037: Nickel Allergy And Eczema w/ Dr. Peter Lio

Eczema can be caused by a variety of factors, including environmental allergies, food sensitivities, and stress. My guest today talks more about these different allergies, and shares some natural tools to help manage atopic dermatitis. 


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Dr. Peter Lio is a Clinical Assistant Professor of Dermatology & Pediatrics at Northwestern University Feinberg School of Medicine.

He received his medical degree from Harvard Medical School, completed his internship in Pediatrics at Boston Children’s Hospital, and his Dermatology training at Harvard where he served as Chief Resident in Dermatology. While at Harvard, he received formal training in acupuncture. He has written a textbook on Integrative Dermatology and has published over 100 papers.

Today, Dr. Lio and I have a discussion about allergies and eczema, why super restrictive diets are often not the best way to go, and some natural methods to manage your chronic eczema.

Do you use stress management techniques to manage a skin condition? Leave a comment!


In this episode

  • Mary's Rash segment on the Ellen Show (that's caused a lot of outrage and pushback from her audience)
  • The three troublesome ingredients in Cortizone-10
  • Is it important to know what skin condition you actually have?
  • How does he differentiate between rashes?
  • Environmental allergy testing for those with severe eczema
  • Can the nickel in foods affect the skin the same way as the nickel found in metal?
  • Why very restrictive diets can be detrimental
  • Dr. Lio's favorite natural tools for skin conditions



“People often say. ‘With dermatology, just look at a picture and you'll know,' and it's actually not always that easy. We really want to hear the story. I want to see the patient. I want to get a sense of what is going on. And, many times, that history is more important than just looking at it, even though we pride ourselves on being a very visual specialty.” [2:55]

“What I've found is that allergies are extremely common with atopic dermatitis, both food allergies and environmental allergies.” [5:55]

“I do feel very strongly that stress brings out eczema in a lot of people. So stress reduction techniques like meditation, Tai Chi, yoga…it sounds kind of goofy and sometimes patients will roll their eyes, but it helps for some people.” [13:46]



Mary's Rash Segment on The Ellen Show

Find Dr. Lio online

Listen to my first interview with Dr. Peter Lio

Textbook co-authored by Dr. Lio –> Handbook of Integrative Dermatology: An Evidence-Based Approach

Follow Dr. Lio on Facebook | Twitter


“People often say. 'With dermatology, just look at a picture and you'll know,' and it's actually not always that easy. We really want to hear the story. I want to see the patient. I want to get a sense of what is going on. And, many times, that history is more important than just looking at it, even though we pride ourselves on being a very visual specialty.”

037: Nickel Allergy And Eczema w/ Dr. Peter Lio FULL TRANSCRIPT

Jennifer:              Hi everyone and welcome back to The Healthy Skin Show. Today we have a recurring guest. I love this recurring guests and he was so kind to come back after his first interview. I'm Dr Peter Lio has joined us. Again, if you miss that first episode, I just want to introduce you to him really quickly. His name, as I said is Dr Lio. He's a clinical assistant professor of dermatology and pediatrics at Northwestern University Feinberg School Of Medicine. He received his medical degree from Harvard Medical School, completed his internship in pediatrics at Boston Children's Hospital and his dermatology training at Harvard where he served as chief resident in dermatology. He knows a lot about the skin, let's just put it that way. And while at Harvard he received formal training in acupuncture. He's written an amazing textbook called The Integrative Dermatology called Integrative Dermatology. And by the way, guys, it's like one of the only integrative dermatology textbooks I could even find and he's also published over 100 papers. Dr Lio, welcome back.

Dr Lio:                   Well thank you for having me back. It's great to be back.

Jennifer:              I know and you know, I was thinking about today what I could ask you and like kind of pick your brain and I thought to myself, one of the most fundamental and basic questions, if I have a rash and I have no idea what it is and I want to go to the dermatologist, how do I get it diagnosed? I mean I would assume so. Okay. Quick question first. Is it important to know what you have? Yes or no?

