The Epigenetic Approach to Symptomatic Skin

Every fall, I see an uptick in clients reaching out for support, even amongst those whose skin appears stable, there’s often an underlying worry that symptoms will return. Clients whose skin feels perfect all summer long often find themselves in a place of vulnerability as the seasons shift.

Whether it’s perioral dermatitis, breakouts, or eczema, I notice the same pattern year after year as we move towards winter. When our skin becomes reactive, the natural tendency is to find the culprit. We want to identify the one thing that caused the flare: The weather? “Was it that new serum?” “Maybe it’s fragrance #1.” “Is it from food?” Or we fixate on a moment, the glass of wine last night, eating out, or the product we used once.

But in my experience, after years of working with clients through these cycles, it’s never just one thing (and to be blunt, you will likely never know exactly what caused it). More importantly, spending our energy searching for that single cause often pulls us away from what really matters: helping the body and skin regain health and resilience. Embracing the mystery and remarkable sophistication of our bodies can take some of the pressure off, reminding us we’re not solely responsible (or in control) for our health.

In this piece, I’ll share a few case studies that break down my approach to managing the seasonal vulnerability that often arises in fall and winter. Everybody is unique and every symptom reflects multiple interacting factors, but my hope is that this serves as a framework, a way to think through what’s happening—how to navigate it and to avoid the common traps when feeling at a loss. 

The goal with all of my symptomatic clients is to move from a place of vulnerability into a place of resilience. To shift the focus away from simply avoiding symptoms toward finding our own full body balance. For the purposes of this piece, I am not addressing chronic skin conditions such as eczema or psoriasis.

Case Study #1: Chelsea

Chelsea is in her mid-thirties, of Asian descent, with thick, gorgeous, oily skin. Three to four months after having her second child, she developed extreme dryness around her mouth and eyes during the fall and winter months (very common). This was new for her, and she felt unsure how to manage it.

Without diving immediately into her health history, we began by narrowing down the most likely variables. I often start by approaching from a microbial lens, and in Chelsea’s case, the simplest hypothesis was yeast overgrowth. I explained that we could assume her skin’s natural yeast population had shifted, perhaps feeding on her sebum and creating dry, red, flaky patches.

We didn’t need to know exactly why this would occur or where it started right away. We simplified her routine, removing all oils and focused on acid balance, strategic antimicrobials and barrier support; Rescue Tonic and Barrier Restore Serum. Within a few weeks, her symptoms resolved. We maintained that minimalist approach through the winter, then slowly reintroduced her regular products as spring arrived.

For Chelsea, the environmental factors, temperature, humidity, and the natural moisture balance in her skin, seemed to be enough during the warmer months to prevent microbial imbalance. But as fall returns, so does the question: Will it happen again?

That fear is common. Many people carry anxiety that their symptoms will return with the season, with travel, or with stress. I believe that a healthy body holds the tools it needs to heal the skin, regain balance so that we don't have to exist on the fine line between balance and symptomatic.

In Chelsea’s case, two possibilities could be true:

1. By reducing microbial overgrowth and supporting her skin’s natural moisturizing factors, the skin was able to heal and strengthen, perhaps fully restoring its balance. Her symptoms were not completely surprising. The body undergoes massive shifts postpartum, and usually around the 3-4 month mark there is often a lack of resources.  It is possible that as time went on her body was able to rebalance hormonally and recover from the significant deficiencies many face after pregnancy, thus reducing overall vulnerability to such symptoms.
   

2. Or, also very likely, while her skin became stronger and more resilient, the deeper imbalance, perhaps an internal yeast overgrowth or immune sensitivity, was never fully addressed. If the body or environment shifts again (for instance, her skin becomes slightly too dry or too alkaline), symptoms may resurface.

So what can she do? When I think about a resilient body and skin, I look at a few core aspects of life. These are the foundations that support recovery and balance:

Sleep—how we rest and repair each night.

• Aim for consistent, quality sleep.
  

• Pay attention to how you feel upon waking: it tells you a lot about your body’s ability to rejuvenate.

The Nervous System—our ability to move between states of activation and rest.

• Become aware of when you’re operating in fight-or-flight.

• Think of the nervous system as a muscle- it needs to be trained, to practice, when we are calm so that it may respond when we need it to.
  

