What is Functional Dermatology?

What is Functional Dermatology?

Not All Dermatology Is Created Equal: Defining Functional Dermatology and Why It Matters

Functional dermatology builds on conventional dermatology by treating conditions at their root cause, from the inside out. At Pore House, we use functional dermatology to inform what we call our Well-Rounded Approach. Pore House aims to treat the whole person using a combination of evidenced-based medicine and integrative therapies when appropriate. This approach focuses on six factors – medical history, lifestyle, nutrition, fitness, sleep and stress/mental health – all of which directly correlate to a major source of dermatologic concerns. We view these elements as potential sources of inflammation or modification of the body’s ability to deal with potential trigger factors of inflammatory processes.

Why do these triggers matter? Inflammation is the root of inflammatory skin diseases, which are the most common problem when it comes to skin health and dermatology. They come in many forms, from occasional rashes, itching and redness, to chronic conditions such as dermatitis (eczema), rosacea, psoriasis, and the most common of all, acne. We’ll be taking a closer look at inflammation later on, but for now, on to the six factors.

  1. Medical History

Medical history can help determine your risk or predisposition for certain skin conditions and disorders. By knowing your family history, your physician can connect any symptoms you may have to a disease that may run in your family. This understanding also helps providers to determine the best course of treatment based on how relatives have responded to medications in the past, or how hereditary conditions could potentially come to impact your response to treatment. Some examples:

  • If your mom, dad, brothers or sisters had acne, chances are you will have a similar form of acne in your lifetime.
  • Rosacea is genetic. If you noticed your mom started developing redness or broken blood vessels in her forties on her cheeks and nose, there’s a chance you may develop rosacea around this age as well.
  • If your family is fair skinned with light eyes, then you may be at an increased risk for skin cancers caused by sun exposure. Melanoma occurs more frequently in persons with fair skin, light eyes and blonde or red hair. There is a genetic component to melanoma as well. One in every ten patients with melanoma has a family member who has also had melanoma. This might be from certain gene mutations that run in a family, or shared lifestyle behaviors (sun worshippers), or the family’s tendency to have fair skin/light eyes.


  1. Lifestyle

Next, we look at lifestyle. How do we define lifestyle? Things like where you live and habits you partake in that don’t fall under diet, fitness, sleep or mental health (although they might actually impact those factors). Lifestyle matters. This is especially true when it comes to your current skincare routine, how much time you spend in the sun, your exposure to pollution, and drinking/smoking. Did you know…

  • Urban Living: Living in an urban environment can really take a toll. Pollution can hurt your skin's barrier function – that’s your skin’s defense mechanism and your way of keeping the good stuff in (moisture) and the bad stuff out (free radicals, dirt, etc). It does this by breaking down collagen and the lipids within it. Lipids are what keep the barrier strong, and once they’re gone, your skin is in danger of increased irritation, rashes and breakouts. Also, as dirt particles can accumulate on skin's surface, they can clog pores when they mix with your skin cells and oils. Hello, MASKNE. Maskne is a good example of how buildup can cause irritation – even if you’ve never experienced it before. How do our providers address this? By understanding your exposure to pollution they can suggest a routine for barrier repair.
  • Sun Exposure, Tanning, SPF: In the case of sun protection, the stats speak for themselves.  The average person’s risk for melanoma doubles if he or she has had more than five sunburns. The percent of increased risk indoor tanners compared to non-indoor tanners have of developing early-onset basal cell carcinoma.
  • Smoking: Cigarette smoke can accelerate the aging process. Some of the toxins in cigarette smoke damage collagen and elastin, the components of skin that keep it firm and supple. This damage can speed up skin aging, making smokers more prone to wrinkles on their faces and body. Cigarette smoking also has been known to deplete vitamins and minerals, including vitamin C, a powerful antioxidant that helps protect and repair skin damage. 


For a long time, the link between skin and nutrition was not taught in medical school – hard to believe, since we now have so much evidence showing there is a direct correlation between what we eat and how our skin behaves. A healthy diet can promote clearer, brighter and more supple skin. It can even help to promote skin’s natural defenses against environmental aggressors. Skin, like any other organ, requires water and nutrients to perform. Some examples:

