325: Keratosis Pilaris Treatment, Causes + Remedies w/ Dr. Julie Greenberg, ND

This episode is bought to you by Quell — to help support rebuilding healthy skin from the outside-in + inside-out!

Take 10% off your next order! Use promo code QUELL10 at check out — Get started HERE!

– – –

If you've been disappointed by keratosis pilaris treatment options + natural remedies — you're not alone!

Keratosis Pilaris (aka. Chicken skin)  is a complex, poorly understood skin problem that can make you feel really insecure (because of how it looks). It can also make your skin texture feel unpleasant + rough (potentially triggering skin picking).

The most common keratosis pilaris treatment includes scrubbing off the involved areas of rough skin, but beyond that – you’re probably already figured out the options are limited.

There is no medicine for keratosis pilaris AND there's very little research on keratosis pilaris causes.

That’s because conventional medicine doesn’t recognize it as a significant skin problem, even though the Cleveland Clinic states that “about 50% to 80% of teenagers and 40% of adults will develop” keratosis pilarsis during their lifetime. (ref)

I previously discussed keratosis pilaris diet concerns HERE, and wanted to share more up-to-date info that will hopefully help you on your journey to ditching chicken skin!

My guest today is Dr. Julie Greenberg, a licensed Naturopathic Doctor (ND) and Registered Herbalist RH(AHG) who specializes in integrative dermatology, holding degrees from Northwestern University (BA), Stanford University (MBA) and Bastyr University (ND). She is the founder of The Center for Integrative & Naturopathic Dermatology Inc, a holistic clinic that approaches skin and hair problems by finding and treating the root cause. She has presented at multiple conferences and she teaches dermatology classes at naturopathic medical schools and is a highly sought-after speaker at conferences across the U.S.

What keratosis pilaris treatment options have you tried? Share your questions, comments + experiences on KP in the comments below!

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

In This Episode:

• What is Keratosis Pilaris?
• Causes of Keratosis Pilaris (yes, there's a gut connection!)
• Where does Keratosis Pilaris shows up on the body
• Keratosis Pilaris treatment options (conventional vs integrative)
• Keratosis Pilaris home remedies — do any really work?
• Fat-soluble nutrients tied to Keratosis Pilaris
• Conditions associated with Keratosis Pilaris
• What does the research on KP say?

Quotes

“If you have a problem like a filaggrin gene mutation and you're not naturally producing a lot of filaggrin, you're not going to be producing a lot of Natural Moisturizing Factor. You're going to be prone to these dry skin diseases like ichthyosis vulgaris, eczema, and keratosis pilaris.” [19:45]

“…It’s linoleic acid, alpha-linoleic acid, these are other types of essential fatty acids that are different than just the EPA and DHA that you get from fish oil. It's bigger than just a fish oil problem.” [21:32]

“It's definitely the check engine light that is flashing and your body is telling you, ‘Hey, we're having an abnormal process here because something is wrong.’ It's not just a cosmetic issue.” [23:05]

Links

Find Dr. Greenberg online and on Instagram

Healthy Skin Show 061: How To Get Rid Of Keratosis Pilaris (Naturally)

Healthy Skin Show 095: Can Histidine Supplementation Help Leaky Skin & Eczema? [RESEARCH]

Healthy Skin Show 220: The Gut Microbiome Of Acne [NEW RESEARCH] w/ Dr. Julie Greenberg

Healthy Skin Show 310: Integrative Perioral Dermatitis Treatment Options w/ Dr. Julie Greenberg, ND

Got Gluten Skin Problems? The Top 18 Signs You Shouldn’t Ignore

 

325: Keratosis Pilaris Treatment, Causes + Remedies w/ Dr. Julie Greenberg, ND {FULL TRANSCRIPT}

Jennifer Fugo (00:06.16)
Dr. Greenberg, I am so excited to have you back to the show. You're like one of the favorite guests. So I really appreciate you coming back because we have so much to talk about with keratosis pilaris treatment options. It's a topic I've only covered once and to be entirely honest with you, it's not really my wheelhouse. I feel like there's so much we don't know. So thank you so much for joining us to talk about it today.

Dr. Julie Greenberg, ND (00:29.386)
Well, thank you so much for having me. You know, I love being here and I actually listen to every single episode of the podcast. So thanks for having me.

