Dr. Teo Soleymani: How to Improve & Protect Your Skin Health & Appearance
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Welcome to the huberman lab podcast, where we discuss science and science space tools for everyday life. I Andrew huberman, and i'm a professor of neurobiology and optimal gy at stamford school of medicine. My guest today is doctor r.

Tao solar money. Doctor tao solo money is a double board certified dramatic logic and dr. Matteo logic surgeon.

He did his training at stanford university, and he was a clinical professor of dr. Matt logy and thermo logic surgery at U. C, L.

A, that is the university of california, los Angeles. Today, we discuss all things related to skin appearance, skin health and skin longevity. For instance, we discuss sun exposure and the impact that can have on both the appearance and health of one skin.

In reference to that, we discuss sun screens, which ones are safe, which ones perhaps a licit a bit more concern, or perhaps should be avoided. And we discuss the surprising relationship between sun exposure and skin cancer. We discussed laser treatments for the skin, both for the appearance of skin, in order to make IT appear more youthful, as well as to prevent certain forms of skin cancer.

We discuss retina oids. We discuss supplements and nutrition, all in reference again to skin health and appearance, thanks to doctor solem's incredible depth of expertise as well as clarity of communication about the dues and do not that relate to skin care and appearance and to avoiding and treating skin cancers. By the end of today's episode, you'll be armed with an immense amount of knowledge that is the very latest in our understanding of how to improve and protect your skin.

Before we begin, i'd like to emphasize that this podcast is separate from my teaching researchers at stanford. IT is, however, part of my desired effort to bring zero cost to consumer information about science and science related tools to the general public. In keeping with that theme, i'd like to thank the sponsors of today's podcast.

Our first sponsor is roca. Roca makes eyeglasses and sung glasses that are the absolute highest quality. I spent a lifetime working on the biology, the visual system, and I can tell you that your visual system has to contend with an enormous number of different chAllenges in order for you to be able to see clearly from moment to moment.

Roca understands all of that and has designed all of their eyeglasses and sunglasses with the biology of the visual system in mind. Roca eyeglasses and sunglasses were first designed for use in sport, in particular for things like running and cycling. And as a consequence, roca frames are extremely light weight, so much so that most of the time you don't even remember that you're wearing them and they're also designed to that they don't slip off even if you get sweet.

Now, even though roca eyeglasses and sung glasses were initially designed for sport, they now have many different frames in styles, all of which can be used not just for sport, but also for wearing out to dinner to work, essentially any time in any setting. I wear roca readers at night or roca eyeglasses if i'm driving at night, and I wear roca sunglasses in the middle of the day, any time, it's too bright for me to see clearly. My eyes are somewhat sensitive, so I need that.

I particularly like the hunter two point oh frames, which I have as eyeglasses and now as sunglasses too. If you'd like to try roka, you can go to roka dot com slash huberman to get twenty percent off your purchase again. That's roca dcom slash huberman to get twenty percent off.

Today's epo de is also brought to us by juve. Juve makes medical grade red light therapy devices. Now there's one thing i've consistently emphasized on this podcast is the incredible impact that light can have in our biology. Now, in addition to sunlight, red light and near infrared light have been shown a positive effects on improving numerous aspects of seller and and health, including faster muscle recovery, improves skin health and wound healing, even improvements in acne, reducing pain and inflammation, improving by a control function, and even improving vision itself.

What says juv lights apart and why they're mi preferred red light therapy devices is that they use clinically proven wavelength anti use a specific wavelength red light and neon fred light incommodities to trigger the optimal seller adaptations. Personally, I use that you handheld light, but at home and when I travel, it's only about the size of a sandwiches. It's superphosphate venial to use.

I also have a due whole body panel, and I use that about three or four times per week. If you'd like to try dube, you can go to dube spell. J O O V V dot com slash human jove is offering an exclusive discount to all human and love listeners with up to four hundred dollars off select duv products.

Again, that's due J O O V V dot com slash huberman to yet four hundred dollars off select due products. Today's episode also brought to us by helix sleep. He looks sleep makes mattress and pillows that are customized to your unique sleep needs.

I've spoken many times before on this another podcast about the fact that getting a great nights left is the foundation of mental health, physical health and performance. Now the matters we see, the bond makes an enormous difference in terms of the quality of sleep that we get each tonight. We need a that is matched to our unique sleep needs, one that is neither too soft nor too hard for you, one that breathe as well, and that won't be too warm or too cold for you.

If you go to the heale's website, you can take a brief 2 minute quiz， and I ask you questions such, do you sleep on your back, your side of your stomach? Do you tend to run hot or cold during the night, things of that sort? Maybe you know the answers to those questions.

Maybe you don't. Either way, he links will match you to the ideal matters for you. For me, that turned out to be the dusk mattress, the U.

S. K, i've been sleeping on a dusk mattress for gosh now more than four years, and the sleep that have been getting is absolutely phenomenal. If you'd like to try helix, you can go to helix, sleep down, comm slash huberman.

Take that brief, two minute sleep is, and helix will matter to a mattress that is customize to your unique sleep needs. Right now, helix is giving up to twenty five percent off mattress and two free pillows again, that he asleep dotcom slash huberman to get twenty five percent off and two free pillows. And now for my discussion with doctor tao solo mony doctor tao solum, welcome.

Thanks for everything is awesome to be here. Very, very privileged to be here. Thank you.

I want it's an honor to have you let's talk about this amazing organ we call skin. So skin of course covers our other organs, its its own living biological entity. And just for sake of educational purposes into frame the rest of what we're going to talk about, how much turnover is there in our skin, meaning the skin that i'm wearing right now, is that going to be one hundred percent, fifty percent of the skin that i'm going to be wearing a year from now? And forty nine years old.

So you look great for forty nine. So whatever you're doing, keep IT up. So the skins, an amazing organ, just like you said, it's the largest organ and the largest dynamic organ we have in our body.

You have new skin, brand new skin, every twenty eight days. So the surface of your skin turns over about every month. Now the stem cells, which are in the lowest portion of our epidermis, remain, and they generate the skin cells.

But you have have brand new skin the same way you have new guidelines every twenty eight days. It's amazing for many reasons, because the skin is one of the few organs that can regenerate because of this. So you can grow new skin.

You can test things on skin if your skin gets injured, IT will regenerate and heal itself. Where's many other organs cannot do that. And because of this, IT also allows us to use IT as a model platform for studying diseases of all kinds. So skins are an amazing organ. I mean, I guess some.

well, I find a twenty eight day turn over just to be incredible. The skin, as I understand, IT is innovated. That is, IT receives connections from the nervous system.

So I think for many people, their interest in skin as skin appearance, although we will also talk about skin health, but in terms of skin appearance, how much does stress, short term and longer term stress, impact the appearance of our skin? And how does that work? I can imagine that the neurons release certain things into the skin.

Does stress make our skin age faster? Does that mean that turns over more quickly or turns over more slowly? We could link these two aspects of our biology for us.

Yeah, that's a great question. So in order to understand that, we have to just look at the the structure of the skin. So the skin generally three layers, the epidermis, the dermis and the subcutaneous fat and the dermis, is where most of the biologic activity resides.

That's where a blood vessels are. That's where the nerve, that innovates sensation and movement reside. That's where our hair focus, oil glands and sweat glands reside. So stress as two components, there's what we call acute stress, meaning stress that happens within a short period of time. And then there's long term stress, chronic stress, and both have different processes in the skin.

And you see the results of stress both immediately in the skin with the release of certain chemical messengers and an auto con patron and hold con fashion. And then you see the long term deal literaria effects of stress in a different mechanism in which there is actually break down of the skin. The easiest way to see this is when people are stressed and they lose their hair.

And the hair, obviously, is an extension of our skin, is a biosensor of our well being. And we see this all the time. Now I see students during finals time where they're really stressed out. They're coming with their hair falling out or after a large medical illness or a pregNancy, patients comment, say, their hair falling out so that acute stress is scene right away and that due to several different reasons and release of messenger and and hormones and and chemical mediators that that do this long term, stress is usually mitigated or caused by cortisol.

And everybody knows court is all is the your fundamental stress hormone of our body IT falls in the same family as drugs that we give, like pret zone um falls in the same family of cholesterol tester estrogen. But course all does something very different. IT breaks things down to allow our body to utilize IT in times of stress, as unfortunately our body doesn't understand the difference between twenty first century stress and old stress.

So as being chased by a lion to our, to our body's messaging system is the same as meeting chronic deadlines at work. And what happens is cortisone is responsible for the breakdown of things like collagen. And alas, and.

Thinning of vessel walls, which allow our skin to look supple and healthy. So as we have a lot of stress and a lot of court as all release, we see aging and there is accelerated aging studies that look at patients and people who are under high periods distress. A great example of studies.

We look at presidents in which they appeared to have agent much more rapidly than matched controls in a four year period of time. So stress plays a really important role. You see IT both immediately and long term.

I guess people rarely are sympathetic to presidents for aging quickly, because I guess if there were a president who did not age quickly, we would worry they did not work hard enough for something of that sort. But the relationship between stress and skin fascinates me, because not just of the direct relationship, like when we see people in their stress, like IT, seems like that they are all the power.

Their skin changes, the kind of level of a gleam in their eyes, change in the course. Eyes are direct. You piece of the nervous system really there, close to the brain as one can get outside the kull. But IT also suggests, because of the dynamics turn over of skin every twenty eight days, that if people were to become less stressed, that their skin health and appearance might improve. Is that also of the case for sure.

is why you see people have a glow after vacation, but you can't quantify that in a test tuba lab. So in the immediate phase, there is a big shift in blood flow to the skin when you're feeling you're very stressed out immediately, there's a fighter flight response that constricts the blood vessels in our skin to shuffle them to muscles and places where we need to our body things we need to utilize them more.

That's why when people are really stressed out, they may look pale or gone. And that's the we see that right away. Um and then as as that builds up over time, the health the actual quality of our dormant and fat deteriorate from chronic stress changes mainly due to cortisone and it's sibling hormones and messaging systems in our skin.

So for sure, I mean, stress is like something that is impossible to quantify, the lab measure, but very easily seen on exam. Just looking at your skin, I can tell you've had either a rough day. If you didn't sleep well, you can see IT in your skin, your eyes.

So, absolutely. I mean, that's why everybody likes to live a stress free life. And now we see changes in improvement in skin health when people move away from that stress or whether to physical stressor, emotional stress er psychosocial stressor, there is actual quantifiable improvements in skin health. And that's pretty fascinating.

IT is fascinating. IT also speaks to the value of having some immediate and long term stress reduction techniques, just as a first principle of taking care of one skin. There are some other things that cause visio construction, the basically the tightening of the vessels and capitals to the skin, as I understand, maybe we could just take through a few of these and and get your sense um I consume caffeine every morning, usually year by montt.

Some coffee a little bit later. Those will increase base of construction to some extent, although chronic caffeine intake may cause via dilation. So i'd like to know the relationship between caffeine and blood flow to the skin and skin health and appearance.

That's the first question. And then dove tailed with that question is nickel, which is also thought to be a visual constructor. IT raises blood pressure because it's a via constructed. What are the effects of caffeine with acute in chronically and nickey? Let's assume that nike tine is consumed either by smoking or oral and gestion um on skin appearance and health.

That's good question. So caffeine is unknown basic constructor. Fortunately, when it's consumed in quantities that we have in coffee, tea, no equivalent beverages, the amount that affects the tiny capitalists in materials in our skin is my new in transit.

So you may get A A transient visual construction with high caffeine intake, but usually there's a compensate visual dillaway as a result. Um so the effect on skin are not as dramatic as people may make IT same. Now one thing that we do see in is a little unclear as to why is that people who have chronic high fi intake tend to produce more seen in their skin.

And IT may be a result of VISA construction may be a result of something that we don't understand that companies as a result of those changes. So a lot of people who consume coffee may experience a little bit oil er skin. That being said, the data equivalent as to whether or not cafe as a deleterious and efficient or net neutral effect on the skin.

I drink a lot of coffee. I haven't found that the visual construction is something that noticeable, but there are people who have different skin types, patients who have roza, for example, who are much more sensitive to those changes. They may notice that change in the color, in the visual construction, more with cafe consumption.

What used to be thought was that caffeine itself was the problem for flushing and redness. And now we've realized it's actually not so much the caffeine because the concentration that reaches the skin is so miniscule. It's actually the temperature of the bever beverages we drink, so hot beverages can affect the color of your skin, can make your flush more, make the redness more pronounced. Cold beverages tend not to have that effect. So used to be an old adage in people who had like rosia, for example, we say, don't drink coffee, don't drink tea, is actually the temperature of the beverages, not so much the cafe in content.

Interesting in what about nick?

So nickey, great question. IT is a known visual constructor. Now, the concentration of nickey when smoked is higher in the skin because of inhalation effect in the local effective negative on our skin.

So you do see a measurable visual construction in the skin that becomes a problem, which is why patient to smoke age faster. Patients who had surgery, who smoke have a higher risk for poor wound outcomes, for poor healing because of that visual construction. Usually, people who who use our consumer neck teine aren't doing IT once a week. Most people are using a daily or multiple times a day, so that chronic visual construction adds up and has a net negative effect on the skin. So if you want to keep your skin healthy, if you want to look Younger, I would refrain from the continues.

What about vapor nickey or oral use of nickel? So ne gum means pouches ah and let's let's touch on vpc first because that's becoming more common.

So with raping, we see the same problems on the skin. We don't know if it's um an inhalational issue or if it's actually the same concentration of negative that's reaching local skin causing the effect. But we see the same visual construction when you match cigarette smoke with with waiting, if you have the same negative content.

Now for patches and gum, it's less of a problem. And why that is, is the concentration marketing that reaches the skin is much lower. Usually when you chew IT, IT has to go through your digestive track, then enter your bloodstream, then reached the surface of the skin. When you have a transdermal patch, IT still go to the bloodstream, then ends up in the skin. So because of how much IT has to be proceed, the concentration that reaches the skin as much lower when we Operate, when we do surgery, with any surgery of any kind, we tried to transition people who smoke reveal to at least guns are patches to mitigate their withdraw effect. But, you know, so they don't have the feelings, but IT doesn't have the same constructive effects on their skin.

