Author’s Note
The skin as elimination organ is one of the cleanest terrain teachings there is, and it is the one dermatology cannot allow itself to consider. Every intervention the specialty offers depends on the skin being a barrier to seal rather than a channel to support. Change that one assumption and the whole treatment ladder reverses.
This is another entry in the Trained Not to Tell You series. Like the earlier variants, it proceeds from a single observation: the specialist you are seeing is a graduate of a curriculum reshaped a century ago by the Rockefeller and Carnegie foundations, and the specialist is doing what that curriculum authorised. The fault lies in the training. Reading this essay as an attack on your doctor is a category error.
If your child has eczema, or your teenager is being handed Accutane, or you have been on Dupixent long enough to notice it never resolves the underlying condition, this essay is for you. It is also for the dermatologist willing to read it.
The essay also names something dermatology cannot name: much of what walks into the clinic began somewhere else. Eczema at three months, cystic acne cycling through antibiotics, the adult on lifetime biologic, all sit on a trajectory with an initiating event the specialty is not organised to investigate.
The skin is the largest elimination organ in the body. Adult skin covers roughly two square metres and processes waste continuously through sweat glands, sebaceous glands, and the shedding of dead cells. What leaves through the skin includes urea, salts, heavy metals, pharmaceutical residues, and the byproducts of cellular metabolism. When the liver, kidneys, and bowels cannot keep up with the toxic load, the body pushes waste outward through the skin. Rashes, eruptions, oiliness, dry patches, and scaling are the body doing its job under overload conditions.
Dermatology treats every one of these signals as a disease to be suppressed. Steroid creams drive the eruption inward and thin the skin. Long courses of tetracyclines destroy the bacterial ecology of the face and gut. Retinoid drugs strip the sebaceous glands of the capacity to eliminate through the pore. Biologic injections costing around $50,000 a year block the molecules that would coordinate the body’s inflammatory repair response. At the end of that ladder, when the child prescribed hydrocortisone at age two has scarring cystic acne at seventeen, sits Accutane, a drug whose own label carries an FDA black box warning for birth defects and a second warning for depression, psychosis, and suicide.
None of this is your dermatologist’s fault. They are graduates of a curriculum reshaped a century ago by the Rockefeller and Carnegie foundations, which reduced American medical schools from 162 to 66 and installed germ theory and pharmaceutical suppression as the entire diagnostic and therapeutic toolkit. Twelve things follow that this curriculum does not teach.
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Part I: The Frame
1. The skin is an elimination organ, not a barrier to be sealed
Herbert Shelton wrote in the 1920s and 30s that the skin, lungs, kidneys, and bowels form the four channels through which the body eliminates waste. When one is compromised, the others take on the burden. He called this vicarious elimination. Bieler in the 1960s described the same mechanism from the liver outward: when the master chemist cannot keep up, the endocrine glands become hyperactive and route toxins to whatever exit the body can use.
The sebaceous glands secrete one to two grams of sebum per day on average, carrying fat-soluble waste the liver would otherwise process. Sweat glands eliminate water-soluble waste, including heavy metals, which autopsy studies have detected accumulated in skin tissue. The epidermis renews completely every twenty-eight days on average, packaging cellular waste into shed keratinocytes.
The child whose eczema patch appears reliably at the same spot on the inner elbow every time a new food is introduced is showing you where and when the elimination burden has exceeded the primary channels’ capacity. Location, timing, and the material excreted carry diagnostic information.
None of this appears in the standard dermatology textbook. Andrews’ Diseases of the Skin, the American training text, treats the skin as a barrier to be maintained and a substrate for pathology to be classified. The organ’s function as an elimination route is absent. Once the elimination frame is missing, every subsequent intervention makes sense within a paradigm where the skin is doing something wrong rather than something necessary. Once the frame is present, most of dermatology’s interventions reverse themselves: you are no longer blocking a disease, you are blocking a body.
2. The skin is a diagnostic surface: read the map rather than erase the signal
The skin is the most accessible read-out of internal terrain the body offers. Where an eruption appears, what it looks like, what season it flares in, what foods precede it, what medications preceded that, what emotions cluster around it, all of it is data.
Hering’s Law of Cure, formulated in the nineteenth century by Constantine Hering and observed across homeopathic, naturopathic, and terrain practice since, holds that the body heals from the interior to the exterior, from the upper to the lower, and in reverse order of appearance. A patient whose disease was suppressed inward reverses that sequence when the body is allowed to heal. The eruption that returns during a fast or a clean phase is the same eruption that was suppressed years earlier by cortisone, and its return is the correct direction of healing. Under dermatology’s frame, the returning eruption is a relapse; under Hering’s frame, it is completion. The two frames produce opposite treatments.
Location carries information. Facial rosacea implicates the gut. Palmar and plantar eruptions suggest metals. Symmetric flexural eruptions indicate internal exposure rather than external contact. Sharp-bordered contact patterns follow what touched the skin. Timing does the same work: seasonal flares track what the body must process in that season, and eruptions on medication withdrawal are the body clearing what the drug was blocking.
The dermatologist trained to name the lesion and prescribe a treatment does not ask the diagnostic questions the skin is trying to answer. The skin is a map, and the training teaches only to erase the marks.