Jennifer Fugo (00:37.78)
You're welcome. So let's talk about what is keratosis pilaris, or KP? My experience with it, I briefly had it earlier in life, was like this really rough, dry, almost like chicken skin on the back of my arms. And it just kind of bothered me a little bit, but not enough that I did anything about it. But I have heard from countless listeners that they find it to be really problematic and they don't tend to, I don't know, it's like nobody cares about it in a sense. So let's talk about what is this condition that is often called chicken skin online, and why you think no one is doing anything to help people with it. I mean, like you had shared with me before, there's not much even research on this topic.

Dr. Julie Greenberg, ND (01:30.314)
Yeah, you're absolutely right. And you're right that our patients and clients care a lot about the Keratosis pilaris, but the medical community doesn't. They kind of consider it a cosmetic problem. And a lot of times patients are just dismissed by their doctors or dermatologists like, oh, don't worry about it, just ignore it. Or maybe the keratosis pilaris treatment options they're given is to try to scrub the bumps down, but it really affects a lot of people and they feel self-conscious about it. It can itch, it can be dry. And like you said, the colloquial or common term is chicken skin because if you think about a plucked kind of chicken skin look, that is what it can kind of look like. There's often these little bumps. There's kind of two physical presentations to keratosis pilaris. One is kind of like white bumps and then the other is more kind of like red bumps or even flat scabs and then it can be on what we call an erythematous base, which is that the skin underneath is kind of red. So any of those presentations. And what's actually going on medically is a term called follicular hyperkeratosis.

So let's break that down. Follicular, it's the follicle. So all of this is happening within the hair follicle. So you can't get keratosis pilaris if you're not dealing in a place with a hair follicle. Now we have hair follicles on almost all of the body. We don't on like the palms of our hands or soles of our feet. So you wouldn't be able to get keratosis pilaris there. We'll talk about where KP usually shows up, but what's happening is down in the follicle. So we have millions of hairs on our body and  there's two types of hairs. There's terminal hairs, which are these hairs on our head or after puberty, hairs in the armpits, on the face of males, or in the genitals. Those are big thick hairs.

Then there's these teeny tiny vellus hairs, like even, you know, for those of you on video, you know, my arm hair, I mean, you can't really see it, just those little teeny tiny blonde fuzzies. But even those hairs, right, we don't really think about, well, how does the hair get out? If we think about the skin, the hair follicles, of course, underneath the skin, and the hair starts growing below the surface of the skin. That hair is gonna kind of travel up through the hair shaft, all tumbling up under the skin.

And at some point, it needs to poke up and through the skin and come out. So again, if you're looking at your arm and you see little fuzzies, or even if you feel your face, we've all got hair in our face. Again, you know, males will have after puberty terminal, but women, we've got these little vellus hairs. And they need to poke up and out and come out cleanly. In keratosis pilaris, there's a problem with that process. It's not being able to tunnel up and out and then poke through the skin cleanly, and so we get a condition called follicular plugging. And instead of it being able to poke cleanly up and out through the skin and just where you can see the hair, it kind of gets trapped and plugged and it can create a keratin plug. So keratin is a protein in the skin and that creates that kind of white bump.

That white bump is the keratin plug. It's not like acne or a zit. It's not something where you can kinda just pop it. You would need to almost insert like a needle, and I'm not recommending people do this, but it's not poppable. And what's happening is that the skin cells that are the corneocytes, which are a type of skin cell, are lining the hair shaft and that top outer layer.

And normally when the hair grows up and out of the follicle and pokes through the skin, those corneocytes are very cleanly getting out of the way of the hair as it grows up through the shaft and it pokes out of the skin. There's no inflammation, there's no process, right? We have 5 million hairs on our body. This is the way it's supposed to happen. We're not supposed to be inflamed when we get a new hair. But with keratosis pilaris, or chicken skin, something is going on. We get these kind of gummed up corneocytes that tend to get dragged by the hair as it comes up and out of the follicle and can even gum up the surface so that the hair can't poke cleanly through. That's where we get that white bump or the red bump and we can get the redness on the skin. It's an inflamed response. This is not a normal process for how the hair comes up and out. And so that's follicular plugging. And that term that I said at the beginning, follicular hyperkeratosis is too much keratin, basically, in the follicle. And it's just basically an abnormal way that hair is coming up and out because there's problems with the skin around the hair.

Jennifer Fugo (06:26.984)
And so how many people does keratosis pilaris affect, and generally who gets keratosis pilaris? Because it seems to be, at least from my experience, fairly common, but I don't know. What do the stats say?

