Mosaic Diagnostics offers a myriad of lab testing options that can assist in the determination of dermatologic underlying causes. This blog provides an overview of various tests we offer will give clues and answers to why one may be dealing with eczema, psoriasis, acne, etc.

Our skin, the largest organ, is the outer layer in which the world first encounters us. This holds true not only in social or professional impressions, but also health impressions made by practitioners. The skin is often a window into someone’s internal health complications. It helps to express dysfunction in a visual and even tactile manner. By visible rashes, lesions, the sensation of dryness and pruritus we can get an understanding of what may be happening or not happening properly in the body. Through the practice of functional medicine, we understand the role of nutrition, underlying gastrointestinal dysbiosis and overgrowth, and the potential for toxin exposures as underlying causes in the precipitation of dermal symptoms.

Mosaic Diagnostics offers a myriad of lab testing options. These options can assist in the determination of dermatologic underlying causes. Various tests we offer will give clues and answers to why one may be dealing with eczema, psoriasis, acne, etc. 

Nutritional Testing

In many cases of dermatologic conditions, various nutrients play a role in healing. Due to the nature of the human body, a wide array of vitamins and minerals are necessary for normal skin health and integrity. In times of depletion, our skin can tend to become dry, flaky, easily wounded, slow to heal, etc. With many following a standard American diet, a lot of individuals are naturally nutrient deficient. Considering the following profiles for testing can shed some light on where people need to supplement. Some of the most beneficial tests we offer include the Omega 3 Index Complete, the Advanced Cholesterol Panel, a Pyrrole test, the OAT, and metal testing profiles.

First, let’s look at the benefits of assessing omega fat status. Fatty acids are the building blocks of cell membrane formation of the stratum corneum. When the cell membrane is properly formed and functioning, there is selective permeability. This allows for nutrients to get in and discernment of entrance to other foreign molecules. Without adequate fatty acid balance, the skin’s selectivity decreases. This decrease leads to a loss of nutrients and an increase of foreign substances. Also, an increase of the wrong fatty acids can make the cell membrane less fluid and supple.

The Omega 3 Index assesses not only omega 3 status but also omega 6 and 9 status. Some individuals have adequate fatty acids in the body, yet the incorrect amounts of specific types that encourage health. Too many omega 6 and 9 fatty acids in relation to omega 3 encourage inflammation and skin barrier dysfunction. Knowing what the fatty acid profile is composed of can help practitioners adequately counsel on diet and supplementation. Trans fats are also tested. An increase of these leads to stiffness, photoaging, and increased damage from UVR. this may be beneficial in someone with skin cancer or a family history of skin cancer, and even in those living in a high UVR area with elevated exposure rates. Having adequate omega 3 fatty acids has been shown to reduce symptoms of psoriasis, eczema, acne, rosacea, and increases quality of life for these individuals. 

Another test that looks at the benefit of fat in skin health is the Advanced Cholesterol Panel. Cholesterol seems to have had a bad reputation for a while now due to its inflammatory nature when it accumulates. One thing about it is that in the right amounts it is very beneficial and necessary, especially for our skin. Cholesterol partners with fatty acids and ceramides in the stratum corneum to protect and maintain skin barrier function. With the lack of cholesterol and these other products, the transepidermal water loss (TEWL) is increased. This leads to dryness, scaling, and irritation as often seen in atopic dermatitis and other inflammatory skin diagnosis. Individuals with atopic dermatitis have been shown to have lower amounts of cholesterol in the skin. By testing cholesterol, we can understand if the person isn’t able to make enough cholesterol. This could be why they are experiencing their skin condition. By increasing cholesterol rich foods and potentially topical cholesterol, the skin barrier can be restored. On the other hand high blood cholesterol is also detrimental. Various inflammatory conditions including acne, psoriasis, and atopy have been associated with dyslipidemia. The profile seen is elevated total cholesterol, LDL-C, VLDL-C, and triglycerides are seen with a decrease in HDL-C. This increase in more inflammatory cholesterol shifts the immune system to a Th2 immunity more prone to immunoglobulin production and inflammation. So assessing a cholesterol panel is beneficial in any dermatologic condition and should be considered.

Nutritionally, we also need to consider vitamin and mineral status for skin health. Many B vitamin deficiencies lead to very visible skin signs. Cheilosis, dry, cracked lips are signs of riboflavin (B2) and pyridoxine (B6). Due to these visible signs, having an OAT profile is a great way to understand someone’s need for supplementation. B6 deficiency also internees with proline synthesis and thus collagen this leads to pellagrous changes in the skin, most commonly associated with niacin deficiency. Another vitamin to consider when viewing an OAT is vitamin C. Vitamin C is key in the role of wound healing and collagen synthesis.

