026: Skin Irritants You've Probably Not Heard Of w/ Lily Mazzarella

I've spoken a lot on this show about eczema, and today, I'll be expanding on the wealth of information we've already received. Tune in to learn more about the roles of stress and skin irritants in eczema. 


Or, listen on your favorite app: iTunes (Apple Podcasts) | Spotify | Stitcher | TuneIn | Subscribe on Android

My guest, Lily Mazzarella, MS, CNS, is an herbalist, nutritionist, educator and writer. She is the owner of Farmacopia, a modern apothecary and integrative practice in Santa Rosa, CA. Lily is the formulator and creator of Farmacopia’s line of Signature Tinctures, Adaptogen Powders and Superfoods, and co-founder and formulator of Reishi Roast Original and Reishi Roast Elixir.

In this episode, take a closer look at the role stress (which is unfortunately so often brushed off) plays in skin rashes, as well as how lesser-known skin irritants can have an impact on the health of your skin. 

Has practicing better stress management helped your skin condition? Tell us about it in the comments!


In this episode

  • Lily's history with eczema
  • The role of stress in skin conditions
  • Lesser-known skin irritants
  • What is balsam of Peru?



“The skin and the nervous system actually derive from the same tissue. It's called the ectoderm.” [6:06]

“The skin has its own stress axis, so it actually is a source of stress hormones.” [7:30]

“If you have impaired genetic pathways for processing sulfur, it can accumulate in your system, and it can add to itch and red flaring skin conditions and flushing and irritability and sleeplessness.” [12:51]

“Four percent of people have an allergy to balsam of Peru.” [21:35]



Find Lily online here

Follow Lily on Instagram


“The skin and the nervous system actually derive from the same tissue. It's called the ectoderm.”

026: Skin Irritants You've Probably Not Heard Of w/ Lily Mazzarella FULL TRANSCRIPT

Jennifer:              Hi everyone and welcome back to The Healthy Skin Show. Today I've got a special guest for you. She is a friend and a colleague of my sister's, so my sister who's an acupuncturist and an herbalist made this connection. Some of you may remember that my sister was a speaker on the eczema and psoriasis awareness week and so my sister Nicole deeply trusts this fellow herbalist, nutritionist and educator in the Santa Rosa, California community and so I'm really blessed and lucky to have her to join us to talk about a bunch of things and connecting herbs and skin conditions and all sorts of stuff. Her name is Lily Mazzarella and she's, as I said, an herbalist, nutritionist, educator and writer. She's the owner of Pharmacopia, a modern apothecary and integrative practice in Santa Rosa, California. She's the formulator and creator of pharmacopoeia's, line of signature tinctures, adaptogen powders and super foods and cofounder and formulator of Rishi Roast Original and Rishi Roast Elixir, which is really cool because I've seen those packages and I did not know that you were involved in that. Lily, thank you so much for joining us.

Lily:                        Oh, it's so great to be here. Jennifer. Thank you so much for having me.

Jennifer:              Not a problem. And I, okay, so I want to like dive right in here and I want to let people know right away that you and I have, we're like eczema sisters. You had eczema. So do you want to share really quick so that people know, the listeners know that you really get this, what your, what's the deal with you was with your eczema?

Lily:                        Yeah, well what's interesting for me was that I was one of those people who had eczema come on as an adult. Often we see it, it's a really prevalent condition in children. But I was in my late twenties when I first got eczema. I was a kind of a rashy and reactive kid. Like I'd wake up with my eyes swollen shut or hives suddenly and, and I was definitely reactive to foods and looking back in my history, I see, well I had a lot of ear infections and strep infections, so it was getting rounds of antibiotics. So, it makes sense to me, you know, my, my clinical mind makes a lot of sense of kind of the trajectory of my childhood into my mid and late twenties where I developed first a type of eczema called Nummular eczema, which is a really kind of persistent eczema that occurs typically on the lower legs.

Lily:                        But mine was not like it hadn't read the book, so it was, it was migrating to other parts and my neck and my hands would also be affected. And you know, I have to say this, you know, having eczema, having really severe eczema with extreme itch really helped me develop my skills of compassion and empathy. You know, living with that degree of disruption on a daily basis. You know, my sleep was disrupted. I was scratching in the night. It was, and I was someone who at that point in time was well on my path to you know, education around herbal medicine than and nutrition. And I was like, pow, you know, what is happening here? So I really took it as an opportunity to kind of learn about the way that different physiological systems impact the skin. You know, so what was going on with me at the time was a lot of food sensitivities, undiagnosed food sensitivities, food allergies that were actually impacting my gallbladder causing gallbladder dysfunction.

Lily:                        They wanted to take it out out, but I still have my gallbladder and I have no gallbladder issues to date us.

Jennifer:              Thank goodness!