Dr. Julie Greenberg, ND (06:39.594)
Yeah, keratosis pilaris is actually super common, and it's shocking to me when we look at how common it is versus how little research there is. So the numbers vary. My youngest patient, I think I've had a nine-month-old with very severe keratosis pilaris, but the kind of average onset is maybe around age nine or puberty, that's kind of where the peak onset is. So it often begins in childhood. But anywhere from, it's estimated, 50 to 80% of adolescents and up to 40% of adults worldwide suffer from some amount of keratosis pilaris. It is very, very common. But yet, because it's considered just cosmetic and not real medicine, keratosis pilaris doesn't get the attention of dermatology research, or research dollars.

And we have a, there's a database called PubMed where doctors and clinicians go to find research. That's where research is published. If you do a search, for example, on psoriasis, you're going to get over 58,000 studies and research projects that have been done trying to figure out different aspects of psoriasis. If you go to that same database and type in keratosis pilaris, you're going to get about 380. It's not a lot, especially when you look at up to 40% of adults have it. It's just completely dismissed by most doctors as like, oh yeah, just don't worry about that, or here, take this steroid, or just kind of scrub it off, slough it off. But I think it's much more than that. I think it's indicative of an underlying problem, and that we shouldn't just dismiss it as a cosmetic issue. And as we've talked about, it really bothers people.

People feel like they can't wear shorts or tank tops in the summer. They're embarrassed, it's itchy, it's bothersome, and I do think it's indicative of an underlying dysfunction, basically.

Jennifer Fugo (08:43.712)
Yeah, so when I was in grad school, the thing that was taught to us was that, well, keratosis pilaris could be a sign of gluten sensitivity. It could be a sign of poor fatty acids from like vitamins and other nutrients in your system so you're not absorbing them well. But beyond that, there was no real explanation. So it was looked at as like, maybe a clinical sign. I guess a lot of times, mostly we were probably looking at it for gluten and possibly like low like, oh, we should probably get labs run for like vitamin D, vitamin A, etc. But beyond that, there has never really been much explanation as to what could be causing keratosis pilaris.

Is there a keratosis pilaris-gut connection? Is there a diet component? How broadly should we consider this from a more root-cause perspective?

Dr. Julie Greenberg, ND (09:40.022)
Yes, these are all great questions. The unfortunate answer is that, even from back when you learned about it, there's still, if you try to look up what causes keratosis pilaris, the answer is unknown. So the real answer is that we still don't really know what causes keratosis pilaris, but there are a list of potential things and I do treat it, and I actually really like treating it because I tend to get good results.

Now, if anyone has heard me speak on your podcast before, they'll know that my kind of methodology is, I do treat only chronic dermatological complaints, which keratosis pilaris is, and I do that a lot by addressing what's going on in the gut. So even for my KP patients, I will still do the same thing. I do a stool test and I do a urine test called an OAT, organic acid test. The reason I'm doing that is I'm trying to assess the gut microbiome and see what's going on in the gut of my patients. And by correcting that gut dysbiosis, I do see a lot of benefits happening on the skin, even with keratosis pilaris. There are numerous other things that I found in the literature that I've gone after that I find helpful as well. But I definitely start with testing and treating the gut.

And to your point with some food sensitivities, I have a patient with eczema and keratosis pilaris, and we'll talk about the connection, for that child, he was about seven. Really cutting out dairy was the key piece, and that really almost like, it was just that simple. For most people, it's not gonna be that simple, just like with eczema, most of the time, it's not just that simple finding the one food that will stop keratosis pilaris.

Dr. Julie Greenberg, ND (11:33.73)
But sometimes it can. So I do think there is a food sensitivity issue. Dairy and gluten are my two big that I try cutting out with keratosis pilaris. But as you mentioned, there's, I think, issues with fatty acid deficiencies. There can be vitamin deficiencies. There can be issues with hormones, inflammation, a gene mutation called filaggrin that I've talked about, and I know many people have talked about on your podcast.

And also something happening within a hair follicle, we have these sebum or sebaceous glands. There seems to be a lack of them in the keratosis pilaris follicle. So we can talk about any of those things that you want.

Jennifer Fugo (12:13.492)
I know, we can go down so many different roads here. So let's talk a little bit about the sebaceous gland piece of this, because I think it speaks to maybe some of how this is happening or why this is happening, perhaps. But I thought your theor’s really interesting. So let's talk about that so everybody can hear where your mind has gone with, you know, again, and I've talked recently on the podcast about how, you know, research is great, but the clinical experience and the things you see clinically can really, can be in some regards much more insightful at times. And we might not have the data to be like, this is exactly what's happening. Like you said, there's very little research on this. So what is going on with the sebaceous glands? And maybe for anybody who doesn't know what a sebaceous gland is, could you just give us a little up-to-date on what exactly is that? Fill us in on that and then go into what is going on with it in keratosis pilaris.

