I’m curious about the condition of cicatricial alopecia, or scarring alopecia. I have a patient who started to notice symptoms in 2010 but wasn’t formally diagnosed by a dermatologist until 2015. Of course, he was prescribed topical steroid cream but hasn’t wanted to go in that direction. He also has a history of tinea versicolor, keratosis pilaris, other skin rashes, blotchy skin, etc. He does not currently eat a Paleo diet. He does have a significant amount of stress related to work. Money is an issue as far as testing goes, so I’m wondering if you would recommend starting with a Cyrex Array 3 or just going for the stool analysis and parasitology testing.

Dr. Amy Nett:  If money is an issue, the cheap way to find out if gluten and wheat is contributing is simply to have patients remove that from their diet. I can’t tell if he’s not willing to try a Paleo diet, but again, I think Cyrex Array 3, if he’s not willing to take out wheat and gluten without having definitive test results, then I would probably prioritize Cyrex Array 3, but if you can explain the strong relationship between wheat and gluten sensitivity and skin issues and he would be willing to do a three-month trial that’s strictly gluten free, then I think you could avoid doing Array 3, but otherwise it’s pretty important, so I probably would prioritize that one. Then if you need to prioritize stool analysis, I would go with the Doctor’s Data CSAPx3. Probably my third test in priority would be SIBO. Fourth test in priority would be the BioHealth #401 stool test. I’m trying to think if there’s anything else I would do in him initially. No, I would probably start there, and if you can, just talk about diet in terms of lowering inflammation and the importance of avoiding foods that can trigger.