New Insights on Inflammatory Skin Conditions: An Interview with Holistic Dermatologist Dr. Alan Dattner, MD
Emerson Ecologics customer Dr. Alan Dattner, MD, is a board-certified dermatologist, immunologist and a pioneer in the field of holistic dermatology. Dr. Dattner practices in New York and his book Radiant Skin From the Inside Out, published in 2015, won the Indifab Award for best independent Alternative Medicine book in 2015. We contacted Dr. Dattner to discuss his views and insights on some of the persistent inflammatory skin conditions that are often difficult to treat and resolve: rosacea, eczema and psoriasis.
Lisa Murray: Dr. Dattner, in your view, what if anything might these conditions have in common?
Dr. Dattner: What they have in common is inflammation as a key part of the mechanism of disease, and they all in my view have some degree of relationship to issues in the gut, related to leaky gut, allergens, inflammatory molecules and toxins entering into Peyers patches and into the blood.
Lisa Murray: What has changed in the last decade in how you approach these conditions?
Dr. Dattner: What’s changed is more understanding about the lack of antimicrobial peptides in patients with Atopic dermatitis, commonly known as eczema. This allows development of secondary infection in skin areas that have been scratched open, which in turn stimulates more inflammation, scratching and itching.
In rosacea, my observation with anti-Demodex treatment is that especially in those people with increased Demodex found on skin scraping and examination, there is a tendency for specific treatment to improve the condition. Rosacea occurs at the upper end of the gastro-intestinal “tube”, involving especially gastric digestion, and involves sensitivities of the mouth and sinus areas. It sometimes is related to Demodex, the mites that live in the skin follicles which may cause inflammation and these Demodex also have a bacteria living within them that have been suspected of further contributing to the inflammation they cause. Vascular factors causing dilation of the capillaries on the face further lead to redness and can be affected by being in wind, cold and sun, or drinking excessive hot drinks, coffee or alcohol.
Psoriasis, which is when the skin overgrows and thickens locally, is a distant cousin to seborrhea—and it can be localized to microorganisms that live in the skin, like yeast. It involves T-cell related immunity, not an immediate antibody response, as you can see by all the biologicals aimed at its treatment. Strep A can be a cause in certain HLA types, especially within certain genetically related groups of people. But there is a whole set of different allergens which can bring this on, which people can develop a sensitivity to. Also, actual tissue injury is a trigger—pressure on the knees or elbows is commonly a trigger. Running and falling on a knee can start new lesions, known to dermatologists as the isomorphic response. Also, people can get psoriasis in areas damaged by sunburn.
And eczema is really about barrier defects, so that water loss is greater, causing the skin to dry out often as a result of defects in the molecule Filaggrin, which when normal is important in the skin vapor barrier. Inflammation plays a role, but (unlike psoriasis) there is no proliferative effect. Still, because of the thickening and scaling it’s sometimes hard to call the difference.
Lisa Murray: What new insights have you gained about these conditions after so many years of research and clinical practice?
Dr. Dattner: I have an answer to that and it’s in my book Radiant Skin from the Inside Out. It describes my perspective, starting with my years of immunology research. I’ve been in several different laboratories, including the Dermatology Branch of the National Cancer Institute, and the work that we did demonstrated how cross reactivity works—that the recognition of a foreign material, an antigen to set off a response is unique to an individual’s own HLA (human leukocyte antigen) characteristics and to the tissue as well. So what was puzzling before as to why one eczema patient would break out from eating oranges but another would not, is in part explained by their exposures, what they are unable to break down and their HLA type. Because the immune system sees the complex of the foreign material and their HLA antigen together, what is actually seen by one’s immune system is uniquely different for each individual.
Lisa Murray: Well, that explains a whole lot doesn’t it?
Dr. Dattner: Yeah, it explains a whole lot about individual unique response right there. Two people received Nobel prizes for studies related to the research we did because it’s such an important understanding. And so you know, when somebody is reading the Internet blogs and says, “I got better because I stopped eating kumquats”, you don’t have enough information to know if stopping kumquats is going to make a difference for you. And this concept is so far from common knowledge of physicians and individuals. Still, 40 years later after we made our discoveries people are still banging around in the one-hit hypothesis of one food-one disease and not understanding the other factors involved. So, this is where a lot of confusion comes in and where our additional level of sophistication is crucial to finding what to remove to heal an individual’s inflammatory skin disorder.
Lisa Murray: Do you have a particular dietary and lifestyle modification program which you recommend that is similar for all these conditions or is there significant variation to your recommendations?
Dr. Dattner: Well, being human, we have a whole bunch of in-common likes and wants, and one of those is we like sweets. The other thing is that our culture loves to sell us things that support our addictions and cravings, such as of sweets and fried foods. So, making the changes away from those things is a very important part of what I suggest. I use supplementation in addressing all of those issues. There are a whole series of common problems, so some of the general categories of what I do are very similar, like fixing digestion. But what I use to do it may be different in different individuals. One person may need an enzyme that breaks down gluten and another needs one that breaks down meat. So yes, there are some things in common with what I do in the foundation, like cutting down on high fructose corn syrup, which would save billions of dollars for our healthcare system. Differences in disease processes, allergen and toxic exposure and genetics require different programs for different people. It’s not just a simple answer, but it’s about trying to get the right balance, sequencing the changes you make, being very diligent at times and having leeway at others. So that’s the foundation.
Lisa Murray: So you don’t start with a certain elimination diet for example?
Dr. Dattner: No, I don’t start with exactly the same diet. I start with a relatively similar diet for everyone, which is then modified according to various things I find by history, by physical exam, by muscle testing, by Chinese diagnosis, for each individual and then I branch out and address the “sore thumbs”—addressing the specifics with them, whether emotional, habits, diet or supplements that are needed beyond what is initially found.
What people have to know is that there is this desire for simplicity. But I just have to say that a number of things out in there in the blogosphere cause so much trouble for people because they don’t understand, for example, that there are people out there using apple cider vinegar or kombucha (to cure their skin issue), but these people may be sensitive to yeast on the one hand and getting it from what they think is therapeutic.
One of the big issues in natural treatment is that most people spend many years developing these conditions and so they come in wanting to be cured in a month. Usually there is no treatment that will work that quickly and it can take many months for things to clear up.
Dr. Alan Dattner’s Holistic Dermatology and Integrative Medicine offices are located in Manhattan and New Rochelle, New York. His website is www.holisticdermatology.com
Lisa Murray, RDN, LD