The application of functional medicine for children’s skin health is essential to holistic pediatric care. Skin issues can affect the child’s well-being, reveal systemic conditions, and impact dermatologic health across the lifespan. The holistic approach to pediatric skin care looks beyond the symptoms to possible systemic causes of dermatologic conditions.
In some cases, dermatologic symptoms are the first manifestation of a more serious disease. It is, therefore, important to view the child as a whole person and attempt to isolate root causes. Additionally, evidence-based functional medicine addresses the child's particular needs and acknowledges the differences in treating a child versus an adult patient.
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Overview of Common Pediatric Skin Issues
Common childhood skin conditions include atopic dermatitis (eczema), acne, psoriasis, and diaper dermatitis (diaper rash). Atopic dermatitis (eczema) is a very common inflammatory condition in childhood. This condition can cause significant discomfort and cosmetic concerns, especially as the child matures. Discomfort arises from the dryness and itching that is typical of this type of dermatitis. These symptoms can be severe enough to cause sleep disruption. Lesions of atopy often arise in the flexor surfaces of the skin, such as behind the knees and elbows. Atopic dermatitis is associated with allergic rhinitis and asthma; patients often have elevated immunoglobulin E (IgE). Eczema treatment involves hydrating the skin and protecting the barrier function of the cutaneous layer. Management often includes identifying allergic and environmental triggers.
Acne is a prevalent condition, especially in adolescents and young adults. Approximately 40-50 million patients are diagnosed with acne annually. There are several causes of acne, including hormone fluctuations, genetic predisposition, and the presence of Cutibacterium acnes (formerly Proprionibacterium acnes). A combination of bacteria, sebum, and keratinocytes collect in the hair follicle and cause acne lesions (comedones, papules, pustules, or cysts). Acne is conventionally treated with topical retinoids, keratolytics (e.g., salicylic acid), and topical or systemic antibiotics.
Psoriasis is a complex immune condition that causes scaling plaques and can also appear in childhood. These lesions range in severity and cause considerable cosmetic disfigurement and quality of life interruption. Additionally, psoriasis can lead to other inflammatory conditions, such as arthritis. Psoriasis appears to have a genetic link and can be affected by the environment. Psoriasis plaques may affect multiple areas of the body but often occur on the extensor surfaces, such as the elbows and knees. Other sites may include the face, nails, and scalp. Psoriasis treatment is complex and evolving, and therapy depends on the subtype and severity of the psoriasis. Topical corticosteroids are a cornerstone therapy in psoriasis. These vary in strength and are used with other topical therapies such as vitamin D, calcineurin inhibitors, tazarotene, and salicylic acid. Phototherapy, systemic treatments, and biologic medications are also used.
Diaper dermatitis (DD), or diaper rash, is a common presenting concern during pediatric visits. This inflammatory condition causes redness, itching, and interruption of the epidermal layer in the diaper area. An infant with diaper dermatitis can be in significant discomfort, causing increased crying and sleep disruption. Diaper dermatitis is caused by skin contact with urine and feces, which causes pH changes and increased enzyme activity, disrupting the epidermis’s barrier function. Other agents, such as creams, lotions, and detergents, may increase irritation of the skin in the child’s perineal area. Management of DD includes reducing the contact time of urine and feces. This prevents irritation and promotes healing of the skin. This intervention includes changing diapers frequently and using diapers with better absorption. An essential part of treatment is protecting the skin barrier with topical emollients, including zinc oxide. If diaper dermatitis does not resolve with initial treatment, further intervention with low-dose corticosteroids, topical antifungals, and topical antibiotics may be necessary.
The Functional Medicine Perspective on Skin Health
In addressing skin health, functional medicine utilizes a complementary approach to promote dermatologic health from the inside out. From a functional medicine perspective, the skin reflects the systemic well-being of the individual and can be the first sign of more severe health concerns. This holistic view works, in particular, to promote the balance of the immune system and gut microbiome to help prevent and treat dermatologic conditions. When treating pediatric skin conditions, it is important to analyze the possible genetic, environmental, and dietary factors contributing to the condition. A holistic approach also involves identifying potential psychological impacts of skin conditions.
Functional Medicine Labs for Pediatric Skin Health
Functional medicine labs can help practitioners gain insight into root causes and contributing factors behind skin conditions. A Comprehensive Stool Analysis by Doctor’s Data, for example, can identify an imbalanced gastrointestinal flora that may be contributing to skin issues. Other great options include the GI-MAP by Diagnostic Solutions and the GI-Effects by Genova Diagnostics.
Allergy testing using the Environmental Allergy Test (88 Antigen IgE) by Infinite Allergy Labs isolates IgE and can help identify possible triggers for skin conditions, including eczema and psoriasis. Nutritional deficiency testing can also provide useful information for the practitioner. Some labs, such as the Genetic Test: Nutritional Deficiencies by Ayumetrix, analyze a patient’s genetic makeup to uncover possible nutritional deficiencies.
The information gained by these functional labs can help identify root causes, rather than just treating symptoms, and tailor treatment plans accordingly.
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Dietary Interventions for Improving Skin Health
Diet is exceptionally important in promoting overall well-being, preventing nutritional deficiencies, promoting a balanced microbiome, and reducing inflammation, all of which lead to healthy skin.
Antioxidants are available in our diets through fruits and vegetables, especially those with vibrant colors. Antioxidants prevent free radical damage and can reduce inflammation throughout the body and skin. Vitamins and antioxidants promote cell turnover and protect cells from environmental damage. A diet rich in whole foods and limited in processed foods promotes the normal physiologic processes of the skin and prevents skin conditions.