Part II: The Suppression Machine
3. Daily topical chemical exposure is what the skin is being asked to eliminate
The average adult woman in an industrialised country applies roughly 168 chemical compounds to her skin before leaving the house in the morning. Stacy Malkan documented this figure and its underlying product categories in Not Just a Pretty Face.¹ The compounds come from shampoo, conditioner, soap, deodorant, moisturiser, face cream, sunscreen, hair styling products, makeup, perfume, and nail polish. The average adult man applies over 80. Infants are bathed and moisturised with dozens of chemical compounds before their first birthday, applied over skin whose barrier function is not yet mature. None of these figures include exposures from laundry detergent residues on clothing, household cleaning products handled by skin, or environmental compounds absorbed passively across a day.
The specific offenders repeat across product categories. Phthalates, endocrine-disrupting plasticisers linked to reproductive and developmental harm, appear in fragrance products and nail polish under trade-secret protection (the ingredient label reads “fragrance” and the chemical composition is not disclosed). Parabens exert weak estrogenic activity and have been detected in breast tumour tissue and in the urine of nearly every American tested. Formaldehyde-releasing preservatives (quaternium-15, DMDM hydantoin, and others) release formaldehyde, a documented human carcinogen, slowly onto the skin. Sodium laureth sulphate is frequently contaminated with 1,4-dioxane; polyethylene glycols with ethylene oxide; ethanolamines can react with nitrites in cosmetic formulations to form nitrosamines. All of these are carcinogens. Lead has been detected in commercial lipsticks at concentrations that would be illegal in candy. Coal tar remains legal in dandruff shampoos. Toluene, a neurotoxin, is standard in nail polish. Each of these compounds is applied to the skin, the elimination organ, at daily frequency across a lifetime, and each is one of hundreds catalogued in cosmetic products currently sold.
This exposure is permitted by design. The 1938 Food, Drug, and Cosmetic Act exempted the cosmetic industry from pre-market approval; the FDA cannot require safety testing or issue mandatory recalls. The industry regulates itself through the Cosmetic Ingredient Review panel, established in 1976, funded by the industry’s trade association, and staffed by members the industry helps select. The panel has reviewed roughly a fifth of the approximately 10,500 ingredients used in cosmetic products. The European Union has banned or restricted more than 1,300 chemicals in cosmetics. The United States has restricted 11.
The dermatologist evaluating your rash has not been trained to ask what you applied to your skin that morning, because the framework does not consider chemical exposure to be within the specialty’s diagnostic scope.
4. Steroid creams drive the toxins inward
Topical corticosteroids, prescribed for eczema and psoriasis and dozens of other conditions, do not resolve inflammation. They block the body’s inflammatory repair response by suppressing local cellular signalling. The eruption fades because the body’s cleaning work at that site has been chemically arrested.
The evidence that this is suppression rather than resolution comes from dermatology’s own literature. Topical steroid withdrawal syndrome, also called red skin syndrome, was first identified by Marvin Rapaport at UCLA. Two systematic reviews describe over 1,400 documented cases.² Patients who stop long-term topical corticosteroid use develop burning, oozing, red skin, sleep disturbance, and desquamation that can spread to areas where steroids were never applied. In 2025, NIH researchers published diagnostic criteria distinguishing topical steroid withdrawal from eczema itself and found the condition is associated with distinct mitochondrial and metabolic changes.³
The mechanism is straightforward. The skin has been prevented from completing its elimination work. When the drug stops, the accumulated material comes out at once, often more violently than before and often over a wider area than the original eruption. The face, genitals, and skin folds are worst affected because these regions have the highest steroid absorption. The National Eczema Association concedes the condition is real, under-researched, and often misdiagnosed as an eczema flare, prompting more steroid use, which prolongs the cycle. The patient is now dependent on the drug that caused the reaction, and the diagnosis that would tell her so is not the one her dermatologist reaches for.
John Tilden had described the underlying frame a generation earlier. Enervation depletes elimination capacity; waste accumulates as toxaemia; symptoms are the body’s effort to expel it; suppression drives the accumulation deeper. Shelton named the resulting cycle the acute-to-chronic mechanism. What dermatology calls the atopic march, from infant eczema through childhood allergies to asthma and food sensitivities, is the predictable trajectory of an elimination system chemically blocked where it should have been supported. Its starting event is examined in Section 8.
5. Antibiotics for skin conditions destroy the microbiome and drive chronic disease
Doxycycline and minocycline are commonly prescribed for months to years for acne. Standard courses run six to twelve months, sometimes longer, and are often continued from adolescence through the early twenties.
These drugs do not target acne. They kill bacteria across the body, including the resident microbial populations on the skin, in the mouth, in the gut, and in the vagina. The 100 trillion microorganisms that inhabit a healthy human body outnumber human cells and perform functions in digestion, cofactor synthesis, hormone metabolism, and terrain regulation that the body cannot perform without them. Long-course antibiotics for a cosmetic condition are chemical devastation applied to a system whose function was not implicated in the acne to begin with.
The documented consequences accumulate. Antibiotic exposure in adolescence is associated with increased rates of inflammatory bowel disease in adulthood.⁴ Post-antibiotic candidiasis, fungal overgrowth on skin, and antibiotic-associated diarrhoea are so common they are treated as expected side effects rather than iatrogenic harm. Tetracyclines deposit in developing teeth and bone, and the oral contraceptive many young women take alongside their acne antibiotic can be rendered less effective by disruption of the gut flora that recycles estrogens.
The antibiotic resistance crisis is the same mechanism made unmistakable. Bacteria under pharmaceutical assault do not simply die. Many transform. Lida Mattman documented cell wall-deficient L-form bacteria arising from virtually any bacterial species under stress, passing through filters, resisting antibiotics, and reverting to walled forms when conditions change. Her work was nominated for a Nobel Prize. What emerges after a year of doxycycline is not a sterile face. It is a face colonised by fungi, resistant bacterial forms, and biofilm communities the body will now spend years trying to reorganise.