What about alcohol? Did an episode, this podcast on an alcoa, which, somewhat to my surprise, you know, was very widely shared, only to my surprise, because i've never been a big consumer of alcohol. But apparently many of there are.

And the data came back least to my understanding that zero alcohol is healthier than any, and that up to two drinks per week is probably okay. As long as you're an adult of drinking age and not an alcoholic, you don't have issues with alcohol use disorder, as is now called probably O K. But beyond that, you start running into some health issues that can be offset by Better behaviours of other types.

But what about the direct effects of alcohol on skin in the short term? Does IT increase blood flow in therefore improve skin? Um are there long term indirect effects? I could imagine that alcohol disrupts the got microbial, which then disrupt skin a so maybe we could break this down into direct acute effects, meaning immediate effects that are really direct from consuming alcohol that day, that week, versus chronic effects through other systems like disruption of sleep and microbial. Yeah.

great question. Alcohol 没有 the alcohol in connections， complicated, convoluted, but generally thought to be a that negative gold short term and long term. So first, alcohol tends to be a mile diagram. So IT makes our body dispose of water A A little bit more frequently.

Um what happens short term is that one you get a almost a mild diabetic effect from alcohol consumption, which is why you tend to be thirst in the middle night and wake up in the morning tend to be parched. As a result, you see that diabetic effect on our skin. You see a little bit of hollowing in areas that you'd have Normal volume and supplements, which is why there you people tend to see bags under their eyes.

They look like they had a hang over from that mild diabetic c effect. Also, as a compensating mechanism, the skin produces a bit more sea bump to compensate for that drawing out effect. So in the acute phase, skin dries out a look a little bit worse because of that diabetic effect in patients who cannot or people who cannot tolerate alcohol.

And there are genetics and vision populations in southeast stations that have a difficulty in breaking down as a tadhil that isn't a toxin that shows up in the skin and makes the skin was so dialect as a result. So that common college term that we used to hear, you know, the flush, the glow, or incorrectly called the asian glow, is as a result of the inability to break down alcohol. And that usually you see immediately, people get a very bright red flush in their skin.

Because of the asset held, the hide build up in the skin long term won, the die eddic effect becomes a problem. So over time, your skin producing constantly more see them to keep the skin support, your skin is dry out, and as a result, you run into things like break out and no congested skin, your black and White things like that. But long term, alcohol use is also associated with lifestyle choices that may make your skin health worse.

Generally speaking, when people are out binge drinking, they tend not. To come home and do things, it'll maintain their skin. That's not a fixed rule. But most of the time when you're out now having a few beers or cocktails at the barry, you tend to come home and not do your diligent skin care routines may not be up now with your hydration status or your dietary habits, so that something we can quantify easily, but contribute significantly to a faster aging, poor skin health.

Then the gut microbiome question, there's a great question because the data is widely variable for alcohol consumption and the effects or changes permanent or transit in the gut microbes. There are some alcohol products like kambaksh that has A A higher alcohol concentration that's healthy for your gut. Then there's hard alcohol with a higher concentration that act as anesthetics and act as got paralytics.

So one of the things we see in people who consume a lot of high percentage alcohol is actually got inability and got paralysis, partly because of the anesthetic effect, partly because of and use the effect of alcohol, and also because IT affects good motility as a toxin. So generally speaking, gut the gut health, depending on your consumption patterns, use and concentration can be very dilatory ous. Some people are very sensitive and they have changes that reflect in the skin as a result of drinking a lot.

And then there are some people who tolerate IT more or maybe consuming things that are um healthier for the gut microbiome, like things like fermented alcohol. I come to turn things like that. So generally speaking, the higher the concentration, the greater the the problems, the hire, the percentage of alcohol, the greater the problems that includes the diabetic effect that includes effect on the good microbiome, that includes lifestyle habits. If you're drinking a lot of higher percentage calls, you tend to feel the effects, you know, not just in the skin, cognitively, behavioral wise, that can affect you. Sometimes lower concentration alcohol, depending on the setting and lifestyle, may be net neutral, may be positive, unclear on that part.

but i'm not hearing any positive effects of .

alcohol on skin healthy gently. Same as what we've seen with other organ systems. The brain deliver, the skin reflects the same thing. If anything, IT may be a net neutral. Most of the time is a net negative.

And what i'm calling from all of the discussion we've had up until now is that improved blood flow and strong hydration status are both important to recommend patients drink a certain amount of fluid each day or maintain adequate hydration as a means to build maintain skin health and appearance.

Great question. So that that's another common misconception that I see in that thinking, drinking a lot of water will or drinking a lot of fluids will directly affect the hydration status of their skin.

And while there is a certain degree of truth to that, if you're dehydrated and that you need a punishment of fluid, know systemically, thus every study that looked at trans epidermal water loss has not shown a great connection with regular your fluid intake and water intake and skin hydration status. We find that that tends to be genetically defined and genetically encoded. Some people have dry your skin.

They need more methods to moisture ze their skin. Some people have oil in your skin, and their serum provides that moisture. Zia, now, if you're doing things, if you're active, if you're an athlete, if you're doing things in which you are dehydrated, then totally different story.

But if you're living a more or less baLanced life for a sedentary life, and you do all the regular things, drinking a lot of water or floods has not been shown to improve skin health. So that's why, generally speaking, most methodists will recommend some sort of moist riser to replenish that. But you gotten know your skin, for example, my skin, I tend to be oil.

Er, I don't usually need a moisture as well as much. Where is somebody who is drier? We'll need some sort of barrier protection to allow to minimize that transit dermal water loss.

What are some of the parameters for selecting a moisture? Er.

yeah you know .

people are immediately going to going to say what constitutes a good moisture? What should I have in IT? What are some .

things to avoid? It's a crazy market. There's a lot of things out there. I mean, you can google skin snail moisture and you'll find people putting snail music on their skin because .

you're telling me before this recording started, there are people who and forgive me for those that current, I say this, that put placental extract human .

placental as means of rejuvenating their skin health. I don't advocated or don't say anything against IT. Um I probably went recommended that there's Better, safer, more cost effective ways of doing this simple things you want to look for.

One is a non commended generic. That's a word you want to look for, for any moist driver that's been tested, not to clog your ports. That's a basic thing to look forward where you won't cause another problem in trying to fix one problem.

Number two, how oil or dry are you? Generally speaking, there are three flavors of moisture. There's ointments, there's creams and their locations.

Ointments are grey. They're like petrol, delia, vaseline based. Those are the best for moist ising your skin, but they're greasy.

Then there's creams, which are water emotions with oil suspended in IT. And then there's lotions, which are generally powders that are resuspension with water. We, as dorman's logic, tend to, like the greece year, the Better that provides the best barrier protection.

But you have to know your skin. If you're somebody that is my phone, you will need something that is an ointment that does Better to protect the skin from drying out. If you're somebody that is agony prone, you won't tolerate crazy things.

You'll break out more. So you want to look for a lighter moisture or that's non kova, jens. So in a long story short, is very person to person specific. You got to know you're skin. But the fundamental things you want to look for us, has this been tested to not cloud pores and is IT in a pumped bottle, or is IT in a jar just tend to be more inclusive.

They tend to provide more moisturizing, but they can lead to problems like making in break out where's things in a pump bottle because they suspend their powers and suspension, and they have to put alcohol in the product to allow you to come out a pum mechanism. They tend to be lighter and not provide as as much moisture. Urias ation, I see.

So when I think about something in a jar of something like aq four or something which is pretty thick, this stuff. So that would be fine for someone with exam, not okay for somebody with agony.

Exactly exactly the Grace. Er the more conclusion IT provides, but in doing so IT clogs everything. If you're one that has some sort of skin issue in which you need, that is the best thing. If your one that is breaking out all the time, you want something lighter.

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Supply a vitamin 3k two。 Again, that's a drink A G one dot com slash huberman to claim that special offer. Why do people wake up with bags under the eyes if they just slept for six or eight hours?

Yeah, maybe you need a little more sleep, or maybe had a child night, you can tell. But generally, the bags are caused by two things. One, fluid retention.

So there's some lymphatic change that occurs the eyes that most noticeable because the skin under our eyes and on the surface of our eyelids is the thist. So fluid changes are seen the quick there. And as we're in a supine or prone position, fluid moves from our extremities back to our central neuva system in its easier to collect in the face. So we see IT around the face. The other thing that we do notice with bags is just age related fat, her nation that shows up more um as we wake up because of positive changes.

So if you've had meal, a heavy meal the night before, something that has a high salt content, you're gonna retain a little bit more water um because of that solid shift, you may notice your eyes or puff far in the morning um if you have allergies, a seasonal allergies as mh example, they run in a family that tends to make your skin retain a little bit more water as a result of that allergy response. So people you know will notice spring time or full time, they their ear swelling or their eyes or puppy, especially when their allergies are flowering. It's a, it's a product of water retention from all the histamine releasing in changes that occurred. Skin.

skin lenzing is a topic that gets a lot of coverage. And I sometimes get chuckles or even attacks for saying, i've always just use accented dove soap, the bar, not the liquid soap, yes, or like a sedia soap. And this is because when I was Younger, like much Younger, I had very sensitive skin.

And when I was like a kid, seven, eight, nine years old, I think I just started using incentive of. So at some point and things like IT gentle you know soap without fraighted ces, what are your thoughts on on those? And I ask not for my own purposes, i'm going to stick with IT because he works for me unless tell me.

But I see this enormous market for skin cancers that includes a range of costs from relatively low to near astrodome. And if you tell me that this intended dove soap, sativa soap is the way to go, by the way, i'm not sponsored by either of those. Let me know who they are manufactured by. So there's no commercial angle here, but i'll be relieved because they tend to fall on the lower end of the cost bracket. Relatives of some of these astronomic Priced .

kenser skin cares a incredible multibillion dollar market. That being said, there is. Not a thread of evidence that anything more expensive works Better than anything cost effective. So that first and foremost, number two, dove White. Our sop is amazing, is what we recommend for newborn's and kids with sensitive skin.

Generally, when we say sensitive skin, especially in kids todgers and adolescence, there is a component of some sort of example, a or a topic germanie s that is not bad enough to have a diagnosis, but enough to say you, I had sensitive skin, so love light bar shop is what I use for my kids and i'm not sponsored by anybody either. But I think it's an amazing uh, product because it's safe, it's effective. But as the least amount of ingredients, no fragrances, these are all things that can irritate or causing a logical response to the skin that is sensitive, meaning your skin mountain and immune response to some sort of environmental allergies or trigger.

That's what we generally mean when we will talk about sensitive skin. I personally use sea file. That's my face h wash.

I have oil skin. I use the one that takes off more the oil. So what you're looking for is defined by what bothers you or what your skin predicant is.

What I do see is a problem nowadays is particularly in the united states, where a hyper hygienic society. So what people tend to do is over cleans. And they overclean for several reasons.

One, because they are told that cleansing will fix their skin issue. Or number two, they're told that some sort of organism is on their skin or some sort of bacteria that needs to be cleaned off to keep their skin healthy. Neither or true. The first thing you want in terms of kenser or something that mild fragrance free and has been tested to be hypolito ic or non compete genre, that's first see the full survey, great stuff. No association with any of them, the incentive .

non fragile institutions, ons of them exactly .

um that's first. Fragrances is tend to be a problem for sensitive skin patients who have a topic german tis or exams. They tend to trigger allergic responses or exacerbations of their exam flares.

So we try to avoid frequently bio means. Then things that are jails or liquids tend to have preserved tips in them to increase shelf, where as bars tend not to. So if you are gonna, pick something that is A A jail, a liquid. Look for one that's been tested by dermatologic group or verified by the american categories.

One that is not uh allergenic or um has multiple preservative because that's another well known but on identified source of problems well known to the german ology world, not known to the they know the average person that the preserve tips in our clean sers are a problem. Overpleasing becomes really problematic in in eradicating the skin microbiome. So what we see a lot of times are clean sers that are either um back to oidor back tera static, things like benzo proxy de, things like seller lic acid, things like certain stringent tones that are alcohol based.

And what they do is not only do they strip the Normal oils from our skin that keep our skin supply and healthy, but they eradicate the Normal host skin microbiome. Those are all the microorganism that live on our skin, and we have trillions of them actively surveying our skin, living in in Normal 新 biotic eo status。 Meaning they are, there are friends there, are living there for a reason, they don't cause any problems.

But when you clean them off and you open up, uh uh an area for pathogens to take effect. And that's when we see a lot of problems. More so in industrial ized countries, the night is a notorious place for washing.

But I after cove IT, wash, wash, wash, wash more, use a toner wash the more. And that becomes really problematic because IT set up for organisms to take seat on, vary with them. So overall, cleaning is great in the amount that you need to clean is based on how oil or savas your skin has.

The older you get, you may not need to clean as much. Their older patients don't need to cleanse your skin at all every day because they don't produce as much severe more oil as Younger patients, but everything should be defined by your skin characteristics. So if you are one in which you notice, by the end of the day, i'm i'm oilily, i'm breaking out cleaning, maybe something that's beneficial for you to take off that excessive. If your one that has dry skin, your one that has sensitive skin as a child, then over cleansings going to be a problem. You're gonna want to minimize that and and keep that moisture zo or that barrier protection going.

So does that mean that people should base probably once or twice a day, but the people that are bathing three times a day, it's probably excessive? I an we saying that you can't get into water. I mean when you say cleaning, you talk about face cleansing.

I realize this is going to be highly individual, but you know some people um or just out of habit you know shower and use clear yon twice a day, yeah once a day. I think for me it's in the morning or in the evening, sometimes both. If I do workout, I try and shower as close as possible after the workout, as soon as possible after the workout, rather because otherwise I will break out. no. So that sounds like one has to kind of learn what their agents and that's going to vary by age.

Um there's a lot of factors to this. I I think ashton couture and millions ess famous. I said the shower, I think one's a week or something like that, and IT start up a lot of conversation when that came out.

Truth be told, you don't have to class every day if your skin is otherwise find healthy. You're not bothered by anything. You live a lifestyle in which you're not sweating excessively or producing a lot to see them them.

