In this episode, Dr. Justin Marchegiani and Evan Brand break down how eczema, psoriasis, and dry winter skin often stem from deeper internal imbalances, not just surface-level issues. They emphasize the gut–skin connection, explaining how low stomach acid, food triggers (like gluten, histamines, and salicylates), and gut infections can overstimulate the immune system and flare skin conditions.
They stress the importance of going beyond steroids and creams by addressing root causes with diet changes (AIP, low-histamine when needed), digestive support (HCl, enzymes, bile), and targeted lab testing (OAT, stool analysis). Environmental factors also play a huge role—things like fragrance-free living, shower filters, air purifiers, clean cabin filters in cars, and avoiding dryer sheets are practical, everyday ways to reduce triggers.
For topical care, they recommend minimalist, hypoallergenic moisturizers (emu oil, Vanicream, Lipikar Balm) and gentle cleansers while the gut and immune system are being healed. They acknowledge medications may help short-term, but stress that true healing requires fixing digestion, environment, and immune balance.
🦠 Gut-first approach: Low stomach acid and gut permeability fuel immune-driven skin flares.
🍞 Food triggers: Gluten, grains, high-histamine, and salicylate foods commonly worsen eczema/psoriasis.
🧴 Topical care: Keep it simple with sulfur soap, emu oil, or eczema-approved moisturizers.
💨 Environmental toxins: Remove fragrances, dryer sheets, and chlorine; upgrade air and water filters.
🔬 Testing: OAT and stool panels uncover yeast, fungal metabolites, strep/staph, and dysbiosis patterns.
🥑 Healthy fats: Proper fat digestion supports skin barrier hydration and reduces inflammation.
💊 Medications: Steroids, calcineurin inhibitors, and PDE-4 blockers can be stop-gaps but don’t solve the root cause.
🌍 Functional medicine path: Layering gut healing, environment cleanup, and diet changes restores skin health long-term.
Dr. Justin Marchegiani: [00:00:00] Hey guys, it's Dr. Justin Marjani. Welcome to the Beyond Wellness Radio podcast. Feel free and head over to justin health.com. We have all of our podcast transcriptions there, as well as video series on different health topics ranging from thyroid to hormones, ketogenic diets, and gluten. While you're there, you can also schedule a consult with myself, Dr.
J, and or our colleagues and staff to help dive into any pressing health issues you really wanna get to the root cause on. Again, if you enjoy the podcast, feel free and share the information with friends or family. And enjoy the show and we are live. It's Dr. Jay in the house with Evan Brand. Today we're gonna be talking about getting to the root cause of eczema and psoriasis, these pesky little autoimmune skin issues.
We're gonna dive into that topic today, Evan, my friend. How we
Evan Brand: doing? I'm doing really good. Uh, you and I are both like bouncing, uh, clinic and podcast today. Mm-hmm. And we hear this every day, all day. People that say, Hey, look, I'm 20 years old, or, Hey, I'm 40 years old and I've got the skin condition and I've been to the dermatologist and they wanna do steroids and they [00:01:00] wanna put me on this medication.
Whether it's some sort of, uh. Oral antibiotic or some other compound. And some of them try it and they say, Hey, I get a little bit better. But then when they get off of X, Y, Z drug, they go backwards and then they call us and they say, okay, I've relapsed. Dermatology can't fix me. What do we do? First place we look?
It's the gut. We know the gut skin axis is a big piece of this puzzle, and I would argue a lot of people are getting. A little too carried away with the the cool foods. The cool foods meaning sourdough. Okay. You got every sister and her sister on Instagram right now? Homemade sourdough starter. Is it delicious?
Yes. I've had some, but do I think it could still be an issue? Yeah, I, I really do
Dr. Justin Marchegiani: a hundred percent anything that impacts the immune system. So 80% of the immune cells. In your body, you're in the gut, right? They're in the malt. The mucosal associated lymphoid tissue that's in the gut, the stomach, and then you have the, um, the gastric associated [00:02:00] lymphoid tissue.
So gastric is the stomach and the mucosal associated. That's the small intestine. And so 80% of these lymphocytes are there. And so anything that stresses out the gut and foods gluten is gonna be a big stimulator. Why? Because gluten stimulates. The toll-like receptor cells in the stomach, the toll-like receptors, they're the centurion guard.
