Carrie Phillips, ND
Introduction
As naturopathic physicians, we recognize that medicine is both an art and a science. It requires clinical reasoning, empirical evidence, and intuition that comes from experience. This balance is reflected in our practice, which is a continuous process of learning, adapting, and refining patient care. Nowhere is this more evident than in dermatology, where complex cases often defy textbook diagnoses, yet individualized treatment can yield profound results.
Skin disease is one of the most prevalent health concerns in the United States, affecting approximately 84.5 million individuals—nearly one in four Americans.¹ Conventional dermatologic treatments often rely on topical corticosteroids and systemic pharmaceuticals, which, while effective, can have significant long-term consequences, including skin atrophy and systemic effects.² As naturopathic physicians, we play a critical role in providing patients with alternatives that address the root causes of skin dysfunction rather than merely suppressing symptoms.
A skin condition is never just a skin condition—it is often a reflection of deeper imbalances within the body. Gut health, in particular, plays a crucial role in dermatologic conditions, as disruptions in the microbiome, intestinal permeability, and systemic inflammation can manifest on the skin.³ By addressing digestive function, reducing inflammatory triggers, and supporting detoxification pathways, we can achieve meaningful and lasting improvements in skin health.
This case study exemplifies the power of this approach, demonstrating significant clinical improvement in a patient with an undiagnosed skin condition. It highlights the efficacy of individualized, holistic treatment strategies—an essential component of naturopathic medical practice, even without a definitive diagnosis. As naturopathic physicians, we have a profound opportunity to help our patients heal from chronic skin concerns by looking beyond the surface and treating the whole person.
Case Presentation 35-year-old female Farrier
It all started with her hands—the very tools of her trade. As a farrier, she spent her days gripping metal, hammering horseshoes, and working in the elements, exposed to dust, sweat, and friction. The calluses were expected, but the painful fissures and thickened, scaling skin that developed over time were not. At first, she brushed it off as an occupational hazard, something a bit of balm and perseverance would fix. But as the seasons passed, her hands worsened. Soon, her feet followed, cracking painfully at the heels, making even walking uncomfortable.
She had always prided herself on her resilience. A tough job required a tough person, and she wasn’t one to complain. But when winter came, her symptoms eased—only to flare back up with a vengeance as soon as the warmer months returned. The cycle was relentless. She tried everything: bag balm, silver sulfadiazine, salves, homemade detergents. Nothing seemed to help. The more she worked, the worse it became. As a new mother determined to get healthy and to be able to model this for her child, she realized it was time to work on herself more deeply.
Unraveling the Underlying Causes
Her medical history painted a telling picture. Though there was no family history of chronic skin conditions like eczema or psoriasis, and having struggled with recurrent bladder infections from a young age, often enduring at least three to four infections per year. Diagnosed with short ureters as a child, she surmised was prescribed more than 100 rounds of antibiotics over the years! The relentless cycle of UTIs had driven her to learn how to be healthy, and in 2023, she attempted to manage her infections with Uqora supplements. But by the end of that year, as she prepared for motherhood, she knew she needed a more comprehensive approach to her health. Resolute to find answers, she sought naturopathic care, hoping for a solution that went beyond just symptom management.
Digging Deeper: Testing & Clues
During pregnancy, we focused on foundational health – diet, lifestyle, and nutraceuticals, improving her overall vitality. Five months postpartum, as she returned to work, her palms and soles began thickening, cracking, peeling, and itching. I knew it was time to dig deeper based on her skin symptoms alone as she did not report any GI symptoms and reported regular well-formed daily bowel movements. Functional lab testing revealed critical insights. And treatment was targeted at the results of the GI-MAP. She remained committed to her diet and nutraceuticals, experiencing steady progress—until the holidays triggered a setback. Indulging in comfort foods, she soon experienced a significant flare—the holidays. Letting her guard down, she indulged in comfort foods: a bite of mac and cheese, a cookie, a celebratory beer. Within days, her skin erupted, red and inflamed, her body seemingly revolting against her choices. When nausea set in, followed by vomiting, she knew something deeper was at play. It was no longer just her hands and feet; her entire system seemed off-balance.
Functional testing provided striking insights.
GI-MAP Results
– H. pylori: 1.02e3 (Elevated)
– Inflammatory dysbiosis: Low Escherichia spp., Bacteroides fragilis, Faecalibacterium prausnitzii; High Proteus mirabilis, Staphylococcus spp., Streptococcus spp.
