The Harmony of Inside-Out and Outside-In: A Comprehensive Approach to Skin Conditions

 In Dermatology

Holly Lucille, ND, RN

As naturopathic doctors, we have a comprehensive approach to treating our patients. In this way, we differ from conventional practitioners of medicine. One way this is very evident is our perception and care for our patients’ skin.

The skin is the largest organ in the body and can be seen as a barometer of what is happening inside our bodies. Typically, when our patients experience some kind of skin condition, we look at what is going on in the inside, not just what’s happening topically, on the outside. Issues like a poor diet, bacterial and yeast imbalances, and other influences can contribute to the skin expressing itself in the form of psoriasis, dermatitis, or acne. Making improvements to diet, lifestyle, and the intestinal milieu from the “inside-out” often helps our patients’ skin improve dramatically. As naturopathic doctors, we know that the “inside-out” approach is effective and essential when it comes to skin conditions. When we treat comprehensively, however, we also value addressing acute concerns and the symptoms that occur from the “outside-in.” Finding topical products that are clinically proven and don’t have harmful side effects can be difficult. So many prescription or over-the-counter products have the potential to do more harm than good. With current advancements in technology, research, and development, there are now effective “outside-in” botanical, topical skincare solutions that can help a patient find quick relief from various symptoms, such as itching, flaking, and scarring, and without the harmful side effects. For example: I have a female patient who has follicular keratosis, which created red bumps on her arms, legs and buttocks. When we first started working together a couple of years ago, we were able to make some significant improvements by cleaning up her diet and ridding her of yeast and bacterial overgrowth. Because of her lifestyle, she wasn’t always able to keep to a strict regimen, which meant that she experienced a more chronic condition and occasional flare-ups. To combat these flare-ups and provide safe, natural symptom relief, I turned to “outside-in” topical bio-herbal skincare solutions. Complementing my patient’s inside-out regimen with topical outside-in skincare solutions gave my patient the extra help she needed. She was able to see results in her skin health fairly quickly, which further motivated her to stick to her regimen. She continued to do her best to abide by the “inside-out” program we had developed, but adding these “outside-in” products created the perfect synergistic solution for her skin condition.

Why Herbal Solutions?

There are many topical skincare products available to patients in the dermatological world. However, many of these products have steroids, parabens, sodium lauryl sulfate, or other chemicals that can potentially harm the body more than help it. While these steroids and other chemicals may help increase of absorption of the medication, the side effects and long-term issues can negate the benefits of rapid absorption. Steroids in topical skincare products have been found to cause steroid atrophy, which can permanently damage the skin, leaving horrible scars and creating long-term pain; they can also cause periorbital dermatitis, which can increase intraocular pressure that, in turn, increases the risk of glaucoma, cataract, retinopathy and systematic adverse effects.1 While these products may help relieve the symptoms of a skin disorder, they do so at a heavy price to the individual. Even if a patient never experiences the side effects of steroids or harmful chemicals, there are other issues associated with products that contain steroids. For instance, patients may find that after only a couple of months or years, they need to change to a new product to avoid potential problems with the steroids in their current product. This is something that can be avoided with herbal solutions. Once a product has been found to work with a patient, he or she can use it for life. So, while it may take a couple of extra weeks for patients to see the effects of herbal products, there are benefits that they will experience for the rest of their lives. Although herbal topical solutions don’t contain steroids, parabens, or harmful chemicals, there was previously no real proof that they were effective. Now, however, there are products emerging on the market that are clinically proven to be effective, as well as safe. Furthermore, clinical studies into the efficacy of certain herbal extracts have greatly improved our ability to act in an informed way. One extract that has shown strong results is Rheum palmatum (rhubarb); see figure. Recent studies2 have shown that extracts of this plant are more effective than hydrocortisone (1%) as an anti-inflammatory. Rhubarb is 1.55 times more effective in PGE2 inhibition, 1.8 times more effective in IL-1α inhibition, and 1.3 times more effective in IL-13 inhibition. Rheum palmatum is also 8.8 times more effective as an anti-oxidant (DPPH inhibition) than a well-known, water-soluble tocopherol analogue.

Lucilloe_May_2014_Figure_Rheum palmatum

Figure. Rheum palmatum, Root Extract Rhubarb extract has been studied as part of herbal skincare mixtures, and has been found to be effective in treating common skin conditions like acne, seborrhea, atopic dermatitis, and psoriasis.2 Additional extracts in this new class of skincare solution include ingredients that have anti-allergic and anti-microbial activity, itch reduction, and repair of damaged skin.

Complementary Regimens

We can now expect the availability of topical solutions on the market or that are in development which allow us to treat our patients’ acute needs without exposing them to the side effects that many traditional products carry with them. In other words, we can find products that are complementary to the philosophy and practice of naturopathy. Skin issues, in my opinion, are truly an inside job. In many cases, however, adding an herbal-based, topical solution can address the acute concerns and barrier issues, allowing naturopathic doctors to comprehensively treat skin conditions safely and effectively.


Holly Lucille, ND, RN is an acclaimed expert in the field of integrative medicine who practices in West Hollywood, CA. Dr Holly lectures throughout the nation, has appeared on a variety of television shows, and hosts her own TV and radio shows, covering a variety of natural health topics. She is also regularly quoted as an expert in both consumer and peer journals. Dr Holly is a member of the Kamedis ND Advisory Committee and advises on Kamedis’ clinically proven, bio-herbal skincare products.



  1. Lebreton O, Weber M. Complications ophtalmologiques des corticoïdes systémiques. La Revue de Médecine Interne. 2011;32(8):506–512.
  2. Kamedis, unpublished data, 2014.
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