Case Study – Skin Rash

Severe Allergic Dermatitis

Courtney F.

Courtney presented with a primary complaint of severe skin rash and itching. And her rash was severe…oozing, crusty, scabbing…to the point she couldn’t bend her elbows without cracking and bleeding.

When we discussed her general health, it was apparent that this situation needed a generalist approach, despite the clear dermatological condition.

Upon review, she described problems with her menstrual cycle, digestion, sleep patterns, muscle weakness and joint achiness. A skin rash will not generally cause a disturbance in hormones, which is characterized by menstrual cycle irregularities and insomnia. The hormonal changes that can produce these symptoms, however, can and will impact the immune system, detoxification systems, and inflammation levels (joint and muscle problems).

If we focused on the rash, her skin, or the itchiness, we may have prescribed an antihistamine, skin cream, or anti-inflammatory.

We did not.

As a generalist, I focus on the interaction of systems. How does the digestive system impact the detoxification system, and how does the detoxification system impact hormonal regulation (endocrine system), or even the other way around…how can hormones influence the digestion or detoxification. And, can this all result in her current (Skin/dermatological) circumstances?

How Light Sensitivity Leads to Skin Sensitivity

In the neurological examination, I tested her pupil response to light. In a healthy individual, the pupils constrict appropriately to a light shined in the eye. With Courtney, this reaction began but immediately the pupils popped back open despite the stress of a bright light.

This reaction, or lack of a reaction, often suggests a chronic stress physiology. A stress physiology is a change in adrenal hormone output and rhythm in response to a perceived danger. This threat can be real, as in a near miss car accident, or an acute infection such as the flu.

Both scenarios result in an instant and obvious change in physiology. Hormones shift, metabolism changes, and with the incredible wisdom of the unconscious, will produce a sudden muscle attentiveness and increase in blood flow, as in the near miss; or a sudden urgency to purge and sleep, as in the flu.

Both responses are remarkably swift and amazingly appropriate to the situation. Both are symptoms of a perceived threat and both are examples of a stress physiology.

If a stress physiology is maintained, it eventually has consequences on nearly every function in your body. Everything shifts in response to the chronic stress, including the immune system. The shift most often observed over time, is a suppression of the T cell immunity, the cells that attack bacteria, which eventually makes you prone to illness, and an increase in B cell immunity, the cells responsible for “tagging” viral invaders, or if there is not a virus to tag, begins to tag environmental irritants, resulting in a histamine response, such as Courtney was experiencing.

Potential Perceived Threats

Again, when considering potential threats, we have to be generalists. This threat could be from emotional fears and worries or past regrets held tight. This threat could be life overwhelm…a never ending 28 hours of work every day of your life. This threat also could be, and often is, a metabolic threat, such as compromised energy production, immune system dysregulation or activation, or blood sugar imbalances.

If your cells can not efficiently produce ATP (ATP = Cell Energy), your cells signal to your brain that they are drowning…they can’t “breathe” in this environment, just as you can’t breathe underwater. Anemic states, blood sugar imbalances, and mitochondrial (the part of the cell that makes energy) dysfunction lead to “drowning” and a perceived threat resulting in your body signaling danger to the brain, and the brain organizing a response, particularly a shift in hormones released by the adrenal glands. That is stress physiology.

Immune dysregulation will cause a defense to mount when there is little or no threat, and yet the signal to the brain is danger. You will react to dust, cats and dogs, pollens, perfumes, or in other words, the air as it exists on this planet. You may mount a defense against your own tissues, such as your thyroid gland in Hashimotos Thyroiditis, your joints and cartilage as in Rheumatoid Arthritis, your brain as in many types of peripheral neuropathy and dizziness, or your pancreas in some types of diabetes.

This is called an Auto-Immune response, and although there is nothing really dangerous about your thyroid or joint cartilage, the signal to the brain is “danger.” Eventually, of course, the tissues being attacked do have “something wrong with them,” as the immune cells damage the tissues.

