The Beauty of Dirty Skin: The Surprising Science of Looking

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 Copyright

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Copyright © 2018 by Whitney Bowe, MD

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 Contents

COVER

TITLE PAGE

COPYRIGHT

DEDICATION

INTRODUCTION: Learning to Love Your Good Bugs

PART I
A GUT REACTION TO RADIANT SKIN

CHAPTER 1 Nature’s Hidden Secret to Great Skin

Why Getting Clear, Glowing Skin Is an Inside Job

CHAPTER 2 The New Science of Skin

Understanding the Gut-Brain-Skin Connection

CHAPTER 3 Mind over Skin Matters

The Brain’s Influence on the Body, Inside and Out

CHAPTER 4 Face Value

What You Know About Skin Care Is Wrong

CHAPTER 5 The Power in Going Pro

Why Probiotics Are the New Antibiotics

PART II
GLOW WITH YOUR GUT

CHAPTER 6 Feed Your Face

Dietary Recommendations for Putting Your Best Face Forward

CHAPTER 7 Take Time to Recover

The Power of Exercise, Meditation, and Sleep
CHAPTER 8 Handle with Care
Reassess Your Regimen and Commit Daily to Proper Skin Care

CHAPTER 9 Supercharge Your Skin

Navigating the Supplements and Probiotics Aisle

PART III
PUTTING IT ALL TOGETHER

CHAPTER 10 Three Weeks to Radiant

Your Plan of Action for Smooth, Youthful, Clear Skin

CHAPTER 11 Recipes
Meals and Masks to Get Your Bowe Glow On

ACKNOWLEDGMENTS

ABOUT THE AUTHOR

NOTES

NEWSLETTERS
 This book is dedicated to the loves of my
life—my tiny angel, Maclane, and my
wonderful husband, Josh. Maclane, may
you continue to glow from within and light
up the world the way you light up my
heart! And Josh, your support, love, and
fierce belief in me and my dreams make
me the luckiest wife; I could not love and
adore you more.
 Introduction
Learning to Love Your Good Bugs

As a kid, I was always covered in dirt. I loved to dig in the earth, and I
loved frogs and grass and bugs. Once, I even hid a snake in my overalls,
which caused quite a stir when my kindergarten teacher discovered it! I was
a blond-haired, blue-eyed, rosy-cheeked free spirit who dirtied a set of
clothes about as fast as I could change into them. But that was all before I
got sick.
You see, that carefree little girl spent her tenth year of life in and out of
the hospital. The environment was sterile and cold. I was afraid. I was in
pain—awful, chronic pain. The doctors didn’t know how to help me. My
parents didn’t know how to help me, either.
It turns out that a bad bug—a parasite—had made its way into my
intestines from fish I had eaten while on a family vacation. It wreaked
complete havoc on my body. Even worse, the doctors couldn’t find it. They
tried to treat me with antibiotic after antibiotic, which eventually destroyed
the healthy bacteria in my gut, leaving behind an infectious type of bad
bacteria called Clostridium difficile, or C. diff, which made me even sicker.
This horrific combination of circumstances, in which one bad microbe was
followed by another, hurt my body and changed my life.
But all was not lost, because as I sat in the hospital, I started to think.
Even as a ten-year-old, I could reason, explore, ask questions, and try to
make sense of things (maybe it was my way of coping). I knew that where
we have bad, we always have good. It’s the age-old balance between good
and evil. So where we have harmful microbes, we also have helpful
microbes—although the beneficial ones that had been slaughtered in my gut
by antibiotics could no longer help me. This thinking process is where the
happy ending to my story began—it started me on a passionate lifelong
quest to find the answers to the question of how to create and maintain a
balance between the heroic and villainous microbes that live in our bodies
and on our skin.
From the moment I was released from the hospital, I was inspired to
make my body strong and healthy. I was concerned with the obvious
outward signs of health, such as glowing, radiant skin, as well as the
hidden, invisible indicators of health, the ones that lie deep beneath the
surface. This is where my passion for health and beauty from the outside in
and the inside out was born. And this is where my fascination with the
science of the microbial bugs that exist on our skin and throughout our
bodies, including in our gut, initially began, because I experienced this
balance (or imbalance) firsthand. Who better to investigate the depths of
this area of science than someone who fought for her life because of it?
I succeeded in what I set out to achieve: a robust body that emanates
health. Now I help others achieve that goal. In so many ways, I am still that
happy and curious rosy-cheeked girl who loves nature. But now I’m also a
doctor who has found a lot of answers to those lifelong questions. My
curiosity about microbiology has only grown fiercer now that science is
finally grasping the magnitude of the influence that the hidden microbial
world within us—and on us—has over our health. And this dazzling new
science shows definitively that these invisible bugs have a lot to do with
how we look. I now know, as you’re about to learn, that even on my best
day, I have microorganisms in the form of bacteria, fungi, viruses, and even
mites living all over my body that support my health from the inside out
and give me that “Bowe Glow.” And even on your best day, you’re a “dirty”
human being, too, whose health and appearance hinges on those bugs! (And
if you’re not having your best day now, read on.)
Learning to harness those things that make you “dirty” will help you
radiate a healthy, beautiful glow from the outside in and the inside out. Your
skin is a window on your overall health. It “speaks” to the other integral
parts of your body through something called the gut-brain-skin axis, a
pathway that you will get to know and understand in these pages. This
groundbreaking science has become my life’s work and has earned me
recognition among my colleagues and among international thought leaders.
Now let’s take an expedition together to find your most luminous skin and
overall wellness using the best cutting-edge science and tools available
today. Like me, you’ll learn to love your good bugs and harness your body’s
full potential. Let’s show that ten-year-old little girl in the hospital bed that
the story turns out beautifully!