Lily:                        Yeah. Amazing. I know, you know, it's amazing. So, yeah, so basically I started on this path of kind of examining every contributing factor, whether it was my hormones and my menstrual cycle or you know, the foods I was eating and and certainly stress in my life. You know, this, this is something that developed at a high stress point in my life and continued while I was in graduate school where I was, you know, working full time, you know, and in a full time through your graduate programs. So it was a pretty intense time. So it took years to kind of unravel what was happening. Because I did it on my own. You know, I think when you're working with a skilled practitioner, you can really accelerate that process. But I was willing to kind of experiment with elimination diets and food removal. I had to understand the role of co-occurring staph on eczema, which occurs in 90% of people with eczema and treat that you know, and I was really tired of going to the dermatologist, you know, in tears you know, saying what else can you do for me? And really just being offered topical and oral steroids, you know, or products as a result. Pretty much.

Jennifer:              Exactly. And that's it. It's sad that it seems like at that, at this point that this is still most of what they have in their toolbox. Now they have some strong new drugs, but those drugs are pretty serious. You have to seriously consider their lifelong usage drugs that have come with some scary side effects. So. Exactly. And I would just ask you a question because you mentioned about stress and the onset of this, and I had the same thing. I was in grad school when my eczema started.

Lily:                        Right.

Jennifer:              So, you know, I think a lot of people think stress is this vague thing and like, Oh, everybody's stressed out. Oh everybody has stress. And we sort of like blow off the role that stress plays in skin conditions. Can you talk a little bit about that and what research is telling us now?

Lily:                        I absolutely can I seriously, it's like one the things I'm most passionate about. So you know, there are so many connections between the skin and stress. And so if we even just go back to embryological development the skin and the nervous system actually derived from the same tissue, it's called the ectoderm. And interestingly that tissue also makes up the adrenal medulla, which is the center of the adrenal gland, not the cortex that secretes cortisol, but the center that secretes adrenaline or epinephrin that's kind of like fast acting stress chemical that we're all completely aware of the effects of, you know, if you slam on your brakes when a kid is running across the street, you know, the effects of adrenaline. So, you know, there's that connection, this, and it makes a lot of intuitive sense, right? Like the skin is a sensory organ. It's alerting.

Lily:                        As you know, if we think about it in an evolutionary sense, it's alerting us to a lot of danger. You know, it's a sensory organ that's taking in information and sending it to the central processing systems, the brain. So there's that connection. What we also know now, so there's been a lot of talk and I'm sure you've more than aware of, you know, the hypothalamus pituitary adrenal axis, which we call the stress access. You know, it's this sort of central axis that amplifies the stress response and is chronically activated in people these days. So when we see these chronic elevations of stress hormones and people kind of crumbling under that over long periods of time, you know, that is chronic activation of the HPA access. What we know now is that the skin has its own stress axis. So it actually is a source of stress hormones. We used to think that this was just in the brain, but the skin itself will secrete stress hormones when a person is under any form of stress, psychological stress, infectious stress. So, you know, why does skin flare when we are stressed out? Well, you know, there's, it's responding or reacting to central messages, but it's also creating an amplifying those messages itself. So if that makes sense?

Jennifer:              Yes, absolutely. And actually that's really interesting you making a lot of really interesting points. I've also read some interesting research that itching and scratching in the middle of the night, especially when you're sleeping can be associated with elevated cortisol levels. So for sure there's a lot to stress that people don't realize. Is there any particular, you know, obviously we can't go deep into this, but any particular tip or maybe something that listeners could kind of spend some time thinking about and mulling over that maybe they need to look and consider some stuff in their lives that you might picture.

Lily:                        Yeah absolutely. Yeah, absolutely. You know, I would say that, you know, a lot of my, my path and healing was kind of, yes, it was the herbs I took and the nutrients I took and the foods I eliminated and the foods I added in. But it was also dealing with stress and my reaction to stress. And so one of my main tools at that time and, and in a continued way has been mindfulness meditation. And I would recommend anyone with a chronic skin condition. So eczema, psoriasis, rosacea, or acne checkout mindfulness based stress reduction or MBSR, which is Jon Kabat Zinn's program from the University of Massachusetts medical school. And that actually has good research on skin conditions, particularly psoriasis and mindfulness meditation in herbal medicine. We also look at categories of herbs like adaptogens and nervines, which help to moderate the stress response and help us respond to stressors better.

Lily:                        So yeah, I mean just, I, I also just really want to emphasize like you are not creating, like there's a lot of, you know, eczema is often called the IBS of the skin and anybody who's been diagnosed with IBS knows that you're like putting the basket case basket. It's a wastepaper basket diagnosis, but you know, it's a little bit like, Hey, this is in your head. And you know that an aspect of that is actually true. There's something called neurogenic inflammation. And what studies show is that, you know, the stress response in the stress access can actually make mass cells, which are these kind of inflammatory cells that have lots of histamine in them, which is another inflammatory chemical. They make those break apart or de granulate, that's the technical term. And so, you know, if you're having these responses, it's not that there's something wrong with you or that you did something wrong, it's that, you know, there are physiological pathways for this.