The terrain framework identifies bacteria as caretakers of the internal environment, responding to conditions rather than causing them. Béchamp called bacteria the flies to a garbage heap: their presence tracks the material available to process, not the cause of the mess. Killing them wholesale does not remove the mess. It removes the cleanup crew.
The dermatologist prescribing a year of doxycycline for teenage acne has not been trained to consider what a year of daily antibiotic exposure does to the ecosystem the drug indiscriminately affects.
6. The biologics: the fifty-thousand-dollar-a-year endpoint
Dupixent (dupilumab), a laboratory-produced monoclonal drug that blocks the receptor for interleukin-4 and interleukin-13, was approved by the FDA in 2017 for atopic dermatitis.⁵ Its retail cost is approximately $50,000 per year.⁶ Humira, Stelara, Skyrizi, and Cosentyx are prescribed at similar or higher prices for psoriasis and related conditions.
Interleukin-4 and interleukin-13 are cytokines, signalling molecules the body uses to coordinate its inflammatory repair response at sites of tissue insult. Blocking them does not resolve what is driving the response; it silences the signalling that would call the response into action. The rash improves because the body has been chemically prevented from mounting the response at all.
The pharmaceutical industry describes this as targeted therapy. The description is accurate. What is targeted is the body’s capacity to respond, not the cause of the response. When the drug is stopped the underlying elimination requirement is unchanged, and the condition returns. The prescription is chronic administration for a chronic condition that decades of suppression have themselves produced.
The psoriasis biologics operate on the same principle at different cytokines in the signalling chain. Humira blocks TNF-alpha; Stelara blocks IL-12 and IL-23; Skyrizi blocks IL-23; Cosentyx blocks IL-17A. Each interrupts a different signal the body deploys to marshal the response that Pagano’s dietary and cleansing protocol addresses at cause. The drugs are prescribed for lifetime administration to conditions terrain interventions have documented as reversible. When the drug is stopped, the underlying condition returns, because the elimination requirement was never addressed.
The revenue structure requires this. A resolved patient is a lost customer. A biologic given for life generates one to two million dollars per patient over two decades. Sanofi reported Dupixent global sales of €13.1 billion in 2024, with more than a million patients worldwide on the drug.⁷ The category is the highest-margin segment in the specialty.
The endpoint of the cascade that began with hydrocortisone in infancy is a lifetime biologic injection whose mechanism is to prevent the body from calling for the repair it still needs. Cost is transferred to the insurer or the state, revenue accrues to the manufacturer, and what the eczema was for is never asked.
Part III: The Conditions Reframed
7. Acne is sebaceous elimination and hormonal-liver terrain
Acne happens when the sebaceous glands are called to eliminate more material than they can process. Adolescent hormones drive sebum production upward at exactly the moment the endocrine and hepatic systems are handling the peak toxic load of the industrial diet: seed oils, dairy from grain-fed cattle, sugar, and the metabolic aftermath of contraceptive hormones in girls. The pore becomes packed with sebum and cellular debris; the local bacterial population, particularly Cutibacterium acnes, proliferates to consume the accumulated material. Inflammation follows because the body is doing the work of clearing.
The bacterium is the response, not the cause. Killing it with antibiotics does not resolve the acne because the material the bacterium was consuming continues to accumulate. Teenage acne is rare in societies without processed food, seed oils, or industrial dairy, as Weston Price documented across traditional populations in the 1930s.
The liver connection is the axis dermatology never examines. When the liver cannot process the estrogens, androgens, and dietary toxins presented to it, the sebaceous glands take on the surplus. Adult women who cycle on and off hormonal contraception and develop cystic acne of a severity they never had as teenagers are showing the endocrine system routing what the liver cannot clear. Naturopathic and Chinese medicine traditions have described the liver-skin axis for centuries. The dermatological textbook does not include it.
Standard treatment moves through benzoyl peroxide (topical oxidative stress applied to inflamed tissue), topical antibiotics, oral antibiotics for six to twelve months, hormonal manipulation with birth control pills or spironolactone, and finally Accutane. Each step suppresses further down the pathway. None examines what the sebaceous gland was trying to eliminate.
8. Eczema is downstream of the paediatric injection schedule
Atopic dermatitis is the most common inflammatory skin condition in children. Roughly one in five children in industrialised countries carries the diagnosis, and rates have doubled or tripled since 1970. The condition is described in the dermatology literature as a chronic, relapsing inflammatory disease driven by type 2 immunity.
The framing that treats eczema as an intrinsic disorder of the skin cannot explain the exposure data. Introduce a new food and a patch appears on the inner elbow within a week; remove the food and the patch fades. Clinicians have observed this for a hundred years. It is why elimination diets work when they are undertaken seriously. Cow’s milk, wheat, eggs, soy, peanuts, and dozens of processed food additives, colourings, and preservatives account for most childhood eczema when the causal work is actually done.
Sam Bailey has described her own son developing a skin rash from a single exposure to red dye number three in candy given as a toilet-training reward. The rash disappeared when the exposure stopped. This is what an elimination organ does when a foreign chemical is presented to a digestive system that cannot process it: the material comes out through the skin.