THE SECRET TO GREAT SKIN

Take a moment to think about your skin. Find a mirror, if that helps. How
does your skin feel and look? How do you feel about it? What do you think
it says about you? Think of your skin’s appearance as a reflection of your
overall health—how healthy do you look?
Within seconds of meeting a new patient, I can use my derm
superpowers (well, years of extensive training and developing expertise, but
that doesn’t sound as cool) to determine her overall health simply by
examining her skin, hair, and nails. Is she diabetic or prediabetic? Does she
eat a Western diet laden with processed sugars and refined carbs? Is her life
overscheduled and full of constant, unremitting stress? Does she suffer from
obsessive-compulsive disorder? A dysfunctional thyroid? An imbalanced
hormonal system? An autoimmune disorder? Insomnia? Does she have a
history of frequent antibiotic use, either orally or topically or both? Is she
overly hygienic, scrubbing her skin with harsh cleansers and facial brushes?
Is her gastrointestinal system in need of serious repair?
My patients come to me hoping to get the Bowe Glow. Too often, they
believe they’re just a scribbled prescription away from a cure for any of the
Big Four—acne, rosacea, eczema, and premature aging. But there’s so
much more than drugs, topical lotions, or laser beams to this story. Every
day I have the privilege of interacting with smart, health-conscious people
who try to maintain their looks and health as best they can, but they often
miss the mark because they don’t have access to eye-opening knowledge
that is still mostly buried in the trenches of scientific literature. But the
good news is that with this book, I’m giving you access to this information
and grounding it in my expertise and years of experience treating thousands
of patients. And here’s the secret: the road to a beautiful glow begins with
simple lifestyle habits that support the gut-brain-skin relationship, which
is the soul of radiant skin. More specifically, I’m referring to the bonds
between the body’s good bugs and the brain and skin.
You’ve probably heard about the human microbiome by now, but trying
to fully understand it might still give you pause. Much has been written in
the past few years about the microbiome—the friendly microorganisms that
support our health and share a powerful, mutually beneficial relationship
with our bodies. The term microbiome comes from the combination of
micro, for “super small” or “microscopic,” and biome, which refers to a
naturally occurring community of life forms occupying a large habitat, in
this case the human body. When I began to study microbiology as a junior-
high-school student, nobody could tell you what a microbiome was; today,
microbiology encompasses one of the hottest fields of study, and I’m proud
to be a part of it. We are at the very beginning of an exciting journey to
understanding—and leveraging the power of—the human microbiome.
The mini ecosystem that comprises a human biome includes a diverse
collection of microorganisms, mainly bacteria, fungi, and viruses. The
bacteria that thrive in our intestines are especially important. Their function
in our health and physiology is so critical that they may affect a wide range
of biological processes and play a role in everything from the efficiency and
speed of our metabolism to our risk for diabetes and obesity. This is to say
nothing of their potential role in our moods and our likelihood of suffering
from depression, autoimmune disorders, and dementia. Perhaps you have
heard about some of this in the popular health media. But there’s another
connection that you probably don’t know about: the “last mile.” This is the
indelible, incredible link from the brain to the skin. Indeed, what’s going on
in your gut right at this moment is determining not only how your brain
performs and responds to signals from the body about its current state and
needs but also what your skin thinks and how it performs. This gut-brain-
skin alliance is, frankly, profound and breathtaking, as this book will show.
And yes, the skin can “think” and “talk” to the brain: it’s a two-way street.
In fact your skin actually contains the same number of cells as sixteen
human brains!