An active infection or true food allergen, as in the reaction to wheat and other grains in celiac disease, will also signal danger to the brain. Many times, opportunistic bacteria, parasites, or yeasts, such as Candida take up residence in your intestines, and they would rather go unnoticed, so they “try” to stay silent. Your immune system notices, however, even if you don’t, and the attack creates inflammation in your gut, and Irritable Bowel type symptoms of bloating, gas, and alternating constipation and diarrhea, in addition to the danger signal to the brain resulting in adrenal hormone shifts.

Courtney’s Perceived Threats

We ran a comprehensive lab on Courtney including a complete blood count with the white and red blood cell counts, a comprehensive metabolic profile providing multiple enzyme and mineral counts, a thyroid panel (not just TSH, but T3 and T4), a lipid panel (cholesterol), and the inflammatory marker C-Reactive Protein.

This panel offers insight into virtually every function in the human body. But, as most of my patients have discovered, the question the doctor asks given a set of conditions determines the level of insight achieved.

In Courtney’s case, the lab markers virtually all came back “normal.” So, I gave her an anti-depressant and sent her home…

Of course you know that is not true. When a mainstream medical doctor looks at these labs, they are asking “where is the pathology”…are the liver enzymes elevated, heart enzymes, white counts elevated indicating infection. Often, as with Courtney, this is not the case (the labs are not “flagged” abnormal). Abnormal indicates pathology or risk for pathology.

I am a Functional Medicine Physician, so I ask, in the same situation, “How can we return to health?” and “What do we see that is not ideal?”

There are lab ranges that are unwritten in mainstream medicine called functional ranges, or in plain terms, ideal ranges. A shift from ideal ranges does not indicate pathology, it indicates a decrease or change in function.

When we looked at Courtney’s labs using the functional ranges, we noticed that many of her lab markers were shifted from normal or ideal.

Most prominently, the white blood cell and red blood cell counts were both low. Only a high white blood cell count triggers the use of antibiotics, the only immune defense assist that modern medicine really has to offer. This wasn’t an acute infection, and didn’t fit in the medical model of infectious disease.

I would consider a low white blood cell count to indicate chronic immune stress, often an intestinal infection. A CBC (complete blood count) includes a percentage of different types of white cells, including Neutrophils, Lymphocytes, Monocytes, Eosinophils, and Basophils. Neutrophils are the dominant white cell in our body, and work to keep our bacterial environment healthy. (Note that we do have a vast network of helpful bacteria in our intestines). Lymphocytes are primarily the viral responders. Monocytes react to chemicals, and rise post-infection to clean up the chemical mess. Eosinophils often indicate a food allergen, and Basophils may indicate a parasite or other opportunistic infection other than viral or bacterial.

These are not firm rules, but general guidelines. When dealing with opportunistic infections, the kind that move in and try to “stay out of the way,” we often have to test the Intestinal Ecology, which means literally taking a sample and seeing who’s there. I have been “fooled” by parasites more than anything else over the years, so now test sooner and more often.

Courtney’s labs showed a chronically stressed immune system (low white blood cells), and a lack of oxygen carrying capacity (low red blood cells). When compared to ideal ranges, we could see that her Eosinophils and Monocytes had increased. That left us thinking foods, chemicals (such as mercury, pesticides, etc.), and still the possibility of an opportunistic infection.

All potential immune activators…all potential causes of a stress physiology.

We also saw that her Hemoglobin and Hematocrit were functionally low…confirmation of an anemic state…meaning that at some level her cells were gasping for air, drowning, and signaling to the brain the danger to survival. Another cause of stress physiology.

Her brain was receiving multiple danger signals, and the brain was telling the adrenal glands to activate the stress hormones. These danger signals are sent by hormones that are released from her cells, called autocrine hormones. Hormones are chemical messengers…they report the circumstances of the body environment to the brain, the brain processes the information and instructs the pituitary gland (located in the brain) to release hormones that travel downward to the thyroid gland and adrenal glands, which release their hormones in reaction to the most updated messages.