• Build tools that help you shift back into calm:  breathwork, movement, visualization and meditation.

Nutrition and Blood Sugar Regulation—how we fuel and stabilize the body.

• Support nutrient density and diversity (35g fiber daily, 30 different vegetables weekly)

  • Many clients I’ve worked with, when suddenly symptomatic, assume that food is the root cause. The common response is to restrict food intake. While cutting out highly inflammatory foods can be very beneficial at times, it is important to note that a restricted diet should be short-term, as prolonged restriction can lead to microbial dysbiosis. Instead of immediately assuming the solution is to restrict, I suggest approaching it from a different angle: consider which foods might be especially nourishing, or which food groups you could eat more of. Focus on creating a body that is well-resourced rather than depleted when symptomatic.

For example, if histamine intolerance is your concern, rather than immediately implementing a low-histamine (restricted) diet, consider going one level deeper: support the gut lining, boost probiotics that “crowd control” histamine-producing microbes, and implement strategies to support elimination and detoxification pathways.

• Regulate blood sugar to maintain hormonal balance and reduce inflammation.

  • Dysregulated blood sugar is likely to result in hormonal and metabolic imbalances and poor sleep cycles.

Pathways of Elimination and Detoxification—the body’s natural ability to process and eliminate waste.

• Support all aspects of gut function and ensure daily elimination.

• Histamine processing is a key part of gut function, and when it’s impaired, it can contribute to both digestive and skin symptoms.
  

• Encourage microbial diversity.

• Start with diet, then turn to probiotics.
  

• Support your ability to process histamines and hormones effectively.

• When the gut lining is compromised, histamine can accumulate in the body.

Hormones—our internal rhythm and communication system.

• Understand whether your body is producing hormones appropriately at certain times.

  • Tapping into lifestyle techniques to support optimal hormone production.
    

• Consider that external stress, diet, and sleep all directly affect hormone balance.

  • Cortisol raises blood sugar, insulin lowers blood sugar, chronic stress can lead to elevated insulin.

  • Chronically elevated insulin levels can alter ovulation rates and levels of reproductive hormones.

There are many ways to explore these categories and a wide range of testing options but each comes with pros and cons. It’s important to remember that tests provide only a snapshot in time and can vary greatly day to day.

Allergy tests, for example, can be helpful short-term tools to identify triggers. But avoiding allergens isn’t the full solution. It’s essential to ask why your immune system is reacting that way in the first place. Without that deeper repair, you remain vulnerable. Research shows that most food based intolerances are actually acquired through the skin. Similarly for environmental allergies. The skin is meant to serve as a protective mechanism keeping a strong barrier between our immune cells and the outside world, however products, treatments and lifestyle can all break down this layer creating multiple entry points. Same goes for the gut lining. 

Stool, blood, hormone, or urine tests can offer valuable insight into how your body is functioning, but I see them as starting points, not answers. When it comes to skin, hormones may be the first thing to blame but rarely, if ever do I see someone come back with hormone panels showing major imbalances.

My preferred approach is to look at each of these areas holistically and assess where your body may need support. Testing and supplementation can be helpful, but the real work lies in building foundational health over time. None of these systems shift overnight.

Remind yourself that your body is unique, your symptoms are information, and your healing path will look like no one else’s. By focusing on consistent, aligned habits and supporting your body from all core functions, you allow true repair, not just temporary relief.

Case Study #2: Daniela

Daniela lives a fast-paced, travel-heavy life. She works long hours, moves through multiple time zones, and often eats and drinks differently while she’s traveling. During one of these trips, after several weeks of late nights, plenty of wine, and a diet heavier in bread and sugar than usual, she noticed redness developing under her nose.

She went to a doctor who prescribed a topical steroid cream. The redness quickly calmed down.

What Steroids Do

Topical steroids work by suppressing inflammation and the immune response in the skin. They provide fast relief by signaling the body to stop the inflammation. The problem is that while this quiets visible redness, it also suppresses the body’s natural defense mechanisms, including the processes that repair the skin barrier and regulate microbial balance.

In Daniela’s case, the stress didn’t ease up. She continued traveling, working, and sleeping irregularly. When she returned home to Los Angeles, the steroid stopped working. Practically overnight, the redness spread into a larger patch of flakiness and pustules.