They sit there by those enterocytes, those tight junctions, and they are sensing bacteria, virus, food, allergens. And when inflammation and stress hits those receptor sites, that's gonna cause this protein called zonulin to increase. And that protein is gonna make that intersite more permeable. The more permeable the intersite is, that exposes the immune system to other.
Foods, other lipopolysaccharides, other mold, toxins. 'cause remember in your gut, in your mucosa, in your small intestine, right, that's actually still outside of your body, right? Food goes in, it's still outside of your body. Then it gets absorbed and then it goes into the bloodstream. Now it's in, so technically it's still out.
Tight [00:03:00] junctions open up, now it's going in and now the immune system is seeing it un in an undigested state and then it can overreact and start to create an immune response to those things.
Evan Brand: Yeah, well said. And hopefully people understand that this is not a forever thing. We're not saying you can never have a piece of good, like organic, real sourdough bread like it.
It's good. I've had some with some butter, and by the way, Kerrygold, which they do add sugar to it. Mm-hmm. I know Kerrygold was controversial 'cause they were feeding some grain in the off season or whatever. But FYI, Kerrygold makes a cinnamon butter. Whoa. Oh it does? Oh, that's amazing. If your kids get a hold of that little stick of cinnamon butter.
They are. Ooh, I didn't know that. Yeah, you're gonna have to like kick 'em out of the kitchen. You're gonna like, y'all get outta here. They're gonna start scooping that thing with their fingernails and like shoving it straight in. So that's great. It's like brown sugar, you know, but, but whatever. And in sparing, in sparing doses, I, I think it's delicious 'cause it still has, it was carry gold.
Dr. Justin Marchegiani: It's still 97, 90 8% grass fat. From what I've seen. It's, it's a very small percent that, that's not fully grassed. So, yeah, so I love it best. And you know,
Evan Brand: it's a fun [00:04:00] treat now. I think you can add things like butter and potentially a sourdough back in, but while you're trying to fix your skin, my best advice is meat and berries.
I would go meat and berries for a month, go lower histamine as well, and see how much better you feel. Because years ago when I was doing a bunch of avocados, I was doing tomatoes, I was doing pineapple, all these high histamine foods and spices. My skin wasn't the best. My skin's not perfect, but it's better than it's been in decades.
Like my entire twenties, my skin was not good and I was still doing these quote healthy foods like nuts. I would do almonds, I would do pistachios, I would do pecans, but I feel that nuts may be even a trigger for skin. What's your opinion on like nuts and, and, and skin? I know you talk a lot about thyroid and so for thyroid health you're gonna say, Hey, go more a IP, which would exclude those nuts.
But in the context of skin, what do you, what you, what are you thinking?
Dr. Justin Marchegiani: That's a great question. So anytime we have an known autoimmune issue, which eczema has an autoimmune connection, so does psoriasis, [00:05:00] we try to cut out the big autoimmune triggers just because they can impact the immune system. And we know conditions like eczema, for instance, has a th I wanna say it's a th.
Um, two dominance, right? Or th 17 for psoriasis. So the immune system starts going outta whack and so that can create problems. Also, we may see an an a histamine issue as well. We may see IgE or histamine issues. And so looking at keeping the histamines down maybe necessary, and again, it just depends when patients have a known autoimmune condition.
I am gonna be more strict and rigid about the food changes. 'cause we try to unwind the immune response so the immune system gets wound up and then it starts becoming more sensitive to everything. And when you have one autoimmune condition, it's like a 78% chance of poly glandular autoimmune syndrome.
That means now there's a great chance almost 80%, that you're gonna have two or even three conditions. And so you have to take it very seriously when you have a known condition. The two. Unwind it. [00:06:00] So we gotta be very careful with nightshades, very careful with gluten, but not just gluten. All grains. That means white rice, that means corn, that means oatmeal, and then we have to really kind of get that dialed in.
We're gonna also be very careful of sodium. Laurel sulfate also fragrances, formaldehyde. Um, we're gonna be using eczema safe, um, detergents, we're gonna be using wash soda instead. No glade plugin, no little trees in your car. We're gonna have air filtration. No sense. No glade plugins. No fbri spray, right?