The more troubling exposure data comes from timing. Eczema in the modern infant begins, with striking frequency, in the days and weeks following the paediatric injection schedule. J.B. Handley describes his own son Jamison, healthy at birth: “on the night following Jamison’s two-month ‘well baby’ visit, during which he received six separate vaccines, his health deteriorated rapidly and never rebounded. He developed eczema all over his body.”⁸ Thomas Cowan, after thirty-five years of paediatric practice, describes the same pattern: the rise in eczema, asthma, seizures, and digestive disorders among his patients “corresponded with the introduction in the late 1980s to the mid-1990s of certain adjuvants and excipients, as well as the introduction of ever more vaccines.”⁹
The mechanism was described in 1901 and has been ignored ever since. Charles Richet, working aboard the yacht of Prince Albert of Monaco with the toxin of the Portuguese man-of-war, discovered that dogs injected with a small dose and then given a second small dose weeks later did not develop immunity to the poison. They died in convulsions. Richet named the reaction anaphylaxis, meaning against protection, and won the 1913 Nobel Prize for the discovery. In his acceptance speech he described the reaction as one of three possible outcomes of vaccination: unchanged sensitivity, diminished sensitivity, or heightened sensitivity. The first injection, he wrote, rendered the organism more fragile and susceptible.¹⁰
Heather Fraser’s The Peanut Allergy Epidemic traces the century of institutional forgetting that followed. Richet had combined two functional mechanisms to produce food anaphylaxis in his laboratory: injection and subsequent ingestion. In the medical literature that followed, the injection half was, in Fraser’s phrase, exorcised from the nascent ingestion hypothesis, leaving only the story that food allergies came from unhealthy digestion of eaten food. The needle disappeared from the account, though it was the needle that had first produced the phenomenon in Richet’s dogs, cats, rabbits, horses, and frogs.¹¹
What Richet demonstrated is what happens on the skin of the modern infant. Injected proteins bypass the digestive modification that renders foreign proteins tolerable to the body, and the body responds by sensitising to those proteins and to bystander proteins present in the same tissue at the same time. Aluminium adjuvant, added to vaccines specifically to intensify the response, amplifies both. University of Virginia scientists have stated the connection: “the era of food allergy began with the post-millennial generation, the same faction who received new immunisations during early childhood. Many of these vaccines contain alum, an adjuvant known to induce allergic phenotypes.”¹² The Japanese gelatin allergy episode confirmed the mechanism from inside the paediatric establishment. When the DTP was replaced in 1994 with an acellular version containing gelatin, Japanese children began reacting anaphylactically to gelatin-containing foods. The paediatric establishment investigated, concluded that the aluminium adjuvant had sensitised children to the gelatin, and removed it from the vaccine. New cases dropped.¹³ The mechanism was contained to gelatin and not permitted to extend to peanuts, eggs, or the eczema that arrives first.
The 2015 LEAP study, funded in part by the National Peanut Board, identified the children at risk of developing peanut allergy as those who already had severe egg allergy and eczema. Fraser reads the finding as circular: existing allergies predict future allergies. What LEAP did not ask was what caused the initial sensitisation. The upstream question is not asked because the answer implicates the schedule.
Cowan describes a clinical intervention that reverses the process. Using Restore, a soil-derived preparation that reduces intestinal zonulin and seals the gut wall, he has documented eczema and asthma clearing completely in paediatric patients within a month of protocol adherence and glyphosate avoidance.¹⁴ The intervention treats what the eczema was: the terrain expression of intestinal damage compounded by injection sensitisation. Nothing about it is compatible with the dermatological framework of eczema as a genetic barrier defect requiring lifetime biologic suppression. Both interventions are documented. Only one is offered.
The gut-skin axis is now conceded even in mainstream literature; what is not conceded is what event upstream produced the intestinal damage in the first place. The child whose eczema clears on a whole-food diet with gut restoration is running the experiment. The child put on Dupixent instead will be on Dupixent for life.
9. Psoriasis reflects overwhelmed liver function, and methotrexate is a chemotherapy drug
Psoriasis is described in the dermatology textbook as a chronic autoimmune condition in which the body’s immune system attacks its own skin cells, causing them to reproduce too rapidly. Two facts undermine this framing before the treatments are considered.
First, the body does not attack itself. The autoimmune model was constructed to explain damage whose actual causes were not being investigated. What is described as the immune system attacking skin cells is more accurately the body attempting to expel toxic material through accelerated cell turnover, with inflammation as the tissue-level repair signal.
Second, the mainstream treatment tells you what the mainstream framework will not. Methotrexate, one of the most commonly prescribed drugs for moderate to severe psoriasis, is a chemotherapy drug developed in the 1940s by Sidney Farber to treat childhood leukaemia. It works by blocking folate metabolism, which suppresses the rapid cell division of both cancer cells and, in this case, skin cells that are trying to turn over quickly. The American Academy of Dermatology and National Psoriasis Foundation guidelines acknowledge chronic liver injury, cirrhosis, progressive fibrosis, and portal hypertension as recognised outcomes of the treatment.¹⁵ A 2013 editorial in JAMA Dermatology stated the position more starkly: “Methotrexate-induced hepatotoxicity in patients with psoriasis occurs rarely and unpredictably. Although liver monitoring must occur, dermatologists currently lack a reliable test.”¹⁶ The specialty writes a leukaemia drug for a skin condition every week and admits it cannot reliably monitor the liver damage it causes.