I myself same thing I work out, so I I shower after working out. I usually shower before I get into bed because after a long day of work, I tend to have things on my skin that shouldn't there, that's only fitting for me. Because if I don't, I tend to have problems, I tend to break out.

I tend to have things. That notion happened because of my hygiene habits. That said, there is no indication or no medical necessity to have to clean your skin even once a day.

Often times older patients cleans your shower once a week, and they're totally fine, but it'll have to be defined by your skin in what problems are available, are specific to you. Generally, if you work out, if you let sweat dry on your skin, IT causes several problems. Number one is irritation itself from the sault that Crystalized from the sway drawing off.

Number two, the sweat itself as a source of food for certain east that are Normal sympathies that live on our skin, contribute to things like dan draft, um what we called tiny versa color, which is a type of east that s on our skin. So generally, if you work out, try to wash those things off. Also, if you are one of your acne prone skin, if you're an adolescent, if you're a teenager for your adult dealing with acne, the sebum that your body's producing is food for the bacteria that cause this.

So you tend to want to clean some of that excess, see them off. Those are simple indications to clean your face and your body. But if you're not having any problems, you actually don't need to do any other. In europe, they shower and cleans at a fraction the frequency that we do in the united states. And when you look at incidences of the most common skin conditions, there's the same.

including things like aconites service IT. You know, most people think about shampoo for the sake of hair, but there's the scalp component. And since you an expert skin, we should probably spend a bit of time on this.

For people that tend to have a dry or flaky scalp, what should they do about that? My understanding is that some of the more typical commercial and I danger of shampoo can contain things that might cause issues for hair itself so they might help with the flaking and drawing in the scale, but damage other aspects of, you know, other appearances are health of hair yeah and what are some really good options for people that have dry scalp? What are some great options for people that have really scale? And let's leave aside the frequency of use and just um craps just put in on the shelf as as much as you need IT, but not more so there could be once a week that could be daily. There could be twice a day in extreme .

cases that sounds like so when we think about the scalp, when we think about trier flaky scalp, we think about two main conditions, either separate dermatitis, which is medical grade danger or or the medical name for danger ff. Or serious is there are two different entities, but they generally contribute to the same problem, which is running, flaking and drainers of the scalp. Now it's important to note that the hair on your head is dead.

It's not alive. The only area that's alive is two and half millimeters in the skin. So the hair that we see on our scale is not a living entity.

So there's a common misconception that you can affect the health or quality of your hair by putting things on the hair. And i'll go into that just a just a minute um but the hair itself that you see is is not living. The only area that living are the stem cells in the pupil of the hair and in the bulge region of the hair which reside in the skin.

So nothing that you put on your scalp will make you lose your hair, will make you grow new hair for the most part. Um why that's important? When we treat dry or flaky scalp, we treat IT with several things. The most common cause is in overgrowth of east from the sweet oil that is produced from our our scale and that's several dramatis that's the medical name for Daniel.

And so we treated by one lowering the amount of that east that's living and that's usually with shampoo um that are prescription or over the counter, you know things like the sink or key to contest or shampoo are very common things. And then the other thing that we do is to dampen the immune sense to this overgrowth of east. So the reason our skin flakes and gets read and proliferate is our immune systems responding to something.

It's either responding the east or it's responding to itself, which is what saria a says. It's an immune mediated over proliferation ation of skin cells because the immune system is overactive in the skin in the way we treat that is just typical, or certain medications that suppress the skin, immune system or immune activity. None of that affect the actual hair itself.

What does happen is shampoos tend to have things that strip oil as a mechanism of cleaning. So when you take a cross section of the hair, their seven layers and the the layer that provides that color, shine and structures called the cuticle. As we age, we lose the cuticle, and that's that's a common problem.

What we see in male and female pattern hair loss or entire genetic alpacas, we'd lose that cuticle, which makes us lose the shine and the structure and the strength of our hair. Our body tries to replenish that with the oils. So when people wash their hair, sometimes they feel like the hair becomes more limp or dull or lifeless.

Less it's because we've taken that artificial oil coating, uh, that replaced the cuticle and and washed IT off. So good news, you're not going to do any harm putting any of the typical on your scalp. Bad news, you probably won't bring a lot of IT back to life either. But when we treat flakiness your red ness, things like that, treating two entities, usually with topical and because either trying to treat over proliferation of something or trying to calm down, the skin's mian .

system got IT. So IT sounds like the best options for cleaning skin. For shampooing really stem from knowing whether not your skin tends to air, oil or dry, figuring out how often to clans. And then as you pointed that out before, even though there's an enormous range of cost for these things, none of the solutions that you're describing like they fall on the high end of cost or even in the middle end of cost, which is a bit surprising to me.

Yeah, this might be one of the few areas where, like if I had a magic wand, I would make for all the organic, uh, non process and minimum progress foods to be very inexpensive. But IT turns out those things tend to be more expensive. You can go to farmers and markets and cut back on the cost at that. But there seems to be an unfortunate trade off between availability and cost and benefit at least risk. But IT doesn't feel like that's the case with skin care or scalp care that one can exercise really excEllent skin and scalp care without having to go into a range of of spending an outrageous amount money.

No, I think one you're absolutely right there is the more expensive does not mean Better if in fact, they sometimes become more problematic because there's more ingredients in the more expensive products, including elegant figurines and stuff like that, which can be problematic. That's number one.

The second thing to know is that, generally speaking, there is some connection between skin health, skin care, in this realm of beauty, which people overlap a lot in, in the when we trend into this realm of beauty, glam, eea Price in objectivity are taken out. And that's why you see a lot of skin care products that are so expensive because they draw toward another level of desire. That's not just medical, it's aesthetic.

And that's where you'll find creams that are two, three hundred dollars for a little amount of cream that does the same thing that you're jar of Peter autum or vasling or awkward does that part is really hard to mitigate. But in general, almost everything that we is german taloo gist and skin cancer surgeons and um expert in in the field recommended really cheap, cost effective and they have the least amount of ingredients in them. And that what I would recommend, that what I recommend for my family and from my patients.

You don't have to spend a lot of excEllent skin caring. You don't need to have IT be a multistep routine. Often times people overdo IT.

The more steps that there are, there's more chances that something your skin will respond to negatively. The more chances you are to have a bad outcome to an ingredient of a product or putting on your skin. So keep IT simple, keep IT cheap, and you'll do great.

It's going to be very reassuring to many people, is also going to be somewhat destabilizing to people who are really attached to the idea that the more expensive products are really doing something that much more beneficial for them.

Not much at all. Not not anything. In another important thing to to consider when looking at skin care, skin health and then trending into that area of aesthetics and beauty, is that most active ingredients, if the really active, tend to be controlled by the F.

D. A. So most things that are sold over the counter have actives that are not at a concentration high enough to be considered therapeutic because that's when you get into the definition of a drug.

So looking at things like anti dandruff shampoos, you antiaging creams, you um active medications, they work a little bit if they worked perfectly, the most medical drama ologies would be had of a lot of patients. And we see a lot of skin disease that still continues because the active ingredients aren't at a concentration high enough to provide therapy. C benefit to save your money if you really need something to change some part of your sand, see a good, dramatic, just see an expert and see what they can come up with.

So this seems like an appropriate time to ask about sun exposure. And then we, we'll also talk about sun stream, sun blocks, skin cancer. But what is the relationship between sun exposure and skin health specifically, meaning how much sun exposure is healthy for our skin? I'm a big believer in getting sun exposure to the eyes early in the day, linking as needed to protect the eyes, of course.

But in order to set one circuit, an rythm for elevated daytime mood, focus on alertness and improved nights sleep, there's just so much data to support setting one circling rythm properly for sake of health. And there's so much data to support the fact that sunlight viewing in particular, is the best way to do that. In sunlight viewing in the early part of the day in particular, is the best way to do that. But beyond that, how much sun exposure to the skin is good for us is IT zero? Is IT five minutes?

Does IT depend great, like great controversial question, and depends on which school of thought were camp. You belong ging. As a skin cancer surgeon in somebody who's developed a reputation for seeing some of the worst, most complicated, life threatened skin cancers in in los Angeles, obviously, I see some of the consequences of long term sun exposure and con chronic photo aging.

That being said, I absolutely think that getting sun is healthy for us. Now why? The studies that talk about vitamin e will touch on vitamin d as its own entity and then overall health as another entity.

But most of the studies that look invite AMD syntheses from U. V. Exposure on the skin suggest that you only need about fifteen minutes and that you don't need a road, a surface area of exposure.

You can get enough written formation with just about fifteen to twenty minutes of sun on your farms. So there is a whole school of thought by a lot of experts to think there is no amount of U. V exposure that's healthy for the skin.

And I tend to be on the other cancer. Several reasons. One, there is a component of feel goodness, if that's a word from being in the sun that affect overall skin end.

Physical biology, when you're out in a Sunny day, you tend to be less stressed, you tend to be a little happier. Now it's it's a generalization. But most of the time when you get outdoors, you get outside and a nice Sunny day, you feel Better.

And although you can't quantify that feeling Better, there are some parameters that can be measured, decreases and core is all response improvement in skin appearance and texture. Um the other important thing about being out in the sun is finding out your own tolerance, right? So I have a little bit more all of skin.

I can tolerate the sun a little bit longer than somebody who is fair and lighter. I in my opinion, I don't think in in most of the evidence there isn't a finite amount of time because that time is dictated by your skin ability to tolerate the uv. But I absolutely do not think that sun avoidance is a healthy thing.

And this is coming from somebody who Operates on head and neck skin cancers literally every day. I think there is a component of sun exposure that's not just provide in design sis, but something that improves your overall wellness that is a visible and maybe not laboratory measurable. But um you definitely are healthier when you're feeling Better and you're happier.

I lived on the east coast in places that had lower uh days of sun, and I had seasonal effective disorder. You bothered me. My moon was lower.

I felt not. Is healthy and i'd come home. My family would I hate you look sick and just I wasn't sick. I had had any son now is lighter than I was.

And my family interpreted that not being healthy, you know, my wife, on the other hand, didn't SHE didn't mind the Greener. So there is a time line for biologic processes like video deformation that's helpful. People can argue that you can get IT through supplementation and food and that that's correct.

But there is a component of sun exposure that makes you feel Better overall and provide some sort of wellness that you may not be able to quantify, but you see an appearance and in discussion and longevity. So absolutely, I think you should be out in the sun. I don't think you should burn, and I don't think you should be long enough where your skin starts to turn red.

That's the first sign that you're reaching kind of critical mass in terms of U. V. exposure. But I absolutely think the sun is a good thing for us.

So even midday sun, maybe if there's some cloud cover or we have some sunscreen on or a physical barrier sun in long, excuse me, like hat and long sleeves, then getting some sun exposure in your mind is good for overall well being moved at such .

a yeah I think you I mean, midday sun has a higher U V N X so you're more likely to burn and have a problem with prolonged exposure. But yeah, absolutely. I think you know there's been numerous studies that that have looked at people who go out for a walk in your busy urban cities and work environments.

If they go out for a walk in the sun, they feel Better than stress. Responses are lower. Their questioners in responding to life stressors and dad day stressors are decreased.

There's a lot of studies that look at being outside as a measure of well being mental health. Well being, uh, is improved with outdoor some exposure. So there's a lot of that.

Now can I quantify IT in the skin? Hard to say. One thing we do know is that obviously too much sun exposure like anything too much of a good thing, can be a bad thing. But I really do think that being out in the sun for the amount that your skin can tolerate is a good thing.

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What about sun screens and sun blocks? And I think we should distinguish between those two labels. You know, in the old days, as I understand, sunscreen was the word used to describe stuff that you put on your skin that absorbs uv.

And then sun block is the stuff that you put on your skin to reflect U V. Typically nowaday people say sun screen more than they say sun block, or they use them interchangeably without any knowledge of the underlying mechanism. Um so first, while let's clarify sun screen versus sun block.

yeah so a lot of the nomenclature data, understanding chemicals, things that were considered O K to be used, came from an original F D A. Nineteen ninety nine manuscript in that data hand changed for almost twenty something years. And more recently in twenty twenty one, the F D A released a proposed final order for the term sunscreens as a whole.

Now when we talk about sunscreens, sunscreens are considered and over the counter non prescription drug. So they're regulated tightly by the fda. There in the same category is any over the counter drug.

So before this this decision ruling, there was a lot of nominal creature wording confusion. Sun block seemed Better than sun screen, some ten sunoil. All of that been changed recently, or has been proposed to get rid of, to unify the field and make IT very clear what the goal is.

So no longer do we use the term sun block, although in the past that had been used for things like sink or zink and titanium based creams like the old nineteen eighties or one thousand and ninety White lifeguard knows, if you remember, that used to be thought as sun block, where as less, less protective chemicals were used as sun screen. Now that's changing. In the fda, twenty twenty one proposed order says we didn't need to unify everything called a sunscreen.

Now, sunscreens being regulated. Drugs take a lot of scrutiny for many reasons. They takes scrutton from the F, D. A in terms of proving efficency and safety. They take a lot of scrutiny in society for being dangerous or not dangerous, effective or not effective, causing down stream effect or not causing down stream effect.

So that's been a big point of contention in terms of the population, the american academies stance, dermatologist stance and then the skin cancer patients beliefs, the beauty experts beliefs and average person's opinions. Sunscreens generally fall into creams, lotions, topical products that protect the skin against sunburn. We used to be able to suggest that they reduce the risk of skin counter um prevented premature aging, but that can be a little convoluted in the F.

D, rewarding that into not being able to say that anymore. And they are proposed order. But what sunscreens intention is is to protect the skin against access U. V. exposure. And they come in two flavors. They come in mineral based sunscreens, which tend to be in the category of sink in titanium minerals, and they tend to be chemically sunscreens, which are a bunch of different chemicals.

Mineral by sunscreens are sometimes called the inorganic yeah.

In organic or physical sunscreens, whether the chemicals are considered organic or chemical sunscreens, totally right.

is the mechanism for these two the same because I was under the impression that the mineral based in organics sun screens um reflected back U V rays um whether the chemical based sunscreens absorbed U V rays. But there's a bit of a online debate about this claiming that they all absorb the race.