Dr Lio:                   Definitely it's critical in fact that will affect everything in terms of the prognosis, in terms of the treatment, in terms of really being able to figure out what we need to do next.

Jennifer:              So if it's now important, the question would be how do you differentiate one rash between another one?

Dr Lio:                   And that is a critical, critical question. That is really the nature of our entire specialty. And I was, sharing with you a little anecdote where I gave a lecture once to a group of emergency medicine doctors and at the end of the lecture one of the docs said, could you just boil all that down on a three by five note card for me? And I said, well, I wish I could. That's my entire specialty. There's huge textbooks that are devoted to sorting all this stuff out. So it is one of those professions where a lot of it is experience. You can be really, really smart, but he has so much as visual, so much as pattern recognition. It really takes a lot of experience to really be able to do this well. That being said, it's not necessarily hard. There's a difference between sort of having to understand the complex diagram about how the kidney works, which is really hard to me or super complex mathematical equations in terms of pulmonary pressure in the heart.

Dr Lio:                   That's hard. Ours isn't necessarily hard to diagnose, but it just takes that repetition and knowledge and experience where you say, you know, I've seen this and this pattern, this distribution on the body, the color of the rash, and then of course the big part of it is the history. People often say, Oh, dermatology, you just look at a picture and you'll know, and I'll say, actually, it's not that easy. We really want to hear about the story. I want to see the patient, I want to get a sense of what's going on. And many times that history is actually more important than just looking at it, even though we were sort of pride ourselves in being a great visual special team. That being said, there are some tests that sometimes we need to do because again, this is huge and others, there are hundreds and hundreds of diseases, and I have a great picture from when I was in training.

Dr Lio:                   One of my teachers had a series of books on his bookcase and it was probably three feet of books, giant setup. It's called a brief course in dermatology. It was just hundreds and hundreds and hundreds of pages. And it's really interesting, so we do have to do some testing. Sometimes you can get it narrowed down to certain areas, so okay, this is definitely an inflammatory condition that seems to be involving this level of the skin, but we might need to do a test. Usually our tests in dermatology are going to be things like a skin biopsy. We're going to take a piece of the skin and unfortunately sometimes patients expect that to be like a computer reads it and it gives us a printout, but actually it's not. That's another doctor, a pathologist, ideally a dermatopathologist pathologist with special training in skin pathology, which we can imagine people spend many years doing this stuff.

Dr Lio:                   Then they'll say, you know what? It looks like it fits best with this, so it's not so much like a blood test where you get a number, it's really an interpretation, and then we make this clinical pathological correlation and work together to say, okay, what does it look like to you? Yes, that fits or admit that doesn't make any sense here. This is totally wrong. This wouldn't happen on the back of the arm. Like we're showing it here. So we've got to think again. Then the pathology, wait a minute, what about this? And we say yes, that fits. So we really have to do this little dance sometimes. Other times it's what we call an aunt Minnie. And this comes from a term that, how do you recognize your aunt Minnie or your uncle Bob? You just know them. It's like, Hey aunt Minnie, you didn't even have to do a test.

Dr Lio:                   You didn't have to check her wallet. You knew who it was. So certain things we see over and over and over that when I walk in or when the patient is being brought back to the room and I say I know what they have. So sometimes it's very easy and other times it's more nuance for atopic dermatitis. We are lucky. It is one of those conditions where it is almost always an aunt Minnie we know it when we see it for the most part. Sometimes patients are disappointed, like aren't trying to do some blood work. And I said, well I can, but I don't know what to do. I can check your blood count and I can check your vitamin D level, but this is something I can make diagnosis with just looking at you and hearing your story. Other times though, I'm worried that there could be something else and so we will need to do some of those testing those tests to make sure we know what else is going on.

Jennifer:              Yeah. And that that said one thing that's interesting is that sometimes people seem to be reacting to stuff that's in their environment. And I was curious to get your take, especially for somebody that has eczema, like say a pretty severe case. What's your thoughts on doing like IGE environmental allergy type testing? Is that a good idea or worth it?