Dr. Julie Greenberg, ND (13:12.498)
Yeah, absolutely. Okay, so we're back in the follicle, right? That's where we started. We said that hair is trying to come up and out. So there's many things happening in the hair follicle besides just the hair growing. We have sweat glands, but we've also got glands called sebaceous glands. And sebaceous glands produce something called sebum. Sebum, I've talked about on acne podcasts with you. So sebum is like an oily substance that's produced down in that gland. Sebum is good.

Part of what sebum does is it lubricates that hair follicle shaft so that the hair can come up and out smoothly. And sebum also will come out on the skin and lubricate part of the skin. Now, too much sebum production, overproduction of sebum is bad, that's where we get acne from. But an underproduction of sebum is bad too because you're gonna get really dry, flaky, itchy skin. And potentially, that hair is not going to be properly lubricated as it's trying to grow up and out the follicle and then poke out through the skin. There was a fascinating study I found, now it's a small study, there was 10 patients. So we say an N of 10, you know, that's not huge, but it's still enough. And they did biopsies from these patients. All 10 patients had keratosis pilaris. They took biopsies from totally clear skin without any KP, and then they took biopsies of the KP spots.

And what they found was there was a complete absence of sebaceous glands in the keratosis pilaris areas. On the normal skin, these people had normal skin, normal sebaceous glands. So this is very fascinating. It's not something genetic in them. It's not like, oh, this person can't produce sebum, they don't have sebaceous glands. No, there's something just happening within the follicle. We don't understand why, but I definitely think there's an issue there with a lack of the sebum gumming up those corneocytes, as we talked about at the beginning. Now the hair is trying to get through this hair shaft without any extra lubrication. It's dragging gummed up corneocytes and it's getting kind of gummed up at the top and trapped and we're getting the bump. You know, we wish we knew why they don't have sebaceous glands. How would we put a sebaceous gland back into that follicle? That, you know, we don't have the answer to.

I do think it's interesting. So, you know, talking about like, where do we tend to see keratosis pilaris? Far and away, the number one location that we'll see it is the back of the arm. And then sometimes it will also kind of creep around onto the front of the arm. That's like over 90% of people are gonna get it in those areas. It can also be like on the top of the thighs, top and side of the thighs, that's the next most common, maybe around 60%, and kind of at the buttocks area about 30%. You can get it in other places, but it's a lot less likely. What I think is interesting is that different areas of the body have different, kind of, set levels of sebum production. So think of where do we get acne? We get it on the face, neck, chest, and back. Those are high levels of sebum production. Those are not areas where we tend to see keratosis pilaris, right? Because we have kind of high level of sebum production there.

The back of the arms and the top of the thighs, we don't get acne there. There's not enough normal sebum production to really get acne there, but that's where we get keratosis pilaris. So I think it's just interesting that areas that are kind of low-level sebum production are the areas where we tend to get keratosis pilaris.

Something is happening to the sebaceous gland. It's getting compromised. It's shutting down. It's not able to produce the sebum anymore. And again, you know, there's a big question why. But I feel like also a lot of times people are told like, oh, this is just something you have to live with. And that's definitely not true. I treat it. I'm quite successful at treating it. And I think it definitely can be treated. I think it's just, you know, approaching again the list of things that we talked about and trying to figure out for that person, what are the pieces that's contributing to the kind of shutdown and the KP for them?

Jennifer Fugo (17:35.92)
Yeah, and I also wanted to ask you about the conditions that are sort of cousins or related to keratosis pilaris, because one of which you mentioned, I've had listeners ask about this condition, it's never been mentioned on the show before. So let's talk a little bit about that.

Dr. Julie Greenberg, ND (17:53.706)
Yeah, so there's several diseases and conditions that are related to KP. The non-derm ones, obesity, diabetes, and malnutrition, those aren't healthy states, right? So that tells you something seems off. So those are non-derm diseases related to keratosis pilaris. But for the dermatological complaints, it comes along with eczema. We all know what eczema is.

There's this other disease I think you're referring which keratosis pilaris is related to is called ichthyosis vulgaris. And ichthyosis is Greek for like fish and like a fish scale. And it's been named ichthyosis vulgaris because people have really dry skin and they can get almost like a fish scale kind of look presentation because the skin is so dry. And keratosis pilaris is kind of a feature of ichthyosis vulgaris, and about 50% of people who have ichthyosis vulgaris will go on to develop atopic dermatitis. So these three are very tightly related. I also see a lot of keratosis pilaris in my atopic dermatitis or eczema patients.

