Restoring Skin with Corneotherapy
Today, we are joined by Hayley Fogarty, a Naturopath and Corneotherapist. Hayley chats to us about how she blends complementary modalities to find the root cause of skin issues and deficiencies within the skin and how she brings the skin back into homeostasis.
About Hayley Fogarty
Hayley is a qualified Naturopath who graduated in 2018 with a Bachelor of Health Science from Endeavour College of Natural Health. Hayley is also a Corneotherapist, a skin treatment modality whose philosophy is to repair and maintain the health of the barrier of the skin (stratum corneum).
At the beginning of 2020, Hayley moved to Sydney and opened up a Naturopathic Skin Clinic – Solstice Skin, based in Bondi, where she combines both her modalities in treating skin and health.
Hayley received recognition when she won the Australian Junior Corneotherapist of the Year award in 2019 at the Dermaviduals Awards.
Hayley’s passion for improving skin health externally with customised Dermaviduals skincare prescriptions, energetic facials and skin needling combined with naturopathic care of internal health provide safe, long term results for her clients.
Solstice Skin has grown to a talented team of 6. It provides a multi-modality clinic that includes an energy medicine practitioner and kinesiologist to assist their clients holistically – mind, body and spirit.
Connect with Hayley:
Andrew: This is “Wellness by Designs” and I’m your host Andrew Whitfield-Cook. Today we’re welcoming Hayley Fogarty, who’s a naturopath specializing in corneotherapy. Welcome to “Wellness by Designs,” Hayley. How are you going?
Hayley: I’m good, Andrew, how are you? Thanks so much for having me.
Andrew: Absolute pleasure. Now, what exactly is corneotherapy, please?
Hayley: Yes. So corneotherapy is really a special type of skin modality. Its main principle is correcting and restoring the barrier, which is the outer layer of skin, so the stratum corne and really supporting the first and third-line defences of the skin. So that’s the acid mantle, the microbiome, the multilaminar lipid structure, and making sure that we’re, kind of, respecting the skin and all of its systems at all times.
Andrew: Okay, so you said first and third lines of defence?
Andrew: The second line is?
Hayley: Well, I guess I meant “first to third” lines of defence.
Andrew: Oh, forgive me. Sorry.
Hayley: So the acid mantle, the microbiome, and the multilaminar lipid structure. So there are three lines of defence.
Andrew: Okay, and can you tell me a little bit about your history and why you decided to specialize in looking after skin conditions and everything within?
Hayley: Yes, so I started my naturopathic degree in Perth, so I did two years of that. And funnily enough, during that time, actually I was experiencing quite a lot of my own skin issues. So eczema is something that I’ve always, kind of, struggled with as a young child, and then it, kind of, developed into more dermatitis presentations as I got older. So then, when I moved to Melbourne, I’ve started working in a clinic while I was still studying my naturopathic degree, and they were using corneotherapy there, and I, kind of, just… The philosophy and the way corneotherapy treats skin just made so much sense to me. So I was very fortunate enough to be trained and mentored there. And we saw lots of different skin conditions. So it was really like a boot camp of training the skin.
And, yeah, since then, yeah, I’ve just been on that path. And I love combining my naturopathic knowledge also with corneotherapies because both of the modalities are really aligned in really finding out what the root cause of the skin issue is and correcting deficiencies within the skin and bringing the skin back into homeostasis just like we do in naturopathy.
Andrew: Tell us a little bit first though about, like, the stratum corne and the different layers of the skin, because I mean, my nursing knowledge taught me that the stratum corneum was dead. That was it. You couldn’t get anything through it. It was an impervious barrier. Even relatively waterproof unless you’re soaked for ages, la, la, la. It seems like this isn’t the case.
Hayley: Yes, so I guess a lot of the beauty world refers to that final layer of skin as dead skin cells. And it’s really incorrect terminology because they’re not dead until they actually fall off your face, and they’re on the floor. So the final layer, our stratum corne is still alive. I, kind of, like to use the analogy of imagining it like a smart roof. So you have your roof tiles, which are your corneocytes, and they’re held together by glue, which is your ceramides.
And their role is really to tell the rest of the house what’s happening in the external environment. So that the top layer has communication pathways down to the deeper layers. So it’s always sending signals like when it’s hot, when it’s cold, if there’s changes in humidity, if there’s UV exposure, so the underlying skin cells can kind of adjust accordingly. So it’s really there to protect us from the outside world and send those beautiful messages down into the deeper layers.