John Pagano, a chiropractor from Englewood Cliffs, New Jersey, worked with hundreds of psoriasis patients across four decades and documented what the condition actually is under a terrain frame.¹⁷ Pagano identified intestinal permeability as the upstream cause. Toxins from a compromised gut wall enter systemic circulation, overwhelm hepatic elimination, and are pushed out through the skin as the accelerated cell turnover the dermatology textbook labels autoimmune. His protocol emphasised colon and liver cleansing (fibre, water, slippery elm and saffron teas), removal of specific dietary triggers (nightshades, red meat, refined sugars, alcohol, fried and processed foods), and restoration of gut wall integrity through targeted whole foods. His book Healing Psoriasis reproduces the before-and-after photographs. One woman afflicted for forty-two years was cleared in six months on the protocol. A young girl was cleared in three. Pagano documented case after case of severe psoriasis clearing, including patients whose dermatologists had prescribed methotrexate or told them the condition was permanent. The intervention costs what groceries cost. It generates no revenue for anyone.
The liver connection recurs. Psoriasis patients show high rates of impaired liver function and compromised elimination capacity, and alcohol use is a documented aggravator. Fasting, which relieves hepatic burden, produces clearing that is often dramatic. Shelton described psoriasis cases resolving during extended fasts a century ago. These terrain interventions reduce the elimination load and produce results because the model on which they rest describes what the condition actually is.
10. Rosacea is gut dysbiosis on your face
Rosacea is described in the standard text as a chronic inflammatory facial skin condition of unknown cause. Standard treatment is topical antibiotics, oral tetracyclines, and metronidazole. None of these addresses cause, because the framework does not admit one.
The gut-to-face connection is documented in the establishment’s own literature. A 2008 study published in Clinical Gastroenterology and Hepatology tested 113 consecutive rosacea patients and 60 matched controls for small intestinal bacterial overgrowth using breath testing. SIBO prevalence was 46 percent in rosacea patients versus 5 percent in controls. Patients randomised to receive the gut-active antibiotic rifaximin cleared their facial lesions in 20 of 28 cases and greatly improved in 6 of 28, while placebo patients were unchanged or worsened. When the placebo group was switched to rifaximin, 15 of 20 achieved complete resolution.¹⁸ A 2013 replication in the Journal of the American Academy of Dermatology found 46 percent of rosacea patients tested SIBO-positive, with 78 percent achieving cutaneous clearing after rifaximin therapy.¹⁹
SIBO is itself a dysbiotic response to a compromised terrain, driven by processed food, alcohol, chronic stress, proton pump inhibitor use, and the antibiotic history that most rosacea patients already carry from previous acne treatment. Killing the overgrown bacteria with more antibiotics resolves the face temporarily. Restoring the terrain that allowed the overgrowth is the durable correction.
More than fifteen years after publication, standard dermatological practice has not adopted the findings. A 2024 letter in American Family Physician recommended against routine SIBO screening for rosacea, citing breath-test limitations and inconsistent replication in smaller cohorts.²⁰ The letter does not explain why an intervention that produced complete clearing in 78 percent of patients across two independent studies is dismissed on procedural grounds rather than pursued with better tests. A dermatologist who refers a rosacea patient to a gastroenterologist is not billing for a topical or a laser session. The framework did not follow the evidence because the practice was not organised to.
Part IV: The Cascade Endpoints
11. Sunscreen chemicals enter the bloodstream, and melanoma rates rise with their use
Niels Finsen won the 1903 Nobel Prize in Physiology or Medicine for treating lupus vulgaris, cutaneous tuberculosis, with concentrated ultraviolet light. His clinic in Copenhagen treated over 800 patients with documented recovery rates that surpassed anything the pharmaceutical era has achieved for the condition. Finsen’s Nobel citation described the work as opening a new field of medical science. The field was heliotherapy: the therapeutic application of sunlight, developed across the late nineteenth and early twentieth centuries by physicians who observed that sunlight cleared conditions the medicine of the day could not.
Auguste Rollier extended Finsen’s work through the 1910s, 20s, and 30s at his Leysin clinic in Switzerland, treating tuberculosis of the bones, joints, skin, and lymph nodes with graduated sun exposure. His clinics reported cure rates of around 80 percent, documented in the medical journals of the period. Heliotherapy sanatoria operated across the Alps, the Rockies, Australia, and the North Sea coasts. Richard Hobday’s The Healing Sun documents the entire history.²¹
The knowledge was displaced within a generation. The antibiotic era beginning in the 1940s made heliotherapy commercially obsolete for tuberculosis. Pharmaceutical treatment could be sold; sunlight could not. The sanatoria closed. The physicians trained in heliotherapy died. By the 1970s, dermatology had reframed sunlight as the primary cause of skin cancer, and the sunscreen industry began the four-decade campaign of daily application from infancy that continues today. The inversion happened within living memory.
Sunscreen is one specific case of the daily topical exposure catalogued in Section 3. What distinguishes it is that the FDA has now measured what enters the bloodstream from its use. In 2019 the FDA published a randomised clinical trial in JAMA in which 24 healthy volunteers applied four commercially available sunscreens under maximal use conditions for four days. All four active ingredients (avobenzone, oxybenzone, octocrylene, ecamsule) exceeded the FDA’s own threshold of 0.5 nanograms per millilitre, above which systemic absorption triggers a requirement for further safety testing. Oxybenzone reached peak plasma concentrations of around 209 ng/mL, more than 400 times the trigger threshold, and remained detectable a week after application ceased.²² A 2020 follow-up with 48 participants and six chemicals had all six exceeding the threshold. Oxybenzone in lotion formulation reached 258 ng/mL, more than 500 times the trigger level.²³ Neither study concluded that sunscreens were unsafe. Both called for further industry testing that was never required. The products remain on the market and continue to be recommended for daily application from infancy.
