Dr. Teo Soleymani: How to Improve & Protect Your Skin Health & Appearance

welcome to the huberman Lab podcast where we discuss science and science-based tools for everyday [Music] life I'm Andrew huberman and I'm a professor of neurobiology and Opthalmology at Stanford School of Medicine my guest today is Dr Teo solmani Dr Teo solmani is a double board certified dermatologist and dermatologic surgeon he did his training at Stanford University and he was a clinical professor of Dermatology and dermatologic surgery at UCLA that is 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 it can have on both the appearance and health of one's skin in reference to that we discuss sunscreens which ones are safe which ones perhaps elicit a bit more concern or perhaps should be avoided and we discuss the surprising relationship between sun exposure and skin cancer we discuss 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 retinoids we discuss supplements and nutrition all in reference again to skin health and appearance

thanks to Dr soloman's incredible depth of expertise as well as Clarity of communication about the dos and do Nots that relate to skin care and appearance and to avoiding and treating skin cancers by the end of today's episode You Will 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 and research roles at Stanford it is however part of my desire and 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 Roka Roa makes eyeglasses and sunglasses that are of the absolute highest quality I've spent a lifetime working on the biology of 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 Roa understands all of that and has designed all of their ey

glasses and sunglasses with the biology of the visual system in mind Roa eyeglasses and sunglasses were first designed for use in sport in particular for things like running and cycling and as a consequence Roa frames are extremely lightweight so much so that most of the time you don't even remember that you're wearing them and they're also designed so that they don't slip off even if you get sweaty now even though Roa eyeglasses and sunglasses were initially designed for sport they now have many different frames and styles all of which can be used not just for

sport but also for wearing out to dinner to work essentially anytime in any setting I wear Roa readers at night or Roa eyeglasses if I'm driving at night and I wear Roa sunglasses in the middle of the day anytime it's too bright for me to see clearly my eyes are somewhat sensitive so I need that I particularly like the hunter 2.0 frames which I have as eyeglasses and now as sunglasses too if if you'd like to try Roa you can go to roka.com huberman to get 20% off your purchase again that's roka.com huberman to get

20% off today's episode is also brought To Us by ju ju 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 redl and near infrared light have been shown to have positive effects on improving numerous aspects of Cellar and organ health including faster Muscle Recovery improves skin health and wound healing even improvements in acne reducing pain and inflammation improving mitochondrial function and even improving Vision itself what sets juv lights apart and why they're

my preferred red light therapy devices is that they use clinically proven wavelengths meaning it uses specific wavelengths of red light and near infrared light in combination to trigger the optimal Cellar adaptations personally I use the ju handheld light both at home and when I travel it's only about the size of a sandwich so it's super portable and convenient to use I also have a ju whole body panel and I use that about three or four times per week if you'd like to try ju you can go to ju spell jv.com huberman juv is offering an

exclusive discount to all huberman lab listeners with up to $400 off select ju products again that's ju jv.com huberman to get $400 off select ju products today's episode is also brought To Us by Helix sleep Helix sleep makes mattresses 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 night's sleep is the foundation of mental health physical health and performance now the mattress we sleep on makes an enormous difference in terms of the quality of sleep that we get each

night we need a mattress that is matched to our unique sleep needs one that is neither too soft nor too hard for you one that breathes well and that won't be too warm or too cold for you if you go to the Helix website you can take a brief two-minute quiz and it asks you questions such as do you sleep on your back your side or 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 Helix

will match you to the ideal mattress for you for me that turned out to be the dusk mattress DS I've been sleeping on a dusk mattress for gosh now more than four years and the sleep that I've been getting is absolutely phenomenal if you'd like to try Helix you can go to Helix sleep.com huberman take that brief two-minute sleep quiz and Helix will match you to a mattress that is customized to your unique sleep needs right now Helix is giving up to 25% off mattresses and two free pillows again that's helixsleep.com huberman to get 25%

off and two free pillows and now for my discussion with Dr Teo solomani Dr Teo solomani welcome thanks for having me it's awesome to be here very very privileged to be here thank you oh well 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 it's its own living biological entity and just for sake of educational purposes and to 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 100% 50% of the skin that I'm going to be wearing a year from now I'm 49 years old so well you look great for 49 so whatever you're doing keep it up so the Skin's 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 28 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 uh remain and

they generate the skin cells but you have brand new skin the same way you have new gut lining every 28 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 whereas 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 Skin's an amazing organ I mean

I guess I'm biased but well uh I find a 28-day turnover just to be incredible the skin as I understand it is inated that is it receives connections from the nervous system so I think for many people their interest in skin is skin appearance although we will also talk about skin Health but in terms of skin appearance how much does stress shortterm and longer term stress impact the appearance of our skin and how does that work I could imagine that the neurons release certain things into the skin um does stress make our skin age faster

does that mean it turns over more quickly or turns over more slowly maybe could link these two aspects of our biology for us yeah that that's a great question so in order to understand that we have to just look at the the structure of the Skin So this skin generally is three layers the epidermis the dermis and the subcutaneous fat and the dermis is where most of the biologic activity resides that's where our blood vessels are that's where the nerves that inate sensation and movement reside that's where our hair follicles oil glands and sweat glands

reside so stress has 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 or chronic stress and both have different uh processes in the skin and you see the results of stress both immediately in the skin with release of certain chemical Messengers in an autocrine paracrine and holocrine fashion and then you see the long-term delerious effects of stress in a different mechanism in which there's actually breakdown 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 it's a biosensor of our well-being and we see this all the time you know I see students during finals time where they're really stressed out and they're coming with their hair falling out or after a large medical illness or a pregnancy patients will come in and say their hair is falling out so that acute stress is seen right away and that's due to several different reasons and release of Messengers and and hormones and and chemical mediators that that do this long-term stress is usually

mitigated or caused by cortisol and everybody knows cortisol it's the you know fundamental stress hormone of our body it falls in the same family as drugs that we give like prednizone um falls in the same family of cholesterol testosterone and estrogen but cortisol does something very different it breaks things down to allow our body to utilize it in times of stress because unfortunately our body doesn't understand the difference between 21st century stress and old stress so us being chased by a lion to our to our B's messaging system is the same as meeting chronic deadlines

at work and what happens is cortisol is responsible for the breakdown of things like collagen and elastin 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 cortisol release we see aging and there's accelerated aging studies that look at patients and people who are under high periods of stress a great example of studies we look at presidents in which they appear to have aged 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 or something of that sort but um the relationship between stress and skin fascinates me because not just of the direct relationship like when we see people in their stressed like it seems like that their whole the power of their skin changes um the kind of level of of uh gleam in their eyes change and of

course the eyes are a direct you know piece of the nervous system really they're as close to the brain as one can get viewed outside the skull but it also suggest because of the dynamic turnover of skin every 28 days that if people were to to become less stressed that their skin health and appearance might improve is that also the case for sure it's why you see people have a glow after vacation but you can't quantify that in a test tube or a lab so in the immediate phase there's a big shift in blood flow

to the skin and when you're feeling you know very stressed out immediately there's a fight ORF flight response that constricts the blood vessels in our skin to shuffle them to muscles and places where we need to our body thinks we need to utilize them more that's why when people are really stressed out they may look p haale or gaunt and that's the we we see that right away um and then as as that builds up over time the health the actual quality of our dermis and and fat deteriorate from chronic stress changes mainly due to

cortisol and and its sibling hormones and messaging systems in our skin so for sure I mean stress is like something that is impossible to quantify in a 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 we see changes and Improvement in skin Health when people move away from that stressor whether it's a physical stressor emotional stressor

psychosocial stressor there's actual quantifiable improvements in skin health and that's pretty fascinating it is fascinating uh it also speaks to the value of having some immed immediate and long-term stress reduction techniques just as a sort of first principle of taking care of one's skin there are some other things that cause Vaso constriction the the basically the tightening of the vessels and capillaries to the skin as I understand maybe we could just um tick through a few of these and and get your sense um I consume caffeine every morning usually yamon tea some coffee a little

bit later those will increase basil constriction to some extent uh although chronic caffeine intake may cause Vaso 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 dovetailed with that question is nicotine which is also thought to be a vasoconstrictor it raises blood pressure um because it's a vasoconstrictor what are the effects of caffeine both acutely and chronically and nicotine let's assume that nicotine is consumed either by smoking or oral ingestion um on skin appearance and health that's a