So historically, IT had been thought that mineral or physical sunscreens, sk sinkin titanium sunscreens, worked by basically acting as a middle reflecting shield. And for the most part, that thinking is not incorrect. There is a, there is a new study that showed that they work by actually absorbing them um but not having any sort of chemical change.

So the way chemical organic sunscreens work is they absorb the ultraViolet radiation. They undergo a chemical reaction to reduce its energy, anticipate that energy as heat. So chemical sunscreens worked by actually absorbing IT in undergoing a change, whether mineral or physical sunscreens don't do that. I still think of them simply as minerals basically shield the skin like armor, where as chemicals act as a sink and undergo a change to reduce that energy. So that kind of the symbolistic way that sun screen top s on strange work.

So what is your recommendation about protecting oneself from the sun? And maybe for the moment, let's just set aside on screens and acknowledge that a physical barrier like hat, long sleeves, long pants, provides a pretty good barrier .

to the sun. correct? yeah. In fact, physical barriers like shade, clothing, hats have been shown to be more effective um then typical sunscreen for several reasons. But there are many ways to protect your skin and you have to ask why you're protecting your skin.

So is IT because you're worried about premature aging, photo damage and things like of that nature? Are you worried about your risk for skin cancer? Um do you have a sun sensitive skin condition like loops or PMI that is sensitive to U V exposure? So the first question is, why are you worried or why are you taking protection? And then you customize your approach to that.

Now sunscreen, topical sunscreens are not the only form by in large. There are many other forms, both physical blockers and certain things in the supplement world that can protect your skin. For example, I myself take uh, protocol sun powder that provides an internal sun shield, allows me to be in the sun longer and without the need to reapply or if I can't reapply, but not buying large, the best way to protect your skin is some sort of shield, whether it's clothing, hat or some sort of cream that you put on.

No, for patient who are worried, for people who are worried about creamy ure aging, they don't have a strong family history of skin cancer. They've never had one before themselves. Then the approach to that is a little bit different than people who are worried about skin cancer development, strong family history of skin cancer.

They're worried about losing a part of their ear or part the nose to the skin cancer development. And that's very different from medical conditions that are very sun sensitive. By and large, the patients who have medical conditions that are sun sensitive, the large of being loops, for example, need the most some protection because they are so inherently sensitive to U.

V. Exposure, something that's very interesting. We know without a doubt that every common skin cancer is many, many skin cancer types.

But the three most common, or basal sol carcinoma scream a sol casino, and melamine was the three most comments ones we see. They have all been shown to have U. V. Mutation signatures when we sequence the tumors.

However, in every single clinical trial and every single randomized trial that looked at typical sunscreens as a means of reducing risk, there has not been a single study that showed any sort of risk reduction in the development of the most common skin cancer, which is basel sol casino. A one in four americans will develop this. Also, there hasn't been a single study to date that showed that diligent sung screen use typical sunscreens will reduce disease specific depth or dying from skin cancer.

So if you think every skin cancer on driven their U V mutation profiles in these tumors, then by using sunscreen should reduce that, right? And it's not that clear. We don't understand fully the drivers of this, so why I bring this up and why we talk about sun screens and barriers to blockade first sunscreens, topical sun screen are not the only form.

No, in fact, clothing and shields, the old shade and hat, or in my opinion, Better. And a lot of studies suggest that their Better. There are oil supplements that can also protect your skin from burning in in, reduce your skin cancer risk. In number three, not everything is sun driven.

We do know that diligent sunscreen use decreases the incidents or the amount of melania formation in squamous formation, but we still don't know whether that reduction has changed the number of patients dying from that, and we also know that IT has no bearing in the development of the most common skin cancer, which is based cell. So we go back to the drawing board and scratch our heads, and hey, what is the trigger? You know, the genetics loads the gun, for example, and maybe even pulls the hammer.

But what in the environment is the trigger is is strictly U. V. Is at some other culprit. So sun springs are a really hotly debated topic. So many things to talk about in in terms of sunscreen.

So if I understand correctly, you're saying that the use of sunscreen can protect against premature ageing, let's say, sun block, because I think we are going to arrive at mineral based sun screens, probably be in the Better option. But we can, uh, make sure that we double click on that sort of speak. But that sun exposure itself perhaps is not linked to the most deadly of skin cancers.

That tells me two things. IT doesn't tell me that I can just spend as much time as I want in the sun, but IT does tell me that I should probably into the things that caused the most deadly skin cancers. Yes, okay. But i'm also hearing that regular application of sunblock and our physical barrier will protect my skin against some forms of premature aging caused by sun exposure but will not necessarily protect me against the most common forms of skin cancer that is peculiar uh in the sense that or even baffling um to the nondum ethologist me because we already know that some exposure causes uv mutations, mutations in the DNA of cells is one of the kind of core components of cancer s so how do we square all .

of this great question? And the more we dive into this and the more experts we we look at, the more data we we collect, the more were scratching our head as we don't know and why this occurs. Now I am not saying don't use sunscreen. Let just let that be known. I think sunscreens are excEllent forms to produce against premature photo aging and signs of sun damage.

I think sunscreens help reduce the incidents of common garden variety skin cancers, but they are not the only former protection, and they seem to not be as important or have as much effect in reducing the incident of our most common skin cancer, which is basically carona. Moreover, I would say, and the data unfortunately shows that the majority of skin cancers that we see that end up hurting people or killing patients don't arise in chronic sun exposed areas. To begin with, you know, I have a twenty seven year old patients right now dying of a metastatic miliana, a that arose and completely sun protected skin.

I have a fifty six old mechanic right now who's dying of a squam muscle car, noma, that rose from the back of his ear. And most experts who have this type of type of experience dealing with these patients have the same observation. So the question is, what's pulling the trigger? For the most part, U.

V plays a big role. The the mechanism in which cancer forms, if we believe this, the basic high school biologists, you know, hyperplasia metal, plastic display a, carson's a so there's A A trajectory of changes that are occurring as a result of cumulative mutations in the skin. If we believe that trajectory, then every skin cancer should see that change, and we just don't see that.

Also, we know that skin cancers that are rise in sun damaged skin behave differently than the ones that are very lethal. So why I bring this up? I I think sunscreen is very helpful.

But we have this unfortunate trend in medicine, particularly in dramatic logy, to guilt people into thinking that they caused this to themselves. I don't think that's right nor okay. And I don't like that because they make IT seem that, oh, the sun you got in one thousand nine hundred eighty seven, that one sunburn and hawaii did IT to you.

And that's absolutely not the case. There are many things that play fundamentally, your genetics and immune system, that play a huge role in skin cancer development, that sunscreen cannot address and will not address. Now the the wild card is, okay, what are my genetics? And that's the part we don't know, which is why dermatologists say, okay, let's at least control the thing that we can, which is U V.

exposure. But I bring this up because people don't feel ahead about getting some sun and don't feel guilty into something that if if something bad occurs, it's not your fault. Some of IT is out of your control and that that's really important because I see a lot of very bad skin cancer. My practice, and I I hate this feeling of patients being feeling like they did IT to themselves.

I think most people would prefer not to have the premature aging caused by sun exposure. So what should those people do? I've taken on a practice of putting a mineral based in organic sunscreen on my face, my arms, if they're going to be exposed back on my neck, tops of my ears, if i'm going to be out in midday or late day on, that feels intense.

And i'll do that every single time I go out on overcast days, not so much for viewing morning sunlight. I don't do that. In fact, when the sun is low in the sky, I don't tend to where sunblock that's me.

That's been my choice. Um there were few years there where I didn't put on sunscreen or if I did IT was like on a camping trip or skin or something where the sun felt very intense. In that case, I would just reach for whatever sun screen or sun block was available because I aware that some of the ingredients in certain chemical based on screen may be problematic. Yeah so um I think I fall into the typical category of a lot of people um but of course, there's the category of people that are like note sunscreens, sunblock is terrible all the time or they're just too lazy, uninterested in playing IT. But then there's this whole category people that are putting IT on every single time they go outside in hopes that that's going to keep their skin much appearing much Younger and just generally are kind of afraid of the sun.

A lot of good point. So there's that famous new land journal medicine picture of the truck driver that got chronics on exposure on the left side of his facing. You see all this wrinkling and modeling of the on the left side and nothing on the right side.

So by absolute measure, sun protection or U, V protection will reduce premature aging. And interesting with that, guy did not develop anything in that area. So again, IT goes back to, well.

what's doing cannot.

So the question is, what's pulling the trigger? Is that truly U, V, S, or something else were missing?

If you tell me that you got can cancer on the opposite side, i'm really going to .

guess I don't know if he's had any on the opposite side, but in that photo, it's purely premature aging. So things that you want to do, obviously no, don't let you can turn red, take some sort of some form of barrier protection, whether it's a sunscreen supplement like polypodium, something that protects your skin from the inside out and skin changes are cumulative um so what we can tolerate our teens and twenties is very different than what we can tolerate or forty fifties and sixties because there's a cumulative mutation profile burden that we see.

Interestingly, there was an allied study that was published recently that looked at iod skin that was removed during your cosmetic surgery, up island lifts that was otherwise discord and when they ran genetic sequencing on Normal island skin, they saw the same mutations that they would see in matched skin cancers, what the islands didn't have any skin cancer. So we know U V triggers these mutations, and we know U. V degrades collagen and lasting IT thins blood vessel walls as a mechanism of of its effect on the dramas.

The data is equipped as to how those mutations trigger skin cancer formation. But in terms of premature aging, absolutely. So you want to take some former protection.

Now, what type of protection do you take depends on your genetics, how much you can tolerate, and what your family linux looks like. Some people have the genetics of early aging is part of their skin biology. And you can change that, but you can mitigate that risk with more strict.

You, the avoidance. Some people, you know, they look Young longer, as you know, some family linders just have great genetics in their skin. They can tolerate a little bit more sun. In terms of physical sunscreens versus chemical sunscreens, that's a hotly debated topic in my personal practice. And for my family, I tend to only recommend minerals in coursing in titanium sunscreens for several reasons.

In the original set of sun screens that were approved by the fda that came out nineteen ninety nine, there wasn't enough data to look at biologic effects, efficacy, internal organ involvement, exedra fast for twenty years. And we've gathered a lot more information about these chemical organic compounds. There is an amazing twenty twenty study that looked at absorption of chemical sunscreens when they are applied onto the skin.

They looked at absorption with single application, and they looked at absorption over four days of application. Now in the study, they applied a little bit more than your real world h experience, wood. But even with single application, they saw blood plasma absorption of these chemicals that were a hundred to five hundred times greater than the upper threshold defined by the F.

D. A. Now the question exists, okay, what does that mean? Is this healthy? Is this not healthy? Is IT neither. That's still up for debate. But in looking at the more recent literature and looking at the chemical structure of these compounds, a lot of these are final ic compounds, meaning they they have one or two, usually two, benzine rings attached together, and they they look very similar to one another.

There's been a lot of basic science, animal study and retrospective human studies in the last two or three years that suggests that some of these chemical compounds, particularly oxy ben zone, particularly oc crying, particularly um occ's ate um that can have underground disruption or affect the nervous system because they mimic a lot of biologic phonic compound and a lot of biologic ormond. If actually look at the structure of oxide ben zone, IT looks very similar to the structure of biz final a, which has been now banned a lot of the lining of plastic bottles. why? Because the same concept now, the data is not a hundred percent one way or another, but there's enough smaller ing evidence that makes me think we should reinvestigate this.

And in fact, the F S. Proposed final order in twenty twenty one changed these chemicals from Grace generally recognize a safe and effective to not Grace because of these concerns. There's data that suggests that the chemicals are found in breast milk, amniotic fluid, blood plasma.

There is a lot of things that we don't know, and I always say this in science, we take two steps forward and then maybe one step by diagonal or side race because we ran into unexpected things. I tend to recommend mineral sun screens because they don't have any of that data. They haven't for the last thirty four years, are considered safe.

And in fact, for Young kids, particularly those six months and under the american academy, germano logy in the american academy, pediatrics generally recommends avoiding chemical sunshine ines. Why children's skin, particularly infants in todgers, behaves more like mucus membranes than adult skin. Their barrier is not as tightly woven, so they absorb these things at a much higher concentration. So if you are to apply something on kids, especially Young kids, six months or under, we recommend minerals to begin with. So I say if you have a pool of compounds that has may be even smaller ing evidence on the basic science level that something's forces of a group of uh compounds that have really no data, which one would you pick and they do the same thing I naturally gravitate.

Or is that so they take away for me? Is physical barrier no issues, mineral based sunscreen safe. So that think oxide titta, ian day, oxx IDE and that's mineral.

not like powder, not mineral powder, but mineral topical because mineral powder are a whole. Another issue talk about.

okay. And then chemical based sung screens are probably best avoided. And then you mentioned polypodium, so this is a pill is a supplement basically that one can take. I only call IT a supplement because um it's not a prescription drug correct um that protects your skin from U V. Damage from the inside.

So exactly right mineral based creams in lotions I tend to prefer and recommend in my practice, in most people will, if you're worried about any risk, any consequence, chemicals I tend to personally avoided. Now this may not be in line with whole my doritos gy colleagues, but I tend to avoid them, and I do not recommend them for kids in terms of things that you can do. In addition to provide sun protection, polypodium ms.

Have firm from the amazon rainforest that was discovered when they studied an indigenous population that would eat this firm before they would go on their fishing expeditions on the amazon. And they've gone for three days. They eat this firm and come back, not burned.

So a lot of studies were done on this firm in the last five, ten years that showed increases your skin minimal eraste modest amount of redness your skin gets from U, V. exposure. That's our general parameter for effectiveness without any topics it's taken or injured ted only.

I personally use a form called sn powder that also has nickem. I and know we can talk about a timi later, if in enough itself. IT works great.

In conjunction with topical, you get the best of both words. You get internal shielding and external shielding. Now IT is a supplement, so it's not a controlled drug the way that F D, A regulates sunscreens. IT isn't really a sunscreen, but it's a way to prevent sun burns, increase the amount of time you can be outside and increased the efficacy of your topical.