Other nutrients to consider for collagen synthesis and normal skin elasticity and production are copper and zinc. Copper is necessary for the production of collagen along with vitamin C. Zinc on the other hand, has many more roles in skin strength. This mineral is antioxidant, plays a role in skin cell formation, cell wall stability, cell division, and protects from UV radiation damage. Zinc has shown great efficacy as a treatment for various skin diagnoses. A common, major diagnosis of acne is well documented in successful treatment with zinc. Psoriasis, keloids, pruritus, anti-aging, vitiligo, keratosis, melasma, basal cell carcinoma, alopecias, eczema, and rosacea have all been successfully treated and supported with zinc addition. A great way to assess zinc status, especially in relation to copper, is via the Copper/Zinc Profile. This profile measures serum zinc and copper, plus additional ceruloplasmin and copper/zinc ratio. This will assist practitioners in dosing zinc and copper without disrupting their delicate balance with one another. The Krytptopyrrole profile is another great test to consider. Pyrolurias are crucial to rule out when someone is depicting B6 and zinc deficiencies despite supplementation. If positive, this could explain why the person doesn’t have adequate B6 and/or zinc as the pyrroles are binging so they are not available for use. Higher doses would be necessary to support one with a pyrrole disorder. Also reducing any stress or other triggers of pyroluria is helpful in increasing vitamin status.

Additional nutritional tests to consider are a vitamin D test, iron profile, and essential metals via hair, blood, or urine. Vitamin D is important to test for as it protects against UVR and regulates immunity. With decreased immunity, there’s an increased risk of infection or dysbiosis that can lead to dermal symptoms. Along with iron it’s also required for epidermal proliferation and differentiation. Iron additionally is needed for adequate red blood cell formation and perfusion. In anemic states, if RBCs are lower there is less oxygen and nutrients getting to the periphery of the body. This nutrition decrease leads to deficient epidermal cells that can lead to dryness, cracked skin, etc. Testing for other essential elements is also crucial. Nutrients like chromium and vanadium being deficient may be the cause of blood sugar dysregulation leading to changes in skin like ulcers and poor wound healing. Other essential minerals are cofactors of collagen and skin cell production and being deficient could be the catalyst for skin dysfunction. Understanding one’s nutritional needs may be the answer or one of many answers that aid in healing.

Hormone Testing

Another body system highly associated with skin symptoms is the hormonal system. In women, oftentimes an imbalance of estrogen, progesterone, and even testosterone are stimulants to acne. In teens, during puberty, a classic sign of hormonal changes is facial, chest, or back acne. Fluctuations in hormonal cycles can make acne cyclical in its eruptions. Stress and increased cortisol levels will also stimulate skin eruptions. Prolonged increases in cortisol have been shown to lead to immunosuppressive outcomes. It leads to increased antigen presentation and antibody formation, increased cytokine release, increased lymphocyte proliferation, and an immunity shift from Th2 to Th2. This shift has been associated as a driving force in many skin conditions. Due to the connection of adrenal and sex hormones on skin barrier function and immunity assessing the Saliva Hormones Panel will round out your assessment.

Toxin Testing

In the event of increased toxic load the body will use all eliminatory organs. This includes the skin. In order to protect vital organs from toxic effects the skin is a large, easy route of elimination. In those that are more prone to skin disturbance due to allergies and or an upregulated Th2 immunity, the skin is a targeted resource for additional detox support. During an exposure, the liver and kidney can get overtaxed and overburdened while trying to remove toxins so the skin may be recruited to assist. Also consider toxins in those that are nutritionally deficient. Without proper nutrition the integrity of the skin is decreased making it weaker and more porous.

Contact dermatitis to certain toxins is a common cause of dermal symptoms. Think of nickel allergies or hives due to certain detergents and the chemicals they may contain. Assessing a heavy metal exposure test and a TOXDetect Profile can assess various exposures through water supply or other industrial processes or products. Mold and their toxins also shouldn’t be excluded. Mold toxins themselves can be immune altering. Due to their immune altering nature B and T cell activity is impaired. Natural killer cells are inhibited. This immune dysregulation leaves the affected susceptible to infection and dysbiosis that can trigger a shift to Th2 immunity. Also consider Glyphosate testing. 54% of the human microbiome has been shown to be sensitive to glyphosate. This is a potential reason for dysbiosis. Ruling out toxic exposures can be a simple way to uncover an often hidden trigger of dermatologic conditions. Plus detoxification support can be a good way to begin relieving irritation.