Lily:                        There is science behind it. It's not in your head. So, you know, the stress in your mind may be triggering these pathways, but you know, it's not like this is quote unquote psychosomatic, which is, you know, a very, very over determined and problematic term these days, you know. So yeah, so I would say exploring, you know, mindfulness meditation and stress relieving techniques. Also breathing exercises. Those are potent. You know, the breath box where you're breathing up across and down and then across in a, you know, so you're breathing three to five seconds sort of as long as you can and holding your breath across. It's, it's those things like that are really, really powerful. And also, you know, it's tricky to prioritize sleep when itching is keeping you awake. But, you know, I would say sleep makes us way more resilient and that, you know, a continued focus on sleep and working on your sleep and paying attention to sleep hygiene is really critical for stress management.

Jennifer:              And you mentioned histamine. There are some other things that can irritate your skin that people might not realize. Do you want to mention what those are?

Lily:                        Yeah, yeah. And they ended up being big players for me actually. You know, I eliminated a lot of the typical foods and they were definitely factors for me. I eliminated gluten and chicken eggs and dairy and soy. And my skin was improving. I was getting better. I was really pleased with my progress, but I was still experiencing eczema and itching. And what I learned was that I had both a sulfur and a histamine sensitivity. So the, I joke like, you know, with my healthy eating friends and, and clients, like the last thing I gave up was like my daily big bowl of steamed kale, which is, you know, quite high in sulfur. So sulfur is, is a heating compound that is present in lots of foods like the cruciferous vegetables and egg yolks and, and meat to an extent.

Lily:                        And, and you know, that is something that if you have impaired genetic pathways for processing your sulfur, that it can accumulate in your system and it can add to itch and red flaring, skin conditions and flushing and irritability and sleeplessness. Histamines really interesting because we find histamines in foods. So there are food borne histamines and those are most prevalent in say, fermented veggies and products. And so I have seen a lot of people who've gotten into trouble trying to heal their guts, eating a ton of fermented foods, and they're like, all of their skin stuff is flaring. And that's because they're ingesting a large amount of histamine, which is just this fast acting inflammatory chemical. So if you've ever been itchy and hot and red or you've ever had a cold and been stuffed up and you know, had a runny nose, you've experienced the effects of histamine. So you can be consuming or over consuming histamine in your diet if you're eating a lot of cured meat and you know, fermented foods. And then some really like healthy foods like spinach and strawberries and even avocado is contained, you know, some histamine. So I tend not to try to restrict those actually. As much as you know, some of the more unhealthy histamine containing foods.

Jennifer:              I actually want to ask you a question about sulfur because sulfur is one of those things that pops up as being good for your skin.

Lily:                        Absolutely.

Jennifer:              Someone's going to go, well, I know I need sulfur for my skin. And to be fair, you need sulfur to form gluten, which is a really important antioxidant in the body.

Lily:                        Yes and for collagen formation.

Jennifer:              Yeah.

Lily:                        These things. I'm so glad you're bringing this up because this is sort of foundational to my, to my practice and my thinking, which is that, you know, nothing is inherently, or very few things are inherently good or bad, right? So it's not like sulfur's bad or that it's bad for everyone. And I think this is one of the issues with the one size fits all approach. Not everybody has sulfur intolerance issues. I mean that is a pathway in me that since getting more genetic testing done I found out is in fact impaired. And so I am going to have a little more challenge with that.

Lily:                        So I consume sulfur or you know, I eat my leafy greens and I eat my cruciferous vegetables. I eat a lot of grass fed meat. However, I um am aware that I need to support myself for pathways, I'm actually able to consume more sulfur on a regular basis. And I think also it's important to think about treatment times versus like regular life. Like sometimes I'm sure, I mean this is what you do. You do interventionist diets, you know, you do things that are interventional for people's health and that doesn't mean it's necessarily the diet that someone stays on forever. So someone may do a low histamine diet or a low sulfur diet for a while, but then be able to reincorporate those foods once the gut and the pathways have healed up.

Jennifer:              And that's an important point because people think that they're going to stay on these diets for an extended.

Jennifer:              And some people unfortunately have stayed on them too long and they end up with nutrient deficiencies and all sorts of things. It's interesting you mentioned the genetic testing and that's how you found out about the sulfur issue. And so is that basically the best way if people are curious to probably go like some sort of genetic testing route and and determine how sulfur is processed in their body?