So we've gotta cut out all the things that could be touching our skin from a water standpoint. That means a really good clean, healthy water filter to filter out the chlorine. Chlorine's, the big one there. We're gonna be getting all of our scents and fragrances. We're gonna be using wash soda or something that's eczema approved to have no, no allergens there.
If we need some kind of a scent, we can use a gentle essential oil and a diffuser, like a frankincense. And, uh, ideally avoid anything topical on your skin that's gonna have something that's, that can have the fragrance in there.
Evan Brand: Yeah. Well said. Uh, I still [00:07:00] find a million people a day on the road with little trees in their car, and it's like, what, what trees terrible are you doing?
What are you
Dr. Justin Marchegiani: doing? Yeah, I just, I just changed the, I got a new car, I changed the air filter in the car and I also did a 20 to 30 minute ozone session of good, good, good. Kind of off gas to kind of clean it out, you know, so. People should be on top of that. And then there's some nice, I think Phillips has one, there's a couple companies that have them that could plug into the 12 volt, and it's a little HEPA that sits in the backseat.
In the, in
Evan Brand: the, yeah, I, I had the iq, the IQ atom or Autumn, I don't know. A TEM is how they spelled it. Yes. The only thing that was annoying though, is it had a super high Bluetooth on it, like it would. Blast car with it. But if it's in the trunk, it was fine. But now a lot of the new cars, the filters are so good on 'em.
Mm-hmm. That you almost don't even need the standalone air purifier in the car anymore. Like, I rarely smell fumes and
Dr. Justin Marchegiani: Oh, and also, yeah, get a good filter like Hanks, I think it's, Hanks is a good one. Um, but make sure, are you saying Hanks?
Evan Brand: Are you saying Hanks, like H-A-N-K-S or what are you saying?
Dr. Justin Marchegiani: It's like H-E-N-G-S-T.
Evan Brand: [00:08:00] Oh, okay. Okay.
Dr. Justin Marchegiani: Um, but I know people who have done the ch like. I know like bm, B-M-W-O-E-M, um, they do the Hanks filters people online. I've watched reviews where they've changed them up for other stuff and they've noticed odors and all kinds of crap. And plus, the Hanks has a really good, um, like an activated charcoal in there.
So you want, you don't want to go cheap on your filters, make sure they're clean, make sure you're choosing a top of the line brand. It's five minutes to go change 'em. Usually they're under the glove box or they're under the steering wheel. It's just like, usually like one of those weird, like hex screws, takes five minutes to change 'em out.
And then you can get a 20 or $30 ozone, um, thing on Amazon, 30 bucks. Let it go for like 20 minutes or so, let the air recirculate on it, and then open it up afterwards. Ozone does jack me up. It does make me feel dizzy and out of it. So have a mask or just. Hold your breath, go in, make the adjustments, do it, uh, do it outside your car.
Um, but totally worth it. Cleans everything out really well.
Evan Brand: Yeah. And why are we talking about cars and air filters and all that in regards to a skin [00:09:00] podcast? Well, because toxins in your car, whether that's mold or fragrances, that can affect your immune system overall, it can trigger the mast cells, which are gonna release more histamine, which can further aggravate rashes or what appears to be rosacea.
I think a lot of people when it comes to skin, they're misdiagnosis, rosacea, and it's. Probably a histamine flushing. I was looking at old pictures the other day. I had a picture from way back when, like 2016 when I first got exposed to mold and I had this kind of like patch of red on my cheek. And I'm now knowing that was a mold rash.
That wasn't eczema, that wasn't uh, sri, that was nothing but just literal histamine. And back then I was doing like avocados every single day. And so this is why I say we need to look at your gut. We're gonna get the oat, we're gonna get a GI and see what's going on with the microbiome. We're gonna get all the fragrances out.
We're gonna get all the topical compounds out, including a lot of the quote natural skincare brands. I'm still seeing them use a lot of preservatives, polys, sobe, and uh, even some parabens. So there are some quote green brands that still aren't clean enough. [00:10:00] So go, go minimalist with your, with your skincare.
Like I just do the Dr. Bronner's and I don't use any other. Essential oil type product, and I just do the unscented, the baby unscented one For soap?
Dr. Justin Marchegiani: Yes. Yeah. I mean, I like the sulfur soap. That's been great. It's been around for a hundred years. That's great. Some people, it can be a little bit drying and so if they, if your skin is really dry already, that's where like a Vanna Cream gentle skin is great.