Immune Activation and Dysbiosis

Other stimulants or triggers of dermal symptoms are immune activation and dysbiosis. Often these two go hand in hand. The most common immune activation is IgE. This allergic type reaction is usually quick to occur when the offending substance is encountered. Consider evaluating the IgE inhalant and Food panels we offer. Recently we have rolled out a new IgE panel that assesses allergic reaction to  various species of mold. As stated before mold toxins can stimulate dermal symptoms. The MycoTOX Profile, OAT, and IgE Mold panel are a wonderful trio of assessments to use simultaneously to see what a mold exposure may look like and how it is affecting your client’s health. 

With a dysbiotic microbiome, there is a potential for increased inflammation and potential for GI permeability. This permeability can lead to antigens, especially food getting into the bloodstream and triggering antibody production. The resulting inflammation is commonly perceived as a rash, eczema, acne, rosacea, etc. Assessing for IgG, or delayed reaction, to foods can be helpful in eliminating offending triggers from the diet. Eggs have been shown to be a common, strong trigger for eczema in particular. This may not completely relieve all dermal symptoms, but avoidance will definitely help to reduce flares. This will also aid to reduce inflammation in the GI tract. Elevated GI inflammatory markers have been associated with common conditions like eczema, psoriasis, and acne. Other conditions include hidradenitis suppurativa (HS), erythema nodosum (EN) and pyoderma gangrenosum (PG). A good amount of these conditions have been shown to be a comorbidity to a diagnosis of IBD. The consideration of a Comprehensive Digestive Stool Analysis (CDSA) is prudent in assessing the cause of almost any condition. It tests for GI inflammatory markers as mentioned above and also micro organisms in the stool. Understanding the bacterial, fungal, and parasitic terrain of the gut can pinpoint what is causing inflammation and areas that can be addressed effectively. Our profile also will provide a sensitivity to various prescription and non prescription agents to address any dysbiotic flora. This can be helpful in the treatment of excessive overgrowths.

The other benefits of the CDSA include the digestive markers. When these are showing low pancreatic enzymes and/or food fibers in the stool there is reason to believe that the client is not doing a great job of breaking down food and absorbing nutrients. Even a healthy diet can’t fully help someone with an absorption issue, and this could be the underlying cause of their symptoms. The short chain fatty acid section (SCFA) is also beneficial. Various skin conditions have been linked to low SCFA and improved with the increase of them. They are helpful in reducing inflammation and improving the integrity of the epithelial layer of the GI tract. One more beneficial secion is the assessment of secretory IgA (SIgA). In too low or too elevated amounts have both been associated with increased inflammation and expression through the epidermal layer. By understanding the immune response, it can either be supported when low or investigations of why it is low can be determined when there is pathogenic or dysbiotic flora populating and a larger immune response is expected. This CDSA profile is comprehensive and informational for anyone dealing with dermal complaints. On the profile, expected bacteria section is also beneficial to know what need there is for good bacteria like Lactobacillus. Many studies have shown the benefit of this probiotic in reducing dysbiotic flora and reducing dermal symptoms. For the intestinal microbiome also consider running a urine OAT panel. Marker 1, citramalic, can be produced by Propionibacterium acnes. This organism has been directly correlated with acne. Evaluating the OAT in addition to a CDSA, will round out your investigation with specific mold and fungal markers, as well as specific clostridia markers.

Overall, dermatologic conditions can be elusive. Sometimes it is difficult to name one cause of their existence. Our wide array of testing makes finding the cause or causes of dermal symptoms much more comprehensive and feasible. Considering combining urine tests is great for simple sample collection for anyone. This is a great technique for beginning your inquiry for narrowing down root causes of dermatologic complaints. From there other blood, serum, stool testing can be done for a collective look at your clients.


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Diagnosing Molds, Mycotoxins, and Things that Go Bump in the Night

About the Author


Jasmyne Brown is a board certified and licensed naturopathic doctor.  She earned her Bachelor of Science in chemistry with a minor in biology from Alabama Agricultural and Mechanical University in 2013. In 2017, she earned her doctorate in Naturopathic Medicine and master’s degree in Human Nutrition from the University of Bridgeport College of Naturopathic Medicine. Her educational background and her experience as a WIC nutritionist with the Florida Pasco County Department of Health allows her to convey complex concepts in a manner that can be grasped by anyone on multiple levels. She is thrilled to be a member of the MosaicDX team and hopes to bring an understanding of functional medicine to all who seek it. She will be using her professional training to interpret clinical data from MosaicDX lab tests and further her passion for identifying the biochemical pathways within our bodies and how nutrition and lifestyle impact them.