Your Skin Has Company

 The skin of an average adult can be spread across a twenty-
two-square-foot room. There are more than one trillion bacteria
in your skin alone, coming from around one thousand different
species. All these microbial living creatures are part of your
skin’s health and behavior, and in some cases they provide vital
functions for the skin that the human body cannot perform all on
its own. If your skin’s ecosystem is off balance, you can
experience any number of skin conditions.

Researchers first discovered this relationship more than one hundred

years ago, but it was forgotten until recently. Today the gut-brain-skin axis
is among the most thought-provoking areas of study, and I believe it
represents a revolution in our field—not least because it equips us
dermatologists with a breakthrough approach to the way we think about the
skin. For the first time, we can envision a future in which we aren’t just
chasing skin issues that are spiraling out of control, we’re also finding ways
to get to the root of the problem. We’re stopping the proverbial match from
being lit in the first place.
I played a major role in rediscovering this link, having spent years in the
lab counting bacterial colonies in a petri dish whenever I wasn’t poring
through databases looking at epidemiological data to support my
suspicions. I loved studying bacteria and figuring out what they could do—
both to help us and harm us. By the time I’d chosen dermatology as a
specialty, I was determined to make the connection between the secret
world of microscopic bugs and the outer world of skin’s appearance. Which
bugs could benefit skin health? Which could harm it? I even coinvented a
patented acne treatment that uses a substance isolated from a certain
bacterium. This patent was filed through the University of Pennsylvania
with my research mentor, Dr. David Margolis. That’s right: we can now use
good bacteria to fight bad bacteria in the battle against acne, which can be
driven by a particular strain of bacteria. I’ve shared my research and
theories with my peers internationally through numerous scientific
publications and lectures. And in 2017, I was humbled to receive the
American Academy of Dermatology’s presidential citation for this work.
 Too many people suffer in silence with their skin conditions because
they lack access to the kind of information I am going to provide in this
book. I can only reach so many individuals in my private practice, many of
whom are in the public eye daily. Their livelihoods depend on looking
good, but they shouldn’t be the only ones fortunate enough to have flawless
skin. With this book, I bring hope, health, and beauty to as many people as
possible. That means you, no matter what you do for a living or where you
live.