Melanoma incidence in the United States has tripled since the 1970s, per the National Cancer Institute.²⁴ The mid-1970s is when high-SPF chemical sunscreens became widely used. A 1993 Preventive Medicine review noted the correlation and observed that chemical sunscreens block UVB while allowing UVA through, permitting longer exposure to the carcinogenic wavelength while suppressing the sunburn signal that would otherwise limit it.²⁵ Indoor workers show higher melanoma rates than outdoor workers, and melanomas occur predominantly on skin that does not receive regular sun exposure.²⁶
Sun avoidance itself carries documented mortality risk comparable in magnitude to smoking, per the Swedish Karolinska cohort work.²⁷ Sunlight on skin produces nitric oxide release, cardiovascular benefit, and mitochondrial effects established in the mainstream literature. What mainstream biochemistry calls vitamin D3 synthesis is downstream of the same exposure, though the compound sold as vitamin D3 is an industrial derivative of lanolin, not what sunlight delivers to tissue. The advice to avoid the sun and coat the skin in chemicals that measurably enter the bloodstream reverses what a Nobel Prize was awarded for a century ago.
12. Accutane: birth defects, inflammatory bowel disease, and suicide on the label
Isotretinoin, marketed originally as Accutane and now as Absorica, Claravis, and other generics, is 13-cis-retinoic acid, a synthetic retinoid. It was approved by the FDA in 1982 for severe cystic acne unresponsive to conventional treatment. Its mechanism, as described in the FDA label, is to shrink the sebaceous glands so they produce less sebum. In terrain terms, the drug chemically disables the skin’s largest elimination route for fat-soluble waste.
The FDA label carries a black box warning, the agency’s most serious safety alert, for embryo-fetal toxicity. The drug is Category X in pregnancy, meaning it causes severe birth defects with even brief exposure. Since 2005, isotretinoin has been available only through the iPLEDGE program, an FDA-mandated risk management system requiring monthly pregnancy tests, two forms of contraception, mandatory patient and prescriber registration, and 30-day supply limits.²⁸ The bureaucratic complexity of the program reflects the severity of the harm the drug is known to cause.
A second FDA warning, issued as a formal alert in 2005 after post-marketing surveillance, covers depression, psychosis, and suicidal thoughts. A JAMA Dermatology analysis of the FDA adverse event database from 1997 through 2017 identified 17,829 reports of psychiatric adverse events associated with isotretinoin, including nearly 2,300 reports of suicidal ideation and almost 1,000 completed or attempted suicides.²⁹ Manufacturer defenders point to observational studies that fail to establish causation. What the label states is that patients reported enough of these outcomes for the FDA to require the warning and continue monitoring.
In 2010, the FDA added inflammatory bowel disease to the label based on post-marketing reports of ulcerative colitis and Crohn’s disease in patients with no prior history of intestinal disorders. Litigation preceded the label change. Thousands of lawsuits were filed against Hoffmann-La Roche alleging that Accutane caused IBD, and several jury verdicts exceeded $25 million. Roche stopped selling brand-name Accutane in 2009. The generics remain on the market and continue to be prescribed to teenagers. Defenders point to a 2014 meta-analysis and a 2019 Israeli cohort of 196,078 patients that failed to establish a significant statistical association.³⁰ The FDA kept the warning on the label anyway, and the juries who heard testimony from injured patients and their treating gastroenterologists reached the opposite conclusion in the cases that produced the verdicts.
The typical patient is a teenager whose acne has been through months of antibiotics and topical treatments, and whose dermatologist has run out of the earlier rungs of the suppression ladder. The prescription is presented as a course of four to six months, often permanently resolving the acne. What the description omits is that the drug permanently reduces sebaceous elimination capacity in the treated tissue, that the toxic burden the acne was expressing must now be handled through other channels, and that the patient, an adolescent, has received a known teratogen with a documented psychiatric risk profile during a period of neurological development.
A skin condition that expressed a dietary and hepatic burden has been treated by chemically ablating the elimination organ. The consequences of that ablation, including the depression, the psychosis, the suicides, the inflammatory bowel disease, and the birth defects, are on the label. The drug is the endpoint of a cascade that never asked what the acne was for.
Across the twelve, one pattern holds. The skin is trying to eliminate, and dermatology is trained to stop it. Each intervention in the ladder from hydrocortisone to Dupixent to Accutane makes the elimination harder and creates the conditions that call for the next intervention. Revenue moves upward through the biologic price point of $50,000 to $100,000 a year, and the patient moves inward through the layers of suppression Shelton described a hundred years ago.
For many of the children now on that ladder, the elimination began with something injected in infancy. The two-month-old who developed eczema across his body the night of his six-vaccine visit was expressing what Richet had described in 1901 and won a Nobel Prize for in 1913: sensitisation to injected proteins produces progressive inflammatory response to subsequent exposures. The specialty that inherits the eczema does not investigate the injection. The pattern continues into adolescent acne and into the adult on lifetime biologic, and at no point in the sequence does the specialty ask what the body was responding to when it first tried to push material out through the skin.
Any frame under which this is medicine requires the skin to be an enemy. Remove that frame and the interventions read as what they are. A child prescribed hydrocortisone at two is being taught to fail as an eliminator. A year of doxycycline for teenage acne takes with it the microbial ecology she needed for life. Dupixent at forty costs $50,000 a year to chemically silence the molecules that would coordinate her own repair. Accutane is what the specialty writes when it has run out of ladder. The cascade is a lifetime, and it started with the elimination the skin was already trying to do.
The skin is telling you something the training was never designed to hear.