– Pancreatic Insufficiency: Elastase = 383 (Low, ideally >750)
– Gut Inflammation: Calprotectin = 1227 (Normal <173) & Steatocrit = 8 (High)
– Low Secretory IgA: <210 (Low)
OAT & Mycotoxin Testing:
– Ochratoxin A positive =27.56 (Normal <7.5)
– Yeast & fungal overgrowth markers: 3-Oxoglutaric, Tartaric, Arabinose elevated, but not significantly
– Clostridia markers detected
– Neurotransmitters & mitochondrial markers low, likely due to gut dysbiosis and environmental exposures
Her GI-MAP results confirmed what her history suggested—her gut microbiome was imbalanced. H. pylori was elevated, and beneficial bacteria such as Faecalibacterium prausnitzii and Bacteroides fragilis were alarmingly low. At the same time, opportunistic bacteria like Proteus mirabilis, Staphylococcus spp., and Streptococcus spp. thriving with overgrowth. Worse, her pancreatic enzyme production was deficient, suggesting she wasn’t digesting and absorbing nutrients effectively. Chronic inflammation was evident, with calprotectin levels soaring at 1227 (normal <173) and secretory IgA dangerously low, leaving her gut barrier compromised.
Further testing revealed the presence of yeast and fungal overgrowth markers on her Organic Acids Test (OAT), which suggested a systemic fungal burden. At the same time, imbalances in neurotransmitters and mitochondrial function hinted at underlying stress and energy production deficits. This led us to Mycotoxin testing which proved positive with elevated Ochratoxin A, a mycotoxin linked to mold exposure. This patient reports regular exposure to visible mold, having a small farm and working with animals and feed. I suspected it would have been much higher and it’s likely she was not detoxifying and excreting well.
Her symptoms were no longer a mystery. The combination of gut dysbiosis, mycotoxin exposure, and food intolerances had created a perfect storm that manifested through her skin.
Connecting the Dots: A Root-Cause Diagnosis
Rather than viewing her condition as merely dermatologic, it became clear that her skin was reflecting internal dysfunction. Still unsure of the exact diagnosis, I focused on fungal overgrowth and trusting this intuitive instinct. Although testing was positive for fungal overgrowth, it was not as significant as I had predicted. My differential diagnosis included;
- Psoriasis (Palmoplantar type)
- Tinea pedis (chronic moccasin type)
- Hyperkeratotic palmar dermatitis/hand eczema
- severe xerosis or ichthyosis.
Final Diagnosis:
1. Palmoplantar Hyperkeratotic Dermatitis— chronic irritant contact dermatitis exacerbated by repeated metal exposure and mechanical trauma. Partially responsive to barrier restoration and emollients.
Underlying Systemic Triggers:
2. Gut Dysbiosis & Pancreatic Insufficiency → Compromising nutrient absorption, immune function, and skin repair
3. Mycotoxin Exposure (Ochratoxin A) → Contributing to oxidative stress and immune dysregulation
4. Food Intolerance-Induced Inflammation→ Driving intestinal permeability and systemic immune activation
Addressing only the skin would have been a temporary fix. A deeper, whole-body approach was and always is necessary.
A Comprehensive Treatment Approach
Healing had to happen from the inside out. Her treatment plan targeted multiple systems, restoring gut health, eliminating mycotoxins, and reinforcing her skin’s natural barrier.
Phase 1: 1 Gut & Mycotoxin Detoxification
– Broad-spectrum antimicrobial and biofilm disruptor, 2 caps BID
– A dairy free immunoglobulin concentrate for mucosal immune support and binder, 4 caps daily
– Organic Chlorella tablets to support metal binding and detox, 5 tablets qd
Phase 2: Skin Barrier Repair & Symptom Management
– Neem Oil topical applied post-shower to calm irritation, 1-2x/day
– Patient preferred to mix this with Bag Balm
Phase 3: Hydration & Lifestyle Adjustments
– Strict elimination of dairy, and potato-grain combinations
– Daily water and electrolyte intake to support detoxification and hydration
– Wearing gloves: To reduce metal exposure (initial resistance, later compliance)
With patience and adherence, she slowly saw improvements—first in digestion, then in her energy levels, and finally, in her skin.
Follow up Visit:
One month later, patient-initiated plan, and then the holiday indulgences induced vomiting followed by chronic diarrhea lasting 6 weeks. It is unclear to me what caused this flare. It could have resulted from die-off, and an additional binder should have been included, possibly due to acute gastritis.