The doctor prescribed another cream, this time for dermatitis, but it did little to help. Next came an antibiotic, which worked for two days before things got dramatically worse: new pustules, more redness, and a flare that felt completely out of control.

What Antibiotics Do

Antibiotics target and kill bacteria, but they don’t discriminate between beneficial and harmful species. They can temporarily reduce inflammation by wiping out bacteria on the skin’s surface, but they also disrupt the delicate balance of the skin microbiome. Once the beneficial bacteria are gone, the skin is more vulnerable to opportunistic microbes, including yeast and resistant bacteria, which can multiply quickly and cause the symptoms to return, often more aggressively.

By this point, the pattern was clear. Daniela’s body and environment had shifted in ways that allowed pathogenic overgrowth, particularly within the nasal mucosa. That small change inside her nose, likely driven by immune stress, travel fatigue, and dietary shifts, became the source of skin inflammation around the mouth and cheeks.

The dryness around her nose created a perfect gateway for those pathogens to spread from the nasal tissue to the face. The steroids had suppressed her immune response and calmed the inflammation, but they also shut down the body’s ability to restore and strengthen its barrier. The true cause: microbial imbalance and barrier dysfunction, which was never addressed.

As her skin became increasingly dry, she tried to compensate by applying rich, heavy creams. While this felt soothing at first, it further disrupted the microbial ecosystem, creating an environment where yeast and bacteria could thrive.

The antibiotic offered a short reprieve until it didn’t. Bacteria are highly adaptive; they communicate, share resistance mechanisms, and learn to survive medications. Meanwhile, the yeast that naturally coexist on our skin unaffected by the antibiotic continued to multiply in this new, favorable ecosystem.

Daniela’s experience is a perfect example of how quick-fix treatments can unintentionally exacerbate dysbiosis and delay healing.

When we finally connected, our approach focused on restoring balance, not killing, suppressing, or erasing. We simplified her routine (see below), rebuilt barrier integrity, and supported her system internally through stress management, sleep support, and gut repair. Over time, the skin calmed, the barrier strengthened, and her body regained its ability to self-regulate. She is free to return to a fast paced life and experience stress as we all do without fear of the symptoms returning—and if they do, she knows what to do.

Summary

Both Chelsea and Daniela’s stories reflect something I see constantly in practice. Their symptoms, dryness, redness, flaking, breakouts and the influencing factors involved are varied, but the route towards healing is more similar than we often assume.

In both cases, the initial instinct was to control or suppress the symptom. It’s understandable—when things happen on our faces it's traumatic, triggering, and scary. We’ve been conditioned to believe that if we can just stop the flare, the problem is solved. But the skin doesn’t work that way. The skin is influenced by many, many variables—the nervous system, the gut, the immune and endocrine systems, and when we attempt to stick to a topical only approach we miss the opportunity to move completely out of the vulnerable state. 

The resilience occurs when we create conditions for the body to step in and do the necessary steps required. This takes time, patience, and a willingness to look beyond the surface. Instead of asking, “What’s causing this rash?”, a more helpful question is, “What can I do today to support some of the foundational principles of health?”. I want to emphasize that for many, this approach can feel daunting, boring, or like you’d rather do anything besides confront the reality of your lifestyle, and I empathize entirely. However, what I have witnessed from clients as they enter a deeper state of health is beautiful and inspiring!

As the seasons shift, many of us will feel more vulnerable. Colder air, lower humidity, and increased stress can all change the skin’s ecosystem. The key is not to fear this change but to meet it with awareness, to support the body so it can adapt. That might mean simplifying your routine, adjusting your sleep or diet, or finding moments to regulate your nervous system.

Overcoming symptoms isn’t about perfection or control. It’s about learning to work with your body rather than against it. Over time, that partnership builds resilience, and resilience allows the skin to represent that state, no matter the season.

Note on What to Do If Your "Products Aren't Working Anymore"

Both Chelsea and Daniela could easily have assumed their products had stopped working, that their skin had become “sensitized” or that they needed something new. But in each case, the shift wasn’t about the products themselves; it was about what was happening to their overall health.