Dr Lio:                   I think it is a good idea if for no other reason it just kind of helps us put things into their proper category. It can be a dangerous rabbit hole. And I think for me the big piece is what I found is that allergies are extremely common with atopic dermatitis. Both food allergies and environmental allergies. So we want to find these, we want to, of course we want to avoid those things, but that's not the same as being the cause. So a lot of my patients aren't quite convinced are like this must be from a food, find the food and we're done. And I always say I wish it were that easy, but I can tell you again, just from the heart, the school of hard knocks, right experience and patients who gone really extreme gone crazy diets for six months. I've had patients in the hospital where we can control their diet really well, better than most people can do it on their own, but they still have eczema.

Dr Lio:                   And so I, to a certain extent by definition, atopic dermatitis for talking about it should not be caused by a single food or foods. If it is, then we'd say, oh wait, actually you didn't have any atopic dermatitis. You had an eczematous food allergy. And that's really rare and really different. So most patients who have that will say, gosh, every time I eat this wouldn't break out in this terrible eczema kind of rash. But otherwise I'm fine, so it's a very different history, right? They're basically clear and then something happens. Bam. As opposed to atopic dermatitis, which kind of does its own thing. Usually it's still there to some extent, no matter even if they're clear, they often still have a little bit of abnormal skin and that things can flare it up. So in this you can realize this is complicated. It's not easy, which is why the job is hard and a lot of doctors don't want to deal with this.

Dr Lio:                   It's like this is a big mess. We don't have the clearest answers, and so we kind of work together. I say, look, we're going to try to find those foods. We're going to try to find those triggers. We're also not going to get sad if you're avoiding everything. Cause many times we'll find things. We'll say, yes, you're allergic to this, you're allergic to that. We're avoiding them. The patient was back and they're totally depressed. They're like, I'm avoiding this stuff and I still have eczema. I said, I know, so we're going to still work on treating it. The truth is though, if you are exposed to something that's making it worse, sometimes the treatments will fail. And I've had that situation, particularly with topical allergens, so what we call contact allergens. Now it doesn't think things get really tricky because there's kind of two major groups of allergy that we test for in eczema.

Dr Lio:                   The first are the ones we're thinking about with like, you know, hay fever kind of stuff like, so mold grass and pollen, those are the ones we can get by a blood test or the prick testing where they just kind of poke your skin and watch you for a half an hour. Those are the immediate type hypersensitivity reactions. So they're going to give you a hive type response. And those can certainly make things worse. But they don't cause necessarily eczema per se because again, that's just the hive, then it goes away. So if you were exposed to like, you know, dogs or cats for your allergic, you get itchy and you get Hivy. But then when they're gone you're okay. Now that may be triggered you. So now you've started scratching and your eczema gets worse. But the second kind of allergy is called a delayed type hypersensitivity or delayed type allergy and these are things that are chemicals that touch the skin and then cause an eczema reaction.

Dr Lio:                   And so these are things, the classic example might be nickel, so people wearing nickel metal jewelry maybe on their watch or their earrings, they get eczema where it is and it removed that it goes away so that contact dermatitis needs to be tested differently. It's very different kind of testing than the protesting because protesting just looks at a hive. We have to do what's called patch testing. We put patches on their back and each patch is a little tiny, well, it looks like a little disc. We put the chemical in there and we stick it against their skin. We hold it against your skin for for two days and we'll peel it off. We look and we say, where did you get eczema? And sometimes it's amazing. We'll say, look, you're allergic to nickel or commonly you're allergic to things in creams and ointments and gels and products.

Dr Lio:                   We say [inaudible]. It's in all these shampoos and foams. It's like, oh my gosh, you have to avoid it. Or MCI this Methyl Pleural Isothio[inaudible] is this common preservative? Tons of kids are allergic to it, so this can be a trigger and sometimes they can actually be a masquerading thing. You know, it's like, wait, this is actually not eczema. You're just allergic to this. And we pull it, they're better. But most of the time kids who have their proper history and adults that have the proper history of having chronic eczema, these can just be things that make it worse. And so we still want to do, want to sort these things out, but they unfortunately tend not to be the whole story for most of the patients.

