Patients are already asking about diet, supplements, oils, probiotics, “natural” products, and what they saw online before they even make it into the exam room. In this episode of The Spot Check, Jamie Restivo, PA-C, sits down with Lauren Stewart, PA-C, for a practical conversation on integrative dermatology and how clinicians can respond with curiosity, caution, and a clear understanding of what the evidence can and cannot tell us.

Stewart defines integrative dermatology as taking a step back rather than a step away from conventional medicine. The goal is not to replace medical therapy, but to look more broadly at what may be contributing to flares, triggers, or disease burden in conditions like atopic dermatitis, and what might help support patients between visits. Her approach blends Western medicine with nutrition, barrier support, select supplements, and other integrative tools, always with an emphasis on clinical realism and practical patient care.

Much of the conversation centers on atopic dermatitis, where Stewart uses integrative strategies most often. She discusses practical counseling around fragrance free products, ceramide containing moisturizers, coconut and sunflower oils, hypochlorous acid, probiotics, and topical vitamin B12, while also highlighting the importance of “putting the fire out first” when inflammation is active in moderate to severe disease.  

The discussion emphasizes that traditional Western medical therapies are often necessary upfront to gain control of the disease, while supportive integrative strategies can then help maintain the skin barrier, reduce flares and overall disease burden between visits, and improve quality of life. The message is not that integrative therapies replace more advanced medical treatment, but rather that they can work alongside conventional therapies to better support long term disease management.

They then move through other common disease states including psoriasis, acne, hidradenitis suppurativa, actinic keratoses, molluscum, and warts with quick, clinically useful considerations for each.

The episode also addresses one of the more challenging aspects of this space: deciding what is truly worth recommending. Stewart talks about reviewing studies, listening carefully to patient experiences, and weighing safety, access, cost, and plausibility when the evidence is not as robust as it is for FDA approved therapies.

The takeaway is not that every clinician needs to become an integrative specialist. It is that patients are already using these integrative therapies, and clinicians should be helping guide those conversations with better questions, clearer guardrails, and thoughtful recommendations that support the care they are already providing.