We are delighted to interview Dr. Philippe Humbert, MD/PhD on his journey from conventional to integrative dermatology, that seeks to understanding the underlying root cause or a skin condition. Dr. Humbert holds an MD with specializations in dermatology, internal medicine, and oncology, as well as certifications in human biology, pharmacology, and sports medicine. He also earned a Ph.D. from the University of Besançon.

NOTE TO READERS: Some of the disease descriptions can be graphic.

1. What led you to incorporate integrative medicine into your dermatology specialization?

I soon realized that from one patient to the next, as a dermatologist, I was taught to recommend the same treatment:

• this patient has eczema, he'll receive a local treatment (corticosteroids)
• this other patient has acne, so she'll receive a local treatment (benzoyl peroxide)

I thought to myself: if this is what medicine is all about, I'm going to get bored writing the same prescriptions all day long!

And then one day, about 30 years ago, I realized that there was far more to dermatology than just the skin.  I had to look inside the body:  a young female patient whose acne had worsened told me that it happened around the same time her periods became irregular (namely every 2 months, spaniomenorrhoea), lasted 7 to 8 days (menorrhagia) and painful (premenstrual syndrome).

That patient was a revelation for me!  I realized I needed to apply what I had learned in gynecology and first treat her premenstrual syndrome with polycystic ovaries.  So I realized that if I wanted to improve her acne, I'd have to treat her gynecological problems!

And then, by chance, a child with eczema that I had previously been treating with betamethasone corticosteroids, spontaneously and significantly improved when his mother took her on vacation to her country of origin and gave her goat's milk.

And, little by little, I realized that there were indeed internal causes for all these skin conditions, and my first integrative medicine successes began in female hormonal acne and pediatric atopic dermatitis.

1. Is your impression that most of the underlying pathologies in dermatology come from the gut?   

 In fact, from what I've read and from my own observations, 80% of skin disorders stem from a gut problem or anomaly. For example, I learned that women who had cystitis, i.e. so-called urinary tract infections and so-called mycosis, actually had intestinal parasites.

When a female patient told me she had had a dozen occurrences of cystitis, I asked her to show me her urine lab analysis; I was surprised to see that her lab results didn't meet the classical criteria for a urinary infection; either there were no bacteria, or there were white blood cells but in very insufficient numbers; I referred back to the standard definition of a urinary infection to see that 100,000 white blood cells were needed.

And when the female patient talked about her “vaginal fungal infection” I asked her if her mucosa appeared bright red with white deposits like curdled milk, and if samples had been taken.  In fact, there was only mucus and phlegm, but no so-called vulvar candidiasis.  So, I thought it was a misuse of language to talk about mycosis when the vulva itches and secretes mucus.

At the same time, I discovered that these female patients also had an itchy anus; so, I conceived that these could be manifestations linked to the presence of parasites, that is small worms in the intestine.

And then my readings, my experience and the healing of these so-called cystitis and so-called mycosis after antiparasitic treatment convinced me that parasites were what it was all about.

And I was able to read that when the mucosa is exudative, worms can accumulate, just as Helicobacter pylori can accumulate in the stomach, and that it is these infectious elements that contribute to gynecological symptoms.

Then, as the years went by, I gradually discovered that if there were parasites in the intestine, then there was an intestinal disease, which would often manifest on the skin, and be mis-diagnosed by a dermatologist as a skin disease.

1. You often mention the role of gluten or cow’s milk (casein lacto globulin lactalbumin).  Isn’t that going too far outside of dermatology?

 What is cow's milk? It's a liquid produced by cows that contains lactose and large proteins such as casein lactoglobulin lactalbumin, which may damage a fragile intestine.  It’s not so much about the lactose.

But, one day I realized that today’s cow’s milk doesn’t just contain lactose and these proteins; it can also contain pesticides, antibiotics and growth hormone!

Then I discovered the work of a Toulouse pediatrician who claimed that any child who suffered from ear infections, tonsillitis or ear, nose and throat (ENT) symptoms in early childhood was intolerant of cow's milk. Apart from this work, there were no published scientific articles that affirmed this, but this Doctor's experience convinced me so much that I went to look at other health diaries to realize that children who had ENT infections between the first month and the 5th year, also had a break in their growth curve. This corroborated an intestinal cause and nutritional deficiency because of malabsorption.

In my patients with atopic dermatitis, I began by eliminating all forms of cow's milk, with spectacular clinical results. These children cleared with no other intervention.

And then there was gluten: every time I hear someone say that “gluten-free” a fad and its benefit must be proven, I don't believe that human beings are foolish enough to deprive themselves of great bread, cookies or cake if they're not intolerant.

I became worried in 2010 when I learned that a large company had released a GMO version of pest-resistant wheat that had twice as much gluten as regular wheat. And then, in many patients having immuno-allergic conditions such as hives (urticaria) and eczema (where there were probably gut parasites also involved), I observed intestinal mucosal disorders caused by gluten intolerance.  So there is most definitely an association here.

1. How did you discover the link between gluten intolerance and these diseases?

As early as 2005, I became convinced that gluten plays an important role in many diseases. I reviewed the medical literature at that time and published a paper that went virtually unnoticed in 2006.