SKIN TELLS THE TRUTH: YOU ARE WHAT YOU EAT

You might be surprised to find that food is at the core of my program. But
don’t panic: I won’t ask you to do anything drastic like totally give up
chocolate, alcohol, bread, or coffee if those things bring you joy. I trust
you’ll find the dietary protocol outlined in chapter 6 to be refreshingly
delicious, inspiring, inviting, and, above all, doable.
Contrary to long-held beliefs in my field, diet, first and foremost,
determines the quality and appearance of your skin. Food provides
information for every cell that makes you, well, you. Everything you eat
becomes part of not only your inner cellular makeup but also the outer
fabric of your body. In fact there’s no more direct way to change the health
of your body’s inner and outer ecology—its microbiome—than to make
specific shifts in your dietary choices. Yes, this probably goes against
everything you’ve been told about the relationship between diet and skin.
Have no doubt. The idea that food is arguably the most important factor in
personal health, including the health of your skin, is old news gaining new
life in our modern medical world.
When I was in medical school, and even during my residency training in
dermatology, we were taught that diet had no impact on the skin. All the
major dermatology textbooks stated that the exception was in cases of
severe malnutrition, which were exceedingly rare in developed countries
such as the United States. Textbooks, lectures, and reputable authorities
such as the American Academy of Dermatology told us that if a patient
suggested that what she was eating or drinking had any influence on her
skin, we were to dismiss that notion as a myth. This was the scientific
dogma of the time, and it was based on research conducted and published
by physicians who were revered as giants and geniuses in our area.
But what I was experiencing with my own skin, and what I observed in
my patients, didn’t seem to fit with this alleged fact. So I approached my
mentor, who also happened to be the chairman of the department at the
time, and I presented him with my skepticism. Looking back, I can’t believe
I was bold (crazy?) enough to think that I, a young resident in training with
barely any real experience under my belt, could take on such a monumental
challenge. But I couldn’t ignore what my body was telling me and what my
patients were sharing with me every day.
My mentor advised me that if I was going to question the word of these
highly respected authorities—lionized experts, really—in my field, I had
better develop an incredibly compelling argument to support my theory.
With a rebellious spark in my belly, I went back to the peer-reviewed
scientific literature and dug deep, reading journals from all fields of
medicine and nutrition and going so far as to have several international
studies translated into English. I mined the few studies published in the late
1970s that were often cited as proof that diet had no impact on the skin, and
I carefully dissected them, finding major flaws in their design. In fact if
judged against the rigorous criteria by which journal submissions are
considered today, these articles would never even have been published!
After many long days and late nights, I wrote a controversial paper that
asserted the idea that diet does indeed affect the skin.1 Armed with
compelling evidence, I laid out the case that acne is exacerbated by diets
loaded with sugar and refined carbohydrates. I also called out the fact that
some dairy products trigger acne, and I hinted at the positive effects of
omega-3 fatty acids and dietary fiber. Ultimately my paper was published in
one of my field’s most respected journals, heralding a new era for
understanding skin health within the context of diet. And my mission didn’t
end there. I took to the lectern, speaking again and again on this topic, and
over the years I published even more studies further supporting my
hypothesis—a belief that was soon becoming indisputable fact. Although
most of my peers were initially skeptical, as any good doctor should be
when presented with new and competing data, I found increasingly that my
dermatology audience was receptive to my message. Eventually other
thought leaders emerged, contributing to the literature and spreading their
own observations and research on how certain foods and beverages affect
the skin. The data only grew bigger and more extensive and impressive. No
one could turn me and my ideas down anymore.
Finally, for the first time since the late 1970s, dermatological textbooks,
resources, and guidelines are being revised to reflect this concept. If a
patient goes to her dermatologist with a hunch that certain foods are making
her skin condition worse, not only can the dermatologist acknowledge that
she is probably right, the doctor can also go so far as to offer evidence-
based advice on how the patient can tweak her diet to benefit her skin (less
sugar, milk, and processed foods; more fibrous, colorful vegetables, fatty
fish, and antioxidant-rich fruits). I’m thrilled not only that my peers have
accepted this concept as fact but also that laypersons and media are
listening with open ears. This “new” fact could not have emerged at a more
critical time.