How to Explain This to a Six-Year-Old
Your skin is like the front door of your house. When the inside of the house gets messy, from food that does not agree with you, or something you touched, or something in the air, some of the mess comes out through the door. A rash is that mess coming out. Your body is smart and uses your skin as an extra way to get rid of things it does not want inside. Sweat is salty and pimple gunk smells the way it does because it is trash the body wanted out.
But something else happens too. Every morning, people paint the door with stuff. Shampoo, soap, cream, spray, perfume. Some of it soaks through and adds to the mess inside. Some of it covers up the tiny cracks the door uses to breathe. So the door has more mess to push out and less room to push it through.
Something even bigger happens when you are a baby. Some of the mess did not come from food or from anything you touched or breathed. Some of it was put in with a needle, on purpose, by a nurse in a room where your mother thought you were safe. The body does not know what to do with the stuff that came in through the needle, because your mouth and your tummy are the doors that get to check food and change it into something safe. The needle skips those doors. So your body remembers what came in that way and it gets ready to fight it every time anything like it shows up again. Peanut butter that used to be fine is not fine anymore. Eggs that used to be fine make your throat close up. And your skin, which is the door for the mess, breaks out in bumps and cracks and itches, because the body is trying to push some of it out.
The doctor’s job should be to figure out why there is mess inside the house, and to stop putting more mess on the door, and to think about what went in through the needle in the first place. But most doctors are taught to put a lock on the door instead so the mess cannot come out. That makes the door look nice. But the mess is still in the house, so it goes somewhere else, like your tummy or your breathing or the way you feel. And now you are sick in a new place. Then the doctor gives you a lock for that place too.
If somebody helped you clean up inside the house instead of putting locks on the doors, the mess would go away for real. Your skin would not have anything to push out. You would not need any locks. The trick is that the people who make the locks earn a lot of money selling locks, and they do not earn money if you clean up inside. So the doctors who work with them are only taught about locks.
In Print
Thirteen of my books are now available as paperbacks, printed to order through Lulu and shipped worldwide. The Unvaccinated lays out the completely unvaccinated as a comparison group across twenty chapters and five appendices — as far as I know, the only book of its kind. Medicalized Motherhood follows a woman through 123 documented interventions from teenage pill to postpartum discharge. Drilling for Profit argues that cavities, gum disease, and crooked teeth are a dietary problem the dental profession treats surgically. What Your Vet Can’t Tell You applies the same critique to pets — food, vaccines, and a profession trained by the industries whose products cause the harm. Escape from Psychiatry documents the fabrication of the DSM, the collapse of the serotonin hypothesis, and the specific damage done by every major psychiatric drug class.
Two go to the paradigm underneath the whole shelf. No Contagion, co-authored with Jamie Andrews, catalogues 258 failed contagion experiments and the case against germ theory itself. No Virus takes the examination one layer deeper — the isolation problem, the collapse of virology’s foundational claims, and a disease-by-disease reappraisal of the entities the framework is built on.
Four take on the remedies and paradigm questions mainstream medicine actively suppresses. The DMSO Book covers 100,000 studies, zero deaths, and one approval — the suppressed science of medicine’s most versatile compound. Chlorine Dioxide: The Forbidden Remedy collects the interviews, protocols, and evidence from the doctors and researchers they tried to silence. The Iodine Book recovers an essential mineral driven out of easy reach by bromide, fluoride, and perchlorate — and the pharmacological tradition that kept its therapeutic use alive across the decades mainstream medicine set it aside. The Hydrogen Peroxide Book recovers a century of practice with a compound the body already makes — mitochondrial, phagocytic, part of thyroid hormone synthesis — suppressed precisely because its clinical utility threatened the pharmaceutical direction that captured twentieth-century medicine.
Two more take on the remedies already in your kitchen. Baking Soda locates sodium bicarbonate inside the terrain framework industrial medicine buried — the compound already in your cupboard, and what it does at the level of the blood, kidneys, lungs, digestion, and skin. The Castor Oil Book recovers four thousand years of documented practice on the medicine mainstream healthcare quietly stopped talking about — the kitchen bottle that doesn’t sit well in a system built on prescriptions and procedures.
A physical book reaches the person a Substack post never will — the sceptical relative, the friend who won’t click a link but might open a book, the visitor whose eye lands on a coffee table. The full shelf is at lulu.com/spotlight/unbekoming. Buy one to keep, and one to give away.
References
Malkan S. Not Just a Pretty Face: The Ugly Side of the Beauty Industry. New Society Publishers, 2007. Daily exposure counts, specific chemical categories, 1938 Food, Drug, and Cosmetic Act cosmetic exemption, and Cosmetic Ingredient Review panel history documented throughout.
Hajar T, Leshem YA, Hanifin JM, et al. A systematic review of topical corticosteroid withdrawal (”steroid addiction”) in patients with atopic dermatitis and other dermatoses. Journal of the American Academy of Dermatology. 2015;72(3):541-549. Follow-up systematic review: Ghosh A, Sengupta S, Coondoo A, Jana AK. Topical corticosteroid addiction and phobia. Indian Journal of Dermatology. 2014;59(5):465-468. Combined cohort across systematic reviews describes 1,479 documented cases.
National Institutes of Health. Topical steroid withdrawal diagnostic criteria defined by NIH researchers. Press release, June 12, 2025. Shobnam N, et al. Metabolic and mitochondrial dysregulation in topical corticosteroid withdrawal.