A whole foods-based diet will also offer a balance of essential fatty acids, which are important in preventing inflammation throughout the body, including the skin. A diet primarily consisting of whole foods and excluding fast foods promotes a higher intake of omega-3 fatty acids and helps strike a balance with omega-6 fatty acids, which can be pro-inflammatory. Next, incorporating foods that are low on the glycemic index may help prevent acne. High glycemic load foods (refined sugar, simple carbohydrates) appear to play a role in increased sebum production, contributing to acne formation. Whole foods are high in fiber, which slows the increase in blood sugar after food ingestion rather than the quick spikes in blood glucose seen with refined carbohydrates.
Lastly, the link between the consumption of dairy products and acne is an area of ongoing research. There appears to be a correlation between dairy and acne formation, possibly due to glycemic load and androgen production.
In functional medicine, exploring the relationship between food allergens and skin conditions is important. Food allergies may exacerbate conditions such as atopic dermatitis, though this link is still being researched. Allergy testing can help identify triggers in children suffering from eczema. In addition to testing, a food diary and food challenge diet can help identify possible food allergies and their effects on eczema.
Gut Health and Its Impact on Pediatric Skin Conditions
The gut-skin axis describes the complex relationship between the balance of bacteria in the digestive system and its effect on the health of the skin barrier. Dysbiosis can occur when the bacteria are not balanced, meaning there is too much or too little of a particular species. This imbalance can affect the skin in many ways, including increased inflammation. Probiotics can be important for maintaining skin health and preventing skin barrier disruption.
Atopic dermatitis can be affected by the gut-skin axis via increased immune response, possibly exacerbated by decreased diversity and an abundance of the organism Staphylococcus aureus. An increase in inflammation from gut dysbiosis and abundance of Staphylococcus and Streptococcus species can also contribute to psoriasis. As previously mentioned, a high level of C. acnes on the skin is a major cause of acne vulgaris. The application of topical probiotics is a subject of ongoing study, but this treatment may help balance the epidermal flora.
Diaper dermatitis is also affected by diet, especially in the early stages of life. The intestinal microbiome and pH of the child’s stool change depending on diet. Breastfeeding can promote a healthy gut microbiome in the child and reduce the incidence of diaper dermatitis.
Diet is critical in maintaining a healthy bacterial balance throughout the body. An eating pattern rich in fiber from fruits and vegetables provides enough prebiotics to feed the beneficial gut bacteria. Probiotics can be ingested through diet via fermented vegetables, vinegar, tempeh, and yogurt products. Improving skin conditions through diet may involve increasing the intake of these foods, adding a high-quality probiotic supplement, and/or using topical probiotics. A medical practitioner can provide guidance about particular probiotic supplements, topical probiotics, and recommended dietary changes.
Lifestyle Modifications and Environmental Factors
Lifestyle changes for skin health can help prevent and alleviate many common skin conditions. We know that stress can alter immune system function. Therefore, stress reduction is very important for overall wellness, including dermatologic health. Adequate sleep can reduce inflammation and stress, leading to improved skin conditions. Reducing contact with environmental toxins can reduce skin barrier disruption and inflammation. A healthy diet also plays a role in properly eliminating toxins from the body. Reducing ingestion and contact with pesticides around the home can help prevent inflammation and a heightened immune response. Using an air purifier, filtering water, and making careful dietary choices can help reduce exposure. Increasing physical activity can promote systemic health, as well as reduce the stress that may contribute to skin conditions.
Herbal and Supplemental Support for Skin Conditions
Herbal remedies can help alleviate discomfort and prevent the progression of skin conditions. Supplementing fatty acids in patients with atopic dermatitis shows promise, especially ingesting evening primrose oil. Topical herbal remedies such as chamomile preparations can reduce inflammation and itching, specifically for atopic dermatitis. There is a correlation between low Zinc levels and severe acne vulgaris; therefore, supplementing with zinc may be a useful adjunct treatment for acne. Aloe vera exhibits anti-inflammatory effects when applied topically and is a mild, soothing substance. It can calm irritation and prevent peeling and itching when applied to irritated or acne-prone skin. Aloe vera can also calm skin irritated by diaper dermatitis.
Caution should be exercised when administering supplements to children. The dosage should always be appropriate and administered under the guidance of a qualified healthcare professional.
The Role of Stress and Emotional Well-being in Skin Health
The skin is affected by stress, which can promote inflammatory conditions. Increased stress can trigger the inflammatory feedback loop, contributing to conditions such as psoriasis and eczema. Reducing stress through mindfulness, adequate sleep, and consulting mental health professionals can help reduce the impact of stress on the skin. Acne can be an extremely psychologically stressful condition because of cosmetic outcomes. Stress can increase the incidence of acne, and outbreaks can increase depression and anxiety, causing a feedback loop. Mindfulness, adequate sleep, and increasing physical activity can all help reduce stress.
Integrating Functional Medicine into Pediatric Skin Care
A multidisciplinary approach to skin health involves utilizing traditional treatments while integrating functional medicine. Working with a functional medicine provider can provide insight into dietary interventions, stress management, supplement use, and herbal remedies. A functional medicine perspective can help treat the child as a whole person, helping to find the root cause of skin conditions.
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Pediatric Skin Health: Functional Medicine Key Takeaways
Proactive skin health strategies can prevent dermatologic conditions from arising and contribute to successful treatment before they progress. A functional medicine approach to pediatric skin health considers diet, environment, skincare, and supplements to help promote dermatologic health. Skin conditions, including acne, psoriasis, eczema, and dermatitis, involve a complex interplay between systemic and dermatologic health. Holistic treatment considers this relationship to promote skin health in the pediatric patient and wellness throughout the lifespan.
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