When the body is under stress, when sleep, hormones, or digestion are off, or when the microbial balance of the skin shifts with the seasons, even the most supportive formulas can feel less effective. That doesn’t mean they’ve failed; it means your skin’s needs have changed.

In these moments, it’s natural to start scanning labels and questioning ingredients; wondering if an oil, active ingredient, or preservative is the issue. While ingredient awareness is (somewhat) important, it’s easy to fall into the trap of over-scrutinizing formulas instead of seeing the bigger picture. Products and ingredients rarely cause imbalance on their own; they simply interact with the state your skin is already in. When that internal or barrier environment shifts, even gentle or familiar ingredients can feel reactive. I like to give the analogy of wine- for most a glass of wine is tolerable, the body can metabolize and you can recover with little to no side effects. However, if your health is compromised- say you are experiencing histamine intolerance, one little glass might result in a bright red cheeks, headache, and feeling off for days. The common reaction would be to think “hmm, something must be off with me”. The same goes for skin and products! 

It’s a common moment of confusion: you reach for new products, eliminate others, or adjust your routine entirely, hoping to fix what feels off. But real improvement doesn’t come from buying more and more or avoiding ingredients. It comes from understanding what your skin is presenting and supporting the body’s ability to self-regulate.

My suggestions for these scenarios are easy: Simplify. Focus on the categories we discussed above, go back to the basics. If your skin can't tolerate anything, then it can't. Give it a break and as your internal and external environments stabilize, your skin’s resilience returns, and the products that once felt like the culprit will return to their beneficial state.

Example Regimen for Stabilizing Skin

If your skin seems to react to everything, the first step is to step back, simplify, and stay curious. When skin is dry, red, inflamed, rashy, or bumpy, it’s usually a sign that a few of the basic principles of the skin barrier are out of balance. I always start by considering the acid mantle and the natural moisturizing factors that help the skin function optimally.

I like to think of reactive skin as an ungrounded wire that needs to be properly encased, as the way we tend to perceive sensation can be proportional to the level of imbalance. Since there’s almost always a microbial component to symptomatic skin—we live in a world of bacteria, and our skin is covered in them—it can help to limit heavy oils, occlusive creams, or balms for a short period and simply observe how the skin responds. I typically give the skin about three days for any “experiment” before reassessing, which often provides a lot of insight into what it truly needs.

Suggested AM+PM Regimen for Highly Reactive Skin

Our products are not designed to instantly eliminate symptoms. Instead, they provide the elements your skin needs to stay healthy, helping resolve visible symptoms while you continue to focus on supporting internal health. A little tingling or flushing is fine! Burning, not fine.

1. Balancing HypoTonic or Rescue Tonic (in cases of pustules or breakouts)

1. Theory: if you can reinstate proper pH Balance, the hydration levels will normalize and it is the best environment for a harmonized microbiome.

2. Barrier Restore Serum (this too can tingle a bit if skin is dehydrated)

1. Theory: Natural Moisturizing Factor balances moisture levels and reduces inflammation. 

If skin is improving after some time, add in:

1. Soothing B3 Serum: am/pm or as often as you'd like.

2. ColorFree Zinc Sunscreen SPF 32

3. Multi-Retinol Night Emulsion: this is wonderful at helping support the epidermal junction and shielding the immune system from the external world, amongst other things…

4. Barrier Lipid Complex: if your skin feels very dry and you have no breakouts or pustules.

Any topic discussed in this article is not intended as medical advice. If you have a medical concern, please check with your doctor.

Resources

Skin Longevity Explored, Subtack by Marie Veronique Nadeau

In the FLO and WomanCode by Alissa Vitti

The Book of Lymph by Lisa Gainsley

Permission to Rest by Ashley Neese

Salad for President by Julia Sherman

Fast Like A Girl by Dr. Mindy Pelz

Glucose Revolution by Jessie Inchauspe

Eat More, Live Well: Enjoy Your Favourite Food and Boost Your Gut Health with The Diversity Diet by Megan Rossi

The Gut Microbiome: Exploring the Connection between Microbes, Diet, and Health by Ana Maria R. Moise 

Unwinding Anxiety: New Science Shows How to Break the Cycles by Dr. Judson Brewer

A Grain Of Salt, Substack by Samin Nosrat