Treatment Plan Adjustments
Phase 1: Gut & Mycotoxin Detoxification
– a broad-spectrum antifungal and antimicrobial, → 2 caps BID which includes; Neem (Azadirachta indica) leaf extract 300 mg, and a blend of AmlaOxy (Phyllanthus emblica) fruit, Belleric myrobalan (Terminalia bellerica) fruit, Chebulic myrobalan (Terminalia chebula) fruit, Indian madder (Rubia cordifolia) stem, Indian tinospora (Tinospora cordifolia) stem
– A dairy free immunoglobulin concentrate for mucosal immune support and binder – mucosal immune support, binder, → 2 caps BID
– ACS spray for Ochratoxin A (aflatoxin). To help treat the mold →12 sprays po BID, hold and swallow. No food or drink for 2 minutes. (prescribed but the patient did not use).
Phase 2: Skin Barrier Repair
– Neem Oil topical, applied 2x/day
– Again, I urge the patient to wear gloves when working to minimize potential reaction to metal.
Second Follow up Visit: Two months later
Phase 1: Gut & Mycotoxin Detoxification
– Butyrate to help feed the good bacteria and help with diarrhea, →2 caps daily
– A formulation that includes: Mastic Gum1000 mg, Proprietary Blend:150 mg, Licorice (root, deglycyrrhizinated), Marshmallow (root), Slippery Elm (bark) to treat the H. Pylori overgrowth in the stomach and help restore proper stomach pH, digestive enzymes, and decrease inflammation, → 2 caps daily ac
– Rotated antifungal which included; Biotin300 mcg 1000%, Sodium (from Sodium Caprylate)20 mg, Berberine Hydrochloride Hydrate150 mg, Oregano Leaf Extract150 mg, Sodium Caprylate150 mg, Cinnamon Bark Extract 100 mg, German Chamomile (Flower)100 mg, Ginger Root150 mg, Pau D’Arco Inner Bark Extract 100 mg, Rosemary Leaf Extract100 mg to treat overgrowth of yeast, → 2 caps TID
– Oral spray for Ochratoxin A to treat the mold, →12 sprays po BID Containing a proprietary Blend: 2000 mcg, Ultra-Pure Deionized Water, Activated Sub-micronized Clinoptilolite Zeolite, Ag
Phase 2: Skin Barrier Repair
– Continue Neem Oil topical 2x/day
Phase 3: Hydration & Lifestyle Adjustments
– Patient reports being diligent in wearing gloves for metal work.
Three months later, the patient experienced significant improvement in skin healing and realized a strong connection between metal contact and skin flares.
Conclusion
This case highlights the importance of addressing systemic inflammation, gut dysbiosis, and mycotoxin burden in chronic occupational dermatitis while emphasizing the value of trusting our clinical intuition as healers. The patient’s significant reduction in fissuring and scaling confirms integrative efficacy, while persistent erythema suggests transient inflammatory reactivity from diet and detox processes. Ongoing monitoring of gut health and mycotoxin clearance remains essential. If symptoms persist or continue to flare, I could consider a referral for colonoscopy.
Additionally, even after the skin clears up, it is crucial to continue treating systemically to ensure complete resolution of underlying dysfunction. If treatment stops prematurely, the root causes—whether gut dysbiosis, toxic burden, or immune dysregulation—may re-emerge, leading to symptom relapse. Long-term management should include maintenance probiotic support, periodic detoxification, and avoidance of dietary triggers to sustain remission and prevent future flare-ups.
This case also underscores the growing need for naturopathic dermatology in patients with chronic, treatment-resistant skin conditions. Many individuals find little relief in conventional dermatology and seek our help to treat their complex chronic skin conditions, as suppressive therapies fail to address underlying systemic imbalances. Naturopathic medicine is critical in providing patients with sustainable, root-cause solutions to persistent skin concerns.
Dr. Carrie Phillips, ND, RH (AHG), is a licensed naturopathic physician specializing in dermatology, pediatrics, and shamanic medicine. She operates a hybrid clinic in Lakebay, WA, combining traditional healing practices with modern naturopathic care. With a deep respect for the body’s innate wisdom, she focuses on uncovering root causes and restoring balance. When not in practice, she enjoys life with her husband, four children, and a small menagerie of animals. Her approach is both practical and intuitive, bridging science and tradition supporting whole-body health in an effort to help patients glow from the inside out—because skin rarely keeps secrets.
References
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