WELCOME TO A NEW ERA

The field of dermatology is changing radically as a result of two immense

forces: an epidemic of skin disorders in a world where powerful drugs such
as antibiotics are losing their efficacy, and new findings about the power of
the microbiome on skin health (and all health, really). Skin issues are the
cause of more than 42 percent of all doctor visits.2 No doubt this staggering
statistic is largely attributable to the fact that you can’t hide from your skin.
You wear your illness for the world to see, and unless you’re going to cover
yourself up indefinitely or refuse to leave the house (two impractical,
depressing prospects), you’re going to seek help. Such conspicuous
imperfections can have a colossal impact on one’s overall mental health and
sense of self.
I can’t tell you how many times I’ve heard stories from people who
breezed through their teenage and young adult lives pimple-free only to
meet angry red spots and lumps covering their chins and faces in their
thirties and forties. Acne has long been viewed as a rite of passage through
adolescence, but it’s not something an adult should be grappling with.
What’s going on? A whopping 54 percent of women age twenty-five and
over have at least one type of facial acne.3 And other skin disorders are on
the rise, including the scariest one of all: skin cancer. In 2017, a report by
the Mayo Clinic sent shock waves through the medical community, stating
that between 2000 and 2010, squamous cell carcinoma (also called
cutaneous squamous cell carcinoma) diagnoses increased 263 percent,
while diagnoses of basal cell carcinomas increased 145 percent.4 These
numbers are mind-boggling given the level of sunscreen use today. To say
we’re entering a new era of skin conditions is an understatement. We’re
also embarking on new treatment territory, and I’ll be discussing all this in
the pages that follow.
Dermatologists only make up 1 percent or less of all doctors, but we
prescribe almost 5 percent (if not more) of all antibiotics, which have long
been held as the gold standard for treating many skin conditions.5 Now, in
the wake of rising antibiotic resistance, we are forced to look elsewhere for
solutions. Part of my work today involves passionate formal talks to other
dermatologists and doctors about this dire matter and pushing for change. I
am sounding the alarm. We dermatologists are part of the problem, but we
need to be part of the solution. The silver lining of the antibiotic crisis,
however, is that it’s opening the door to understanding the power of
balanced gut microbes and probiotics in the treatment of skin. As the term
suggests, probiotics (meaning “for life”) are beneficial strains of live
bacteria that you can ingest through foods, some beverages, and
supplements. The science in this area is exploding with new research to
show that probiotics can help recolonize the intestinal microbiome and can
even help balance certain hormones. We’ll be exploring all these
mechanisms, which have everything to do with skin health. The science
behind topically applied probiotics is also a burgeoning area of study. We’ll
see how your skin’s microbiome has a big say in your skin’s health and
function.
Some of the information in this book will serve as a wake-up call you
did not expect. Get ready to ditch a few of your trusty daily habits and
establish new, unexpected ones. Do you drink milk and diet soda? Time to
rethink. Do you go through the same physical exercise routine almost every
day? Or barely bust a move at all and have no personal downtime? Time to
rethink. Do you use hand sanitizers and antimicrobial soaps, or regularly
wash your face with exfoliating scrubs or tools like brushes, loofahs, and
abrasive washcloths? Time to reassess. But again, don’t worry about
bracing for extreme overnight changes. I promise to make this practical for
the real world. Hey, I still love to play outside under the sun and eat
pancakes on Sundays. And yes, I have been known to get fully dressed in
workout clothes only to climb back into bed with my daughter and wake up
an hour later when it’s time to get her dressed for school. I’m not your
typical dermatologist, one who preaches staying in the shade. I want my
patients and readers to live out loud and feel their most confident every
single day. To find that balance we all seek in life. To cherish their health
and to make the most of it.
Most dermatologists, for example, will tell rosacea patients to avoid
typical triggers. Want to know what those are? Exercise, alcohol, hot
beverages, spicy foods, hot temperatures, and very cold temperatures. From
my perspective, that’s like asking someone to zap all the joy out of life (and
it’s no wonder patients with rosacea have a hard time being compliant with
those recommendations). Unrealistic. What kind of life is there without a
margarita and Mexican food once in a while? How can I expect someone to
start her day without a hot cup of joe? And how could I possibly tell
someone not to exercise when we know how much exercise benefits the
entire body? Yes, there are certain things that can trigger certain skin
problems, but my goal is to find workable, real-life solutions so no one feels
deprived.
You will never hear me ask my patients to give up all the things that
make life fun and contribute to overall health and well-being for the sake of
their skin. Moderation is key. I am all about finding ways to get these skin
conditions under control while living life to the fullest and relishing every
moment. My message is equally about self-empowerment, self-
improvement, and liberation from the clutches of feeling unattractive. I
know of no easier or quicker way to get more of what you want out of life
than to first love the skin you’re in, as the old Olay commercial advises.
In this book I present a revolutionary new way to think about and take
care of your skin. Whether you’re hoping to end a chronic skin condition or
enhance your skin’s appearance, you’ll find easy, simple solutions you can
implement in your life right away and see results relatively quickly—in as
little as three weeks. No surgery or prescriptions are required. (Of course,
it’s fine if you are already following a course of treatment recommended by
a dermatologist, and it’s fine if you want to visit a dermatologist today and
use my program in combination with a formally prescribed regimen. This
program is super compatible with prescribed treatments.) Soon you will
learn to love your good bugs and let your personal transformation unfold
before your eyes.
This isn’t just about skin, either. The strategies in this book will elevate
everything about your health. Happy, glowing skin is a reflection of overall
general health. And you’ll gain other measurable benefits, such as