good question so caffeine is a known Vaso constrictor fortunately when it's consumed in quantities that we have in coffee tea and you know equivalent beverages the amount that affects the tiny capillaries and arterials in our skin is minute and transient so you may get a a transient Vaso constriction with high caffeine intake but usually there's a compensatory vasod dilation as a result um so the effects on skin are not as atic as people may make it seem now one thing that we do see and it's a little unclear as to why is that people who

have chronic high caffeine intake tend to produce more sebum In Their Skin and it may be a result of Vaso constriction may be a result of something that we don't understand that's compensatory as a result of those changes so a lot of people who consume coffee may experience a little bit oilier skin that being said the data is equivocal as to whether or not caffeine has a dilus beneficial or net neutral effect on the skin I drink a lot of coffee I haven't found that the Vaso constriction is something that's noticeable but there are people

who have different skin types patients who have rosacea for example who are much more sensitive to those changes they may notice that change in the color in the Vaso constriction more with caffeine consumption what used to be thought was that caffeine itself was a 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 minuscule it's actually the temperature of the bever beverages we drink so hot beverages can affect the color of your skin can make you flush more make the redness

more pronounced cold beverages tend not to have that effect so it used to be an old adage and people who had like rosacea for example we'd say don't drink coffee don't drink tea it's actually the temperature of the beverage not so much the caffeine content interesting and what about nicotine so nicotine great question it is a known Vaso constrictor now the concentration of nicotine when smoked is higher in the skin because of inhalational effects and the local effect of nicotine on our skin so you do see a measurable Vaso constriction in the skin that becomes

a problem which is why patients who smoke age faster patients who had surgery who smoke have a higher risk for poor wound outcomes for poor healing because of that Vaso constriction usually people who who use or consume nicotine aren't doing it once a week most people are using it daily or multiple times a day so that chronic Vaso constriction 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 nicotine use what about vaping nicotine or oral

use of nicotine so nitin gum mints pouches and let's let's touch on vaping first because that's becoming more common so with vaping we see the same problems in the skin we don't know if it's um an inhalational issue or if it's actually the same concentration of nicotine that's reaching local skin causing the effect but we see the same Vaso constriction when you match cigarette smoke with with vaping if you have the same nicotine content now for patches and gum it's less of a problem and why that is is the concentration of nicotine that reaches the

skin is much lower usually when you chew it it has to go through your digestive tract then enter your bloodstream then reach the surface of the skin when you have a transdermal patch it still goes through the bloodstream then ends up in the skin so because of how much it has to be processed the concentration that reaches the skin is much lower when we operate when we do surgery whe any surgery of any kind we try to transition people who smoke or vape to at least gums or patches to mitigate their withdrawal effect but um

you know so they don't have the feelings but you know it doesn't have the same constrictive effects on their skin what about alcohol you know question did an episode of this podcast on alcohol which somewhat to my surprise you know uh was very widely shared only to my surprise because I've never been a big consumer of alcohol um but apparently many out there are and the data came back at 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 it's now called probably okay but beyond that you start running into some health issues that can be offset by better behaviors of other types but what about the Direct effects of alcohol on skin in the short term does it increase blood flow and therefore improve skin um um are there long-term indirect effects I could imagine that alcohol disrupts the gut microbiome which then disrupts skin Etc 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 let's say versus chronic effects through other systems like disruption of sleep and microbiome yeah great question um alcohols alcohol and skin connections complicated convoluted but generally thought to be negative both shortterm and longterm so first alcohol tends to be a mild diuretic so it makes our body dispose of water a little bit more frequently um what happens short term is that one you get a almost a mild diuretic effect from alcohol consumption which is why you tend to be thirsty in the middle of the

night and wake up in the morning tend to be parched as a result you see that diuretic effect on their skin you see a little bit of hollowing in areas that you'd have normal volume and suppleness which is why there you know people tend to see bags under their eyes or they look like they had a hangovers from that mild diuretic effect also as a compensatory mechanism the skin produces a bit more sebum to compensate for that drying out effect so in the acute phase your skin dries out you look look a little bit worse

because of that diuretic effect in patients who cannot or people who cannot tolerate alcohol um and there are genetics in Asian populations and Southeast Asians that have a difficulty in breaking down acetal dhide that is a a toxin that shows up in the skin and makes the skin vasodilate as a result so that common College term that we used to hear you know the flush or the glow or you know 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 uh flush in their skin because of the acetal theide buildup in the skin long term one the diuretic effect becomes a problem so over time your Skin's producing constantly more sebum to keep the skin Supple your skin is drying out and as a result you run into things like breakouts and you know congested skin you know blackheads whitee heads 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 Bing drinking they tend not to come home and do

things that'll maintain their skin now that's not a fixed rule but most of the time when you're out you know having a few beers or cocktails at the bar you tend to come home and not do your diligent skincare routine or you may not be up you know with your hydration status or your dietary habit so that's something we can't quantify easily but contributes significantly to faster aging poor skin Health then the gut microbiome question this is a great question because the data is widely variable for alcohol consumption and the effects or changes permanent or

transient in the gut microbiome there are some alcohol products like kombucha that has u a higher alcohol concentration that's healthy for your gut then there's hard alcohols with a higher concentration that act as anesthetics and act as gut paralytics so one of the things we see in people who consume a lot of high percentage alcohols is actually gut immobility and gut paralysis partly because of the anesthetic effect partly because of the analgesic effect of alcohol and also because it affects gut motility as a toxin so generally speaking gut the gut health depending on your consumption

patterns use and concentration can be very dilus 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 um fermented alcohols like kombucha and things like that so generally speaking the higher the concentration the greater the the problems the higher the percentage of alcohol the greater the problems that includes the diuretic effects that includes effects on the gut microbiome that includes lifestyle

habits if you're drinking a lot of higher percentage alcohols you tend to feel the effects you know not just in the skin cognitively behavior-wise that can affect you whereas sometimes lower concentration alcohols 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 Health generally not generally not it it same as what we've seen with other organ systems the brain the liver the skin reflects the same thing if anything it may be a net neutral most of the time

it's a net negative and what I'm pulling from all of the discussion we've had up until now is that improved blood flow and strong hydration status are both important do you recommend patients drink a certain amount of fluid each day or maintain adequate hydration as a means to build or maintain skin health and appearance great question so that's 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's a certain degree of Truth

to that if you're dehydrated and that you need replenishment of fluid you know systemically the every study that's looked at transepidermal water loss has not shown a great connection with regular you know fluid intake and water intake and skin hydration St status we find that that tends to be genetically defined and genetically encoded some people have drier skin they need more methods to moisturize their skin some people have oilier skin and their sebum provides that moisturization 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 or a sedentary life and you're doing all the regular things drinking a lot of water or fluids has not been shown to improve skin health so that's why generally speaking most dermatologists will recommend some sort of moisturizer to replenish that but you got to know your skin for example my skin I tend to be oilier I don't usually need a moisturizer as much whereas somebody who is drier will need some sort of barrier protection to allow to minimize that transepidermal water

loss what are some of the um parameters for selecting a moisturizer um yeah you know people people are immediately going to go to say what what constitutes a good moisturizer what should it have in it what are some things to avoid yeah it's a crazy Market there's a lot of things out there I mean you can Google skin snail moisturizer and you'll find people putting snail mucin on their skin as a moisturizer telling me before this uh recording started there are people who and forgive me for those that cringe when I say this um that

put placental extract human placenta as a means of rejuvenating their skin health I don't Advocate it or don't say anything against it but um I probably wouldn't recommend it there's better safer more cost-effective ways of doing this simple things you want to look for one is it non-comedogenic that's a word you want to look for for any moisturizer that's been tested not to clog your pores that's a basic thing to look for where you won't cause another problem in trying to fix one problem number two how oily or dry are you generally speaking there are

three flavors of moisturizers there's ointments there's creams and there's lotions ointments are greasy they're like petrolatum jelly or Vaseline based those are the best for moisturizing your skin but they're greasy then there's creams which are water emulsions with oil um suspended in it and then there's lotions which are generally powders that are resuspended with water we as dermatologists tend to like the greasier the better it provides the best barrier protection but you have to know your skin if you're somebody that is eczema prone you will need something that is an ointment that does better to

protect the skin from drying out if you're somebody that is acne prone you won't tolerate greasy things you'll break out more so you want to look for a lighter moisturizer that's non- cogenic so in a long story short it's very you know personto person specific you got to know your skin but the fundamental things you want to look for is has this been tested to not not um clog pores and is it in a pump bottle or is it in a jar jars tend to be more occlusive they tend to provide more moisturization but they