And yeah, of course, it’s definitely waterproof. A strong healthy barrier will be nice and waterproof. And if we’ve got no tiles missing on our skin roof, then we’re gonna be keeping all the good things in like water and oil which are really protective, but we’re also gonna be keeping those external factors out of the skin as well. So our philosophy with corneotherapy is always to go back and repair your skin roof. And that just means that everything in the house will function more optimally.
Andrew: Okay, so just talking about that sloughing off of the skin. You know, we think about beauty therapies, you know, dermabrasion, and even just scrubs and things like that. If you’re thinking about corneotherapy, about putting stuff on the skin, how does that allow for the normal sloughing off of dead skin cells? Perhaps I’m oversimplifying it. Like, are you stopping normal sloughing of the skin by doing anything?
Hayley: No, definitely not. So I guess if you’re going in and repairing that barrier, and you’re feeding the skin all those beautiful nutrients, then it’s gonna be functioning more optimally, which means that skin cell turnover is gonna improve. So it definitely helps with that natural desquamation of, yeah, that sloughing off kind of function of the skin. So it’s not about putting anything on the skin and inhibiting that. It’s really about allowing the skin to do what it naturally should do in a healthy way if that makes sense.
Andrew: Yeah, no, absolutely. I’ve got to ask, though, about absorption. And I have discussed this with a couple of people, Amie Skilton and Mary-Louise-Condon. But to get your take on this, because this is something where I’m only just waking up and that is absorption. You know, we talk about being, forgive me, a waterproof protective layer, if you like. And I was taught that it was impervious and that there was no absorption of nutrients through it. But that doesn’t seem to be the case, right?
Hayley: Yes. So absorption is definitely one of the roles of the skin for sure. Keeping things that shouldn’t be in the skin is definitely a part of what the skin barrier function is doing. Also, differentiating between absorption and penetration. So, absorption is when, like, certain chemicals get through the stratum corneum and actually get into the bloodstream. Whereas penetration is when a chemical gets down into the deeper layers and stays within the skin. So probably the better terminology would be the penetration of certain ingredients into the skin.
So definitely that’s what we’re preferring because even though a lot of skincare can get absorbed into the bloodstream and we’ve got to be cautious of what we’re putting on the skin because we know we don’t wanna be putting anything harmful on the skin that could get absorbed into the bloodstream, but there’s definitely ways of, yeah, products penetrating through that top layer. It just depends on the way those products work. If you have to use, kind of, harsh or abrasive chemicals like AHAs and BHAs to disturb that barrier to get those ingredients down, then you can run into some issues. But if you’re using skincare that contains a certain technology that allows that penetration of actives to get into the skin without damaging that stratum corne that’s kind of what you’re really looking for.
Andrew: AHAs and BHAs, alpha-hydroxy citric acids, is that what it is? Alpha hydroxy acid?
Hayley: Yeah, alpha hydroxy acids, and then you’ve got beta hydroxy acids.
Andrew: When are they used?
Hayley: And they all… Sorry.
Andrew: Sorry. When are they used? What’s their differences?
Hayley: So it really depends on the concentration. So, AHAs are typically more of a stronger form of chemical exfoliation, whereas BHAs are a little bit more of a gentle form of exfoliation. So it kind of depends on what you’re going for. The skincare range that I use, we don’t use AHAs because we believe that is too disturbing to the barrier.
Andrew: The snakeskin.
Hayley: Yeah. Yeah, yeah, yeah.
Andrew: So tell us a little bit more about beta hydroxy…sorry, your beta hydroxy acids.
Hayley: Yes, so your beta hydroxy acids, we use a beta hydroxy acid in the dermaviduals range called salicylic acid. So we actually have salicylic acid in our skin cells already and that helps with that natural desquamation process without going in too aggressively and again removing that stratum corneum because some AHAs and chemical peels not only remove the first layer but can remove up to the first top three layers of the skin.
And I like to explain it to my clients, we really want those skin cells to come to the surface and mature before they desquamate. If we remove those top three layers of skin cells, then we’re really exposing teenage skin cells. And I like to use the analogy, it’s like letting teenagers off in the house. You know, they haven’t quite mature enough to be in the outside world. And then there’s issues with communication within those skin cells as well, so let alone removing really important lipids from that top layer, too. So we can lose a lot of water through the skin if we don’t have those top couple of layers protecting us.
Andrew: I’m loving your analogies like letting teenagers loose in the house.
Hayley: Yeah, analogies
Andrew: You’re Well, it gels with something I spoke to somebody I spoke to the other day about keeping things simple. And it was really amazing how we can… Particularly in something like skin, you know, where you can throw away these really technical terms, and they just confuse the patients, so they don’t go away with knowledge. They go away with overwhelm.