“Sick” messages, as all of us have experienced, make us tired, weak, and sensitive.

When we looked at the rest of her lab information, using functional ranges, we saw that her thyroid, kidneys, heart, liver, and gall bladder were all tired, weak and sensitive. Specifically, she had a low T4 (Thyroxine, the thyroid hormone), and BUN (kidney function), and the enzymes ALP, GGT, and LDH. These enzymes are used in medicine to detect organ failure or damage. For instance, with gall stones, the GGT climbs higher and higher. With a heart attack, the LDH rapidly increases with the damage to the heart. When these same enzymes are low, they are ignored in traditional medicine, but in functional medicine, we see that as a sign of tired, weak, and sensitive organs.

Waking up the Body

In Courtney’s case, we decided to do a clinical trial, addressing all the potential needs, versus testing further for food allergies, intestinal infections, and chemical sensitivities. We know how to treat these issues had they come back confirmed positive, and with natural medicine the worst that can happen is a lack of effectiveness, so we decided to treat as if it were confirmed.

I used muscle response testing, where we examine her muscle groups for neurological inhibition (weakness) and use a variety of sensory tests to see what will facilitate (strengthen) the muscles.

When viewed in a relaxed standing posture, I could see a rotational posturing in her hips and shoulders toward the right and a leaning posture towards the right. If all muscles are balanced and fully functional, she would appear symmetrical and level, but she did not. In order for her body to assume this shifted posturing, some muscles had to be inhibited (weaker) and some had to be increased in tone (stronger).

I often explain that in order to bend your arm at the elbow, the bicep must increase tone, and the tricep must “allow” that movement by decreasing in tone. The same is true of postural muscles…in order to twist to the right, certain muscle groups must “fire” and others relax. It is the first insight into the neurological health of the individual.

We found several muscles weakened, and used them to test for strengthening substances, and used her strong muscle groups for testing stressor substances…substances that weakened.

Courtney weakened to histamine, yeast, and egg. She also weakened when I pinched her leg, which is my instant stress test to evaluate her stress physiology. If a persons stress physiology is calm, their threshold for stress is high. I can pinch them and they can take it…they don’t weaken. They might not prefer it, but they can withstand it without a neurological consequence. In someone, like Courtney, with a high stress physiology, a pinch exceeds their threshold, and we can witness the neurological consequence through muscle testing.

Courtney strengthened to natural anti-histamines, including Ascorbic acid and a liver extract that aids in elimination of histamine, probiotics, including a specific species that has been researched as effective with yeast, and an adrenal formula designed to nourish the adrenal glands and calm the danger messages from the brain. We also supplemented B12 to replenish her red blood cells which was indicated from the labs directly.

While we did this all at one time, it is important to note that if I missed the anemia, or the infection, or any other danger signal, the adrenal formula would have appeared to “not work.” You can not reset the stress messaging without addressing the stress trigger. In Courtney’s case, we did “get them all.” It is possible that we treated something that wasn’t there…we’ll never know because we didn’t do confirmation testing. We do know that we treated everything that was there, because in days, her oozing, scabby arms completely healed and she was able to move freely once again.

I’ll let her tell you in her own words…

“When I first came to see Dr. Stone, it was because of an unexplainable itchy rash on my arms, neck and chest. I have studied natural health for a while and had already done everything I could think of with no results. It was embarrassing as well as incredibly agitating. I was mainly treating my liver internally and the rash externally…as I knew if the liver was sluggish or toxic it would detox through the skin.

What really impressed me was how deep Dr. Stone’s knowledge was…and on so many levels. He confirmed my own theory that the liver wasn’t functioning optimally, but he was able to really target the specific cascade of chemical interactions in my body. He gave me the supplements my liver needed. I felt better immediately and felt inspired and validated. There was a sense of relief in that I knew more about the cause…the itchiness and welts disappeared completely within a few days. My energy levels also improved.

I have since gone back to Dr. Stone for many health questions and concerns and always leave more optimistic and healthier.”

            -Courtney F.