Metabolic Dermatology

Your Skin Condition May Not Be a Skin Problem.

Q: Can metabolic treatment replace my biologic or immunosuppressive medication?

In some cases, yes, particularly for patients whose skin disease developed alongside metabolic dysfunction. For others, metabolic treatment will improve outcomes and potentially allow dose reduction. I'll give you an honest assessment based on your condition and labs.

When psoriasis, hidradenitis, hormonal acne, or eczema are driven by insulin resistance, hormonal imbalance, or metabolic dysfunction, treating only the skin never fully resolves the condition. I find and treat the metabolic root — so your skin can actually heal.

Book a Metabolic Dermatology Consultation

The Problem

"Your Labs Are Normal." The most common sentence patients hear.

The standard metabolic panel that most doctors order misses a critical marker: fasting insulin. A patient can have perfectly normal blood sugar while their insulin levels are dramatically elevated — a condition called insulin resistance that the standard workup won't catch.

That elevated insulin is not a silent problem. It produces inflammation. It impairs blood flow. It drives skin conditions like psoriasis, hidradenitis suppurativa, and hormonal acne — and it makes every inflammatory skin disease worse than it would otherwise be.

I order this test and other metabolic labs that identify metabolic disease. And then I treat it.

These conditions share a common thread: metabolic dysfunction that fuels inflammation from the inside. Treating the skin alone rarely leads to lasting improvement. I treat both.

Original research

Psoriasis

In most adults with psoriasis, the disease develops alongside metabolic dysfunction. My research has shown that elevated insulin loads into psoriasis plaques and amplifies inflammation. Treating metabolic disease alongside psoriasis leads to dramatically better outcomes.

Hidradenitis Suppurativa

HS is one of the most debilitating and mismanaged conditions in dermatology. Its relationship to obesity, insulin resistance, and systemic inflammation is well-established — but rarely acted on. I address both the inflammatory skin disease and its metabolic drivers simultaneously.

Hormonal Acne

Spironolactone treats the symptom. Identifying and addressing the underlying hormonal imbalance — often connected to insulin resistance, PCOS, or perimenopause — treats the cause. I evaluate the full hormonal and metabolic picture before prescribing.

Eczema (Atopic Dermatitis)

Eczema often has both immune and metabolic components. For patients with significant metabolic dysfunction, addressing it can substantially reduce flare frequency and severity.

Lichen Planus

A chronic inflammatory condition with strong associations to metabolic and immune dysfunction. I evaluate both dimensions and tailor treatment to what's driving the disease.

PCOS-Related Skin

Polycystic ovarian syndrome drives hormonal acne, abnormal hair growth, and other skin manifestations through insulin resistance and androgen excess. Treating PCOS metabolically — not just symptomatically — produces lasting skin improvement.

Dr. Bordone reviewing metabolic lab results

My Approach

Treating Inflammation at the Source, Not Just at the Surface.

My evaluation goes well beyond dermatology. I review dietary patterns and lifestyle factors. I order a metabolic workup that includes fasting insulin, not just fasting glucose. I assess hormonal status — particularly relevant for women in perimenopause, whose estrogen decline directly affects insulin sensitivity.

My research has demonstrated that the insulin spike that follows a high-glycemic meal can be detected in psoriasis plaques, where it directly drives inflammation. You can't fully treat a problem that's being recreated multiple times a day by diet and metabolic dysfunction.

This doesn't mean medication isn't part of the plan. For patients with significant active disease, I will often combine a biologic or immunosuppressive with metabolic treatment — because the two approaches reinforce each other. The goal is to eventually need less — not to add more indefinitely.

Initial Consultation

I take a detailed history of your skin condition and a lifestyle and metabolic history: what you eat, your activity level, your hormonal history, and any relevant family patterns. This consultation is primarily diagnostic.

Lab Workup

I order a comprehensive metabolic panel — including markers that standard lab orders typically omit. You complete the bloodwork at a lab near you.

Follow-Up Consultation

I review the full results with you, explain what I found, and build a treatment plan that addresses both the skin condition and its metabolic drivers. For complex metabolic conditions, expect an initial consultation visit followed by a follow-up visit to discuss labs to build a complete picture.

Standard lab panels often miss fasting insulin and other metabolic markers important in skin disease. If you have a chronic inflammatory skin condition and your doctor has only checked standard panels, there may be relevant information that hasn't been evaluated yet.

Not necessarily. The goal of metabolic treatment is to improve your underlying metabolic health to a point where you need less support over time — not to add a permanent medication. Many patients are able to reduce or discontinue medications as their markers improve.

Yes. Insulin resistance can exist in people of any weight and any diet. Smoothies, fruit juices, and high-glycemic foods that appear "healthy" can produce significant insulin spikes. Estrogen decline in perimenopause is another common cause. A proper workup is the only way to know.

In some cases, yes — particularly for patients whose skin disease developed alongside metabolic dysfunction. For others, metabolic treatment will improve outcomes and potentially allow dose reduction. I'll give you an honest assessment based on your condition and labs.

Ready to Treat the Root, Not Just the Symptom?

I'm accepting new patients via telehealth in NY, NJ, FL, and AZ. New patient visits from $375.