Jennifer:              Right.

Jennifer:              And actually can we just delve a little deeper into the nickel issue because I get a lot of questions about that and I'm sure you're familiar at this point with the, the nickel that can be found in certain foods. And so people have asked me you know, Hey, my ears get really funny or my, my skin gets really funny from wearing cheap jewelry. Do I have to avoid all of these foods? Like can the foods that contain nickel cause the same reaction as the metal touching your skin? What are your thoughts on that?

Dr Lio:                   It's a great question. And the answer is yes, it can. For some people. The nickel free diet can be used particularly in severe cases where I know they have a strong allergy hand dermatitis. Sometimes people will get called dyshidrotic eczema, the little blisters. I've honestly had patients who when they cut nickel, they are just so much better. The hard part is it is a really tough diet. It's in a lot of food.

Jennifer:              It is. Like I looked at it and I was like, I'm gluten free and like basically everything that I eat I cannot have.

Dr Lio:                   So I ah, yeah, that's a, so I feel terrible when I recommend it for patients and I say, you know, let's give it like only, I try to keep it as short as we can. Like can we try it for just like a month? And the big thing about that is some people would say, well you might need longer. I agree, but if you do it for a month pretty well, then you add it back. If you have a big flare up, then I feel like that's a pretty good testing, that sort of approving I'll say, and I think you probably this is contributing. If you do it for a month, no matter what happens and you add it back and you don't notice a big flare, I'll say it's probably lower risk for you. You probably don't have to worry. But it is hard as we say.

Dr Lio:                   So I try not to do it much each year and to put it into perspective, I see a lot of eczema patients every year and each year I probably only have to recommend that diet a handful of times, maybe five times total. So the vast majority of patients, I feel like we can get them better, they don't have to worry about it. And that's the other piece. You know, you read on the internet, you read something and you kind of grab onto it. It's like, maybe this is for me, but part of my job to sort of help put it into perspective because it'd be, it'd be great. I mean, I wished that we'd be done, we don't have to worry about it, but for most patients that's not, at least doesn't seem to be the answer. And so I try not to get a false hopes

Jennifer:              And I appreciate that because in my world of clinical nutrition, a lot of times people want to just keep taking out more foods. So they're already on a really limited diet. And I'm like, wait, hold the phone here. We need to back up a little bit. Because also too, you can be to missing critical nutrients that are also necessary for your skin to, you know, rebuild helpfully. And it just in general for your body it also makes it really difficult. I mean you already don't feel well when you have skin rashes and then you're sort of isolating yourself further. So I just feel from a social and physical and even mental standpoint doing incredibly restrictive diets, unless they're, very, very warranted is not always the best way to go cause it just causes more stress.

Dr Lio:                   And that's where I need you to because right, the patients will get on these super strict diets and I'm like, I don't know if nutritionally this is sound, you're going to hurt yourself, you know, as you know, you can call it, you can go too far. So that's why we need a person who understands nutrition to help them balance it and put things in perspective.

Jennifer:              Well, so let's talk a little bit about some more of these natural options. Like I love the fact that you have training in acupuncture that is so cool and so different than most doctors that I know through my dad being a physician. And just in general. So what are some of your favorite, like kind of natural things that you would use with patients that, you know, if I went to a dermatology conference that you probably would never hear them talk about but like you found that they might have some efficacy or, or should be considered?

Dr Lio:                   Absolutely. A couple of my favorite things. So I do feel very strongly that stress brings out eczema and a lot of people, so stress reduction techniques like meditation, Tai Chi, yoga, it sounds kind of goofy. Some of those patients roll their eyes, but it really it helps for some people. Right. another thing that I really like in terms of natural products, I feel that most of our patients are probably a little bit low on vitamin D. So I liked them to take a vitamin D supplement. There've been a couple of papers showing both with the atopic dermatitis, but also with hives. You know, they're kind of closely related in a lot of ways that if you supplement D, some patients get better. And over the years I've had a few patients really say this made a huge change and it's pretty safe. I don't go overboard. You know, I'm doing over the counter type supplement. Plus we're in Chicago, we're half the year. It's pretty grey, so I don't feel too bad about doing that. My other thing that I love topically is I love using sunflower seed oil.