Gluten intolerance and skin diseases.

Humbert P, Pelletier F, Dreno B, Puzenat E, Aubin F. Eur J Dermatol. 2006 Jan-Feb;16(1):4-11.

But I already had experience with gluten-free diets for treating diseases such as lupus and scleroderma (skin thickening), which are virtually incurable, and where the patients' symptoms improved significantly on a gluten-free diet.

When, in 2010, while listening to the news, I learned that French bakeries were going to be supplied with this new wheat with double-gluten that was produced by a single large company, I became very frightened, and above all I discovered more and more situations where the elimination of gluten was beneficial.  This was one case where agro-tech was not benefiting human health.

I didn't know how to describe the situation, until one day a friend of mine, another dermatologist who follows me at conferences, Dr. Paul RODOLAKIS, told me to read this publication, which I believe lays down the facts of what you've observed:

Celiac disease and non-celiac gluten sensitivity.

Lebwohl B, Ludvigsson JF, Green PH. BMJ. 2015 Oct 5;351:h4347. doi: 10.1136/bmj.h4347.

And so I finally had a publication that recognized the role of gluten other than in celiac disease.  And this was 5 years after the arrival of this new wheat with double gluten on the world market.  From then on, I started calling this pathology Lebwohl's disease or NCGI Non-Coeliac Gluten Intolerance.

Reading articles about this form of gluten intolerance convinced me more and more of the harmful role of this food product, so much so that I've spent the last 9-10 years, from 2015 to the present day, looking for pathognomonic signs of gluten's harmful role on the body.

In 2016, when I was seeing many patients suffering from joint pain due to Ehlers Danlos syndrome or joint hyperlaxity, I had one of my students, Lauriane LOUVRIER, write a thesis demonstrating that when you have hyperlax joints (aka “double-jointed” or joints that have greater range of motion than normal), you have symptoms of “leaky” gut. This was a major step forward and has now been confirmed by both Israeli and Swedish studies.

1. Can you please explain how hyperlaxity is correlated with intestinal pathology and gluten?

Every time patients have joint hyperlaxity, we notice that they have abdominal pain, sometimes diarrhea or constipation, sometimes mucus, and that their clinical evaluation ranges from simple indigestion (dyspeptic enteropathy) to Crohn's disease; basically, I've noticed the greater frequency of Crohn's disease in hyperlax people.

From this, we can deduce vitamin B12 or D deficiency (both are normally absorbed in the ileum - the last part of the small intestine), parasitic infection (responsible for scalp pruritus, body itching, pseudo-cystitis, and pseudo mycosis), stabbing abdominal pain, diarrhea, constipation, followed by more serious systemic illnesses such as Parkinson's disease, dementia, and Alzheimer's disease.

1. So what you’re effectively saying is that by eliminating gluten, you can improve most of these diseases?

Yes, and I'm not the only one to say so: several authors have published the benefits of a gluten-free diets in dementia, Parkinson's disease, Crohn's disease...

1. How can you be sure that someone is gluten intolerant?  Eliminating gluten is not easy for most people.

If you want to convince a patient to go gluten-free and cow’s milk-free for a year, you need solid arguments.  That’s not easy for most people to do.  However, if you convince that these changes will have a big impact on their skin condition, they will usually try it for a few months, see improvement, and then continue the new routine.

This is how we now know that hay fever is strongly correlated with dietary gluten intolerance; patients who change their diets in the long-term no longer suffer from annual allergies.

How do you find out if gluten is really the suspect in the first place?  I first check that patients are hyperlax by bending their wrist over their forearm.  I also ask questions about their digestion: when you eat bread or cakes, do you have quick bowel movements, do you become constipated, or do you have diarrhea?

And then I discovered the pathognomonic signs, i.e. the characteristic features of gluten intolerance:

• First, there's a particular skin texture called keratosis pilaris, which is often seen on the outside of the arms, and which is a reason for consulting a dermatologist. I discovered that this goose-bump-like appearance could also be observed on the thighs or any other part of the body.  This is one indicator of gluten intolerance.
• Then, I observed that thicker, rough skin (squamous hyperkeratosis) on the elbows is another indicator of gluten intolerance.
• Finally, characteristic symptoms on the knees, which I called fissured hyperkeratosis are yet a third indicator of gluten intolerance

Any one of these signs is an indication of gluten intolerance, most often non-celiac.

Thank you so much, Professor Humbert, for teaching us about the gut-skin connection and how gluten is intolerance is linked to many skin conditions.

More about Prof. Humbert: Dr Humbert is a Professor of Dermatology at the University of Franche-Comté and the University Hospital of Besançon. He previously headed both the Department of Dermatology and the Laboratory of Cutaneous Engineering and Biology at the hospital. He is the President of the International Society of Cutaneous Pharmacology and co-founded the French-Speaking Skin Engineering Society. Additionally, he has held leadership roles in European dermatological societies. A prolific author, he has published over 600 international papers and co-edited the second edition of Agache’s Measuring the Skin. His honors include the Knight of Academic Palms and multiple awards from French dermatological and cosmetology societies.