• weight loss,
• increased energy,
• better sleep and less insomnia,
• reduced stress and better coping mechanisms,
• relief from moodiness, anxiety, and depression,
• a reduction in gastrointestinal conditions, including chronic
constipation and bloating,
• a lessening or reversal of metabolic disorders, including insulin
resistance and diabetes,
• heightened mental clarity,
• a stronger immune system and reduced autoimmunity,
• a more youthful appearance,
• and more.

In the pages ahead, we’re going to get up close and personal with this
remarkable organ called skin. In part I, you’ll learn more about why getting
clear, glowing skin is an inside job—from your state of mind and how your
gut functions to what you put in your mouth and on your skin. You’ll gain a
skin-care education that probably goes against conventional wisdom (be
prepared to throw some of your beauty products away). Then, in part II,
you’ll learn practical tools that will transform you and your skin. By the
time you reach my three-week action plan in part III, you’ll be primed—and
excited—to put these ideas into practice. You’ll be making subtle, doable
shifts in your daily habits, from what you eat for breakfast to how you
exercise, reduce stress, supplement with vitamins and probiotics, ensure
restful sleep, and treat your face.
Get ready to go. And get ready to glow.
 PART I

A Gut Reaction to Radiant Skin

You are here because you want to know the secrets behind glowing,
beautiful skin. I have dedicated my life’s work to uncovering those secrets,
and you’re about to read about them. But they are not as “new” as you
might think. While the science of great skin may seem like a subject that’s
in rapid development today, thanks to our burgeoning knowledge of the role
of the human microbiome, we actually began to understand this information
more than one hundred years ago. The difference, however, is that now we
finally know how to leverage it for our skin’s (and whole body’s) benefit. It
is no longer a mystery how exactly the gut, brain, and skin are all
connected.
In this first part, we’re going on a tour of the groundbreaking research
from past to present and will even cast off to what lies ahead in the near
future so you are prepared to benefit. I will share all this captivating
information in an easy, accessible way that will have you making mental
notes and rethinking how you’re living each day. You will learn a wealth of
useful, highly practical knowledge that will inspire you to execute my
program right away. By the end of this part, you will have a new
appreciation for the interconnectedness of your body’s systems and parts,
including its microbiome. It is now proved that your skin reflects your diet,
sleep schedule, stress levels, exercise regimen, and of course the health of
your microbiome. And, as you will soon experience, the power of glowing,
healthy skin is so much more than skin deep. When you feel wonderful
about your skin, you unlock your confidence, courage, and overall well-
being. I am so excited to share this gift with you. Knowledge is not just
power. It is your ticket to looking—and feeling—beautiful. Your glow starts
here.
 CHAPTER 1