Anyway, you were mentioning communication there and talking about the maturation of the different layers. Can we go through that a little bit and how that’s affected by various conditions? So I’ll go into how you’re treating the conditions a little bit later if we could. But with this communication, what’s happening there?
Hayley: So, yeah, I guess, as I explained, if you are removing that barrier, then the communications within the deeper layers can get a little bit confusing. So those deeper skin cells aren’t getting that information about what’s happening in the external world. So, for example, you know, you’re coming out of autumn into winter, and all of a sudden that humidity in the air drops, and you go into a more of a lower humidity type client. People normally notice those couple of days, their skin is feeling really, really dry. And then all of a sudden, those deeper layers get those messages, and they go, “All right, we need to send more essential fatty acids to the surface of the skin to really line that barrier.” So that’s just, kind of, one example of why that cellular cell-to-cell communication is important.
Also, if your barrier is disturbed, what sits right underneath your barrier is your immune system. So all of a sudden your immune system, if you imagine there’s no tiles on your skin roof, your immune system is, like, reacting to every little thing that’s landing on the surface of the skin. So that’s another way that that communication can break down as well. And then you’re seeing inflammation. You’re seeing redness. You’re seeing tight, dry potentially skin that is breaking out in perioral dermatitis.
Yeah, and the same kind of applies for acne, so that communication within the skin has been disturbed. So all of a sudden you have that C. acne bacteria overmultiplying, maybe your oil production, you know, is too high or not high enough. So there’s kind of lots of different things that are happening within the skin when you damage that cellular communication response.
Andrew: Yeah, you’re mentioning something there that really feeds into the skin microbiome as well. So how do you employ, I guess, probiotics? Do you employ them both internally and topically or do you employ different ones for the skin?
Hayley: Yeah, so we definitely have… We’ve got bacteria. We’ve got yeast. We’ve got mites on our skin. And I say to clients, these are all good, you know, things that should be on the skin. It’s really when the environment of the skin changes that we can see an overgrowth in certain bacterias like C. acne bacteria. It used to be called P. acne bacteria, but now it’s been changed to C. acne bacteria. Staphylococcus aureus, which can obviously lead to a staph infection. So, yeah, that microbiome is really, really important. Yeah.
Andrew: And, sorry, we were also discussing before, fats and oils and things like that. So can you take us through the penetration of the fats and oils? Do you choose things like, you know, macadamia oil for instance that might have, you know, a high monounsaturated or do you choose different variations or types of fats depending on the condition that you’re treating?
Hayley: Yeah, so essential fatty acids are so important for skin cell health, so they line our skin cell membrane. So definitely kind of the range that I use… There’s lots of different essential fatty acids. Yes, we definitely have macadamia oil. We use kiwi seed oil. I always laugh at kiwi seed oil because I can just imagine pressing the little tiny baby kiwi seeds and making oil out of it.
Andrew: I’ve never heard of that, kiwi seed.
Hayley: Kiwi seed oil. Yes, it’s amazing. It’s full of essential fatty acids and omegas. I just wanted to go back to that point of probiotics on the skin, actually. So I have probably the last year have definitely been experimenting with giving clients actually breaking open a probiotic capsule. And it works really nicely for my eczema dermatitis clients. So, yes, definitely internally, but I have a protocol that uses actual external probiotics as well. And I find that works really nice at repairing that microbiome. Yep.
But, yeah, back to essential fatty acids, super, super important for the skin. We also use Boswellia resin, which is really anti-inflammatory and full of essential fatty acids. And then you’ve also got the essential fatty acids that’s naturally found in the skin. So the range that I work with mimics those essential fatty acids in the skin and uses plant-based ingredients, which is quite cool as well.
Andrew: Just on that point of Boswellia that you made, like, is that hard to procure as a raw material?
Hayley: So, I mean, I’m not part of the, kind of, manufacturing process. So the range that I use is formulated in Germany. So, yeah, it’d be really interesting to know how they procure the Boswellia resin. But, I mean, I definitely… That would probably be something you’d have to ask them. But in terms of, like, my practical application of Boswellia, we use it in lots of different skin conditions. So I use it in my acne clients, I use it in my eczema clients, I use it in my rosacea clients, just because it has such powerful anti-inflammatory properties. Really helps to reduce collagenase or helps with slowing that breakdown of collagen elastin in the skin. So it’s really good for using it in healthy aging. Yeah, it’s a pretty amazing all-around active that we have, which is quite cool.
Andrew: I’ve got to say like, you know, the use of fat, it makes sense, but we’ve never thought of it, never taught it, never learned about sort of thing. I guess no commercial company in Australia has released itself. Of course, there’s no need. But it really does make sense to use… Well, you know, we’re sort of more attuned to using things like myrrh, you know, but Boswellia, it’s related. So certainly, these, sort of, resonance components.