can lead to problems like acne and breakouts whereas things in a pump bottle because they're suspend their powder in suspension and they have to put alcohol in the product to allow it to come out of the pump mechanism they tend to be lighter and not provide as as much moisturization I see so when I think about something in a jar think of something like um aquafor or something which is pretty thick thick stuff so that would be fine for someone with eczema not okay for somebody with acne yeah exactly exactly the greasier the more ACC

clusion it provides but in doing so it clogs everything now if you're one that has some sort of skin issue in which you need that it's the best thing if you're one that is breaking out all the time you want something lighter I'd like to take a quick break and acknowledge our sponsor ag1 by now many of you have heard me say that if I could take Just One supplement that supplement would be ag1 the reason for that is ag1 is the highest quality and most complete of the foundational nutritional supplements available what that means

is that it contains not just vitamins and minerals but also probiotics prebiotics and adaptogens to cover any gaps you may have in your diet and provide support for a demanding life for me even if I eat mostly Whole Foods and minimally processed foods which I do for for most of my food intake it's very difficult for me to get enough fruits and vegetables vitamins and minerals micronutrients and adaptogens from food alone for that reason I've been taking ag1 daily since 2012 and often twice a day once in the morning or midm morning and again in

the afternoon or evening when I do that it clearly bolsters my energy my immune system and my gut microbiome these are all critical to brain function mood physical performance and much more if you'd like to try ag1 you can go to drink a1.com to claim their special offer right now they're giving away five free travel packs plus a year supply of vitamin D3 K2 again that's drink a1.com huberman to claim that special offer why do people wake up with bags under their eyes if they just slept for six or eight hours yeah well maybe you

need a little bit more sleep or maybe you had a wild night I can't tell but generally the bags are caused by two things one fluid retention so there's some lymphatic change that occurs under the eyes that's most noticeable because the skin under our eyes and on the surface of our eyelids is the thinnest so fluid changes are seen the quickest there and as we're in a supine or prone position fluid moves from our extremities back to our Central ner Venus system and it's 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 herniation that shows up more um as we wake up because of positional changes so if you've had you know um a heavy meal the night before something that has high salt content you're going to retain a little bit more water um because of that solute shift you may notice your eyes are puffier in the morning um if you have allergies uh seasonal allergies you know um asthma eczema 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 Springtime or fall time they their eyes are swollen or their eyes are puffy especially when their allergies are flaring it's a it's a product of water retention from all the histamine release and and changes that occur in the skin skin cleansing is a topic that gets a lot of coverage um and I sometimes get um Chuckles or even attacks for saying um I've always just used unscented did Dove soap the bar not the liquid soap or like a Cetaphil soap

um and this is because when I was younger like much younger I had very sensitive skin when I was like a kid seven eight nine years old I think I just started using unscented Dove soap at some point and things like it gentle you know uh soaps without fragrances what are your thoughts on on those and I ask not for my own purposes I'm going to stick with it because it works for me unless you tell me I shouldn't but I see this enormous market for skin cleansers that includes a range of costs from relatively

low to near astronomical yeah and um if you tell me that this uh unscented Dove soap or Cetaphil soap is the way to go and by the way I'm not sponsored by either of those I don't even know who they're manufactured by so there's no commercial angle here um but I'll be relieved because they tend to fall on the lower end of the cost bracket relative to some of these Aston om priced um cleansers skincare is a incredible multi-billion dollar market that being said there is not a shred of evidence that anything more expensive works

better than anything cost effective so that's first and foremost number two Dove white bar soap is amazing it's what we recommend for newborns and kids with sensitive skin generally when we say sensitive skin especially in in kids toddlers and adolescents there's a component of some sort of eczema or atopic dermatitis that is not bad enough to have a diagnosis but enough to say you know I had sensitive skin so Dove white bar soap 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 it has the least amount of ingredients no fragrances these are all things that can irritate or cause an allergic response to skin that is sensitive meaning you your skin mounts an immune response to some sort of environmental allergen or trigger that's what we generally mean when we talk about sensitive skin I personally use Cetaphil that's my face uh wash I have oily skin I use the one that takes off more of the oil so what you're looking for is defined by what bothers you or what your skin predicament is what I

do see is a problem um nowadays is particularly in the United States where a hyper hygienic Society so what what people tend to do is over cleanse and they over cleanse 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 cleansed off to keep their skin healthy neither are true the first thing you want in terms of a cleanser something that's mild fragrance-free and has been tested to be

hypoallergenic or non cogenic that's first Cetaphil Dove Cate great great stuff um no association with any of them the unscented non-f fragranced versions of them exactly exactly um that's first fragrances tend to be a problem for sensitive skin patients who have atopic dermatitis or eczema they tend to trigger allergic responses or exacerbations of their eczema flare so we try to avoid fragrences by all means then things that are gels or liquids tend to have preservatives in them to increase shelf stability whereas bars tend not to so if you are going to pick something that is

uh a gel a liquid look for one that's been tested by dermatology group or verified by the American Academy of Dermatology as one that is not uh allergenic or um has multiple preservatives because that's another wellknown but unidentified source of problems um well known to the Dermatology world not known to the late you know the average person that the preservatives in our cleansers are a problem over cleansing becomes really problematic in in eradicating the skin microbiome so what we see a lot of times are cleansers that are either um bactericidal bacteria Statics things like benzol

peroxide things like salicylic acid things like certain astringent toners that are alcohol-based and what they do is not only do they stret the normal oils from our skin that keep our skin Supple and healthy but they eradicate the normal host skin microbiome those are all the microorganisms that live on our skin and we have trillions of them actively surveying our skin living in in normal symbiotic homeostasis meaning there're there are friends they're living there for a reason they don't cause any problems but when you cleanse them off you open up a a an area for

pathogens to take effect and that's when when we see a lot of problems more so in industrialized countries the United States is a notorious place for washing especially after covid wash wash wash wash more use a toner wash some more and that becomes really problematic because it sets up for organisms to take seed when they shouldn't be there so overall cleansing is great and the amount that you need to cleanse is based on how oily or sebaceous your skin is the older you get you may not need to cleanse as much there you know older

patients don't need to cleanse their skin at all every day because they don't produce as much seam or oil as younger patients but everything should be defined by your Skin's characteristics so if you are one in which you notice by the end of the day I'm I'm oily I'm breaking out cleansing may be something that's beneficial for you to take off that excess sebum if you're one that has dry skin if you're one that had sensitive skin as a child then over cleansing is going to be a problem you're going to want to minimize that

and and keep that moisturization or that barrier protection going so does that mean that people should bathe probably once or twice a day but the people that are bathing three times a day it's probably excessive I mean are we saying that you can't get into water I mean when you say cleansing you're talking about face cleansing I realize this is going to be highly individual but you know some people um are just out of habit you know shower and use cleanser you know twice a day or once a day I think uh for me it's

in the morning or in the evening sometimes both if I do a workout I try and shower yeah as close as possible after the workout as soon as possible after the workout rather because um otherwise I will break out you know so it sounds like one has to kind of learn what their cadences and that's going to vary by age um there's a lot of factors to this I I I think Ashton Kutcher and milakunis famously said they shower I think once a week or something like that and it stirred up a lot of conversation

when that came out truth be told you don't have to cleanse every day if your skin is otherwise fine and healthy and you're not bothered by anything you live a lifestyle in which you're not sweating excessively or producing a lot of sebum I myself same thing I work out so I I shower after working out and I usually shower before I get into bed because after a long day of work I tend to have you know things on my skin that shouldn't be 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 you know shouldn't happen because of my hygiene habits that said there is no indication or no medical necessity to have to cleanse your skin even once a day often times older patient patients cleanse or shower once a week and they're totally fine but it'll have to be defined by your skin and what problems or ailments 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 salts

that crystallize from the sweat drying off number two the sweat itself as a source of food for certain yeast that are normal symbiotic yeast that live on our skin so it contributes things like dandruff um what we call tinia versicolor which is a type of yeast that grows on our skin so generally if you work out try to wash those you know things off also if you are one of you know acne prone skin if you're an adolescent if you're a teenage if you're an adult dealing with acne the sebum that your body is producing

is food for the bacteria that cause this so you tend to want to clean some of that excess sebum off those are simple indications to cleanse both your face and your body body but if you're not having any problems you actually don't need to do any of that in Europe they shower and cleanse at a fraction of 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 acne psoriasis yeah you know most people think about shampooing for sake of

hair but there's the scalp component and since you're an expert in skin we should probably uh spend a bit of time on this um for people that tend to have a dry or flaky scalp uh what should they do about that my understanding is that some of the more um typical commercial anti-dandruff shampoos can contain things that might cause issues for hair itself so they might help with the flaking and drying of the scalp but damage other aspects of you know either appearance or health of hair yeah um what are some really good options for