Nature’s Hidden Secret to Great Skin

Why Getting Clear, Glowing Skin Is an Inside Job

You know it when you see it. The woman who walks into a room and
attracts everyone’s notice. A gravitational force surrounds her presence—a
je ne sais quoi that makes her beautiful. But her beauty transcends
physicality. Something about this individual speaks compellingly to others
as she radiates health, grace, strength, vitality, and confidence. Her glowing
skin reflects this all-encompassing sense of wellness. And she is living life
to the fullest.
You’re reading these pages for a reason. You’ve made a choice to take
better care of yourself. With the plan in this book, you’ll learn how to do so
in a way that helps you achieve the smoothest, clearest, most beautiful skin
possible. As a result, you, too, can become the best version of yourself.
More self-assured. More outgoing and adventurous. Even more successful,
too. Somewhere deep down you know that there’s a hidden power to having
great skin. And you’re right.
From my vantage point as someone who helps people cultivate gorgeous
skin, I don’t need a scientific study to tell me how transformative
satisfaction in one’s appearance can be. You know that when you love your
looks, anything is possible. But what you might not know is how much of
an “inside job” getting that great skin is and how much it reflects overall
wellness. Let me share with you some little-known facts to prepare you for
your journey to healthier skin and a healthier body, starting with some
alarming statistics. This, my friends, will help you see that you’re not alone.
 If you’re suffering from a skin condition, you’re among the majority.
Tens of millions of people in the United States live with chronic skin
conditions, which have been on a steep rise in the last two decades—right
alongside autoimmune and other chronic diseases not caused by a germ or
pathogen. Sixty million Americans, including adults, have acne (an
estimated 85 percent of us have acne at some point).1 Thirty-five million
suffer from eczema, also called atopic dermatitis, a chronic condition that
causes the skin to become itchy, red, dry, and cracked. Psoriasis, another
chronic but autoimmune-based skin ailment, affects 7.5 million Americans.
And at least sixteen million have rosacea, which is common in adults and is
characterized by redness and visible blood vessels in the face. There are
more than three thousand diseases of the skin treated by dermatologists.
These numbers are so large as to seem meaningless. Most of us can get
through life without being diagnosed with a rare illness, but none of us
reaches adulthood without at least one skin affliction, be it a pimple, rash,
superficial burn, or sunburn (one in five Americans will develop skin
cancer over the course of a lifetime, largely because of overexposure to the
sun). And nobody escapes the march of time in the form of aging, whether
it’s gradual and natural or fast and premature (as in, Where did that line
come from? What’s happening to me?!).
As a dermatologist who juggles the competing demands of lecturing to
peers, treating patients, and appearing in the media regularly to talk about
matters involving skin and the outward signs of aging, I try to keep abreast
of all the latest and greatest when it comes to addressing skin disorders.
Never has there been a more thrilling time in dermatology: we are
experiencing a rapid expansion of our understanding of skin, its properties,
and its connection to the rest of the body. The fact that I can detect a wide
variety of illnesses by looking at a person’s skin says a lot about the
interconnectedness of the human body, from its deepest recesses to its
outermost layer. I’ve identified an untold number of afflictions in patients
who have come to me about a seemingly isolated topical skin issue. These
afflictions include lupus, thyroid disease, certain cancers (including lung
cancer), congenital heart disease and birth defects of the heart, peripheral
artery disease, chronic obstructive pulmonary disease (COPD, or
emphysema), cirrhosis (liver disease), anemia, alcoholism, Cushing’s
syndrome, Addison’s disease, polycystic ovary syndrome, diabetes, and
lymphoma. Indeed, the skin is not a solitary, secluded organ that works all
on its own. It’s highly dependent upon what’s going on in remote areas of
your body, where the sun doesn’t shine.
My patients have taught me so much over the years. Their conditions are
just a very small piece of who they are. I pour my heart and soul into
working with them and helping them to look and feel their most
empowered. It is very much a team effort. As I mentioned in the
introduction, during my early days of training, I routinely saw a disconnect
between what I was learning from my textbooks and lectures and what I
saw and experienced firsthand—both in regard to my own body and my
patients’ signs and symptoms. Thank goodness I listened intently to my
patients and followed my gut instincts!
Nowadays, you get to choose how fast you age, whether you prefer to
use at-home protocols combined with affordable drugstore products or go
the route of my celebrity patients who use cutting-edge in-office procedures
in combination with a sophisticated daily skin-care regimen. How can I say
this with confidence? Because every day I witness the transformation in my
patients, many of whom are dealing with very stubborn skin disorders. And
many of them begin to see major changes through highly practical strategies
anyone can implement. They simply work from the inside out, healing those
innermost, hidden corners of their bodies in order to generate radiance.

WHEN LIFESTYLE HABITS AFFECT SKIN

I always look forward to my appointments with Jennifer. She is one of those

high-energy types with a magnetic presence, colorful both in her personality
and in her amazing fashion picks! With a knack for being acutely aware of
the next big trends in beauty, makeup, and hair, she is often into something
fresh and new that she likes to talk about when I see her. I had been
working with Jennifer for about six months to treat her rosacea. Through a
series of laser treatments, dietary changes, and stress management
strategies, we had gotten her skin condition beautifully under control, and
her skin had looked fantastic at our last appointment. Happy patient, happy
doctor!