And then from moisturizing, I like. The EMU oil, I love it. They use it on burn victims. So the people that have the most sensitive, inflamed skin possible, that's a third degree burn and it works great. They use that in in major hospital burn units. If not, we'll use an eczema. So Eczema Society approved. Um.
Moisturizer like a van cream, like a lipor bal, something that's gonna have ceramides in it. Uh, a very light, light amount of hyaluronic acid. Um, but that builds back up that lipid barrier. The problem with a lot of these ex people is their lipid, their skin barrier is just beaten up. And because of that, it's gonna be very.
Raw and sensitive and can get dry and itchy, and so then [00:11:00] you're scratching it, which then makes it more inflamed. So there's this vicious cycle, so you have to bring moisture to the skin. And some of the, the Eczema Society approved ones, they aren't the best, but I find a lot of the natural stuff that have a lot of different oils and things.
Can sometimes trigger the immune response. So you have to do different things to build up the skin barrier and then down the road heal it. But my general protocol is the sulfur soap and then adding in some kind of, um, witch hazel based toner. I have my favorite ones. I'll link down below. And then usually the emu oil or we go to an eczema society approved one that's gonna be very helpful.
Uh, but in regards to foods. Salicylates can be a big deal too. And again, with patients with big skin issues, you gotta be really, really strict outta the gate. Cut out, salicylates, maybe histamine full a IP. We may have to go deeper, right? It depends on your gut, depends on how chronic things are. I follow a lot of these eczema groups on Facebook and it's really sad.
Everyone is just looking for a magic potion to fix the issue. And I'm sorry, but that's not gonna be a way to, to actually heal it in [00:12:00] general.
Evan Brand: Uh, let's, I'm trying to see if I could bring up like a graphic for folks to see high Solicitate foods. You guys can, can easily, uh, you know, Google this and pull this up too for yourself and see, but there is.
Okay, here we go. So like salicylates in fruits, for example. I believe blueberries are, are up there. Let me look. Yes. Yeah. So here we go. So, so very high. Let me try to make this one bigger here. Boom. Okay. So for example, in fruits, very high would be like apricot, blackberries, blueberries, boys and berries. So on the low side or negligible would be like banana and pair, which is interesting, right?
Because then you've got the issue with FODMAPs and then you've got the issue with higher histamine. So I, I don't wanna overwhelm people with this, but I would just say this is why we do consults, because some of this we're fine tuning because you may look at this and go, oh, Dr. J said go low salicylate, but bananas are high histamine.
So what do I do? And a lot of these things it, it's about. Are you just overdoing them? I mean, if you're doing like a pound a day, you're [00:13:00] doing like a multiple containers of blueberries that could be too much for you. And I've had some clients say they have arthritic like pain if they do too many blueberries, for example.
So this is all just like, it's not set in stone and we don't wanna overwhelm you. But let me show you some nuts and, and snacks. So like almonds, that would be considered high, whereas cashew would be considered low, pecan would be considered low. That's just a couple examples. Um, how about beverages? Let's see what this one shows.
Oh, it's so tiny. I can't even see it. It's like a low quality graphic. I apologize. Very high. Says tea. And then, uh, negligible says coffee, decaf coffee. Il tea is low. So not the greatest image, but there you go. Let's
Dr. Justin Marchegiani: go. You can do the coffee. At least. Lemme pull up a couple here that I, I have my own little graphic here.
So big thing out of the gate. So some of the higher offending fruits here, let's go over that. So your berries, your strawberries, your raspberries, your blueberries, your blackberries, and again, when it comes to. Eczema and psoriasis. We really only have, and this is [00:14:00] more for eczema by the way. Psoriasis typically more autoimmune, but we'll do both.
I want to get momentum with patients out of the gate. This is chronic. We want to get momentum, and so we gotta be strict as we get improvements, we. Things get better over time. We can start to cut things out, not be as strict, but if we can try to at least lower the salicylate load by 80%, that's, that helps.
We have our berries, our cherries, our grapes, our raisins, our mandarins, our tangerine, our stone fruit, our pineapple, most dried fruits, vegetables, tomatoes. So a lot of these we cut out. By cutting out nightshades, right?