I also had another point to ask you about the probiotics that you were using. Do you tend to stick to one species or strain, or do you tend to use a mix, or do you tend to employ a base like yoghurt to apply them? How do you utilize them?
Hayley: Yeah. So, yeah, I haven’t tried yogurt on the skin. Not yet. I like to use a spore-based probiotic. So it has, yeah, a few different strains in it. I find that that works really nicely to help bring that microbiome on the skin back into balance. Because especially when I’m looking, like, at an eczema or dermatitis inflamed skin, then typically that microbiome has been disturbed. And when the microbiome has been disturbed, that can just be setting off a cascade of inflammation.
So it’s something that, yeah, I’ve definitely been experimenting with clients and getting good results with that. But I haven’t gotten down to the point where I’m using exactly different particular strains on different conditions. I’ve just found that that particular probiotic works really nicely. And in all the research I’ve done, that’s kind of something that is being typically applied to skin conditions as well.
Andrew: Right. That’s really interesting. Like, you know, it’s really interesting how we judge probiotics, or I should say bacteria. You know, we’d like to own them. They’re all human, they’re human strains. But it does make sense about these… You were talking about Bacillus coagulans, is that what you’re referring to?
Hayley: Yeah, Bacillus coagulans. Yeah, it’s kind of five different Bacillus. So there’s licheniformis in there. There’s indicus, subtilis, I think.
Andrew: Subtilis. Yeah.
Hayley: Yep. So they’re kind of supporting the immune function in the gut, but then we know our gut immunity and our skin immunity is really intrinsically linked. So it seems to be working for my clients. Yeah, it’d definitely be something that I’d love to, kind of, do a bit more research into and how it’s actually having that really deeper, kind of, influence on the skin microbiome. But it’s definitely new, kind of, exciting research that’s coming out as well. So, yeah, I’ll stay tuned for that.
Andrew: Yeah, but I mean, it really sparks my interest, because although we know we’re smothered with the maternal microbiota upon birth, hopefully, and that they can set up resident populations, we also interact with the outside world for the rest of our lives. So, you know, we’re picking up dirt and handling dirt. And so it would make sense that we look to some of those organisms to be natural co-inhabitants of our skin and possibly having therapeutic activity. It’s really interesting.
Hayley: Yeah, and it can also be quite interesting to seeing, like, what those different, kind of, bacteria and how they’re communicating with the outside world as well. I think that would be interesting to, kind of, look into.
Andrew: Yeah. So let’s go into some of the conditions. You’ve mentioned, like, dermatosis and things like that, but can you detail what you use in certain conditions, what you found of benefit?
Hayley: Yes, so I guess the main ones that I treat are, yeah, as I said, acne, eczema, dermatitis, treat a lot of rosacea. I have treated some autoimmune skin conditions as well and some fungal skin conditions too. And then I get people coming in just wanting general skin health. So things that are gonna help with pigmentation, things that are gonna help with aging, and then just general dull, lackluster skin.
So I always say my first point of goal with my clients is let’s get those foundational ingredients into the skin first. And when I’m talking about foundational ingredients, how we really look at skin is like, “Okay, our skin is an organ. It has lots of different nutrient requirements. What are those different nutrient requirements and how can we re-feed the skin those beautiful nutrients?” So I think in the beauty world, it was so far removed from the fact that the skin is an organ and has lots of different functions and nutrient requirements. And it’s really going back in there and re-feeding the skin, first of all, things like phosphatidylcholine, triglycerides, fatty acids, cholesterol and things like that and also our ceramides.
And then once I’ve kind of done that, probably after six to eight weeks, then I can start introducing different serum actives into their program. So my other analogy for that is like, “Let’s go repair your roof, and the structure of your house, and the floors, and the walls. And then in six to eight weeks’ time, we can introduce the furniture and the cool artwork.” And that’s those serum actives that really have that, kind of, punchy response in the skin.
When I’m treating acne, in terms of serum actives, and the actives that I have to choose from in the range that I work with, we have 40 different actives. So we have vitamins. We have minerals. We have herbs. We even have algae as well. So in terms of something like acne, I might be looking for an active that’s really high in linoleic acid because that’s actually a fatty acid that acne clients are really deficient in. Phosphatidylcholine is another ingredient that I love to use in acne. I use a bit of azelaic acid, and that’s really anti-inflammatory and has antimicrobial…well, microbial-regulating properties to it. I love B vitamins as well. So B3, B5, B6, B7. They’re great for that post-inflammatory pigmentation you get left behind with acne. It helps to regulate sebum production. I love using zinc as well. So zinc is very wound-healing, and also green tea.