So if you're somebody who is very first skunk who burns all the time, or if you're somebody who has like what we call sun hives or or prickly sun rash, pm, this is an added thing that you can use that will boost your some protective factors is awesome. And hear somebody who's active, like you're in the water or your exercising, you're playing a sport. You can't reapply. I love polypodium. For that added benefit.

What are the dosages of polypodium that are useful? And are there any side effects?

Yeah, great question. So there has been a wide variety of doses investigated anywhere from fifty hundred to forty four eighty .

generally and fifteen hundred.

Sorry, fifty milligrams is hundred milligrams two hundred forty four hundred eighty somewhere in the between fifty and four hundred eighty milligrams is what's commonly used. The most common side. If I can be a little upset stomach, if you can tolerate the plant .

for looking daily.

it's taken. You can either take a daily as a method of preventing premature photo ageing and pigments tary change, or you can take IT as an as needed an hour before you get sun um to shield you from the sun um the other thing that IT helps prevent um that some sunscreens cannot, particularly the chemical centuries cannot, is the effect of visible light.

So there are certain skin conditions, the most common as malaysia a, which a lot of women have, which I think the pain of their existence used to be called the mask of pregNancy. And malasia a is something that is very sensitive to both. U.

V. In visible light. Chemical sunscreens. S, down to a good job locking visible light. Polypodium been shown to help block the effect of visible light as well, which makes malaysia worse. It's this discovering that we see mostly in women, usually after pregnant here, women who on birth control IT is really chAllenging to treat. And sun protection is the first line like diligence and protection, but we found that supplementing with polypodium enhances this and makes patients treatments more effective.

interesting. And you mentioned sun powder as a potential that's a brand name.

So yes, sun powder is a brand, is a product that I helps formulate with one of my colleagues over harvard, who's a laser and aesthetic germano logic harvard trained. And this is something that we came up with when I was up at stanford. And it's a it's a supplement dedicated to skin health.

And IT does two things. I take a daily myself as a single scoop. IT helps reduce your skin cancer risk, your non melanoma skin cancer risk, by up to thirty percent.

And the data was published in the new england journal of medicine in a face three randomised trial for one of the ingredients. The other ingredients, obviously, is ny polypodium. And I take that one to prevent you sun related changes, but also help produce my risk of burning.

Often when I personally find the need for sunscreen is when I can apply, is that the water and swimming my sun seven he raises on a swim team. I cannot get this kid to reapply sunsprite. So this is a supplement that I I give him.

And we IT took us several years of formulation and testing, including M E D testing, which is minimal erth y madou testing to come up with. It's easy over the counter and it's one of many supplements that contain polypodium. I just like IT because it's a single scoop and I mixit into my morning drink. I'm done terrific.

I think we both agree that the mineral based sun screens are going to be the best option of the ones out there. If one is IT all concerned about some of these chemical components in chemical sunscreens for enough. yeah.

So within that category, are there particular things to look for? I'm not necessarily trying to aim for particular brands here, but given that I have no relationship to any skin care products, I would just like to know which one to to look for or will any zinc oxide and or titanium dioxide containing sunscreen provided their no chemical components in there besides the inactive ingredients, of course? Um will any suffice because in that case, people going to shop for cost or availability.

So I tend to take a pragmatic approach in this. My my recommendation is a brand that you will use because if I recommend a brain you don't like IT doesn't feel good to smell good. You're never gonna IT always to your money in time.

So number one, any brand that is mineral based is fine. You what you're looking for, a broad spectrum coverage, which almost all mineral based science provide broad spectrum, meaning U V A, N, U V B. And we know these two U V forms do different things in the skin.

We know that U V B is more complicated and redness and some early skin cancer changes. We know uva is linked to uh, premature uh, photo aging and certain melanomas. So you want something that provide broad spectrum coverage. You're looking for a number. The S P, F.

We talk about you're looking for a number of thirty. why? Why thirty? Because every study that looked at defining the S P F requires you to put a certain amount on the skin generalists and entire shot glass worth of the product on sun exposed.

And most of the time in real world practice, people don't put on that much. They put on maybe half that. So what you're really getting when you buy something that S P F fifteen is like P F eight.

So if you're looking for something that provides protection, S P F thirty or greater is higher. Higher is in concentration. The Better IT protects against U, V, invisible light, the choke you and may go on.

So that kind of where you find that baLance, that's actually where the chemical sunscreens came about, is the Cosmos udal industry finding things that felt nice. R, on the skin so that people could put makeup on without that grainy choky. Ss, but in doing so, we ran into some issues. What are some, if any.

of the concerns that some of the components in chemical based screens can cross the blood brain barrier?

It's not um unjustified to think that they are organic phillip compounds. They are hydro a phobic there a lip, Philip, meaning they can cross membranes very easily, which is why they run into this undercurrent disruption in some nervous system. This regulation, whether that's been validated to be problematic and humans has yet to be seen.

But at least in veteran studies, in certain animal models, we see this. So when you apply a certain concentration in with that twenty twenty study that showed that were seeing IT in the blood at levels that are two hundred to five hundred times the upper limit of Normal as defined by sunscreen criteria, now we have to scratch your head. Where is this circulating? Where is this going? Or recollecting IT in our atop st.

tissue. If we're collecting IT, there we may be. Collecting IT up here, we may be collecting IT in the nerves. So it's a really fascinating world to see where we're going with these. And in fact, the sixteen most common chemicals that in ninety nine were everywhere from your spray on screens and bottles and things like that are now being defined as question mark, maybe not safe by the fda, the very company that regulators.

Another call for the mineral, a sun screens, just as you know, why? Why take the risk? Or even you shade hat clothing.

you know, if you're really worried about putting something on an absorption, you get excEllent protection by metro barriers.

This seems like a good time to shift a little bit of our attention to nutrition and to got microbes. Now this is an an infinitely large topic, but we could spend several episodes discussing this. But if you were to provide us some of the any major takeaway as IT relates to nutrition and skin health, nutrition in skin appearance got in skin health appearance, what would those be?

So there is an incredible connection between the gut microbiome and skin health in the skin microbial, of which were only now just understanding the gravity, the extent in the connection. We know from many studies, many elegant studies, a lot of studies done out of my colleagues, labs up at stanford, that module, the gut microbiome, affect inflaming conditions of the skin.

Meaning, if you control the this regulation of the gut microbiome, if you have an anti flaming dietary habit, actual skin disease decreases in intensity, in severity. Serious is examine aconites. And this is not just subjectively, it's measurable and quantifiable and reproduce able.

So the the connection is fascinating. Now how we modulated, that's the unknown. We know in many different studies that some patients got microbicides are wildly fluctuating what they do from their environment in terms of dietary habits.

In a odic things like that, some people got microbiome or rock solid. Nothing changes them in disciplining whose will benefit from what is the hardest part in terms of nutrition overall. Obviously, everybodies told you this since know the donor, modern medicine is a well, time is good for everything.

Unfortunately, the twenty first century, there are a lot of diets, there are a lot of fat diets, there are a lot of restrictive diet. And that's where we seen nutrition plan important role in both appearance and actual skin disease health. And there are so many different avenues to discuss this, things like dietary habits and changes for agony, things like dietary habits and changes for anti aging, things like dietary habits for rh disorders, like services and exams. It's so much to explore.

So my understanding we'll get into this mores that relates to aconitum is that patterns of eating either content, food volume, that is, clerk load at sea, that increase in saline and things like m tour are pro agony, are going aggravate or increase economy, whether the things that tend to lower circulating blood, lue cose in and reduce inflation tion tend to be kind of anti acne. We pull in the other direction towards a reducing active load.

But if we were to just step back and say, okay, the typical person who wants to have the healthiest, best appearing skin, who's not dealing with any specific issue because we will get into those specific issues, can we say they should, you know, a vegan diet of vegetating diet. Is that kid to be an omen of war? Some people are on the extreme of this of war type diet.

Some of those people actually report, you know, elimination of a certain skin conditions. I don't know. I've never tried one of those the extreme diets.

But you hear this, but then, and you hear a lot of things. So that seems to me that the relationship between keeping the got microbes am healthy and ingesting sufficient count of fiber is pretty clear. sure.

The relationship between keeping the gut microbe I am healthy and overall, that is systemic inflation law is pretty clear. And that eating foods that are mostly unprocessed or minimally processed keeps inflation tion on the lower side as opposed eating more processed oos. But assuming you would you agree or disagree that feel free to disagree, please? yes.

So so assuming that that's all true, is there any evidence that the congestion of specific foods can make skin healthier? Like you'll see this stuff like, oh, you know, if you have two cups of blueberries a day, your skin is going to be healthier? Or is all of that indirect by virtual specific microbial trends that are in those foods?

So there's a lot of layers to unravel on this. So if you're gona pick one simple diet for optimal skin health is a high protein and time climate that so high protein, animal source proteins, fruits and vegetables, based on your ability tolerate the fibers and the fruit and vegetables, things that are inflaming and flaming for two reasons, one, the blue coast insulin pathway, but number two, the bacteria in our good process and release by products of metabolism of certain things, and those buy products, basically their digestive products can be very principle matory.

So often you hear these anecdotal stories of I eliminated tomatoes and my rice cup at them. That person may have had an inability to tolerate tomato because they're got microbiome ability. I just like piner, whatever IT is. We do know for certain that anytime flaming diet do improve skin health that are measurable and seen in clinic.

So absolutely high protein, a complete protein um when I say complete protein tends to be animal based products, eggs, meat, chicken, fish less so plant proteins just because of by availability and complete an acid profiles you want a high protein anti climate day, that's number one in terms of what you can introduce your skin to improve one or two parameters, I don't think that's real. Why I bring this up, we see a lot to talk and you've had a lot of people discuss collagen, for example. And this is an incredibly popular product in the skin world because it's claim to fame as IT.

Does everything keep you look at Young, keep your skin healthy. Exeter, we we know collagen is essential to our skin health, literally, is what our dermis made up that give us our supplements. Our youth, no wrinkles.

You know, things like that college is made of three minos its licence polin usually hydrox y polling or hydrox who licking OK there's three mino acid or non essential impacted, meaning your body has the ability to sync ze these from sugars and fans that IT eats. So collagen supplementation is not an essential al protein, unlike animal proteins, which provide all twenty minal assets, including the essential ones your body cannot synthesize. Now you may ask, O, K, C, all these studies that suggest college and supplementation improves skin health, skin appearance.

There are several reasons for that. I don't think IT doesn't. I think there is some benefit. The question is, what are the confounding variables to this where the people in the studies on restrictive diet because they were thinking about beauty, aesthetic, or they restricting patterns of food, dietary food, things like that, in which they weren't getting a sufficient amount of protein source to begin with. So when they supplemented, we saw improvements in their skin.

In a lot of these studies are patient recall or patient questioner studies in which there is inherent subjectivity in confounding variables. In this, when people take an intervention that says, hey, you may look Better or this may approve the appearance of your skin, not only do you have a placable al effect and saying, yeah, I do look Better, you may also do other things during your day, change your behaviors and lifestyle to fit the goal that you have consciously want. So that's one.

Number two, there is a component in, for example, college in supplementation that is forgotten about quite a bit. And that's the increase in blood osmotic. And I learned this in the fitness world.

There was really begin to fitness in college and and he was my escape, me from life stressors. And we found that people who supplemented with any powder protein source does not matter college in argument way. And more so with people who support with creating that there is an increase in blood oz or plasma osmotic.

So the solid concentration increase in the blood, which draws water in that predicted how things like creating make you look bigger. And I know we're gonna on attention. One of the reasons the way college and works is your blood osmotic increases.

You draw little bit more water into the vessels, which plum up the appearance of the skin. So there is a hydration component from the water draw. And this is measurable.

You can draw patients blood after consuming college and protein way protein and see this Spike in classroom protein. So there is that component as well, which is not truly a benefit, but it's an esthetic benefit. Why that tends to be a problem.

Sometimes people supplement with college and end up actually having high blood pressure and their otherwise healthy. And this was something that we saw in the fitness role. A lot is that Young college athletes to high school athletes that would come in, they would otherwise be completely healthy and would be running high blood pressures. If you took away their protein and, uh, creating supplementation.

their blood pressure is dropped.

And it's it's really fascinating stuff. And know I used to work out I U C A with a, uh, one of the professors of fine sii who was a really big dude. And we worked out together. We did all these studies and looked at Young, otherwise healthy people. So that one component.

The other question is, do any of these food changes actually quantifiably increase skin collagen density, skin, alas, and density? There's no evidence that taking these things with traffic or meaning will go to where you want to. It's kind of silly to think if I drink, this is going to go into my stomach, go to my interest and be absorbed.

And they know to go exactly to my cheek. Usually doesn't occur that way. And when we've looked at histologic comparison studies, the data equivocality, some studies have showed a slightly increase in college and density.

And you wonder, are those patients one that are on restrictive diet to begin with? And then there are some studies that have shown there is really no density change in college inal last. And so the supplements really don't actually make a physical difference.

not. The other question is, is that body too short of term? How long you stay on these data wild? And there's a lot to understand, but we do know high protein, complete proteins and time flaming dites absolutely critical for skin health.

Guess the most direct question is D U yourself. Consume college in proteins in a supplement form or making a point things like bone roth, which contained high percentages of college en .

right question um I do supplement only in sun powder, which is my daily supplement. IT contains bioactive college and peptides. Aside from that, I think natural sources are Better.

So my wife cooks a lot at home. Bone gross, beef bone broth, chicken bone broth, a lot of animal meets. My diet tends to be more in them.

This old school you'd call like kid atkins or kito diet. I eat a lot of proteins and mostly fruits and vegetables. I'm not very restrictive, but I know that's what's made the biggest difference.

I know that if I go on a sugar binge in few days, i'm breaking out. It's it's like clock work for me. Some people are not a sensitive my body is and that's that's where the personalize medicine comes in.

Is there a role for omega fatty acids like fish als, and thinks of that sort for skin health specifically?

Yes, I know. Yes, there is some evidence that omega three supplementation and tends to be Better in fish form than non fish format. But omega trees tend to be, in time, flaming ory.