people that have dry scalp what are some great options for people that have oily scalp yeah um and let's leave aside the frequency of use and just um perhaps just put it on the Shelf as uh as much as you need it but not more so that could be once a week it could be daily could be twice a day if in extreme cases it sounds like so when we think about the scalp when we think about dry or flaky scalp we think about two main conditions either CC dermatitis which is medical grade dandruff or

or the medical name for dandruff or psoriasis they're two different entities but they generally contribute to the same problem which is redness flaking and dry 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 2 and 1 12 millim in the skin so the hair that we see on our scalp 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

in just a just a minute um but the hair itself that you see is is is not living the only area that's living are the stem cells in the Pilla 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 an overgrowth of yeast from the sweat

and oil that is produced from our our scalp and that's CC dermatitis that's the medical name for dandruff and so we treat it by one lowering the amount of that yeast that's living and that's usually with shampoos um that are prescription or over-the-counter you know things like zinc or ketoconazol shampoos are very common things and then the other thing that we do is to dampen the immune response to this overgrowth of yeast so the reason our skin Flakes and gets red and prolifer Ates is our immune system is responding to something it's either responding to

the yeast or it's responding to itself which is what psoriasis is it's an immune mediated over proliferation of skin cells because the immune system is overactive in the skin and the way we treat that is just topicals or certain medications that suppress the Skin's immune system or immune activity none of that affect the actual hair itself what does happen is shampoos tend to have things that strip oils as a mechanism of cleaning so when you take a cross-section of the hair there's seven layers and the the layer that provides that color Sheen and structure is

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 patterned hair loss or androgenetic alipas we 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 their hair becomes more limp or dull or lifeless it's because we've taken that artificial oil coating uh that replaced the cuticle and and washed it off so good news is you're not

going to do any harm putting any of the topicals on your scalp bad news is you probably won't bring a lot of it back to life either but when we treat flakiness you know redness things like that we're treating two entities usually with topicals and because we're either trying to treat over proliferation of something or trying to calm down the Skin's immune system got it so it sounds like the best options for cleansing skin for shampooing really stem from knowing whether or not your skin tends to air oily or dry figuring out how often to

cleanse and then as you pointed out before even though there's an enormous range of cost for these things none of the solutions that you're describing sound like they fall on the high end of cost or even in the middle end of cost which is a bit surprising to me this might be one of the few areas where you know like if I had a magic wand I would make for all uh you know organic uh nonprocessed and minimally processed foods to be very inexpensive but it turns out those things tend to be more expensive you

can go to farmers markets and cut back on the cost Etc but there seems to be um an unfortunate tradeoff between availability and cost and benefit or at least risk but it doesn't sound 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 of 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 fragrances and stuff like that which can be problematic that's number one the second thing to know is that generally speaking there's some connection between skin Health skin care and this realm of beauty which people overlap a lot in and there when we Trend into this realm of beauty glamour Etc price and objectivity are taken out and that's why you see a lot of skincare products that are so expensive because they draw towards another level of desire that's not just medical it's aesthetic and that's where you'll find creams that are $2

$300 for a little amount of cream that does the same thing that your jar of petrolum or Vaseline or aquafor does that part is really hard to mitigate but in general almost everything that we as dermatologists and skin cancer surgeons and um experts in the field recommend are really cheap coste effective and they have the least amount of ingredients in them and that's what I would recommend that's what I recommend for my family and for my patients you don't have to spend a lot to have excellent skincare and you don't need to have it be

a multi-step routine oftentimes people overdo it you know the more steps 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 you're 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 it's also going to be um uh somewhat uh 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 and 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 ingredient ingredients if they're really active tend to be controlled by the FDA 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 know anti-aging creams you know um acne medications they work

a little bit if they worked perfectly then most Medical Dermatologists would be Ahad of a lot of patients and we see a lot of skin disease that's still continues because the active ingredients aren't at a concentration high enough to provide therapeutic benefit so save your money if you really need something to change some part of your skin see a good dermatologist 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'll also talk about sunscreen sunblocks skin cancer sure 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 blinking as needed to protect the eyes of course but in order to set one's circadian rhythm for elevated daytime mood focus and alertness and improv nighttime sleep there's just so much data to support setting one's circadian rhythm properly ly 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 and 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 it depends on which school of thought or Camp you belong in as a skin cancer surgeon and a somebody who's developed a reputation for seeing some of the worst most complicated life-threatening skin cancers in in Los Angeles obviously I see some of the consequences of long-term sun exposure

and chronic chronic photo aging that being said I absolutely think that getting sun is healthy for us now why the studies that talk about vitamin D and we'll touch on vitamin D as its own entity and then overall health as another entity but most of the studies that look at Vitamin D synthesis from UV exposure on the skin suggest that you only need about 15 minutes and that you don't need a broad uh surface area of exposure you can get enough vitamin D formation with just about 15 to 20 minutes of sun on your forearms

so there's a whole school of thought by a lot of experts who think there's no amount of UV exposure that's healthy for the skin and I tend to be on the other camp for several reasons one there's a component of feel goodness if that's a word from being in the sun that affect overall skin and 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 it's 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 in core disol response improvements 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 olive skin and I can tolerate the a little bit longer than somebody who is fairer and lighter eyes in my opinion I don't think and in most of the evidence there isn't a finite amount of time because that time is

dictated by your Skin's 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 for vitamin D synthesis but something that improves your overall Wellness that is 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 it bothered me my mood was lower I felt not as healthy you know I'd come home my family would say Hey you look sick and it just I wasn't sick I hadn't had any sun I was lighter than I was and my family interpreted that as not being healthy you know my wife on the other hand didn't she didn't mind the grayness so there's a timeline for biologic processes like vitamin D formation that's helpful people can argue that you can get it through supplementation and food and that's that's correct but there

is a component of sun exposure that makes you feel better overall and provides some sort of Wellness that you may not be able to quantify but you see in appearance and in discussion and Longevity so absolutely I think you should be out the sun I don't think you should burn and I don't think you should be out 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 UV exposure but I absolutely think the sun is a good thing for us so even midday

Sun you know maybe if there's some cloud cover or if we have some sunscreen on or a physical barrier like sun and long uh excuse me like hat and long sleeves then getting some sun exposure in your mind is good for our overall well-being mood Etc yeah I think I mean midday sun has a higher UV index 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 you know busy

Urban cities and work environments if they go out for a walk in the sun they feel better their stress responses are lower their questionnaires in responding to life stressors and day-to-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 um is improved with outdoor sun 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 I'd like to take a brief break to thank one of our sponsors element element is an electrolyte drink that has everything you need and nothing you don't that means the electrolytes sodium magnesium and potassium in the correct ratios but no sugar now I and others on the podcast have talked a lot about the critical importance of hydration for proper brain and bily function research shows that even a slight degree of dehydration

can really diminish cognitive and physical performance it's also important that you get adequate electrolytes in order for your body and brain to function at their best the electrolytes sodium magnesium and pottassium are critical for the functioning of all the cells in your body especially your neurons or nerve cells to make sure that I'm getting proper amounts of hydration and electrolytes I dissolve one packet of element in about 16 to 32 ounces of water when I wake up in the morning and I drink that basically first thing in the morning I also drink element dissolved in

water during any kind of physical exercise I'm doing especially on hot days if I'm sweating a lot and losing water and electrolytes if you'd like to try element you can go to drink element.com huberman spelled drink lnt.com huberman to claim a free element sample pack with the purchase of any element drink mix again that's drink element.com huberman to claim a free sample pack what about sunscreens and sunblocks and I think uh we should distinguish between those two labels um 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 sunblock is the stuff that you put on your skin to reflect UV um typically nowadays people say sunscreen more than they say sunblock or they use them interchangeably without any knowledge of the underlying mechanism um so first of all let's clarify sunscreen versus sun block yeah so a lot of the nomenclature data understanding chemicals um things that were considered okay to be used came from an original FDA 1999 manuscript and that data hadn't changed for almost 20 something years and more recently in 2021 the

