detoxification (e.g. liver, lymphatics, and digestion) with NRF2-activators via herbs collectively referred to as Alteratives (or Depuratives) can also help reduce toxic burden and subsequent inflammation upon the skin and body as a whole. There are multiple pathways by which the body eliminates waste, and many herbs that can be of help include:

• Hepatics and gentle laxatives which support bile flow and bowel elimination such as Oregon Grape (Berberis aquifolium) and Yellow Dock (Rumex crispus).
• Lymphatics such as Cleavers (Galium aparine), Echinacea and Calendula (Calendula officinalis).
• Nutritive and mineral-rich herbs like Stinging Nettle (Urtica diocia).

Nutrition & Lifestyle

Supporting a healthy inflammatory response is vital for promoting healthy skin, as inflammation in areas such as the gut and overall systemic inflammation are often contributory factors. Therefore, nutrition and lifestyle factors for skin health are a fundamental part of any treatment protocol. Smoking and sun exposure are both known to lead to cumulative skin damage and contribute to cancer risk and should be minimized or avoided.₁₄ Topical applications to the skin alongside the oral consumption of nutrients and other dietary ingredients to promote skin health is essential. Supporting collagen synthesis and mitigating oxidative stress with macro- and micronutrients from whole food sources such as buckwheat and fish oils may be particularly important alongside vitamins C and D, zinc, and carotenoids, which all play crucial roles in skin health, integrity, and immune function.₁₅

References

1. Lim, H. W. et al (2017). The burden of skin disease in the United States. Journal of the American Academy of Dermatology, 76(5), 958-972.
2. Salem, I.  (2018). The gut microbiome as a major regulator of the gut-skin axis. Frontiers in microbiology, 9, 1459.
3. O’Neill C. A. et al. (2016). The gut-skin axis in health and disease: a paradigm with therapeutic implications. Bioessays 38 1167–1176
4. Forbes J. D. et al. (2015). The gut microbiota in immune-mediated inflammatory diseases. Front. Microbiol. 7:1081
5. Levkovich T. et al. (2013). Probiotic bacteria induce a ‘glow of health’. PLoS One 8:e53867
6. Fisk, W. A., Lev‐Tov, H. A., & Sivamani, R. K. (2014). Botanical and phytochemical therapy of acne: a systematic review. Phytotherapy Research, 28(8), 1137-1152.
7. Bian, D. et al. (2013). Asiatic acid isolated from Centella asiatica inhibits TGF-β1-induced collagen expression in human keloid fibroblasts via PPAR-γ activation. International journal of biological sciences, 9(10), 1032.
8. Bylka, W. et al. (2014). Centella asiatica in dermatology: an overview. Phytotherapy research, 28(8), 1117-1124.Suguna, L., Sivakumar, P., & Chandrakasan, G. (1996). Effects of Centella asiatica extract on dermal wound healing in rats. Indian Journal of Experimental Biology, 34(12), 1208-1211.
9. Clifton, P. M. (2004). Effect of grape seed extract and quercetin on cardiovascular and endothelial parameters in high-risk subjects. Journal of Biomedicine and Biotechnology, 2004(5), 272
10. Green, B. et al. (2010). Grape seed proanthocyanidins increase collagen biodegradation resistance in the dentin/adhesive interface when included in an adhesive. Journal of Dentistry, 38(11), 908-915.
11. Smith, J. V., & Luo, Y. (2004). Studies on molecular mechanisms of Ginkgo biloba extract. Applied microbiology and biotechnology, 64(4), 465-472.
12. Liu, X. et al. (2007). Extract of Ginkgo biloba induces phase 2 genes through Keap1-Nrf2-ARE signaling pathway. Life sciences, 80(17), 1586-1591.
13. Kennedy, C. et al. (2003). Effect of smoking and sun on the aging skin. Journal of investigative dermatology, 120(4), 548-554.
14. Udompataikul, M., Sripiroj, P., & Palungwachira, P. (2009). An oral nutraceutical containing antioxidants, minerals and glycosaminoglycans improves skin roughness and fine wrinkles. International journal of cosmetic science, 31(6), 427-435.