So there's an improvement in skin help because of that. One thing we do see as they thin the blood. So people tend to Bruce a little bit more. So actually, in my practice, I have people stop, oh, mega trees before any sort of surgery because they believe more.

What about some treatments that are going to be beneficial for the appearance and health of skin? Yes, people are not as aware. Yes, right? Because I think people who are concerned with their skin health and appearance, you know they think about sun stream, we've earned a lot about that from you. But what are some things that really work to improve skin health and appearance, though perhaps require a visit to the german ologies, but that you don't hear enough about .

yeah so too big categories. So we know the skin turns over, right? IT turns over every twenty eight days.

So in theory, if you keep turning the skin over, you can get rid of those mutations that occur in the skin that stacking up and hope to bring out more vital youthful skin that's not just appearing vital, but actually biologically healthier. And there is two categories of things you can do. The first is the family of retina ids.

Amazing medications, amazing drugs been around for fifty years. They come in or form and topical form, and these increase the time, or they shorten the time. They increase the skin turn over from twenty eight days to summer, between seven to nine days. And in doing so, they've been shown to decrease skin cancer and free cancer formation. We've been actually shown to grow new collagen.

They've been shown to increase a lasting an appearance, and this has been histologically verified in study after study, meaning we take a biopic of the skin, have them start a prescription retina ID rebiya y the skin, and staying up for college and A N and you see a market improvement. It's every german ologies well known tool, and for some reason is still not well known in the population. It's original indication was for economy and still is first line for economy, because what he does is IT tries out the oil gLance. But in doing so, IT also helped repair skin. So I recommend every single person to be on a prescription strength, the retina yd, which is different than over the counter retina.

And there is a lot of confusion, and I think the confusion is intentional in the Cosmos udal world as to why this says, but everybody should be on a prescription strength retina y usually typical is all you need the most common or things like try to know in a APP eline or teaching and there's oral forms the most common is accurate or also treat knowing and to a lesser known um a lesser known drug called asset threaten or syria te and I usually reserve that for my high sn damaged skin cancer patients. IT really makes a difference. But when I touch back about retina versus retina noise, so many, many years when we studied retina ids, the way retina ids work is there actually at the activate transcription factors, their nuclear messaging um hormones.

So these compounds bind retina ic acid receptors and they activate uh, the transcription of certain genes. One of the genes we know that I can affect is the sa kit jg pathway in some of the embro logic genes. Why that important? When we first studied retina ids in oral or cream version, we noticed that these can affect the development of affects and they can be passed your breast milk and through uh h spr seamon.

So because of this issue, the fda regulated IT very tightly and it's pretty regulated worldwide because the effects are devastating, you know, missing arms, missing legs, type of birth effect, because the medication was so effective when we saw an improvement in both quality and appearance of skin, the cause measured al beauty world to know, okay, this is awesome. We need to figure out a way to get this on the shelf, but not be a prescription outcome. Red nose with an O L, which is the inactive version of retina ic assets, which is retina ids.

And what has to happen is retina needs to be converted in a two step process to become active retinoid. Otherwise it's a completely inactive prodrome, which is sold over the counter at concentrations that are not biologically active. That's how cosmeceuticals companies can get away with prescribing this for people of child during age.

In my opinion, if you want to retrod get a prescription for IT, the over the counter stuff is not very effective, if at all, the shelf stability. Many studies shown that almost all retina ids over the court, retina over the counter um are basically unstability zed by one year. So you don't even know what you're paying for.

The prescription is easy. Again, you can see pretty much any dermatologist and it's the only version that's truly effective. So everybody should be on IT protects your skin, keeps you look at Young ry duce skin cancer.

Rex grows new college. And literally the only consequence is that when you first start, your skin may be a little bit rather ply, as this can eliminate or turns over than that. nothing.

Why do you think, given the immense interest in skin appearance in health, we don't hear more about this?

Because that's a great question. So we hear so much about retinal every magazine you open that has anything you'll see like intensive night cream, intensive of icon uh, regenerated, I repair and all them have red noll. None of them have retina or treat known for many reasons original news made for agony and the patients that came in to get get in fracking. We're not necessary in the same line thought of your .

premature aging in lung gefty .

like routine yeah routine exactly. Or act or different. These are the brand names for these products. So there is a disconnect between the people seeking the antiaging um effects and the people getting IT as a prescription.

That's one in number two, as soon as cosmeceuticals companies figured out a way to market over the counter and active versions that went haywire. So you can google right now and there's million things when you google treat no and you only hear about iconic. So there's a little bit of a disconnect, much like all in medicine, between what dogs know and think the population knows and what the population actually knows.

But that's the one thing I think we've been doing a great job on in modern day social media is advocating for these, for these medicines. Now that's one realm of things that you can do to absolutely improve the quality of your skin. Long term health appearance actually revitalized the skin.

Then there is a whole set of procedures that you can that can be done that have been shown to improve not only the appearance but actual biologic health. So that's where we fall into the laser world. And somebody who's you been in photo biology, um i'll be a slightly different around you know the effects of light um and the incredible changes that I can have in biology.

Most of what we understand for lasers in medicine came out of dermatology studies no A A lot of the understanding of laser biology came out of the whelan institute over a harvard or many, my colleagues are. And we now know that certain laser devices, certain resurfacing devices, not only improve the appearance of your skin clinically, they reduce your risk of skin cancer by twenty percent, may be greater. And even more amazingly, is when you do micro o array gene studies, they actually activate the genes of more youthful, healthy skin in cells that were quiescent as we age.

So there is genetic verification, clinical verification and aesthetic verification. These things are awesome. Now laser is a big umbrella term.

Some of the devices we use are not laser. They're actually light, broadband light or uh, intense post light. Some of them more laser, some of more a ablative, some of them on ablative. And we get into the nuances of these things, but there are a few lasers that have been shown to make these dramatic differences. So very interested and see.

see an expert. So this would be, go to a dermatologist to ask for some, is IT laser resurfacing? Yeah.

yeah. The laser resurfacing IT tends to be in what's really populated, two forms of laser resurfacing. There's what we call non native, meaning a dozen burn or they rise the top layer of skin. And then there's a lade of resurfacing, which vb rises the top layer of skin. Obviously, ablative ones are much more aggressive, much more effective, a lot more downtime, a lot of risky because you're literally peeling the face off or any part of the body and IT regrows without any scoring. That's also another beauty of the skin as you can literally peel IT off entirely and have a regrow as nothing ever happened.

So people have this done once a year.

So yeah for for not for a lady surfacing, it's like want every five years or so on, it's pretty dramatic.

And how long .

is the downtime for ablative resurfacing? Uh, two weeks, usually two weeks are pretty raw and saw it's fAllen out of favour in most big cities because of the downtime and inherent risks but is still used in the right patient nonablative resurfacing, meaning IT doesn't vapor ize the top player, but drills holes into the dermis and targets certain part of the epidermis out, causing burn injury.

That's become much more popular because the downtime is markedly less. People can go back to work and enjoy their activities while having pretty much the same benefits. I'll be IT a little bit less than blade of lasers. These we generally recommend annually or by annually, depending on what you're trying to target. A large harvard study just came out that showed that nonablative fraction input laser resurfacing, particularly with the device called proxy, actually cut your skin cancer risk by twenty percent because IT eliminate those mutations and get rid of those cells that had been collecting the stuff. amazing.

How is this different than exfoliating skin? Like if one word to just try um you scrape away some of the dead skin through some you sei vigorous buffing of the skin with like a sponge. I've never done, i've never done either of these procedures like that. My skin routine is very basic. It's the incentive of sop the shower once twice a day .

and still looks great.

And then I feel pretty good. I mean, I think, you know, sleep seems to play a significant role for me. I do get probably a bit more sun exposure than most people conscious of checking for skin cancers and will talk about that because I was to run in my family. But in, I try to ride and exercise. Ride haven't consumed much alcohol in my lifetime.

I was wrong. So that's the first line. Now you talk about the dermagraft or microbial migration. The goole saint ives April cuts scrubs that every germano logic you frown upon.

But ironically, I use myself after a heavy work out of the beach and am all greasy. But don't don't get mad me for you. And that stuff, the depth is key.

So when we do microevolution or some sort of demography, only thing we're really scraping off is really the strain corum, which is the highest layer of skin cells that don't even have a nuclear. They're dead skin cells. That's all you're scraping off.

Where is laser target through the epidemic and into the dermis and you control for that depth. And what you control for is the amount of heat energy delivered to that depth to target a certain thing. So in theory, what you describe in terms of is the same premise.

The old school, a bladed lasers, do they just fry everything off and you grow new skin? And in frying everything off, if ries off, sun damage, wrinkles, pre cancers and skin cancers. But in doing that, you're a bloody mess for a few weeks.

Not popular for many reasons, but very effective. We did a tone of this stanford, and we did a tone of the other one is time for my practice. I do a lot of laser work as well.

The nonablative sluff picks and chooses. That was the beauty of idt. Learning about laser and photo biology is how we target a certain structure and avoid damaging all the other ones.

That the theory of selective photothermal zi is that came out of rocks, Anderson's lab, harvard, that was a game changer. We can now pick any appendage in the skin and find a way to target IT and leave the rest disturbed. So if you have broken blood vessels, you decide to use B, P, C, one, five, seven and eight grade, and the blood vessel start to growing. You like, I don't like the look at them. There is a laser that targets solely blood vessels.

Is that the I P L laser? E.

I P L is okay. I P, L stands for intense post light. It's somewhat effective but not very effective. The the gold standard is what we call the pulse dialed or or the v beam laser in that is a not five hundred ninety five nanometer laser that targets oxyde hemoglobin.

I've had that actually because I had an goma yeah that at three times and the third time they hit this thing, IT went away, but not without a very significant Bruce lasting almost a month like, you know. I mean, IT was pretty dramatic, right? But I did eliminate the the vessel that was by .

any means necessary right to just yeah skin.

So as long as were on the topic of photo biometry lation, what about red light? Near in for red light? Is there any evidence that I can benefit skin health and appearance? Nowadays, you can find masks that will limit red light. Some people purchase red lights, they stand in front of.

I think they're very effective. I think they work great. The question is, to what extent is that improvement objective is measure and what extent is subjective? Vapp said.

There's a lot of evidence that shows that red light therapy improves vascular flow in the skin. We use IT for things like hair restoration, post procedure recovery, um improvement in skin health after U V damage. We actually found a recent study that looked at red light therapy and um irradiating a mice.

And if you retreat the mice with red light therapy before they get U. V exposure, compared to controls, the pretreated group had much less of the changes with the U. V. Exposure of very fascine stuff. How IT works, uncertain.

We think a lot of IT has to do with increased vascular flow, which is why a lot of time we recommend IT for post procedure, we recommend IT for hair uh regrowth. There's some evidence that if you increase blood flow to the dermal pupilage, the hair IT grows new hair. That time in oxygen or rogaine works. Um but I I like IT.

I think it's a great product um great great group of products or devices as a stand alone uncertainty to how effective they are in one of the reasons of the hydrogenated in the data, like so much difference is there is no regulation in terms of the energy, the density of light, the the type of light, the duration of treatment. So some devices have high water age, high energy output, identity light. They may be more effective than its equivalent counterpart until that gets defined. More uniform in in accessibility. I don't know which device to recommend you know there I I obviously have preferences, one where another um but there's so much on the market that's market that is red light that is not effective and some stuff that's really good.

So probably looking for something that at least endorsed by dermatologists. Yeah and I should say here, I I ve know no angle into this. I want these masks that emit red lighter.

I don't have any business relationship to them. So that's not why bringing IT up. I was just very curious. I see them in my instagram feed probably by virtue of doing public facing health and science information um in my interesting light what about oh yes.

say the panels tend to be much higher and energy much more effective. And most of the studies have looked at the big wall panel. The battery powered face max are just aren't powered enough to have much improvement.

We do see some improvement when read m blue is used together mostly for economy prone skin because blue light alone has some anti microbial properties. So when used in conjunction, you can get some improvement in actual skin illnesses, but their masks alone with just read, like most of them, are not powered enough. They don't have enough energy, but there are some that are good. The wall panels tend to be Better.

Thank you for that. And full disclosure, I was accurate and saying that I don't have any relationship. Any red light mask companies are products. But um this podcast is sponsored by due, which makes medical grade panels for red light and near and fred light and I do own one of those and I used I have a small portable when I use and then I have a panel I stand in front of so that includes my face yeah and then i'll turn around and if so, do a whole body and times a week .

you is a good companies and run for a while. And most of the expert and laser and photo biology agree the panels are their way to go. If if you want red light.

it's interesting IT when um people see and hear about red light and near and for red light therapies, think a lot of people think this is kind like next stage biohacking. But there was a noble prize given for photo bio modulation for the treatment of lupus in the early one thousand nine hundred hundreds. So this is not a long standing thing, the use of light of particular wavelength, or combination es of wavelengths, of which red light in the light are, of course, in order to target different layers within the skin to .

get some desired effect. And yeah, light has been around for a long time. I have a phototherapy unit in my practice in which we use narrow band ultraViolet b light to treat conditions like syria is to treat conditions like vital.

I go, there's a very strong imminent modulator effect of light on the skin. IT actually suppresses overactive immune activity. IT can help increase vocular ity in the skin, can improve blood flows, are depending on the wavelength th you pic and where IT overlies on the absorption curves makes a big difference.

It's interesting that we talk about light. And as a skin cancer surgeon, this is always been interesting to me in that we use U. V light to treat certain conditions. And we assume U V light is purely pathogenic, and I don't think that's the case.

And why I bring this up is one of the most common things we use like like there before is patients with vitiligo, which is this auto mune condition in which your immune system attacks the cells that produce our skin color. In the standard treatment, he is certain creams that suppress immune system in the skin. Phototherapy examiner laser, which is A U.

V. laser. And then now the new world of imo therapies by pill form, the jack inhibitors, have made a huge difference.

But if we thought, and I go back on this tangent, cause the more we think about the, the less we know, if we think uv is truly delicti ous, then patients with vitiligo should have a higher incidence of skin cancer. And in fact, the opposite is true. They have a lower incidence of skin cancer, even when you match them for amount of U.