Jennifer:              You said that the last time. Sunflower seed and what's the next one?

Dr Lio:                   And coconut.

Jennifer:              Okay, great.

Dr Lio:                   I have a little mixture that I make here, but patients can just do it themselves. Just get good, good quality, you know, organic sunflower seed oil and like a cold pressed coconut oil and you just kind of mix them together. They both have properties that are really, really nice. In terms of atopic dermatitis, the sunflower seed oil is a very good moisturizer. It has a lot of good fats that help rebuild the skin and it's also a little bit anti-inflammatory, which is great. And then the coconut oil is fascinating because it has antibacterial properties. And so by doing that we kind of get rid of some of the bad bacteria, the staphylococcus bacteria on the skin. And I'm pretty convinced that it can help. Now it's not enough to, you know, treat your eczema.

Jennifer:              Right, exactly.

Dr Lio:                   But it's a really nice adjunct. So I liked that in a, for a lot of patients I feel like I can boost them a little bit and then I can use my other traditional treatments as well.

Jennifer:              And I think that's an interesting point that you bring up. Cause I think I worry sometimes when people hear somebody like yourself or myself or any guests on the show, they think this one suggestion that we give will be like that. Like, oh, put this oil on your skin and it's going to fix everything. And that's not the case. It oftentimes is like, I call them protocols, but there's a number of things that go into resolving or helping to really manage a situation or a condition that somebody has. And I think it's important that they remember that not to go, Oh, I should take nickel out of my diet. That's gonna solve it, or I'm going to put this on my skin. Would you agree with that?

Dr Lio:                   100% and in fact, sometimes I worry that it overwhelmed people because when they come and see me, I give them a whole plan and it has the kind of cleansers to use and the moisturizers to use and the topical therapy, and I'll have some lifestyle pieces. And so people feel overwhelmed. I say the problem with this condition is it's not a one hit thing. So we really want to get it from all sides. And that's part of being integrated to and holistic. We're trying to take care of everything instead of just giving you the one thing or removing the one thing. Because if we were that easy, people would have figured it out.

Jennifer:              Exactly. Well, thank you so much for joining us. I hope this will be maybe a little bit of a trend we'll have you on to keep, you know, I, I love the fact that you are, you're kind of straddling both of these worlds, which is really nice, but you're at a major university. Like you, you're really in there helping to change the way things are and hopefully I, I, my hope is that over the next few years we'll really see some change in the way that conventional dermatology is addressing these issues and providing people maybe some of these alternatives and options as opposed to just like, here's a steroid cream. I don't know what to tell you.

Dr Lio:                   I love it. And yeah, thank you for having me. I'd love to come back and I'll just encourage people to look up the national eczema association. It's a nonprofit organization that has a lot of clearinghouse stuff and I'm pretty active there. I write a lot there so they can find a lot of my writings on that site.

Jennifer:              Yes. And I also want to mention to everybody who's listening. You can also find Dr Lio at chicagoeczema.com. He's also got a Facebook page and a Twitter page, and I'm gonna put links to everything, including that wonderful textbook he authored. By the way, guys, I was just so impressed when I was looking through the, I was like, oh my gosh, he's talking about botanicals and all sorts of things. This is amazing. So it's just really exciting to me as a nutritionist, and I know that while most people listening are the patients, I do know that there are people who are clinicians or practitioners and are looking for other solutions to help support these folks. So I'm glad to help everybody. So maybe we can all help each other to find more joy, more better skin in life. So thank you, Dr. Lio. I really appreciate your time.

Dr. Lio:    Thank you for having me.Talk to you soon.

Jennifer Fugo, MS, CNS

Jennifer Fugo, MS, CNS is an integrative Clinical Nutritionist and the founder of Skinterrupt. She works with women who are fed up with chronic gut and skin rash issues discover the root causes and create a plan to get them back to a fuller, richer life.

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