And all of those different actives also help to reduce 5α-reductase in the skin, which we know if we’re reducing that conversion of testosterone in the skin, too much testosterone in the skin is gonna upregulate oil production and also make our oil quality thick and gluggy, so getting trapped in the follicle. And then once that follicle is a little bit inflamed, then those P. acne bacteria start to feed on that oil production and have a little bit of a party. And then I also love, at some stage, introducing like a vitamin A in the skin for acne.
In terms of dermatitis and I see a lot of, like, perioral dermatitis, which kind of presents from the nose around the outside of the mouth and on the chin. And also periorbital which can kind of present around the eye area as well. Again, I love using phosphatidylcholine. I love using both Boswellia for dermatitis for those anti-inflammatory essential fatty acid properties. Sometimes I use kiwi seed oil as well for those nice essential fatty acids. And then, kind of, once I’ve got that under control, I’m looking at an active called EGCG that really helps to strengthen the filaggrin formation which a lot of dermatitis clients suffer from is something called a filaggrin gene deficiency, which means their barrier…they’re just not great at making a good skin barrier.
In terms of rosacea, again, I’m using Boswellia. I’m using phosphatidylcholine. I’m using something called tranexamic acid. Yeah, and sometimes I introduce echinacea as well, because we know echinacea is a really nice, immune regulating property.
Andrew: Take me through… Forgive me, was it as azelaic acid?
Andrew: I don’t know that at all. Where do we get that from?
Hayley: So azelaic acid or azelaic acid, depending on what you wanna call it, it actually comes from a yeast. Well, it’s produced by…so we actually produce azelaic acid ourselves. So it comes from the Malassezia yeast. In terms of how they actually formulate that in an active, yeah, I’m assuming they create that from a byproduct of some type of yeast.
So, yeah, it’s getting definitely more common in the, like, beauty world. It’s really, really anti-inflammatory. It, again, helps to regulate the microbiome in the skin. So that’s why, for example, something like it’s really great for rosacea because we know, with rosacea, they have about 18 times more Demodex mites in this skin, and those mites can be causing inflammation, which is quite interesting as well. Sometimes we look at rosacea, and we think redness and capillaries, but we’re also gonna think of the microbiome on the skin as well. And again, it’s a 5α-reductase inhibitor, so it’s great for acne. It’s a bit of an all-rounder. It’s a bit like Boswellia. It can do a lot of different things.
Andrew: Yes. I’m just thinking here about, you know, there’s about 10 different questions whizzing around my head. Like, one is when you talk about…did you say 5 to 10 times as many mites?
Andrew: Eighteen times. Okay. So, the question there is, is that cause or effect? Are they there because they’re trying to do a job cleaning up stuff or are they the cause of it? And what’s led to them overgrowing? Does anybody know? Like, do we…?
Hayley: Well, I guess, again, if your barrier is impaired, then it can be changing that microbiome, but in terms of the Demodex mites, yeah, that’s an interesting one. I mean, we know with rosacea that…usually when I’m looking at rosacea clients, I’m thinking what’s going on with their gut. So is there a link between, you know, kind of, dysbiosis in the gut, which is causing dysbiosis in the skin? Yeah, so that’s kind of an interesting one.
Andrew: And you’re saying that that fatty acid was made from yeast. Sorry, it’s gone blank now. Malassezia?
Hayley: I think you might be thinking of tinea versicolor where you get the hyperpigmentation on the shoulders. So we have Malassezia yeast all over our body, but it’s mainly predominant in our scalp because we have so many sebaceous glands. So the yeast loves feeding off our sebum. So that’s why some people might experience it because that yeast actually starts to come down the back of the neck and then it can kind of be populating more abundantly in the shoulders and then it actually starts to inhibit pigmentation in the skin as well. So I think that might be where you’re going.
Andrew: Yeah, yeah, gotcha. And, of course, you were getting to a place where you’re talking about not just the roof capping and then the furniture and the artwork, but now we have to address the sewage system. So we have to treat internally as well as externally. Yeah, so how do you balance both the internal and external because you specialize in corneotherapy, but obviously, as a naturopath, you’ll be treating internally as well?
Hayley: Yeah, so, you know, I definitely believe we kind of need both. We need to be doing all the right things externally, using really, really good quality skincare, making sure we’re not doing anything to harm it. But then, of course, internals play such a huge role in skin condition. So anyone walks in with a skin condition, I’m thinking, “All right, what’s going on with your gut? What’s going on with your hormones? What’s going on with your lymphatic system, liver? What’s going on with your nutrition? You know, how’s your diet? What’s happening with your stress? Lifestyle factors. Drinking too much alcohol or smoking and all those things are gonna play such a pivotal role in our skin health.”