Lily:                        Yeah, I mean sometimes it's very obvious. For me it was super obvious even before like that that testing was confirmation for me. I got it actually years later. So for me, it was very obvious that I had eliminated so many things and my reactivity was so low and I was doing so well that I could actually tell when I ate three scrambled eggs with a bowl of kale that I was flaring, you know, so, so there's definitely,uyou know, I was able to kind of zero in and then, you know, just kind of going back to my, you know, my biochem and remembering sulfur, right, it's really heating.

Lily:                        It's a very active molecule. Like this is something that, you know, it makes sense that it would cause this type of flare. So yeah, I did the 23andMe testing and then I ran that raw data through you know various web tools exist. I think I used mthfr.net. You can also use LiveWello. There's a whole bunch of, of online tools for that. And then, you know, you can take that information to somebody who actually knows how to interpret it. And I have my own schooling in, in Nutrogenomix and methylation. But I, I don't consider myself an expert. I've just done some trainings, you know? But I knew enough to be able to look at those pathways and see, Oh wow, I have a lot of, you know, mutations or variations in those pathways. So it was, you know, same, same with the histamine pathways actually. It was very confirming like, Oh wow, my body doesn't make as much of the DAO enzyme, so I don't break down food borne histamines as well. So that was a really interesting and stuff.

Jennifer:              And so this is something, as you're talking, this is reminding me, so I thought I would share this with everyone listening, is that there is a danger in assuming that what works for someone you read on about online is gonna work for you because, and this is, this has been my challenge. People were like, oh, well don't you have some general across the board protocol? And I'm like, no, because everyone's different. It's this complex constellation of root causes that not everybody has a thyroid issue. Some people do, some people don't. Not everybody has food sensitivity. Some people do, some don't. I've had clients that have gut infections and low stomach acid and all sorts of stuff, but have no GI symptoms. So you just don't know.

Lily:                        Absolutely. It just shows up in your nervous system.

Jennifer:              Exactly. So you really have to, you have to remember that your journey is unique and you have to be willing to approach it from that perspective.

Jennifer:              Otherwise it's a guess. It may work, it might make it worse, it might hurt a little bit, or am I not do anything at all? And so you just have to remember that when you're able to find a practitioner or clinician that can work with you, right? So they use specific, who's listening to this, that will allow you hopefully to navigate that path a little more effectively and efficiently. Let's let it, that's the fingers crossed approach is that we find these things, we can say, Oh well look, you've got this issue with the DAO enzyme. You're not able to break down histamines as well. So here's what you need to do. Or you have low stomach acid or whatever might be. So I just, I love the, that's what you're underlining here. And one last thing you mentioned in our, in some notes that you had sent to me before about Balsam of Peru. Do you want to talk a little bit about that?

Lily:                        I do because it's actually something that I, I recently found out about. So I was I was having the little reaction around my eyes, you know, and I haven't had any skin issues in so many years. I was like, what is going on? So I went to the dermatologist and had probably the first like useful dermatology appointment in which they did patch testing on my back for contact dermatitis. So there are about 90 different substances tested. It was really, really interesting and I came back as mildly sensitive to something called Balsam of Peru. And then I looked into it and I was so fascinated to find that. Basically it's a component. So sort of chemically speaking, it's a component of almost every fragrance molecule that's out there. So for people who are sensitive to artificial and natural oral fragrances either sort of in a chemical sense or like in a skin sense, you may be allergic to Balsam of Peru.

Lily:                        It's also something that we it cross reacts with a bunch of common foods. So tomato, citrus, chocolate, vanilla and cinnamon. So that's like a big, I know, big list. So if someone's experiencing, they've, they've liked, they've done all the work of the elimination diet, you know, those aren't things that are typically, I mean, some of those things may be eliminated, but not all of them. And so how do you find out? So, you know, it's just one of those pieces I found out that 4% of people have an allergy to Balsam of Peru. That's a huge number. And so it's one of these under diagnosed things that can affect you in a contact way. You know, in my case it was using, I was at all natural a face oil. I was using a beautiful, you know, herbal face oil that did contain something that, you know, I no longer use. Or that I may return to at a certain point when I'm desensitized.

Jennifer:              Wow. Isn't that funny? So it's an all natural and that's an a good point to remember. Everybody can be a natural, a completely natural product, and you could become, be sensitive to that. Wow. That is crazy. That's a good one to add to the list. You know, I'll tell you something, I feel like we have so many more things to talk about. So I would love Lily if you would be interested in coming back. So, cause I think, I feel like there's a lot more, especially to from the herbal perspective that we could talk about.

Lily:                        Oh my gosh, so many full studies. Oh my gosh. Yeah.

Jennifer:              Okay. So, so I hope that you'll come back and join us and I just thank you so much for sharing your story as well as talking. I think the stress component is so important because you should never poopoo that or demean it or say it's not valuable to look at because stress and a lot of these other pieces are integral.

Lily:                        Right. Absolutely.

Jennifer:              Thank you so much.

Lily:                        Thank you, Jennifer.