FDA released a proposed final order for the term sunscreens as a whole now when we talk about sunscreens sunscreens are considered an over-the-counter nonprescription drug so they're regulated tightly by the FDA they're in the same category as any over-the-counter drug so before this this decision ruling there was a lot of nomenclature wording confusion sunblock seemed better than sunscreen suntan um suntan oil all of that's 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

sunblock although in the past that had been used for things like zinc or zinc and titanium based creams like the old 1980s or 1990s white lifeguard noses if you remember that used to be thought as sun block whereas less less um protective chemicals were used as sunscreen now that's changing and the FDA 2021 proposed order says we need to unify everything and call it a sunscreen now sunscreens being regulated drugs take a lot of scrutiny for many reasons they take scrutiny from the FDA in terms of proving efficacy and safety they take a lot of

scrutiny in society for being dangerous or not dangerous effective or not effective causing Downstream effects or not causing Downstream effects so that's been a big point of contention in terms of the population the American Academy's stance dermatologists stance and then the skin cancer patients beliefs the beauty experts beliefs and average person's opinions um sunscreens generally fall into creams lotions topical products that protect the skin against sunburn we used to be able to suggest that they reduced the risk of skin cancer um prevented premature aging but that can be a little convoluted and the FDA is

rewarding that into not being able to say that anymore in their proposed order but what sunscreen's intention is is to protect the skin against excess UV exposure and they come in two flavors they come in mineral-based sunscreens which tend to be in the category of zinc and titanium minerals and they tend to be chemical sunscreens which are a bunch of different chemicals mineral-based sunscreens are sometimes called inorganic correct inorganic or physical sunscreens whereas the chemicals are considered organic or chemical sunscreens totally right is the mechanism for these two the same because um I was under

the impression that the mineral-based inorganic sunscreens um reflected back UV rays um whereas the chemical-based sunscreens absorbed UV rays but there's a bit of a online debate about this um claiming that they all absorb UV rays yeah so historically it had been thought that mineral or physical sunscreen zinc zinc and titanium sunscreens worked by basically acting as a metal reflecting shield and for the most part that thinking is not incorrect there's uh there was 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 and dissipate that energy as heat so chemical sunscreens work by actually absorbing it and undergoing a change whereas mineral or physical sunscreens don't do that I still think of them simply as minerals basically Shield the skin like armor whereas chemicals act as a sink and undergo a change to reduce that energy so that's kind of the simplistic way that sunscreen topical sunscreens work so what is your recommendation about protecting oneself from the Sun and maybe

for the moment let's just set aside sunscreens and acknowledge that a physical barrier like hat long sleeve 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 than topical sunscreens 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 uh photo damage and things like of that nature or you worried about your risk for skin cancer um do

you have a sun sensitive skin condition like lupus or PM that is sensitive to UV 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 and large there there are many other forms both physical blockers and certain things in the supplement uh world that can protect your skin for example I myself take a product called Sun powder that provides an internal sun shield allows me to be in the sun longer um without

the need to reapply or if I can't reapply but you know by and 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 now for patients who are worry or for people who are worried about premature 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 you

know losing a part of their ear or or part of their nose to 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 one being lupus for example need the most sun protection because they're so inherently sensitive to UV exposure something that's very interesting we know without a doubt that every common skin cancer there's many many skin cancer types but the three most common are you know basil cell carcinoma squa cell carcinoma and melanoma those are the

three most common ones we see they have all been shown to have UV mutation signatures when we sequence the tumors however in every single clinical trial and every single randomized trial that looked at topical 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 basil cell carcinoma one in four Americans will develop this also there hasn't been a single study to date that showed that diligent sunscreen use topical sunscreens will reduce disease specific death

or dying from skin cancer so if you think every skin cancer is sun-driven there are UV 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 sunscreens and barriers to blockade first sunscreens topical sunscreens are not the only form you know in fact clothing and shields you know shade and hat are in my opinion better and a lot of studies suggest that they're better there are oral supplements that can

also protect your skin from burning and and reduce your skin cancer risk and number three not everything is Su driven we do know that diligent sunscreen use decreases the incidence or the amount of melanoma formation and sasil formation but we still don't know whether that reduction has changed the number of patients dying from that we also know that it has no bearing in the development of the most common skin cancer which is basil cell so we go back to the drawing board and scratch our head saying 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 it strictly UV is it some other culprit so sunscreens are a really hotly debated topic so many things to talk about in terms a sunscreen so if I understand correctly you're saying that the use of sunscreen can protect against premature aging let's say sun block because I think we're going to arrive at mineral-based sunscreens probably being the better option but we can uh make sure that we double click on that so to 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 look into the things that cause the most deadly skin cancers yeah okay but I'm also hearing that regular application of sunblock and or 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 that or even baffling um to the you know non- dermatologist me um because we already know that sun exposure causes UV mutations mutations in the DNA of cells is one of the kind of core components of cancer 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 and the more data we we collect the more we're scratching our head as to we don't know and why this occurs now I am not saying don't use

sunscreen let's just let that be known I I think sunscreens are excellent forms to predict against premature photoaging and signs of sun damage I think sunscreens help reduce the incidence of common Garden variety skin cancers but they are not the only form of protection and they seem to not be as important or have as much effect in reducing the incidence of our most common skin cancer which is basil cell carcinoma moreover I would say and the data unfortunately shows that the majority of skin cancers that we see that end up hurting people or or killing

patients don't arise in chronic sun-exposed areas to begin with you know I have a 27-year-old patient right now dying of a metastatic melanoma that arose in completely Sun protected skin I have a 56-year-old mechanic right now who's dying of aamil carcinoma that arose 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 UV plays a big role the the mechanism in which cancer forms if we believe this the basic

high school biology is you know hyperplasia metaplasia dysplasia carcinoma 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 um change and we just don't see that also we know that skin cancers that arise 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 dermatology to guilt people into thinking that

they cause this to themselves and I don't think that's right nor okay and I I I don't like that because they make it seem that oh the sun you got in 1987 that one sunburn in 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 skincare 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 UV exposure but I bring this up because PE you know don't feel bad about getting some sun and don't feel guilted into something that if if something bad occurs it's not your fault some of it is is out of your control and that that's really important because I see a lot of very bad skin cancers in my practice and I I hate this feeling of patients feel feeling like they did it to themselves I think most people would prefer not to have the premature aging

caused by sun exposure yeah so yeah what should those people do um I've taken on a practice of putting a mineral-based inorganic sunscreen on my face my arms if they're going to be exposed back of my neck tops of my ears if I'm going to be out in midday or late day sun that feels intense and I'll do that every single time I go out now um on overcast days not so much uh for viewing morning sunlight I don't do that in fact when the sun is low in the sky I don't tend to wear

sunblock that's me that's been my choice it um there were a few years there where I didn't put on sunscreen or if I did it was like on a camping trip or skiing or something where the sun felt very intense and in that case I would just reach for whatever sunscreen or sunblock was available because I wasn't aware that some of the ingredients and certain chemical based sunscreens may be problematic yeah 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 nope sunscreen sunblock is terrible all the time or they're just too lazy or uninterested in applying it but then there's this whole category of 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 points so there's that famous New England Journal of Medicine picture of the truck driver that got chronic sun exposure on the left side of his face and you see all this wrinkling

and modeling of the skin on the left side and nothing on the right side so by absolute measure sun protection or UV protection will reduce premature aging now interestingly that guy did not develop anything in that area so again it goes back to well what skin cancers so the question is what's pulling the trigger is it truly UV or is there something else we missing if you tell me that he got skin cancer on the opposite side I'm really going to gasp but no I I I I don't know if he's had any on the

opposite side but in that photo it's purely uh premature aging so things that you want to do obviously know don't let your skin turn red take some sort of some form of barrier protection whether it's a sunscreen uh supplement like poly iium something that protects your skin from the inside out and skin changes are cumulative um so what we can tolerate in our teens and 20s is very different than what we can tolerate in our 40s 50s and 60s because there's a cumulative mutation profile burden that we see interestingly there was an eyelid study that

was published recently that looked at eyelid skin that was removed during you know cosmetic surgery upper eyelid lifts that was otherwise discarded and when they ran genetic sequencing on normal eyelid skin they saw the same mutations that they would see in matched skin cancers but the eyelids didn't have any skin cancer so we know UV triggers these mutations and we know UV degrades collagen and elastin it thins blood vessel walls as a mechanism of um of its effects on the dermis the data is equivocal as to how those mutations trigger skin cancer formation but in

terms of premature aging absolutely so you want to take some form of protection now what type of protection do you take depends on your genetics how much you can tolerate and what your family lineage looks like some people have the genetics of early aging it's part of their skin biology and you can't change that but you can mitigate that risk with more strict UV avoidance some people you know they look young longer you know some family lineages 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 uh mineral zinc or zinc and titanium sunscreens for several reasons in the original set of sunscreens that were approved by the FDA that came out in 1999 there wasn't enough data to look at biologic effect efficacy internal organ involvement Etc fast forward 20 years and we've gathered a lot more information about these chemical organic compounds there is an amazing 2020 study that looked at absorption of chemical sunscreens when they're applied onto the skin they