V. Explosion over time. So IT goes to tell us that there's so much about light and skin we don't understand, so much about sign and U.

V. And skin we don't understand. And an incredible component about our skin's immune system that we're only now figuring out that play an important role.

You know, patients who have transplants, for example, transplant patients in the early nineties, the number one cause of death for transplant patients that was not related to their transplant was metastatic skin cancer. And this was impatients, who were strictly unprotected. So we we talk about your biology, photo biology, L E D U V and skin health. There's so much we don't know as we gather more data and look at populations and cowards. So I know why I brought that up as attention.

but no, I think it's a very relevant attention because the relationship between the immune system, function and skin is very clear. And these conditions that you're referring to vitiligo. So I exmoor a have interesting relationships to the immune system.

So that's actually a perfect segway for what i'd like to talk about next. sure. So let's start with saris.

What is the story with services? What is IT? What can make IT worse? What can make a Better .

soria is is like the quint essential skin condition. I have IT myself, my elbows, knees. And for about one hundred years, IT was thought to be a problem, a rh that is caused by too much skin, turn over a excess skin proliferation ation. And for one hundred years, we treated at the same way we gave medicines that basically took the skin off, we call kratovil s.

We found that that wasn't very effective in some people can be hospitalized and IT can be life threatening if the rises involves the entire body and usually looks like red patches or plax with kind of a silvery scale on the surface and start usually elbows and need are the scale um but can involve pretty much the entirety the body. And what we found in the last thirty years of a lot of elegant studies and a lot of very, very nice basic science um research is that it's actually do to overactivity of our skin's immune system. So there is over activity of certain interludes, which are these messenger that are immune als produce that makes the skin turn over faster than IT should.

And this epiphone y was remarkable because we found that instead of targeting the skin, we can target the immune system and we can eradicate or treat serious is entirely. And in the nineties and early two thousands, that targeting was very crude. IT was a very umbrella approach.

We suppress the entire ammon system and ran into the consequences of that. So medications that we gave for that increased risk for infection and no skin cancers, except now we have amazing drugs that get one or two molecules, messenger molecules of our immune system, and clear up people's isy. I mean, we have drugs.

Ny, you take three times a year and you could have head to toes and be completely clear. IT tends to run in families. There is a very strong editor genetic component to IT.

And IT tends to be associated with authorities, sorry, atic authorities. So sorry. This is like the quint essential skin condition that people see uh ologies and even logic for.

So these drugs that target these specific interaction seem like the most directly to treat serious sis. Some people, for whatever reason, have an aversion to prescription drugs. Yeah, yeah, yeah. I not necessarily one of those people, but I, like everybody else, would like to know what we can do to reduce symptoms of things like saros without having to go and take anything.

Yeah, I should probably backtrack. So obviously comes in severity. The disease, which majority of people have. There's moderate and severe. And generally speaking, the most common things that we treat mild uh, saros with is creams and lotions, moisturisers, sometimes low potency topical steroid or high potency topical steroid and then things like cratylus, like caliza that take that excess scale off.

We also know that there because it's an immune inflaming condition that diet plays a big role in improving milder, moderate. And we also know that weight loss plays a very big role in improving the appearance of services. So as we lose weight, as there's improvement in insulin resistance and as we transition diet and lifestyles from inflaming to anti flaming, sorry, is tends to clear without any intervention needed, without any medical intervention needed, if there still continued no rashes and skin activity.

Then you look at topics like cord zones um emlie like oak form masi know things with some sort of acid or retina y to get rid of that excess scale that the fundamental cornerstone of treating services. And then when IT gets bad, we talk about additional pharmacological interventions. Also interestingly, one of the earliest um conditions in which phototherapy was used is serra. We know that when we shine U V light on the skin, that IT suppresses the skin's immune system and clear serious is and that an excEllent way to treat IT without formal logic intervention, without any creams, pills, injections or otherwise medication, and used to be using in the dead sea, people would go lather in the muddle the dead sea and sit out in the sun. And that was the first crude way to use phototherapy treats rises.

If there was my question, since the sun limits uv, why not just get some additional sunlight exposure .

for serious so you can most differentials won't recommend that. I think it's actually not a bad thing. My services is clears in the summer time, in flares in the winter time.

The problem with pure sunlight is that it's a mix of race, right? There's x rays, gamers which generally don't penetrate the atmosphere. There's U V, C U V, B U V, A visible light in for red light, so that hya genius light.

Some have no improvement in rios and some have great improvements. So we were able to figure out which wave links make a big difference. And it's around the three eleven, three twelve animal range.

But sunlight does clear people's ize us up. That's why we see in northern latitudes where there's less sun intensity that incidents of services is markedly higher than equatorial attitudes. And patients will say their services gets Better when they're on a beach fiction when they go back home. Their services flares, also some component with vitamin a as well. But I think that's just secondary to the lack of you view exposure.

What about videos? This is something I did not cover in the solo episode about skin health. But I got a lot of questions about the ego, of course, being this typically patchy non pigmented regions of of skin um that you said is at least some cases are related to the immune system. Um these people get skin cancers less often.

Is that right? Yeah so vital I go is a auto immune, meaning your immune system is attacking itself. D pigment tary skin disorder, meaning, is a condition in which your immune system a taxing kills the milanaise, which are the cells that produce our skin colour.

And we've found that is an automated une condition from many basic science and elegant studies is also very closely associated with other automotive e conditions. So patients to also have a topic german tide s automotive ero disease, automotive ima. There are some sort of immune disGrace that involves the like go patients.

And what happens is the immune system at first paralyzees these cells with immune tivy attacking them, and over time, these cells no longer survive and die off. The cornerstone in treatment has always been, to some way, to suppress the skins immune response, when most of the time of the ligo tends to be vocal, single areas, or segmental. Unfortunate in certain cases, that can be whole body or completely defied mental, very uncommon.

But we see this. We treat IT by doing things that i'll help quite the unresponsive the skin. So topical crimes, topical stories, accept a topical caller and inhibitors, which are non sterile and time file medications.

We also use certain wavelengths of U, V light to treat this example. Iser three o eight, nine meters, A, U V B, U V, A. And then the the renison some middle goes, happened in the last three or four years with the identification of jack inhibitors, which are these drugs that block the janis kinney's pathway.

And we found that the Jackson pathway plays a really important role in auto mune mediation of milano IDE death. So new crimes and actually oral medications have come out for patients who have very refectory vote. I the immune component is very fascinating because understanding immune biology in the immune systems affect on skin health comes from studying these patients.

When patients have vitiligo, they lose all of their colour. So you would assume that they're much more except table to sun burns, which they are. But when you look at incidents of skin cancers, they have a significantly lower incidence of in cancer.

And this is because of the immune phenomenon in immune surveilLance of cancer, and that occurs throughout the body. But the skin is a model platform for this. What happens is your immune system surveys for mute changes that occur, whether it's movie related, exit infection talks and whatever.

And patients who have the I go have over activity of these immune cells and over surveilLance. So they are able to clear a lot of these precancerous s changes before they form into something. So that played a big role in not only understanding how to treat the lego, but some of our new medicines. Actually, the medicines that won the nobel prize in 21 for treating melanoma came from understanding immune activity and cancer pathogenesis。

It's fascinating, again, speaking to the fact that skin is far more than just this protective out outer sheet. It's it's a reflection of so much that's going on internally. And we know that into i'm also by observing others.

I think this is one of several ways that parents can communicate well with their children or their children with their parents rather in terms of how they're feeling prior to language. You know, they'll look at their skin. They are stool, yeah, obviously fussiness and mood and those things too. We seem to have developed into the understanding that a shift in the electoral, the skin, or some other features of the skin signal to us, wellness.

or lack of wellness, yeah. And the skins a biosensor, the entire skin, hair, nails, is a biosensor. So you can utilize the skin as the first barometer of illness. I mean, from acute illness, chronic illness, acute, you can see changes.

And just like looking with power, looking gas, late things like that, chronic illness as well, when you use to go to the pediatrician and they would do this to look in your eyes, what they were looking for was the color of the conjuring tava. If IT was White to or pale, they knew you had iron deficiency. You know, when kids get handful t mouth and drome, they have a high fever or they lose their fingernails.

When college students are stressed out, they lose their hair. The body's amazing ability to tell you its under stress is shown in the skin, hair and nails. What he does is says, while my wasting energy producing something that is not necessary because i'm fighting something else, let's just shed this and you can tell right away.

I mean, we used to in clinic when i'd see, you know, medical students or college students come in, I knew as final week they come with climb to hair. And as soon as final week past, I usually took a few months, they'd rebec. It's, it's awesome. The skins are really cool biosensor you can tell .

a lot IT is so cool. What about hony happy seems very common. You know, as we progressed through puberty, that seems to be more agony. Sometimes it's transient, sometimes it's not. Um what are some things that people can do to prevent or reduce acme.

another quint essential term problem, that is affects so many people um actually tends to be a condition that is by model, meaning we tend to see IT in adolescence. We tend to see you in twenty five to thirty five years. And for the unfortunate roup of people that bridge that gap, we see IT anywhere from twelve to thirty five.

Agony is a condition that usually seen by pimples. You know, what we call black hands or White heads sits or boils, and is thought to be caused by three important things. It's an overproduction of sea bum, which is the oilily stuff that comes at your skin and that's dictated by your hormones.

Your hormones will increase the output of sea boon, and that usually occurs in puberty, but can also occur if you're taking medications like rezone, coral, testosterone, anything that is a hormone on driver. So sea bum is the first cause, even is the food for the act, for the bacteria that cause acne. So as there more food, the Victory delivery.

And in proliferation, IT recruits an immune response, your immune systems as, hey, where there's a little bit too much of these organisms, let's go and take care of them. That's where you get that red is IT. So in treating economy, you gotta a treat all three components to get really effectively clear skin somehow reduce the sea bum, get rid of the bacteria and called the immune system down. That's done with cream oral medications um of combination of both sometimes certain lasers can help eradicate the oil glands that feed the bacteria um but actions of a fascinating condition almost everybody will have IT at some point .

in their life is IT true that eating a diet that is of slight accessing calories because IT will tend to push the instant glucose regulation system more into them. positive. As opposed to let her say higher level of incident in a circulating bug. Blue coast than one would observe that say mainland calories or submarines calories that you know over reading a little bit could cause agony um that any foods that promote increases in google in instant. So sugary foods, hygeia mic foods, these sorts of things can that actually increase aconite fried food.

So it's not the color coLoring deficit or the cleric surplus, is the glycemic index or the amount of instant response. So we know that high gye mic index fans will make aconites SE. And almost every study that we've looked at in sugar y processing oos will flare your aconites. There are some component of that inflaming response that not only drives in production in bacteria growth, but actually worsens the skins and unresponsive skins and unresponsive fisty when you're eating prom pilatre things. The other thing that I do hear a lot about is dairy.

And there is a misconception that dairy causes actually y what we really see when we looked at a really cool study that was done at a pen state is that it's not so much whole fat dairy products, but swim in non fat diary products that can make your acne flair. And the reason for that is usually in the united states, there's an a motifs that put in non fat or skin products to give the same mouth, feel as full fat so people feel like they're getting the same without the calories and that has a glass mic response. So it's usually sugary food, non fat skin um dairy products that will make the racing flare.

What about russia? I hear so much about this, and i'm going to assume that we can mark off at least one thing as clear, which is that alcohol can exacerbate asia, maybe directly, but certainly indirectly, by, you know, impeding some aspects of the microbes yam disrupting sleep. Asia gets worse. But what are things that people can do um do and don't that is for rotation um if it's mild roza like excessively a ready cheeks or um superficial riding capitalists that um seem to bother a lot of people. I know that bothers a lot of people because they asked about this quite a lot in the questions when I, when I solicited for questions.

So roza, which commonly known as adult acne, tends to come in four flavors. The first form is the redness form, what we call era's metal tel, gic atic form, or the readiness, broken blood vessels, redness of the cheeks and flushing that's buying for the most common forms. There is also the popular postulate form, which is the pimple form, which is what we think about an adult acme.

There is also the five midst form, which is the enlargement of the nose that kinds looks like told skin we used to think he was a sign of alcoholic or sailors um you know construction workers that would have these in large nose. We thought that was a product of their environment that actually a form of roasted. And then there's ocular roaster, which affects the ice buying.

For the two most common that I we see people in in practice for is the redness form, redness and flushing or the people for you're absolutely written that alcohol can contribute to IT and worsening if for two reasons. One, alcohol itself as a vasishtha atter and as a till, the hide is a much more potvin IO dialect or so when you drink, you flush. Also, chronic impairment of the microbial and lifestyle changes that make you drink more probably will exacerbate your for asia.

But things that trigger the redness include U. V, light because of visio dilution. Spicy food and hot beverages, emotions, life stressors, all the things that make you flush. What triggers the breakout is a little bit different, and why that's important is how we treat them.

So what triggers break out is thought to be both organisms that live on our skin, including bacteria certain might might but also immune diregus tion in our skin that we don't really understand are just now elucidating um how the immune system in the skin becomes dis functional to show those break outs. In terms of treating redness, we have some creams that are OK at temporarily branching those vessels up, but they're not great in their temporary. We don't have great treatments for them, but we have great lasers for redness.

So when patients come to see me for redness or any dramatics for redness, generally there's a discussion about laser destruction of those blood vessels. When we talk about breakout or inform of rosa, we have excEllent medications in terms of both creams and oral medications that suppress both the bacterial in my growth as well as the immune sense in the skin. So you kind of have to take a look at what form you have and what will .

be the best treatment.

Ema umbrella term for what we generally considers eight topic dermatitis, or what used to be no cloquet, a termed as sensitive skin and childhood, and that a very prominent skin condition, also dictated by the immune system. But in two forms, emma tends to be caused by three major prongs. The first pong is a genetic barrier defect in the skin.

So patients with example tend to have a microscopic wave of their skin that's not as tight as somebody without examine. That's usually defined by a gene called filaggrin. That's the first reason to develop examine. The second reason is an environmental allergen or trigger that's able to get through these waves easier because of this genetic change. The third thing is an aber ant immune sense to these trigger.