Evan Brand: Yeah, yeah. On an autoimmune
Dr. Justin Marchegiani: diet, some of their cucumbers, right? And then our herbs and spices, a lot of herbs and spices.
And then our condiments, our teas, our wines, our honeys, and then of course our nuts, right? So a good chunk, I think what happens on an autoimmune is you cut most of that
Evan Brand: out. That's true. And this is why a lot of people say they, they get skin improvements if they're going more carnivore too. So if they're doing carnivore with some veggies, like you said, you're, you're cutting out a lot of that if you're slanting more autoimmune anyway.
Dr. Justin Marchegiani: When you go full autoimmune and or [00:15:00] carnivore. Carnivore is autoimmune, right? Mm-hmm. That you cut a lot of that down. But we have to also look at, you know, mold in the home because if we have a lot of mold that could be jacking up the histamine if we're have a lot of sense and fragrances that could be jacking stuff up.
If we're bathing our. Clothes and all kinds of scents and fragrances and wearing colognes or perfumes that are nasty. That's a, so this is where like as a functional medicine doctor, like we're trained to look and see all of this 360 as a patient. It gets like really overwhelming 'cause a lot of things.
And so when we work with patients, we're really understanding what your life looks like. We're doing an inventory audit of all the stressors you have, and then we're just trying to start with the most likely to the least and just try to trim from there.
Evan Brand: Yeah. And uh, so we went to an Airbnb and it was unscented laundry, but then they used dryer sheets.
And so my wife, she's, she's had to wash her pants. She came around me the other day with these pants on that she had wore at that house in that bed. And I was like, you gotta go wash those pants again. So the dryer sheets contaminated the whole suitcase. So the whole suitcase had to be off gassed. So this issue of [00:16:00] like fragrance transfer.
Is a big deal and I'm amazed at so many people being so like nose blind to it. So I really encourage all of you listening, if you have not gone unscented, like for example, this, this, this house had unscented free and clear laundry, but then they have quote fresh scent dryer sheet, just like, no, you, you just defeated the whole purpose of of the unscented laundry.
And so please, please, please clean that stuff up. Do not finish the bottle of Tide before you switch. Ditch it. Ditch it. It, it's just, it's not worth it. And I wanted to show a couple, a couple labs and then I gotta jump off. But, um, can you pull up this OAT test real quick? 'cause you're talking about mold in the home and, and how this may manifest and, and create issues with the gut and the skin.
And so if we're looking at an oat test, we can see a whole bunch of yeast and fungal metabolites. And you'll see this one here, number six. Tartaric acid is high in this person, and that's sky high. I mean, we want less than six and a half. This person wasn't 84. So if you look like this on paper, you can absolutely have issues with not only chronic fatigue, mood, uh, depression, uh, sleep issues, but skin issues.
I, I wouldn't be [00:17:00] surprised
Dr. Justin Marchegiani: a hundred percent. And when we look at. Mold. So a lot of these things, right? You just set it and forget it. They're like, they're lifestyle changes, meaning like you change the detergent, you get rid of all this stuff, you get a really good air filter, like it's just set it and forget it and it's done.
You live your life with food, you know? You gotta make these changes and decisions every day. Then if we have gut issues, you know, we have to be a little bit stricter outta the gate. We're gonna have to maybe look at getting your enzymes and your acid and your bile vi. Then if it's chronic digestion issues, motility stuff like constipation or gas or diarrhea, we gotta look at that.
And then of course, infections play a major role, right? A lot of these immune issues, they can be impacted, um, by. Infections. And so pull up this page three
Evan Brand: here, pull up that page three. Let's show people that. 'cause when you're saying infections, we're like, what the heck does that mean? Is that like, uh, I don't know, I got, I got tetanus.
No, this is stuff you're gonna see on a stool test, which for folks on the audio, you're missing it. But on the video here, you're looking at Ella, you're looking at strep and staph. So this is what he means when he says infections. Correct. And then these
Dr. Justin Marchegiani: [00:18:00] things can impact the immune system. It can impact the TH two immune response.
It can throw off the immune system. And so getting the infections eradicated can be helpful. And people wanna look at these things in a reductionistic way. Well, like what's the one thing? It's like, well man, you may have infections, you may have food, you may have gut permeability, you may have low stomach acid and enzymes in bile.