looked at absorption with single application and they looked at absorption over 4 days of application now the study they applied a little bit more than you know Real World Experience would but even with single application they saw blood plasma absorption of these chemicals that were 100 to 500 times greater than the upper threshold defined by the FDA 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 phenolic compounds meaning they they have one or two usually two Benzene 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 2 or three years that suggest that some of these chemical compounds particularly o ozone particularly octocrylene particularly um Octon oxinate um that can have endocrine disruption or affect the nervous system because they mimic a lot of biologic phenolic compounds and a lot of biologic hormones if you actually look at the structure

of oxybenzone it looks very similar to the structure of bisphenol a which has been now banned in a lot of the lining of plastic bottles why because of the same concept now the data is not 100% one way or another but there's enough smoldering evidence that makes me think H we should reinvestigate this and in fact the fda's proposed final order in 2021 changed these chemicals from Grace generally recognized as safe and effective to not Grace because of these concerns there's data that suggest that the chemicals are found in breast milk amniotic fluid blood plasma

urine so there's 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 di diagonally or sideways because we ran into unexpected things I tend to recommend mineral sunscreens because they don't have any of that data they haven't for the last 30 40 years they're considered safe and in fact for young kids particularly those six months and under the American Academy of Dermatology and the American Academy of Pediatrics generally recommends avoiding chemical sunscreens why children's skin particularly infants and toddlers behaves more

like mucous 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 6 months or under we recommend minerals to begin with so I say if you have a pool of compounds that has maybe even smoldering evidence on the basic science level that something's off versus a a group of uh compounds that have really no data which one would you pick and they do the same thing I naturally gravitate towards that so the takeaway

for me is physical barrier no issues mineral-based sunscreen safest so that's zinc oxide titanium dioxide up and that's mineral not like powder not mineral powder but mineral topicals because mineral powders are a whole another issue we'll talk about but okay and then chemical-based sunscreens um probably best avoided um and then you mentioned polypodium so this is a pill it's a supplement basically that one can take I only call it a supplement because um it's not a prescription drug correct yeah um that protects your skin from UV damage from the inside yeah so exactly right mineral

based creams and lotions I tend to prefer and recommend in my practice and most people will if you're worried about any risk any consequence chemicals I tend to personally avoid now this may not be in line with all my Dermatology colleagues but I tend to avoid them and I don't not recommend them for kids in terms of things that you can do in addition to provide sun protection polypodium is a fern from the Amazon rainforest that was discovered when they studied an indigenous population that would eat this Fern before they would go on their fishing

Expeditions on the Amazon and they'd be gone for 3 Days they'd eat this Fern and come back not burned so a lot of studies were done on this Fern in the last 5 10 years that showed it increases your Skin's minimal athema dose the amount of redness your skin gets from UV exposure that's our general barometer for Effectiveness without any topicals it's taken or ingested orally I personally use a form called Sun powder that also has nicotinamide in it we can talk about nicotinamide later but if in and of itself it works great in conjunction

with topicals you get the best of both worlds you get internal shielding and external shielding now it is a supplement so it's not a controlled drug the way the FDA regulates sunscreen so it isn't really a sunscreen but it's a way to prevent sunburns increase the amount of time you can be outside and increase the efficacy of your topical so if you're somebody who is very fair skinn who burns all the time or if you're somebody who has like what we call Sun hives or or PE um prickly sun rash pmle um this is an

added thing that you can use that will boost your sun protective factors it's awesome and if you're somebody who's active like you're in the water or you're you know exercising or you're playing a sport you can't reapply I I love polypodium for that added benefit what are the dosages of polypodium that are useful and are there any side effects great question so there's been a wide variety of doses um investigated anywhere from 500 240 480 generally you said 1500 no uh sorry 50 milligrams 100 milligram 240 480 uh um somewhere in the between 50 and

400 80 milligrams is what's commonly used the most common side effect can be a little um upside stomach if you can't to at the plant forever it's taken you can either take it daily as a method of preventing premature photoaging and pigmentary 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 sunscreens cannot is the effects of visible light so there are certain skin conditions the most common

is melasma which a lot of women have you know it's I think the bane of their existence it used to be called The Mask of pregnancy and melasma is something that is very sensitive to both UV and visible light chemical sunscreens don't do a good job blocking visible light polypodium has been shown to help block the effects of visible light as well which makes melasma worse it's this discoloration that we see mostly in women usually after pregnancy or women who are on birth control is really challenging to treat and sun protection is the first line

like diligent sun 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 it's um a product that I helped formulate with one of my colleagues um over at Harvard who's a a laser and aesthetic dermatologist 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 it daily myself

as a single scoop it helps reduce your skin cancer risk your non-melanoma skin cancer risk by up to 30% and the data was published in the New England Journal of Medicine in a phase three randomized trial for one of the ingredients the other ingredient obviously is NI is polypodium and I take that one to prevent you know Sun rated Chang ches but also help reduce my risk of burning often when I personally find the need for sunscreen it's when I can't apply always at the water I'm swimming you know my my son he's seven he

races on a swim team I cannot get this kid to reapply sunscreen so this is a supplement that I I give him and we it took us several years of formulation and testing including me testing which is minimal athema dose 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 mix it into my morning drink and I'm done terrific I think we both agree that the mineral-based sunscreens are going to be the best option of the

ones out there if one is at all concerned about some of these chemical components and chemical sunscreens ABS absolutely agree yeah so within that category are there particular things to look for um I'm not necessarily trying to aim for particular brand here but given that I have no relationship to any skare products um I would just like to know which one to look for or will any zinc oxide Andor titanium dioxide containing sunscreen provided there are no chemical components in there besides the inactive ingredients of course um will any suffice because in that case people

can just shop for cost or availability yeah so I tend to take a pragmatic approach in this my my recommendation is a brand that that you will use because if I recommend a brand and you don't like it it doesn't feel good or smell good you're never going to use it and it's a waste of your money and time so number one any brand that is mineral-based is fine you what you're looking for is broadspectrum coverage which almost all mineral-based sunscreens provide broads Spectrum meaning UVA and UVB and we know these two UV forms do

different things in the skin we know that UVB is more implicated in redness and some early skin cancer changes we know UVA is linked to uh premature uh photoaging and certain melanomas so you want something that provides broad spectrum coverage you're looking for a number the SPF we talk about you're looking for a number above 30 why why 30 because every study that looked at defining the SPF required you to put a certain amount on the skin generally it's an entire shock glass worth of the product on sun Exposed Skin most of the time in

real world uh 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 SPF 15 is like an SPF of eight so if you're looking for something that provides protection SPF 30 or greater is higher higher the zinc concentration the better it protects against UV invisible light the chalkier it may go on so that's kind of where you find that balance that's actually where the chemical sunscreens came about is the cosmical industry finding things that felt nicer on the skin so that people could

put makeup on without that grainy chalkiness but in doing so we ran into some issues um yeah what are some if any of the concerns that some of the components in chemical-based sunscreens can cross the bloodb brain barrier it's not um unjustified to think that they are organic phenolic compounds they are Hydro phobic they're lipophilic meaning they can cross membranes very easily which is why they run into this endocrine disruption and some nervous uh system disregulation whether that's been validated to be problematic in humans has yet to be seen But at least in vitro studies

in certain animal models we see this so when you apply a certain concentration and with that 2020 study that showed that we're seeing it in the blood at levels that are 200 to 500 times the upper limit of normal as defined by Suns green criteria now we have to scratch our head where is this circulating where is this going are we collecting it in our adapost 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 it's a really fascinating world to see

where we're going with these and in fact the 16 most common chemicals that in 99 were everywhere from you know spray sunscreens and bottles and things like that are now being defied as H question mark maybe not safe by the FDA the very company that regulates it another call for the mineral based sunscreens just as a you know why why take the risk or even you know shade hat clothing you know if you're really worried about putting something on an absorption you get excellent protection by actual barriers this seems like a good time to shift

a little bit of our attention to nutrition and the gut microbiome yeah now this is an infinitely large topic um you we could spend several episodes discussing this but if you were to um provide us some of the kind of like major takeaways as it relates to nutrition and skin Health Nutrition and skin appearance gut and skin health and appearance uh what would those be so there is an incredible connection between the gut microbiome and skin health and the skin microbiome of which we're only now just understanding the gra Gravity the extent and the connection