And you’ll notice that. You’ll see people with really beautiful healthy skin, and 9 times out of 10, they’ve got a good diet, you know, their stress is down, and, you know, normally their gut and their hormones are functioning correctly. So I’m a naturopath but then I also have a naturopath who works for me called Melissa. So she’s really focusing on my big internal cases, which is amazing.
So, yeah, that kind of naturopathic understanding really helps me to guide the client into what type of care they might need. Do they need further, you know, GP testing and functional pathology testing while we’re also doing the externals as well? So it’s really that holistic picture and looking at skin health.
Andrew: Concentrating on acne at the moment, do you get any clues as to the presentation of acne, whether it’s high on the cheekbones, or low on the jaw, or anything like that, as to what the hormonal imbalance could be? Like, I remember some people teaching this, and it didn’t sit with me from a physiological point of view but yet I’ve spoken to people that have got really good results. And I’m like, “Okay.” Where do we sit with this?
Hayley: Yeah. I think it’s like, kind of, TCM, that facial mapping. I think that’s where it originated from. And, yeah, I mean, I’ve seen thousands of skins. So I can, kind of, pick up pretty quickly when someone comes in and presenting with acne, why they might be presenting with acne, I typically find the forehead can be more of a gut diet presentation. I find in between the eyebrows and the temples can be liver congestion. Upper cheeks, I find small intestinal bacterial overgrowth is quite common. And then near that typical jawline presentation, I’m thinking, “Okay, what’s going on with your hormones?” And then really anything close to the mouth, I’m thinking gut as well.
So they’re pretty common patterns that I see with my acne clients for sure. And it’s just the more faces you see, the more patterns you start to link. It doesn’t mean that you, kind of, just, you know, naturopathically prescribe them based on what’s going on, like, visually, but it does give me clues as to where it might be stemming from and also different ages as well. So if they’re coming in as a teenager, I’m thinking, “All right, you know, that big dose of hormones is hitting in. Are they on dairy?” I can always see if someone’s intolerant to dairy. I can tell that pretty quickly, and 9 times out of 10 I’ll say, “Do you have a lot of dairy?” And they’re like, “Yeah, yeah. I drink, like, a glass of dairy a day.” And I’m like, “Yeah, I can see it in your skin.” So there’s definitely clues.
Andrew: What’s the presentation?
Hayley: Yeah. Yeah, yeah. So typically a lot of inflammation around the nose, kind of, congestion around the nose, I see that a lot with dairy. Sometimes it can be breakouts on the forehead as well. But that around the nose presentation, I’m thinking, “Yeah, that person’s having a bit too much dairy, for sure.”
Andrew: That’s really interesting. And what about other therapies that you employ like things like… You know, we’re all well-aware of the alpha and beta hydroxy citric acids… Hydroxy citric acids or hydroxy acids?
Hayley: No, yeah. Hydroxy acids.
Andrew: Hydroxy acids. So we’re quite well-aware of those, but what about physical things? What about, you know, acupressure, acupuncture, needling, things like that?
Hayley: So, yeah, in my clinic, we do facials, and I love doing like… We do a lymphatic facial massage, which is also really important to get the lymph moving and to get circulation to the skin. And then I also offer something called skin needling. So this is a type of treatment that we use tiny stainless steel microneedles, and we penetrate the skin in a vertical fashion. And what that is doing is setting off a cascade of responses underneath the skin to start eliciting a scarless wound-healing response. So, great for stimulating collagen elastin production, hyaluronic acid production, so really good for fine lines and wrinkles. Great at reducing the appearance of acne scarring as well because I get in there with the needle, and I break down that old scar tissue and then lay down that new collagen elastin.
Yeah, I mean, I definitely do incorporate some gentle facial acupressure. I would love to do some more training in that. I think that would be amazing. And then also, in my clinic, I have two other therapists, one is an energy medicine practitioner, and one is a kinesiologist. Because definitely my years of experience treating skin, it’s not just physical, so the externals and the internals, which we treat with corneotherapy and naturopathy. There can also be emotional blockages within the body that’s preventing healing on a physical level. So I really think it’s important to, kind of, tap into that subconscious energetic element that everybody has. So that works really nicely for some of my clients as well, that mind-body, kind of, spirit connection.