You may have a lot of environmental toxins. You may have mold. It could be 10 things on that list. Each time we peel one thing off, we're gonna get five or 10% improvement per month. But if I go through our list, we make sure we address all the low hanging fruit, and as long as we're getting about 80% of the big, big stressors, your body has the capacity to heal.
Yeah, we, we
Evan Brand: took
Dr. Justin Marchegiani: my kids big barriers.
Evan Brand: We took, we took my kids and well said, we took my kids to a pickleball lesson yesterday. Oh, nice. And uh, and so the lady, I don't know, you know, you know how this works, man. You, you just like wind up in these conversations in front of these people. Yeah. Where God, God puts you in front of these people.
Sure. Or whatever. This lady sitting there watching her kid play starts yapping to me about mold and then gets into Lyme and Babesia and, and then my wife, she's [00:19:00] like, wow. She's like. You just did a consult with that lady? I'm like, no, not really. This is just like my everyday conversation. 'cause the way you and I, the way you and I banter back and forth like this, I, I could see some, some person that, that's maybe not used to listening to stuff like this just go, okay, I'm just gonna throw my hands up, but for you and I, it, it's easy.
And, and so I told her, I'm like. That wasn't really a consult for me. That's just my everyday conversation. So maybe that's heavy to the average listener, but that's just the way it works. It could be seven or eight or nine or 10 variables and, and this is why Dermatology's likely not gonna fix it. This is why just GI is not gonna fix these issues, unfortunately.
It's a web and I, I encourage people to embrace that web. And does it take a little more time for us to see everything? Yeah, sometimes. Like it's not put the steroid on and two days later the skin's better. You know, it's not a two day fix, but within a reasonable amount of time. You and I have cleared up thousands and thousands and thousands of skin issues.
Dr. Justin Marchegiani: Correct. And the mainstream medications that are typically used, you know, for eczema, sometimes they'll [00:20:00] use corticosteroids, which can thin out the skin barrier. So you gotta be careful with that. Um, you have things like odele or um, piro or tacrolimus, which are gonna be a calcium urine inhibitor. And that does help reduce the t t-cell activation.
It does decrease IL two, interleukin two and other cytokines. And that can be helpful to modulate the immune response in the short term while you fix everything else. But if you're just suppressing the immune system overall, that's not good. And the other one is, uh, Eucrisa. That's a pd. E four inhibitor that blocks the phosphodiesterase four in the skin.
It raises tic a MP, it down modulates inflammatory signaling nuclear fat to Kappa Beta, and it lowers all the cytokines. And they use that for kids that are younger, you know, less than three for the Eucrisa, and the LL is older for adults. There is a cancer warning on that if you use it and you smother your skin in it for years.
There's a lymphoma warning on that. But again, if you. These medications are used, it's for a very short period of time while you're getting to the root cause. I tell patients I'm not [00:21:00] anti-medicine, I am pro root cause. And if medicine is being used while you're getting to the root cause, and it's a simple stop gap to help push you in the right direction,
Evan Brand: I'm okay.
Just make sure the root cause is being addressed. Amen. Amen. Well, I gotta run. My kids are coming in here. They're all over here staring at me, so, uh, excellent. Like literally all right here. Hey.
Dr. Justin Marchegiani: Alright girls.
Evan Brand: Alright, so Daddy's, daddy's gotta run.
Dr. Justin Marchegiani: You have to put 'em on the screen. Make him famous Haven, Evan, have all, not
Evan Brand: today.
Not today,
Dr. Justin Marchegiani: no. Okay,
Evan Brand: then don't wanna jump on. We gotta roll. We gotta roll. Alright man, so I'm gonna get outta here. Alright man. Alright brother. Good chatting with you bro. Yeah, thank you all for tuning in and uh, maybe Dr. Jay's gonna finish riffing it out.
Dr. Justin Marchegiani: Yeah, head over to evan brand.com, reach out to Evan, functional medicine consults worldwide.
We'll also look at mold, lifestyle, all the things we talked about. And then myself, Dr. jay@justinhealth.com. We are here for you. We schedule worldwide if you want that support. You guys have an awesome day. Take care y'all.
Evan Brand: Thanks so much for being here. All
Dr. Justin Marchegiani: right, you too. Bye. Peace.
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