we know from many studies many elegant studies a lot of studies done out of my colleagues Labs up at Stanford that modulating the gut microbiome affects inflammatory conditions of the skin meaning if you control the disregulation of the gut microbiome if you have an anti-inflammatory dietary habit actual skin disease decreases in intensity and severity psoriasis eczema acne and this is not just subjectively it's measurable and quantifiable and reproducible so the the connection is fascinating now how we modulate it that's the unknown we know in many different studies that some patients got microbiomes are wildly fluctuant

to what they do from their environment in terms of dietary habits antibiotics things like that some people's gut microbiomes or Rock solid nothing changes them and deciphering who will benefit from what is the hardest part in terms of nutrition overall obviously everybody's told you this since you know the dawn of modern medicine is a well-balanced diet is good for everything unfortunately in the 21st century there are a lot of diets there are a lot of fad diets there are a lot of restrictive diets and that's where we see nutrition play an important role in both

appearance and actual skin disease health and there's so many different Avenues to discuss this things like dietary habits and changes for acne things like dietary habits and changes for anti-aging things like dietary habits for rash disorders like psoriasis and eczema it's so much to explore so my understanding and we'll get into this more as it relates to acne um is that patterns of eating either content food volume that is caloric load Etc that increase insulin and things like mtor are sort of pro acne they're going to aggravate or increase acne whereas the things that tend

to lower circulating blood glucose insulin and reduce inflammation tend to be kind of anti-acne or so pull in the other direction towards a reducing acne 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 cuz we will get into those specific issues can we say they should eat you know a vegan diet a vegetarian diet is it okay to be an omnivore some people are on the extreme of this you know kind of carnivore type

diet some of those people actually report you know elimination of certain skin conditions I don't know I've never tried one of those um extreme diets but um you hear this but then again you hear a lot of things so seems to me that the relationship between keeping the gut microbiome healthy and ingesting sufficient amounts of fiber is pretty clear sure the relationship between keeping the gut microbiome healthy and overall that is systemic inflammation low is pretty clear and that eating foods that are mostly unprocessed or minimally processed keeps inflammation on the lower side as opposed

to eating more processed foods but you know assuming you would you agree or disagree with feel free to disagree please yeah so so assuming that that's all true is there any evidence that the ingestion 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 virtue of specific micronutrients that are in those Foods so there's a lot of layers to un unravel on this so if you're going to

pick one simple diet for optimal skin health it's a high protein anti-inflammatory diet so high protein animal Source proteins fruits and vegetables based on your ability to tolerate the fibers and the fruits and vegetables things that are inflammatory are inflammatory for two reasons one the glucose insulin pathway but number two the the bacteria in our gut process and release byproducts of metabolism of certain things and those byproducts basically their digestive products can be very pro-inflammatory so often you hear these anecdotal stories of I eliminated tomatoes and my soris got better that person may have had

an inability to tolerate tomatoes because of their gut microbiome's ability to digest the lopen or whatever it is we do know for certain that anti-inflammatory diets do improve skin Health that are measurable and seen in clinic so absolutely high protein you know 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 bioavailability and complete um amino acid profiles you want a high protein anti-inflammatory diet that's number one in terms of what you can introduce to your skin to improve one or

two parameters I don't think that's real why I bring this up we see a lot of 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 is it does everything keeps you looking young and keeps your skin healthy etc etc well we know collagen is essential to our skin Health literally it's what our dermis is made of that give us our suppleness or youth no wrinkles you know things like that collagen is made of three amino acids it's

glycine Proline and usually hydroxyproline or hydroxy line okay those three amino acids are non-essential amino acids meaning your body has the ability to synthesize these from sugars and fats that it eats so collagen supplementation is not an essential protein unlike animal proteins which provide all 20 amino acids including the essential ones your body cannot synthesize now you may ask okay well I see all these studies that suggest collagen supplementation improves skin Health skin appearance there's 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 were the people in the studies on restrictive diets because they were thinking about beauty and aesthetic were 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 and a lot of these studies are patient recall or patient questionnaire studies in which there's 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 placebo 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 gold that you subconsciously want so that's one number two there is a component in for example collagen supplementation that is forgotten about quite a bit and that's the increase in Blood osmolality and I learned this in the fitness world I was really big into Fitness in college and and it was my Escape you know from Life stressors and we found that people who supplemented with

any powdered protein Source doesn't matter collagen Albin whey and more so with people who supplement with creatine that there is an increase in blood o or plasma osmolality so the solute concentration increased in the blood which draws water in that's predominantly how things like creatine make you look bigger and I know we're going a little bit on a tangent but one of the reasons the way collagen works as your blood osmolality increases you draw a little bit more water into the vessels which plumps up the appearance of the skin so there is a hydration component

from the water draw and this is measured you can draw patients blood after consuming collagen protein whey protein and see this spike in uh plasma protein so there's that component as well which is not truly a benefit but it's an aesthetic benefit why that tends to be a problem is sometimes people who supplement with collagen end up actually having high blood pressure and they're otherwise healthy um and this was something that we saw in the Fitness World a lot is that young college athletes 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 creatine supplementation their blood pressures dropped interesting and it's really fascinating stuff and you know I used to work out at UCLA with a uh one of the professors of fisi who was a really big dude and we worked out together and we did all these studies and looked at you know you know young otherwise healthy people so that's one component the other question is do any of these food changes actually quantifiably increase skin collagen density skin elastin density there's no

evidence that taking these things will traffic or meaning will go to where you want them to it's kind of silly to think if I drink this it's going to go into my stomach go into my intestine be absorbed and then know to go exactly to my cheek usually doesn't occur that way and when we've looked at histolog comparison studies the data is equivocal some Studies have showed a slightly increase in collagen density and you wonder are those patients one that are on restrictive diets to begin with and then there are some studies that have shown

there's really no density change in collagen and elastin so the supplements really don't actually make a physical difference now the other question is is that study too short of term how long do you stay on these data is wild and there's a lot to understand but we do know high protein complete protein anti-inflammatory diets absolutely critical for skin health I guess the most direct question is do you yourself consume collagen proteins in a supplement form or make it a point to eat things like bone broth which contain High percentages of collagen great question um I

do supplement only in Sun powder which is my daily supplement it contains bioactive collagen peptides aside from that I think natural sources are better so you know my wife cooks a lot at home bone broth um beef bone broth chicken bone broth um a lot of animal Meats my diet tends to be more in the guess old school you'd call it keto um Atkins or keto diet where 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 a few days I'm breaking out it's it's like clockwork for me some people are not as sensitive my body is and that's that's where the personalized medicine comes in is there a role for omega-3 fatty acids like fish oils and things of that sort for skin Health specifically yes and no yes there is some evidence that um omega-3 supplementation and tends to be better in fish form than you know um non-fish formats but Omega-3s tend to be anti-inflammatory so there's an improvement in skin health because of that one thing

we do see is they thin the blood so people tend to bruise a little bit more so actually in my practice I have people stop Omega-3s before any sort of surgery because they bleed more what about some treatments that are known to be beneficial for the appearance and health of skin that people are not as aware of right because I think people who are concerned with their skin health and appearance you know they think about sunscreen we've learned a lot about that from you but what are some things that really work to improve skin health

and appearance that perhaps require a visit to the dermatologist but that you don't hear enough about yeah so two big categories so we know the skin turns over right it turns over every 28 days so in theory if you keep turning the skin over you can get rid of those mutations that occur in the skin that's stacking up and hope to bring out more vital youthful skin that's not just appearing vital but actually biologically healthier and there's two categories of things you can do the first is the family of retinoids amazing medications amazing drugs been

around for 50 years they come in oral form and topical form and these increase the time or they shorten the time they increase the skin turnover from 28 days to somewhere between 7 to 9 days and in doing so they've been shown to decrease skin cancer and pre-cancer formation they've been actually shown to grow new collagen they've been to increase elastin in appearance and this has been histologically verified in study after study meaning we take a biopsy of the skin have them start a prescription retinoid rebiopsy the skin and stain it for collagen or elastin

and you see a market Improvement it's every dermatologist's well-known tool and for some reason it's still not wellknown in the population its original indication was for acne and still is first line for acne because of what it does is it dries out the oil glands but in doing so it also helps repair skin so I recommend every single person to be on a prescription strength retinoid which is different than over-the-counter retinol and there's a lot of Confusion And I think the confusion is intentional in the cosmical world as to why this is but everybody should

be on a prescription strength retinoid usually topicals is all you need the most common are things like tretinoin adapalene or Tartine and there's oral forms the most common is acutane or isot trein and to a lesser known um a lesser known drug called acitretin or sorotan and I usually Reserve that for my high Sun damaged skin cancer patients it really makes a difference but I'm going to touch back about retinol versus retinoids so many many years we we studied retinoids the way retinoids work is they're actually they activate trans description factors their nuclear messaging um