Andrew: You know, that really tags into another podcast I did on “Wellness by Designs” and that was with Natasha Sidoti about listening to your patient and what their language was telling you, not just the symptoms that they’re presenting. It’s really interesting stuff. So, everybody, have a listen to that one, if that interests you. Can I just ask you about when you’re talking about the acne scarring? Is it called box scarring? Is that right? Is that the correct term where they’re quite deep and the needles can break it up? Is that right?
Hayley: Yeah, there’s a few different presentations. So, people that typically had cystic acne, what’s happening is not only is it disturbing the epidermis, but it’s actually disturbing the dermis. So the inflammation goes down into the dermis, which is our kind of the second layer of skin underneath the epidermal layers. And in the dermis, there’s collagen elastin. So that inflammation has actually caused trauma to that collagen elastin, which means all of a sudden that collagen elastin is lost. So, yeah, you get that box or icepick scarring that some people have as well.
Andrew: Got it. And obviously, we’ve got to talk about safety things. So what about, you know, when you’ve got rampant infections? You’ve got school sores or herpes rather than, you know, just a rash or a rosacea-type presentation. You’ve got to be really on your game to pick, which is which, right?
Hayley: Yeah, for sure. And one of the things we do, we send out a, kind of, client questionnaire before we see the client, and there are all those questions in there. Do you have an active cold sore? Do you have an active staph infection? So we can pick it up before the clients even come in and, you know, ideally reach out to them and just say, you know, make sure you go away and get this cleared. Or, if they present into the clinic and they do have that, we just say to them, “You know, we can’t do any treatments today. Please go away,” and refer them to the GP to get a swab or, you know, whatever they need to do to, kind of, help reduce that cold sore infection. So, yeah, def. That’s, kind of, the top priorities, definitely making sure we’re aware of what staph infections look like, different types of infections look like, and a cold sore, you know, kind of, viral infections look like as well on the skin. So, yeah, that’s definitely of the utmost importance.
In terms of the therapist that I have, I mean, one’s a naturopath and one’s also a nutritionist, so we’ve all been through that kind of level of…we’ve all been through that education in being able to spot red flags as well. So I feel like this really helps us, kind of… It gives us the extra bit of knowledge, yeah, to understand, “Okay, this person is presenting with this. Is this in our scope of practice or is this out of our scope of practice? And when do I need to refer to a GP? When do I need to refer to, you know, a psychologist or whatever it may be or when I need to send them straight to a hospital?”
Andrew: Okay. Hopefully not. Just the last question as well. How open are you to working alongside pharmaceutical therapy? You know, like, you’ve got fulminant conditions sometimes. You know, people go through horrid presentations of psoriasis and, you know, weeping dermatitis. How open are you to working alongside that sort of therapy? And what’s your goal? Is to eventually wean them off or reduce their need for the pharmaceuticals?
Hayley: Yeah. And, I mean, this is definitely something from personal experience. In terms of skin stuff that I’ve had in the past, I’ve had to, you know, at times use topical steroids because my skin condition was so severe. So I feel like that was a really great learning lesson for me to go, “Yeah, there’s definitely a time and a place for those pharmaceuticals and, yes, we can 100% work alongside whatever medication, topically or internally, that they’re on.” And just having a very measured approach to that as well but also offering our clients education on those pharmaceuticals.
That’s a big part of what I do, too, on the pros and cons to all of that. So giving the client…really empowering the client as to what direction they want to head. And if that’s something that they want to eventually wean off, I do see clients going through topical steroid addiction, topical steroid withdrawal. That’s kind of a niche of what we treat as well, and that’s really not cutting anyone off cold turkey from a topical, kind of, application that they might’ve been using their whole life. It’s really working with that client to help repair the barrier, also to help, you know, support them internally, and then really weaning them off slowly. I found that’s always been the best method. So working with a client where they’re at and making sure safety’s always paramount.
Andrew: That’s really interesting. Can I ask you from your experience do you find that those people that sometimes have to rely on pharmaceuticals… Let’s cherry-pick and go the topical steroid cream, you know, 1% whatever. Do you find that stress is the hallmark of when they need to start using it or do you find that seasonality has a big play? Like, as you’ve mentioned, when winter comes into effect and there’s that dropping humidity, what are the major factors playing on that?
Hayley: Yeah. I mean, I guess, like, doing a long, kind of, history. Is that client, you know, atopy presentation? You know, have they had eczema as a child? You know, what’s going on with their barrier? Do their skin naturally produce enough lipids? Are they a lipid-dry skin presentation? Which means they’re going to be more susceptible to things like eczema and dermatitis. That’s kind of important to establish initially.
