As part of Eczema Awareness Month, we will feature Eczema Champions — individuals who are helping lead the fight against eczema. In this interview, we learn more about Dr. Peter Lio.
Dr. Peter Lio is the co-founder and co-director of the Chicago Integrative Eczema Center. He is also Clinical Assistant Professor of Dermatology and Pediatrics at Northwestern University, Feinberg School of Medicine, and former faculty member of Harvard Medical School. Dr. Lio is a graduate of Harvard Medical School and completed his residency through the Harvard dermatology residency program. He is also trained in acupuncture and has interests in alternative medicine. He is a member of the National Eczema Association scientific advisory board.
How did you become interested in eczema? Were there specific experiences that drew you towards this disease?
In medical school, I was very interested in neurology since my background was in neuroscience as an undergraduate. One of the tough things about neurology was that there were not always good treatments for many of diseases, and that was frustrating and sad. Dermatology really captivated me because you could directly treat the skin in so many ways: from topical creams, to oral medications, to lasers and light! I think I am drawn to eczema because it is a tricky problem and one that causes a great deal of suffering, but one that has many potential treatments that can help patients get better. It’s exciting to be a part of something that we don’t understand fully yet, but that we continue to close in on. One of the things that really made me think in eczema was the fact that there were so many strong opinions about what worked and what didn’t. So many voices, but yet still no easy cure. I wanted to delve more deeply into this to better understand it, and my journey has taken more than a decade, including a year of acupuncture training. Excitingly, the journey continues, because although I know so much more than when I started, I still do not have all the answers…
Were you also always interested in acupuncture and alternative medicine? What led you to pursue these interests?
My mother had a powerful effect on me here: she had many “home remedies” and was interested in folk treatments for many diseases. She had come from a big family (11 children!) and there was a lot of local wisdom. As I learned things in medical school, I remained interested in this other type of medicine, and was sort of surprised that much of it was not discussed. Most of my teachers were thoughtful about other approaches to health, but there wasn’t much that was really taught then. However, I think I am living at the right time: shortly after, the alternative medicine explosion seemed to start, and there was more interest than ever before! Lots of doors began to open for me, including a life-changing experience with Kiiko Matsumoto and David Euler in the course called “Structural Acupuncture for Physicians” offered at Harvard Medical School. As I learned more about Traditional Chinese Medicine and Acupuncture, I was also voraciously reading about naturopathy, different types of herbal treatments, homeopathy, and other forms of alternative medicine. Moreover, patients who were interested in this were increasingly being referred to me; I can honestly say that I’ve learned more from patients than from books about alternative medicine!
You are unique in that you are well-versed in both traditional and alternative medicine. At times, people present traditional Western medicine and alternative medicine as being mutually exclusive. How do you see the relationship between traditional Western medicine and alternative medicine? Have there been instances where the two have been difficult to reconcile?
For me, it’s important to keep an open mind for both systems. I try to take the “best” from both worlds and really try to use the idea of “Integrative Dermatology” to bring it all together to optimize health. I do have patients who don’t want any “conventional” medicine, but I am usually able to show that much of what we call “conventional” is actually very close to nature; it’s a misconception (by doctors as well as patients!) that there is a hard line between these two worlds. For example, there is an FDA-approved prescription medication cream for genital warts that is entirely based on green tea! It’s one of the first botanicals ever approved by the FDA, but it clearly lives in both worlds. Other medications, such as azelaic acid, also are very close to nature; this is derived from buckwheat and is produced naturally by the commensal yeasts that live on our skin. Most of the time, I am trying to use as many gentle and supportive treatments as possible, in order to minimize or totally avoid the so-called “big guns”; however, for more serious conditions, I do find that powerful medications can make an incredible difference, and–when used properly–can do so safely. That is why I think I am firmly planted in the world of “Integrative Medicine”.
What is your treatment approach for eczema? Do you pursue both traditional and alternative medicines both at the same time? Do you let your patients help guide you?
My general approach is to first do the following: identify and avoid any and all triggers, strengthen the skin barrier with natural agents and moisturizers, work on re-balancing the skin and gut bacteria by decreasing staphylococcus and adding probiotics, and finding ways to decrease itch and inflammation naturally. Once these are optimized, some patients do not need anything else! Those are awesome success stories, but, unfortunately are relatively few given the more complicated cases that are referred to me. However, we try to do this first for pretty much all cases. If this is not enough, we have a “phase 2” on the Eczema Action Plan for patients that generally involves a prescription anti-inflammatory, usually a topical corticosteroid or calcineurin inhibitor to be used for up to 2 weeks per month maximum. In this way, we aim for good effect with absolutely minimal risk of side effects. I have most of my more severe cases come in frequently, both to check the skin and monitor for any signs of side effects, but also because it is very difficult to do these plans day in and day out, and so there is an element of support and cheerleading that goes on in a visit that is difficult to explain but seems very important. Should that fail, we then usually discuss wet-wrap therapy or the healing power of phototherapy (Narrow band UVB light treatments) next. Beyond that, we can discuss powerful systemic treatments such as cyclosporine, mycophenolate, and azathioprine; fortunately, those are necessary only for a small portion of patients.
Can you tell us more about the Chicago Integrative Eczema Center?
The Chicago Integrative Eczema Center is a resource for patients and families with atopic dermatitis seeking a more holistic approach to care. We emphasize integrating natural therapies, Traditional Chinese Medicine, and Acupuncture/Acupressure in addition to trusted conventional medical treatments. There are 4 components: education, with the website which has lots of neat resources including videos, and the Center meetings once every other month on a Saturday AM which have specialized education content and awesome guest speakers; the support group (sponsored by the National Eczema Association) which is incredible for patients and families; patient care with me and with Dr. Ryan Lombardo, a Traditional Chinese Medicine doctor; and then research that will hopefully allow us to continue to answer more questions and get to the bottom of this disease. It’s been a very exciting few years as we’ve grown, and patients have come from incredible distances to attend the meetings. We do, however, constantly struggle with how we can do things better and serve our patients and their families better.
What led you to co-found the Chicago Integrative Eczema Center?
One of the frustrating things was that all day long I would go from room to room to see patients with eczema and there would be a common refrain: “I feel alone in this.” And it was ironic because each patient felt alone, but I was seeing this entire community of patients–they just didn’t know each other! At the same time, there is so much information to go over with eczema–it’s not just applying one cream and being done! Safety issues, moisturizing tips, bacterial infections: there is just really too much for a single visit. Additionally, concerns about medications also take a long time since there are usually specific questions that patients would like to ask. What has been incredible about the Center is that it provides an opportunity with time and space to deal with these issues, which has been a true game-changer.
Eczema centers are more popular in Europe but are few and far between in the United States. Could your integrative eczema center succeed in the rest of the US?
This is a very good point. In Europe there are similar centers that are sometimes called “Atopy Schools”. They are very rare in the US, in part because insurance does not pay for the services at all. Accordingly, all the educational and support resources of our Center are free for patients, which has been wonderful, but we wish even more patients and families would attend and we continue to try to get the word out!
What advances are you most excited about in the field of eczema? How should resources be prioritized in the fight against eczema?
There are some really exciting new ideas in eczema. Most exciting, perhaps, is the concept that “leaky skin” may be the real driving force for many of our most severe patients. This is a developing story, but it could mean that–for some at least–simply protecting the skin barrier could actually prevent eczema and possibly even food allergies! So much time, money, and energy is devoted to calming the eczema once it has started, it is intoxicating to think that the whole thing could be prevented… I’ve written a bit more about this idea here: http://chicagoeczema.com/resource/leaky-gut-or-leaky-skin/