So these three go along hand in hand and it kind of comes down to what you were saying at the beginning. It's a very dry skin. And there's something called a filaggrin gene. And filaggrin is a protein in skin and I and others have talked about filaggrin on your podcast many times. Filaggrin is what we call kind of the master regulator of the skin barrier. It's a really important protein in the skin, and with filaggrin we make something called natural moisturizing factor. I think it's one of the best-named proteins in the skin because it tells you what it does. It naturally moisturizes the skin.

So if you have a problem like a filaggrin gene mutation and you're not naturally producing a lot of filaggrin, you're not gonna be producing a lot of natural moisturizing factor. You're gonna be prone to these dry skin diseases like ichthyosis vulgaris, eczema, and keratosis pilaris. So we see this filaggrin gene mutation showing up in some keratosis pilaris patients.

Jennifer Fugo (20:13.3)
And so with the, because I do think it's important, we've talked about fatty acids and I've had people too who've emailed me and said, I've been doing all of this omega-3 supplements for like the last month or two and I don't see any improvement and I thought that this meant that I had an omega-3 fatty acid deficiency. But this sounds, from what you're saying, that keratosis pilaris goes far beyond just an omega-3 deficiency or just a vitamin D deficiency or something like that, or vitamin A deficiency, there is kind of a combo of things that you have to consider in order to be really effective and efficient, so to speak.

Dr. Julie Greenberg, ND (20:57.39)
That's absolutely right. And I actually, you know, I think that it's more connected with the fatty acids than just omega-3. I actually supplement patients with hemp seed oil and flax seed oil, both oral and topical. Their polyunsaturated fatty acids are a little bit more, they also include like omega-6 fatty acids. So I don't think it's as simple as just, oh, just take fish oil if you have keratosis pilaris and it's gonna clean up.

That's not actually the route that I'm normally taking with patients. And like you said, it's usually a bigger issue. But it's linoleic acid, alpha-linoleic acid, these are other types of essential fatty acids that are different than just the EPA and DHA that you get from fish oil. So it's bigger than just a fish oil problem.

Jennifer Fugo (21:45.64)
In terms of some steps in the right direction of like, hey, what could I possibly test out at home, what do you think someone could even just try on their own? Because obviously if it is something, I think the message here, this is the takeaway that I'm getting from what you're saying, is that if it bothers you and it's to the point where it is interfering with how your skin feels and whatnot, it may be worthwhile to dig into what’s causing the keratosis pilaris because it could be a sign of other underlying problems that may not have become so severe with other symptoms that are bothering you at this point in time.

It's sort of like the check engine light is flashing on and it's an opportunity to say, hmm, maybe I should look into this before it becomes, you know, the car needs to go into the shop and will not start, sort of problem. So is there anything that, you know, whether it's, I mean, I hate to suggest that, just try your omega-3, like you said, it's more than just fish oil. Is there anything else that people could maybe consider on their own or look at their health in a certain way to help them maybe see things that they didn't see before or consider before that it could be connected to?

Dr. Julie Greenberg, ND (23:03.306)
Yeah, so I would absolutely agree with you. Keratosis pilaris is definitely the check engine light that is flashing and your body is telling you, hey, we're having an abnormal process here because something is wrong. It's not just a cosmetic issue. So yeah, I would agree with you that, you know, finding a licensed healthcare practitioner in your area who's knowledgeable in keratosis pilaris and can kind of help you figure out the pieces would be helpful.

But for those at home who are really trying to, you know, dig into the pieces themselves, you know, I think starting with things like are you eating, you know, what are you eating? Are you getting a broad spectrum of nutrients from your food? You know, it's one thing to do a multivitamin and multivitamins are fine, but you know, ideally we would also like to be getting it from our food. So are you eating an abundant number of varieties of plants and, you know, healthy foods? So checking in on your diet.

Are you eating a lot of or any amount of dairy or gluten? Trying to take them out for a couple of weeks and just see what happens with your skin is an easy thing. I've talked about before, with dairy, there's this whole notion like, oh, don't I need to get calcium from it? The answer is no, if you did, you would still be breastfeeding from your mother. And I think the vast majority of people listening to this podcast are not still breastfeeding from their mother. So getting it from milk is not the way that any mammal has evolved to get calcium once they're beyond infancy. Leafy green vegetables, there's lots of good sources of calcium.

