Looking beyond the surface: The osteopathic approach to dermatology

Sometimes a rash is just a rash. But DO dermatologists say skin issues are frequently interconnected with other aspects of health. For instance, acne often takes a toll on self-confidence and can be a sign of adrenal gland disorder in some patients. The DO recently spoke with two DO dermatologists about the osteopathic approach to dermatology and how it benefits patients.

‘The skin can tell a story’

Osteopathic dermatologists are trained to recognize when patients’ conditions are more than skin deep, says Shannon Trotter, DO. A clinical assistant professor of dermatology at Ohio State University in Columbus, Dr. Trotter was drawn to the field after treating a patient whose leg ulcer, initially attributed to poor circulation, turned out to be a symptom of ulcerative colitis, a gastrointestinal disease. “That was fascinating to me—the skin can really tell a story about what’s going on inside the body,” Dr. Trotter explains.

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Discussing that bigger story with patients is another critical element of how DO dermatologists practice. Bridget McIlwee, DO, a dermatology resident at University of North Texas Health Sciences Center/TCOM in Fort Worth, has treated pediatric patients with acanthosis nigricans, a darkening of skin in body folds that can indicate insulin resistance. Dr. McIlwee is careful to counsel these patients about nutrition and exercise when explaining their diagnosis. “When you approach patients’ treatment holistically, their appreciation is so evident,” she says.

Visibility hurts

In addition to noting any links between skin issues and other health concerns, DO dermatologists say it’s crucial to consider how patients’ skin impacts their emotional well-being. “If a patient has a severe rash or a disfiguring autoimmune disease, the signs and symptoms of their condition are visible to everyone around them. This has really profound psychological effects on the patient,” notes Dr. McIlwee. And if the condition is deforming or scarring, it can impact the person’s quality of life and ability to perform daily activities. That’s what makes the whole-patient approach to care so important, Dr. Trotter says: “As an osteopathic dermatologist, you’re treating this disease, but also treating the person and understanding how their skin disease affects them in a greater way.”