Kronman MP, Zaoutis TE, Haynes K, Feng R, Coffin SE. Antibiotic exposure and IBD development among children: a population-based cohort study. Pediatrics. 2012;130(4):e794-e803. Ungaro R, et al. Antibiotics associated with increased risk of new-onset Crohn’s disease but not ulcerative colitis: a meta-analysis. American Journal of Gastroenterology. 2014;109(11):1728-1738.
U.S. Food and Drug Administration. FDA approves new eczema drug Dupixent. Press release, March 28, 2017.
Institute for Clinical and Economic Review. Dupilumab (Dupixent) for atopic dermatitis: effectiveness and value. ICER final evidence report, 2017 and subsequent updates. Retail pricing per GoodRx and pharmacy comparison data. Psoriasis biologic annual cost ranges per ICER reports and manufacturer pricing disclosures.
Sanofi. Full-year and fourth-quarter 2024 results. Press release, January 30, 2025. Dupixent full-year 2024 net sales €13,072 million. More than 1 million patients on Dupixent globally as of Q4 2024.
Handley JB. How to End the Autism Epidemic. Chelsea Green Publishing, 2018. Jamison Handley post-vaccination clinical course documented in author’s family narrative.
Cowan T. Vaccines, Autoimmunity, and the Changing Nature of Childhood Illness. Chelsea Green Publishing, 2018. Clinical timeline of paediatric chronic illness onset correlating with vaccine schedule expansion documented throughout.
Richet C. Nobel Lecture: The Anaphylaxis. Nobel Prize in Physiology or Medicine, 1913. As documented in Fraser (2017), Chapter 2.
Fraser H. The Peanut Allergy Epidemic: What’s Causing It and How to Stop It. Skyhorse Publishing, third edition 2017. Charles Richet’s 1901 physalia experiments, cross-species anaphylaxis demonstrations, and the institutional erasure of the injection mechanism from the ingestion hypothesis documented in Chapters 2 and 3.
McKee AS, Munks MW, Marrack P, et al. As cited in Handley (2018), reference 61. Primary literature from the Marrack laboratory on aluminium adjuvants and allergic phenotype induction.
Fraser (2017), Chapter 8, documenting the Japanese gelatin allergy episode 1988-1998 and paediatric acknowledgement of vaccine causation. Primary sources: Nakayama T, Aizawa C, Kuno-Sakai H. A clinical analysis of gelatin allergy and determination of its causal relationship to the previous administration of gelatin-containing acellular pertussis vaccine combined with diphtheria and tetanus toxoids. Journal of Allergy and Clinical Immunology. 1999;103(2 Pt 1):321-325.
Cowan (2018), Chapter 11. Restore protocol clinical outcomes for paediatric eczema and asthma documented in author’s practice notes.
Menter A, Gelfand JM, Connor C, et al. Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis with systemic nonbiologic therapies. Journal of the American Academy of Dermatology. 2020;82(6):1445-1486. Methotrexate hepatotoxicity risks (chronic liver injury, cirrhosis, fibrosis, portal hypertension) documented in the guideline text and cited safety monitoring sections.
Bangert CA, Costner MI. Methotrexate in dermatology: reevaluating the role of an old drug. JAMA Dermatology. 2013;149(10):1223-1224. Editorial noting the unpredictability of methotrexate hepatotoxicity and the absence of a reliable monitoring test.
Pagano JOA. Healing Psoriasis: The Natural Alternative. Pagano Organization, 1991; Wiley expanded edition 2008. Chiropractic practice from Englewood Cliffs, New Jersey. Case documentation, dietary protocol, and clinical outcomes with before-and-after photographic portfolio reproduced across the volume.
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Weinstock LB, Steinhoff M. Rosacea and small intestinal bacterial overgrowth: prevalence and response to rifaximin. Journal of the American Academy of Dermatology. 2013;68(5):875-876.
Sánchez-Pellicer P, et al. Rosacea, microbiome and probiotics: the gut-skin axis. Frontiers in Microbiology. 2024;14:1323644 (with subsequent AAFP correspondence, May 2025).
Hobday R. The Healing Sun: Sunlight and Health in the 21st Century. Findhorn Press, 1999. Finsen Nobel Prize (1903), Rollier’s heliotherapy at Leysin, and the sanatorium-era treatment record documented throughout.
Matta MK, Zusterzeel R, Pilli NR, et al. Effect of sunscreen application under maximal use conditions on plasma concentration of sunscreen active ingredients: a randomized clinical trial. JAMA. 2019;321(21):2082-2091.
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National Cancer Institute, Surveillance, Epidemiology, and End Results (SEER) Program. Melanoma of the skin incidence trends, 1975-2020.
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Alhusayen RO, Juurlink DN, Mamdani MM, et al. Isotretinoin use and the risk of inflammatory bowel disease: a population-based cohort study. Journal of Investigative Dermatology. 2013;133(4):907-912. Etminan M, et al. Isotretinoin and risk for inflammatory bowel disease: a nested case-control study and meta-analysis. JAMA Dermatology. 2014;150(2):216-220.
When I was a child, people used to comment on my skin, because it was flawless. None of the children in my family had skin problems. People in the 1930s, 40s and 50s did not know how blessed they were not to have money. There weren't drugstores on every corner selling products. We had no money for products and not even money for much food. it was a blessing, because my parents knew nothing about nutrition. We were skinny, but we were five healthy children.. It is amazing, four of us are still here. The only one who is gone...took the vax!
Daily reminder that modern medicine is poison and is a trillion dollar industry to profit; not to heal:
https://unorthodoxy.substack.com/p/modern-medicine-as-poison
https://unorthodoxy.substack.com/p/healthcare-the-4-trillion-empire