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

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.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.


  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.

This article was originally published by Naturopathic Doctor News & Review.

Holly Lucille ND, RN

Dr. Holly Lucille, ND, RN, is a nationally recognized and licensed naturopathic doctor, educator, natural products consultant, and television and radio host. Dr. Holly is also the author of several books including Creating and Maintaining Balance: A Women’s Guide to Safe, Natural, Hormone Health.

An acclaimed expert in the field of integrative medicine, Dr. Holly lectures throughout the nation on a variety of natural health topics. Her appearances include national media programs and networks including Dr. Oz, The Doctors, and Lifetime Television for Women, PBS’s Healing Quest, The Hallmark Channel, and Discovery Fit & Health channel.

She is on the editorial advisory board of Alternative Medicine and Natural Practitioner and is also regularly quoted as an expert in both consumer and peer journals. In 2007, Dr. Holly was listed in Time Magazine’s “Alt List” as one of the “Top 100 Most Influential People.” In 2012 she launched her own talk show, “Myth-Defying with Dr. Holly” on the Z Living network and is currently the host of “Mindful Medicine: The Dr. Holly Lucille Show” on RadioMD.

Dr. Lucille believes in the science, art, and mystery of healing and has a heartfelt passion for the individual wellness of all people. Built on this foundational belief, she uses the magnificence of multiple media platforms to truly make a difference and empower people to heal. Dr. Holly’s private practice in Los Angeles, Healing from Within Healthcare, focuses on comprehensive naturopathic medicine and individualized care.

Dr. Holly is the past president of the California Naturopathic Doctors Association where she worked to ensure the availability of safe naturopathic health care by spearheading a lobbying effort to have naturopathic doctors licensed in the state of California. She has also worked with the L.A. Free Clinic providing health education, promotion, and prevention in the public health system and recently was awarded the “SCNM Legacy Award” for her “contribution to the advancement and development of the field of naturopathic medicine.” Dr. Holly graduated from the Southwest College of Naturopathic Medicine in Tempe, AZ, where she received the prestigious “Daphne Blayden Award” for her “commitment to naturopathic medicine, academic excellence, compassion, perseverance, a loving sense of humor and a positive, supportive outlook.”

In her “off time” she enjoys being with her family, two- and four-legged, playing the bass guitar, tending to her hydroponic garden, and riding her motorcycle through the mountains and along the beaches of Los Angeles.