And gluten again is just one of those, unfortunately, inflammatory foods for a lot of people. Making sure you're getting healthy seeds and fats and oils in your diet. You can eat hemp seed, you can eat flax seed. These are all beautiful additions to a diet and they're rich in fiber as well and they're anti-inflammatory. So checking in on those kind of lifestyle issues, you know, are you drinking a lot of alcohol, that's super inflammatory and gonna potentially cause some nutrient deficiencies. So, it's what we call the fundamentals of health, asking yourself, are you doing those kind of basic things, you know, with your diet and with your lifestyle, or are there things that you could clean up there to reduce inflammation? I do think that that fundamentally helps with keratosis pilaris and that overall kind of health of the vehicle, so to speak.

Jennifer Fugo (25:28.808)
Yeah. Do you think that the supplementation with L-histidine, the amino acid that makes up a big portion of filaggrin… somewhere between I think 11 to 13% of the protein, do you think that that's possibly helpful in these particular individuals to give a try? Because most of the time, l-histidine supplementation is geared towards folks with eczema.

Dr. Julie Greenberg, ND (25:58.186)
Yeah, I use it. I use it in eczema and I use it in keratosis pilaris. I don't want people going out there and self-dosing with L-histidine. I don't leave patients on it forever. I have a starting plan and then we ramp down. But I do think the L-histidine can be helpful. Again, I'm not ever keeping somebody on L-histidine forever, so that's not the answer. If someone has a filaggrin gene mutation, they just have a filaggrin gene mutation. We don't have the capability right now to change people's genes, so that just is what it is. But again, what we say is, genes load the gun, but environment pulls the trigger. So anyone with eczema, anyone with keratosis pilaris, yes, you may have a filaggrin gene mutation, yes, you may be predisposed to getting these conditions, but the environment is going to pull the trigger. You don't need to have eczema and you don't need to have keratosis pilaris as long as you're not pulling the trigger. And that is this kind of, you know, idea of keeping your proverbial bucket from overflowing by, you know, checking in, again, all the lifestyle factors, and then maybe working with a knowledgeable healthcare practitioner who can help you drain that bucket and figure out the pieces that are contributing to the eczema and potentially KP.

Jennifer Fugo (27:18.74)
And one last quick question, because we kind of touched on it here and there. Any thoughts on the topical keratosis pilaris treatment options to just “scrub it off” using different acids and exfoliants? Is any of that really all that helpful that you have found with your clients or patients?

Dr. Julie Greenberg, ND (27:33.51)
Again, it's really symptom suppression, right? Which is, you know, unfortunately a lot of kind of Western medicine, especially with derm, because we don't really understand what's going on, keratosis pilaris is about, “well, let's just scrub it off.” And, maybe it will make someone's bumps a little bit smoother, but it can irritate the skin to scrub at it like that. And it's not really addressing any of the underlying issues. So that's not at all the approach that I take. If people find it helpful and it makes them feel more confident to scrub at it, I think as long as they're doing it gently, not actually, you know, aggravating the skin and increasing inflammation. But it's not a path I take because it's just symptom suppression. It's not at all addressing or cleaning up the root cause.

Jennifer Fugo (28:25.036)
That is perfect. Thank you so much, Dr. Greenberg. I really appreciate it. I love diving into these conversations with you, especially because the clinical insights that you bring to the table have been so helpful for all of the listeners. And I know that everybody can reach you, you have your own your own private practice. And then you also have a training program which we’ll link up for health professionals, anyone who’s interested in going into the realm of this whole integrative dermatology space of like how to actually put all the pieces together and figure it out, which is so needed because so many people need help. What is the best website where everyone can find you?

Dr. Julie Greenberg, ND (29:11.894)
Yes, so if someone is a resident of California, Oregon, or Washington, they can go to my website and you can find me there and potentially become a patient. There's also a lot of resources. If you're a practitioner looking to become trained in this kind of integrative functional dermatology space, you can head over to Root Cause Dermatology. I have cohorts that run at different times, so you can see if one is coming up or when the next one is. And you have to be a licensed healthcare professional to be accepted into the training program. But then I train all about this, how to treat keratosis pilaris this way, eczema, psoriasis, all sorts of conditions.

Jennifer Fugo (30:30.925)
Well, thank you so much for joining us today and I look forward to having you back the next time.

Dr. Julie Greenberg, ND (30:36.666)
Thanks so much Jennifer.