  • Water for Hydration: In the same way that we use topical moisturizers to feed our skin moisture and protect ourselves from moisture loss, we can replenish moisture levels by drinking water throughout the day. Yes, the process is slower – our skin doesn’t instantly feel dewier, but drinking water on a regular basis is the best way to refuel.
  • Amino Acids for Collagen Production: Eating foods with healthy oils, omega-3 fatty acids and healthy proteins helps stimulate the collagen production in your skin. Increasing your skin’s collagen production boots suppleness and smoothness, helping to prevent premature wrinkles and skin sagging.
  • Beta Carotene for Antioxidant Protection: While the best way to protect skin from environmental aggressors, specifically UVA and UVB rays, we can ramp up our skin’s natural defenses by eating diets rich in antioxidants and beta carotene.
  • Leafy Greens to Ward Off Melanoma: Heart-healthy diets, complete with fish and leafy greens, have been found to protect your skin best from melanoma.
  • Minimize Sugar for Maximum Gut Health: Limiting sugar intake and consuming gut-healthy probiotics can limit the causes of acne flare ups and blemishes.


There is evidence that shows 30 minutes of exercise five times per week can promote heart health and longevity. In this same vein, fitness has a direct effect on skin health. Why? Because it promotes healthy circulation, and the increased blood flow helps nourish skin cells and keep them vital.

  • In With the Good: Blood carries oxygen and nutrients to working cells throughout the body, including the skin,"
  • Out With the Bad:. Blow flow also helps carry away waste like free radicals, flushing cellular debris out of the system, cleansing skin from the inside

Exercise is also known to help reduce stress – the benefits of which we’ll get to shortly.


Lack of sleep causes the stress hormone cortisol to be released, which in turn encourages inflammation in the skin, causing flare-ups in conditions like acne, psoriasis, and even eczema. When we sleep, we recharge. The body makes more collagen, which minimizes fine lines. More human growth hormone is released, increasing muscle mass and strengthening skin. Some key tactics for maximizing this effect:

  • 8 Hours A Night: Duration is key – your body needs 8 hours for maximum collagen production.
  • Quality: Uninterrupted REM sleep is best for promoting collagen synthesis and minimizing cortisol

Sleep also plays a major role in mental health, which is the next and final attribute we assess as part of our approach. Research has found that stress caused by sleep deprivation increases signs of aging, such as fine lines, reduced elasticity, and uneven pigmentation. The loss of skin elasticity may also contribute to the formation of bags under your eyes – swelling or puffiness beneath your eyelids. As the supporting muscles around your eyes weaken, these become more common with age.

Stress/Mental Health

In a vicious circle, stress, depression and other kinds of psychological problems can exacerbate the skin problems Evidence shows that common dermatological issues are often made worse by stress, including acne, rosacea, psoriasis, itching, eczema, pain and hives.

How and why? Although researchers are still investigating the link between stress and skin, studies show that the sebaceous glands, which produce oil in the skin, are influenced by stress hormones. When you feel stressed, your body produces more of the hormone cortisol. Cortisol causes a part of your brain known as the hypothalamus to produce a hormone called corticotrophin-releasing hormone (CRH). CRH is thought to stimulate oil release from sebaceous glands around your hair follicles. Excessive oil production by these glands can clog your pores and lead to acne.

According to a 2014 review published in Inflammation & Allergy Drug Targets, a study found that stress impairs the barrier function of your stratum corneum and may negatively affect skin water retention. The stratum corneum is the outer layer of your skin, which contains protein and lipids that play a critical role in keeping your skin cells hydrated. It also acts as a barrier that protects the skin underneath. When your stratum corneum isn’t working the way it should, your skin can become dry and itchy.

Stress has the potential to weaken your immune system. A weakened immune system can lead to an imbalance of bacteria in your gut and skin known as dysbiosis. When this imbalance occurs on your skin, it can lead to redness or a rash. Stress also causes changes to the proteins in your skin and reduces its elasticity. This loss of elasticity can contribute to wrinkle formation. On top of that, there’s the repeated furrowing of the brow that comes along with stress – yes, it’s real and it’s been studied – which can contribute to the formation of wrinkles.

  • Meditate Away: Finding 10 minutes a day to medicate can help promote mental clarity and rejuvenation.
  • Time Management: Using productivity tools to help manage tasks can help reduce stress over time.
  • Exercise: As we mentioned previously, exercise has been proven to reduce stress.
  • Sleep: Sleep is the body’s way of recharging and replenishing. Levels of the stress hormone cortisol fall during sleep, which helps skinrepair daytime damage.


In conclusion, Functional Dermatology views the skin as a window into what’s going on inside the body – and in order to treat specific conditions or concerns, it’s critical that we understand what’s going on underneath, and what other factors might be impacting your skin health, so that we can put together a plan that will actually work. It’s not an approach taken by every provider, sometimes simply because it takes more time for diagnosis and to land on the right course of treatment – but we believe this is truly the best way to deliver a better experience with better results.


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