And then, of course, winter hits and, you know, people that are prone to eczema and dermatitis, that’s kind of the worst time for them because that humidity in the air is being reduced. So it’s not protecting the skin anymore, and they’re losing lots of water through their skin. And of course, stress can be a big influence and diet. You know, things like gluten can be quite inflammatory for those types of skin conditions. Obviously, again, sugar and dairy can also be quite inflammatory. So there are so many factors that are, kind of, influencing why someone might be using those topical steroids for sure.
Andrew: I said one last question, but there’s one last question. Evening primrose oil. We’re talking 25 more years ago was, you know, a herald. It was the essential fatty acid that we needed. And there was work by Prof. David Horrobin, which supported its use. Of course, he was lambasted after he died because basically all of the positive research for atopic dermatitis, using, of course, it was his evening primrose oil, was by foundation supported by him, and none of the independent studies supported the results at all.
Having said that, I know people that gained great benefit out of evening primrose oil, not fish oil, which we, sort of, jumped to. Are we jumping back or are we tending the use of the balance of essential fatty acids now?
Hayley: Are you talking obviously internal applications? So taking evening primrose oil internally?
Andrew: Yeah, forgive me. Yes.
Hayley: Yeah. I mean, I guess, you know, we’re looking at evening primrose oil being an omega-6 fatty acid. So I guess the beauty of essential omegas, is you’re getting that omega-3. I mean, I think both can be beneficial for sure. In terms of, like, what I believe to be the most effective essential fatty acids for the skin, I’m definitely thinking of fish oils. So, yeah, they’re just very, very anti-inflammatory, and we know those skin cells are lined with those beautiful lipids. So that’s what we’re, kind of, really looking at supporting the skin.
But in terms of do, I kind of prescribe much internal evening primrose oil, not necessarily. Like, I’m normally thinking fish oil, omegas. Yeah, I have to do a bit more, kind of, research into evening primrose oil, but it’s nice to have that mix of omega-3 and omega-6 in there as well.
Andrew: I think there’s been an evolution to the balance, it’s really interesting, but also the foundational stuff. Like, you mentioned delta-6, delta-5 desaturase. And, you know, not easily but the commonality there, if you look at the enzyme system, is zinc, B6, and magnesium, three of the simplest nutrients. Do you tend to employ those a lot?
Hayley: Yeah, for sure. And I’m thinking, you know, issues with, you know, D6 saturation, I’m thinking eczema and dermatitis, for sure. So B6, magnesium, yeah, that would definitely be helping. Yeah. I mean, anyone that comes in with a skin condition, I immediately think magnesium because it has such a profound impact on, like, a whole system. And I think just in our modern society, I think we’re leaching a lot of magnesium and, you know, our kind of busy lifestyles and our stress.
So I think skin conditions play a lot into that nervous system stress response, and if you can get people sleeping properly if you can help them move their bowels properly. In terms of what magnesium is also doing for the skin is increasing fatty acid production in the skin, so that’s also an added bonus as well, and really bringing down that cortisol response. And we know cortisol, again, can upregulate testosterone in the skin, which can upregulate that unhealthy oil production in the skin that can lead to acne. So I think all skin conditions need magnesium. Yep.
Andrew: I’m loving your thought processes. Yeah. But it’s awesome to talk to you, Hayley. I have to ask, do you have a course or do you mentor other naturopaths in corneotherapy?
Hayley: It’s funny you ask this because I had someone call me yesterday, booking for a consult, and she was a new corneotherapist that had just started, and we just chatted for an hour. And I, kind of, got off the phone and I was like, “That was so fun.” So I would love to do that for sure. I mean, there are a few avenues you have to, kind of, go through as a naturopath before you become a corneotherapist. So there’s kind of extra studies that you have to do. But I, kind of, foresee maybe one day in the future helping with that really practical application of treating skin from an external point of view for sure, because, yeah, I love the big cases. I love treating lots of different skin conditions, and I’ve seen lots of different skins as well. So something in the future, something in the pipeline.
Andrew: There are so many other naturopaths also that, you know, they have a bent, if you like, for treating skin and they have a love for it. And obviously this love for, you know… You’ve actually started by need, but you have a real dedication to helping other patients with their skin conditions and it shines through. So I’ve got to say thank you so much for giving me a few things to think about. Kiwi seed oil is one of them.
Hayley: I know.
Andrew: But thanks so much for taking me through the finer points of corneotherapy today on “Wellness by Designs,” Hayley.
Hayley: No worries. I loved it. Thank you so much.
Andrew: And, of course, thank you for your company today. You can find all the show notes and the details of this and other podcasts on designsforhealth.com.au. I’m Andrew Whitfield-Cook. This is “Wellness by Designs.”