So patients with example a tend to have an immune system that responds a little bit more vigorously or over actively to the same environmental trigger, probably because there's more trigger getting in through the barrier defect than somebody who doesn't. So the corner stone in treating example is treating these three things. Why, dr. Matou gist, make a big think about moisture ies. Moisture is moist rise, for example, is to seal that barrier with a moist riser.

Because we're basically putting the murder back in between the bricks, which are the skin cells to seal the skin off, to not allow the environmental alleging to get in that the first, the second is to avoid environmental trigger so fragrantia preserve tive seasonal allergies, poland, things that trigger that immune sponge we try to mitigate. Now, obviously, trying to control environmental pollen is hard, but using things like we talked about earlier, fragrance free clean sr is fragrance free detergent frequence free skin care products, non preservation base skin care products will mitigate the environmental trigger. And then the third thing is just coming the immune system down and that can be done in a variety of ways, most commonly to topical medications like topical steroid that damped in the immune system in the skin.

And when exams is really, really bad, there are uh biologic medications that control certain interlude ans. And they've made an incredible advancement in, in example, control people. We can control patients for life with some of these injected medicines.

A couple things that you taught me that I just wanna pass along in short form. And please correct me. I have this wrong one. If you can avoid popping pin males definitely avoid IT, because I can cause damage. Recruitment of these matrix monteleone teases, which essentially digest some of the deeper layers of the skin, leave scars.

Yeah yeah, totally. So it's I mean, it's very ying and you want to do IT. There's like some subconscious desire to like pop a pimple. I haven't myself any time I see a people I want to get .

eradicate the infection type of thing you know even if it's not an infection.

I think like like a evolutionary reason yeah very, very possible. The reason we don't want to do that um and the reason why we always don't pick up your skin is when there's an immune response in the skin, the immunity stems trying to fix something and fight something. And in doing so, IT recruits different enemy, the most common enzymes, what you exactly describe, matrix metalloproteinase, which are these instance that eat a part college in.

And last thing, to allow IT to remodel. When you cause physical trauma, the skin, you recruit a much larger immune response than what was warranted for that insult. So these m.

Mp, these matter to metallic aces enter at a much higher amount, and they either wait the college in. That's what leaves an acne score. Now, people are going to pop the pimples, whether we want to or not.

So if you're gonna do IT, I don't recommend IT. But if you're gonna do IT, generally what we recommend is if there is no tip, don't even think about IT. If there is a small White tip and not much painter induration, you can use a warm compress to see if you can solve in that. And sea file excel itself pushing, we don't recommend stretching, can sometimes unroof a temple tends to cause less trauma. But again, if you listen to one thing, don't do IT.

And if they pop on their own, can we were having this conversation, but that skin health and appearance episode, after all, play pop on their own and cleaning IT with a gentle kinzers part of this way ago. No topical antibiotics. Is that right?

Don't use any new hydro proxim. The common misconception, thinking IT fights things. Proxy doesn't let wounds heal and just kills anything living. So no proxy and no topical antibodies that are over the counter. Most of these don't have any anio tics properties anyway because most organisms are resistant to him because of the widespread availability and use and too they cause a lot of um allergic contact, dramatizes and rashes in people who are suspected table to them. So we just say, if IT pops on its own, leave alone may want to put a little pointless on there if you have a sore, but otherwise ignored.

And what about the use of cortical astern cream? Like if somebody has a red bomb and they headed to an adventure, something, and they want, you know, eliminate some of the redness and bump this .

so a common thing, we see a lot of people for its like a day before their wedding or a day before a big social event, they and they say, no, what can you do for me? I need this gone. So exactly like we talked about, topical cortical steroids to a greater extent, injectable intromissions cortical steroid, suppress the immune response IT temporarily, so you can use them cautiously if you have an event within the next new day or two.

Long term use, IT causes multiple problems that causes thinning of the skin, and uh, can increase the risk of the economy scar forming, and you can have rebound economy from typical story used all over the face. Often times we see a lot of people who are in the public. I am asking for steroid injections of their iconic.

I as a surgeon usually see a lot of the consequences of that so I tend not to utilize steroid injections for agony. Um the reason for that is if you place just a little too much and we're talking less than point one more leader difference, you can have a permanent atrophy uh divide uh in the skin that is only fixed by surgery. So I see a lot Young patients that come in who a netley spot injected here now that David is left than that permanent in if it's gonna be done IT should be done by a thermal logic.

Who knows what they're doing? Low concentrations, usually bottom half of the face, can be effective in getting rid of A A really bad people that needs to begin immediately. You just got to know the risks.

assuming sterile technique and other safety measures in place are tatoes inherently bad for skin?

No, I don't think so. I think tattoos are an awesome form of art. And I think IT used to be linked to me stereotypes that are no longer true.

I think the chAllenge with tattoos, two things, making sure that what is being placed underneath the skin is not an elegant. We see this mostly with the reds that use climates. They produce a lot of grain elamites reactions or foreign body reactions.

One, making sure obviously they're using clean, safe equipment that stereo you want. The bloodborn pathogens, the real chAllenges surveying for growth in patients who have a lot of tatooed. It's hard to see small skin cancers form or changes in moles because usually the tatoes are a dark colour.

So the surveilLance part becomes a little bit more chAllenging. So if you have a lot of tattoo, just make sure you to see your german ologies and somebody who feels comfortable and confident in screening. But other than that, no, there's they've been around for hundreds and hundreds of years, and I think they're fine if done correctly.

Ly, that's a good segway into surveying for skin cancer. Earlier you talked about some of the more common forms of skin cancer, score cell, caromel, basel, cl cars, cinema. But then there's the one no one truly wants, which is melania.

So I was taught to keep an eye, my mls, if they change, changing border, change in size. That said, a to notify dermatology gist, um I get my malls checked about. I just had IT done less than a year ago.

But what about getting all skin track? I mean, what are you? This is your area of expertise. So so if you add a magic wand to help prevent skin cancers, what would, what would you have? People do?

Great, great questions. So obviously, there are many forms of skin cancer. But the three of commons, like we talked about, basel slca, a scam milita. There are other types like miracle cell in acedera, but there far less common. No history.

Ally melanomas been our number one killer for skin cancer until about a few years ago, around twenty eighteen, when the nobel prize was won for the new drugs that treat in mellon oma. This year, we expect three times as many deaths in the united states from squash carcinoma. Then we do melanoma, but nobody talks about that.

We lose a patient every about sixty two minutes to melanoma, but one every thirty seven minutes to square a soccer. no. First and foremost, the thing that you want to look for in terms of skin cancer risk, in predisposition to look at family history, your family history, your genetic plays the largest role in creative position for skin cancer development.

If you can gather a family history, you can understand your risk in developing IT, and you can help dictate your screening. Now, if you can't get a family history, you don't know your family history, not a problem. Generally, we recommend an annual skin exam by a good, reputable boards, certified dermatologist.

And that includes every square inch of your skin, including your, your hair between your toes. In the generation, we can develop a skin cancer anywhere. Bob marley died of a milano, ana tony that was thought to be a soccer injury.

You know, Jimmy buffett died of a merkle cell, or Normal, one of these types that occurred, sun exposed areas. Anybody can get them. Obviously, there's previous positions in highest populations, but it's such an easy, non in base of exam to do that everybody should get one at least once a year.

The other reason why I bring this up is skin cancers can develop in sun protected areas, one of the areas that I see a rapid increase in skin cancer development is in genital areas and in the mouth due to H. P. V.

And we see this a lot in Younger and Younger patients. Probably in the last month, we've Operated on six or seven Young patients under the age of with square cell. Carston is caused by H.

P. V. In the genital region. This is obviously not sung driven. It's not something you can put sunscreen or take up your product to protect you from, but it's something that's easily monitored surveyed.

So I would say that very minimum, get a family history or a personal history, get an annual surveilLance exam if you have a lot of moles. I used to direct the pigmented lesions and lonna clinic. This is something that was really hard for a lot of thermal logic and patients to follow when they when they're covered with molesey.

Which one is changing? There are tools that can be utilized, including whole body photography, mol mapping in some new AI base software that basically track the walls and look for changes as you feed the software, more and more pictures from the patients is fascinating. A lot of the stuff is developing from our are moshed to I on the motor but up but stanford is these A I based software apps that allow us to survey some of the most chAllenging patients.

So if you have a lot of moles, your screening may be more than once year. If you have a lot of moles, you inherently have a slightly increased risk for milano a. Now we always use these terms interchangeably. Milano ma, skin cancer, basel, squash ea importantly to know for everyone, melanoma, there is ten non melanoma skin cancers that namely basel sunscreen is all about five million americans will be diagnosed with one of the non milano as this year alone .

five million .

big number that about one in four a one in four americans at some point in their lifetime will develop a skin cancer encroaching one in three americans by end, by the end of twenty thirty. So it's a lot majority of these are not life threatening, but they're functionally and cosmetically disfiguring. They arrive on sun exposed areas. So surveilling is really .

important for the H P V that eventually becomes squam a cell carcinoma. Is the H P V vaccines effective even at older ages?

Yeah, great question. So the we are seeing H P V become a real problem in many cancers in the body, not just the original survey, cancer which was the number one killer and Young women for cancer until the vaccine came out, but we're seeing IT now is the number one cause of throat cancer and Young adults and sexually active adults, uh in significantly increased risk of squash. Carson's as in sun protected areas, ima suppressed patients.

The vaccine, the guardians of vaccine, which, which treats or build immunity to H P V, covers the strain that caused cancer. Sixteen, eighteen, thirty one, thirty three and so on. I recommend anybody who is either sexually active or anybody who, in population, literally anyone should get vaccinated.

The new um guidelines have extended the age up until I think late forties for both men and women are used to be only for Young Young women because the local cancer. But now we have found that so many things are implicated with HPV that the the on label use is up to the late forty. So if if you have any concern, I highly recommend getting the vaccine.

As I recall, planters words, which are these words that get borrow a kind of root into the bottom of the foot. They are very painful that actually. Can be caused by H P V.

It's a form of H P. V. And it's not actually transmitted. Ted, its locker room tran's.

yeah. So H P becomes in about two hundred trains, or like a hundred ninety trains. strange.

One, two and four, for example, cause words on the hands and feet. What you see, like gym goers and kids, you know, they get worse. H P V six and eleven, for example, caused genital warts.

H P V strains sixteen, eighteen, thirty one and thirty three cause cancer. The question is, when you get something does IT come with its its brothers or its siblings? And that's the question.

We don't know. The vaccine was made to treat highly sk strains. But because of cross antigenic, we see that patient to get vaccinated.

Their words go away. And we saw this in the hospital in transplant patients who were covered with words because of their imminent suppress effect. When we would vaccinate them, their words would get Better words .

on their fingers, words on their planters, words on their feet .

yeah transport patients and anybody who is imminent suppressed um they have a tough time fighting plan. Tories words, no finger words, any sort of viral based um condition because our mean system is suppressed from medications or otherwise. So they usually have a tough time fighting these things.

They have a higher incidence of a lot of things. But the vaccine was cool, eradicating. Now i'm not saying and go get a vaccine because you have a plan to our work. That's silly, an overkill. Usually your words we treat with freezing in office procedure is easy things.

But planters words can be burnt out.

Yeah, we burn them or freeze them or scrape them, use a little medication. But the vaccine does improve some of the burden of disease even though IT doesn't target that train. Do you think .

soon we will be in the landscape of vaccines for all forms of skin cancer?

I think we're on the forefront. And the term vaccine is a really big umbrella term.

loaded term.

Yeah I know it's going to know a lot of questions. I think yes, absolutely. There is a new study that showed that um um an M R A vaccine and that is already pretty controversial, was shown to improve milano a survival after surgery and chemotherapy.

So what the goal of all these things is to prime your immune system and have the immune system know what to target, is to teach the immune system, hey, this is bad. Next time you see this, go attack IT. It's like showing a blood hound of stake and then going on the hunt.

The blood hot now knows what to send for and what is Normal and what isn't. So the vaccines have a lot of controversial things. I think for medicine and cancer biology, it's gonna be revolutionary. We see if for brain tumors, we see if clubs stoma incredible changes with then redial vaccines. We see IT for melanoma now and in the future may be used for all skin cancers with an astra, depending on how much we can activate the immune system to target IT.

Fascinating and a good place for us to probably pause until the next time we have you back to talk about where that technology evolves. Because today you've taught us so much about skin, what IT is, it's anatomy, it's physiology, what IT reflects in terms of our internal workings, health law, in some cases, chAllenges with health, talk about various conditions, such as rice as agony, emma dangerous as it's uptime called.

And what we can do know that the role of the nutrition, avoiding certain things like excess alcohol, nickey said, but also some of the newer and more exciting treatments that exist for um all these conditions, some merely cosmetic and uncomfortable, some truly life threatening and dangerous like melanoma. So for all those reasons, and also for taking time out of your very busy clinical scheduled to come talk us, I really appreciate IT and I want to voice my appreciation. But for myself and for those listening and viewing, I know people have many, many questions.

So we will refer them to your um social media accounts and links to your clinic and so forth so that they can have those questions addressed in who knows, maybe you get the chance to work with you. In the meantime, I just want to say thank you for this public education gift that you've given us. I'm thinking about skin very differently now, and I planned to do and not do certain things in light of today's conversation, unintended.

So thank you for the opportunity. Incredibly grateful to be here. I think, I think teaching is really important.

Having evidence based discussions is really important. ChAllenging dog man is also important. Done in the right way, in the evidence based way.

I love what I do. I love everything about the skin. I love you seeing patients and also you chAllenging you the status concern thing.

So thank you for the opportunity. Has been a lot of fun. There's a lot to talk about in skin parly talk for a decade if you let me, but I appreciate you.

Thank you. Well, we will certainly bring you back up for the discussion. Meanwhile, thank you ever so much. Pretty solar money. Thank you.

Thank you for rejoining me for today's discussion about how to improve and protect your skin with doctor tao solo mony to learn more about his work and find links to his clinic, please see the show note captions. If you're learning from and or enjoying this podcast, please subscribe to our youtube channel. That's a terrific zero cost way to support us.

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