hormones so these compounds bind retinoic acid receptors and they activate uh the transcription of certain genes one of the genes we know that it can affect is the Sonic Hedgehog pathway and some of the embryologic genes why that's important is when we first studied retinoids in oral or cream version we notice that these can affect the development of a fetus and they can be passed through breast milk and through sperm or semen 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 defects because the medication was so effective and we saw an improvement in both quality and appearance of skin The cosmical Beauty World said oh okay this is awesome we need to figure out a way to get this on the Shelf but not be a prescription out came retinols with an O which is the inactive version of retinoic acid which is retinoids and what has to happen is retinol needs to be converted in a two-step process to become active retinoic acid otherwise it's a completely inactive prodrug which is sold over

the counter at concentrations that are not biologically active that's how cosm tical companies can get away with prescribing this for people of childbearing age in my opinion if you want a r noid get a prescription for it the over-the-counter stuff is not very effective if at all the Shelf stability many Studies have shown that almost all retinoids over the counter retinols over the counter um are basically unstabilized by one year so you don't even know what you're paying for the prescription is easy to get you can see pretty much any dermat ologist and it's the

only version that's truly effective so everybody should be on it protects your skin keeps you looking young reduces skin cancer risk grows new collagen literally the only consequence is that when you first start your skin may be a little bit red or peely as the skin acclimates or turns over other than that nothing why do you think given the immense interest in skin appearance and health that we don't hear more about this because that's a great question so we hear so much about retinol every magazine you open that has anything you'll see like intensive night

cream intensive Eye Serum uh Regenerist eye repair and all of them have retinol none of them have retinoid or tretinoin for many reasons originally it was made for acne and the patients that came in to get the get them for acne were not necessarily in the same line of thought of you know premature aging and Longevity this would be things like retina yeah retina exactly or Accutane or um different these are the brand names for these products so there is a disconnect between the people seeking the anti-aging um effects and the people getting it as

a prescription that's one and number two as soon as cosmical companies figured out a way to Market overthe counter inactive versions that went haywire so you can Google retinol and there's million things when you Google troan you only hear about acne so there's a little bit of a disconnect much like all in medicine between what docs know and think that you know population knows and what the population actually knows but that's the one thing I think we've been doing a great job on you know 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 um actually Revitalize the skin then there's 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 know been in photobiology um albe a slightly different realm you know the effects of light um and the incredible changes that it can have in biology most of what we understand

for lasers in medicine came out of Dermatology studies you know a lot of the understanding of laser biology came out of the Wellman Institute over at Harvard where many of my colleagues are and we now know that certain laser devices certain resurfacing devices not only app improve the appearance of your skin clinically they reduce your risk of skin cancer by 20% maybe greater and even more amazingly is when you do microarray Gene studies they actually activate the genes of more youthful healthy skin cells that were quiescent as we age so there's genetic verification clinical verif

verification and aesthetic verification these things are awesome now laser is a big umbrella term some of the devices we use are not lasers they're actually light Broadband light or uh intense pulse light some of them are laser some of them are uh ablade some of them are nonablative 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 if you're interested I mean see a see an expert so this would be go to your dermatologist ask for some is it laser resurfacing

yeah yeah so laser resurfacing it tends to be and what's really popular there's two forms of laser resurfacing there's what we call nonablative meaning it doesn't burn or vaporize the top layer of skin and then there's ablative resurfacing which vaporizes the top layer of skin obviously ablative ones are much more aggressive much more effective a lot more downtime and a lot riskier because you're literally peeling the face off or any part of the body and it regrows without any scarring that's also the another beauty of the skin is you can literally peel it off entirely

and have it regrow as if nothing ever happened so people have this done once a year or so yeah for for not for a blade of resurfacing it's like once every five years or so on it's it's pretty dramatic and how long is the downtime for a blade of resurfacing uh two weeks usually two weeks you're pretty raw and sore it's fallen out of favor in most big cities because of the downtime and the inherent risks but it's still used in the right patient nonablative resurfacing meaning it doesn't vaporize the top layer but drills holes

into the dermis and targets certain parts of the epidermis without 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 albeit a little bit less than a blade of lasers these we generally recommend annually or biannually depending on what you're trying to Target a large Harvard study just came out that showed that non-ablative fractionated laser resurfacing particularly with a device called fraxel actually Cuts your skin cancer risk by 20% because it eliminates those mutations and

gets rid of those cells that had been collecting the stuff it's amazing how is this different than exfoliating skin like if one were to just try and um you know scrape away some of the dead skin through some you know semi vigorous buffing of the skin with a like a sponge I've never done I've never done either of these procedures like I said my skincare routine is very basic it's the unscented Dove soap the shower once or twice a day and your skin looks great so keep doing what you're doing I mean I feel pretty

good I mean I I think um you know sleep seems to play a significant role uh for me um I do get probably a bit more sun exposure than most people I'm conscious of checking for skin Cancers and we'll talk about that um because those do run in my family um but and I try and eat right and exercise right haven't consumed much alcohol in my lifetime so look your skin will tell you if something's wrong so that's the first line now you talk about you know dermabrasion or microdermabrasion the good old St Ives apricot

scrub that every dermatologist you know frowns upon but ironically I use myself after a heavy workout at the beach and I'm all greasy but don't you know don't get mad at me for using that stuff the depth is key so when we do microdermabrasion or some sort of dermabrasion the only thing we're really scraping off is really the stratum corneum which is the highest layer of skin cells that don't even have a nucleus they're dead skin cells that's all you're scraping off whereas lasers Target through the epidermis 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 dermabrasion is the same premise the old school ablade of lasers do they just fry everything off and you grow new skin and in frying everything off it fries off sun damage wrinkles precancers 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 ton of this at Stanford and we did a

ton of the other one at Stanford in my practice I do a lot of laser work as well the nonablative stuff picks and chooses that was the beauty of ident learning about laser and photobiology is how we target a certain structure and avoid damaging all the other ones that the theory of selective photothermolysis that came out of rock Anderson's lab at Harvard that was the game changer we can now pick any appendage in the skin and find a way to Target it and leave the rest undisturbed so if you have broken blood vessels you decide

to use bpc 157 and it work great and the blood vessels started to grow and you're like I don't like the look of them there is a laser that targets solely blood vessels is that the IPL laser IPL is okay IPL stands for intense pulse light it's somewhat effective but not very effective the the gold standard is what we call the pulse die laser or the vbeam laser and that is a 595 nanometer laser that targets oxyhemoglobin I've had that actually because I had an an angioma yeah had it three times and the third time

they hit this thing it went away but not without a very significant bruise lasting almost a month a like you know I mean it was pretty dramatic done it right but it did eliminate the the vessel that was very by any means necessary right it's just new so as long as we're on the topic of photobiomodulation what about red light and near infrared light is there any evidence that it can benefit um skin health and appearance nowadays you can find um masks that will emit red light some people will 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 and measurable and what extent is subjective that being said there's a lot of evidence that shows that red light therapy in improves vascular flow in the skin we use it for things like hair restoration post-procedure recovery um Improvement in skin Health after UV damage we actually found a recent study that looked at red light therapy and um irradiating a mice and if you pre-treat the mice with red light therapy before they get UV exposure

compared to controls the pre-treated group had much less of the changes with UV exposure so very fascinating stuff how it works uncertain we think a lot of it has to do with increased vascular flow which is why a lot of times we recommend it for postprocedure we recommend it for hair uh regrowth there's some evidence that if you increase blood flow to the dermal Pilla of the hair it grows new hair that's how minoxidil or rain Works um but I I like it I think it's a great product um a great great um group of

products or devices as a standalone uncertain as to how effective they are and one of the reasons of the heterogenity and the data are like so much different is there's 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 wattage high energy output high density of lights they may be more effective than its equivalent counterpart and until that gets defined U more uniform in in accessibility I don't know which device to recommend you know there I I obviously have preferences one

way or another um but there's so much on the market that's marketed as red light that is not effective and some stuff that's really good so probably looking for something that's at least endorsed by dermatologists Mak sense absolutely and I should say here I I have no no angle into this I what these masks emit red light or I don't have any business relationship to them so that's not why I bring 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 and my interest in light yeah what about oh yes EXC I was going to say the panels tend to be much higher in energy much more effective and most of the studies have looked at the big wall panels the battery powered face masks just aren't powered enough to have much improvement we do see some improvement when and blue is used together mostly for acne proin skin because blue light alone has some antimicrobial properties so when used in conjunction you can get some improvement in actual skin illnesses but the masks alone with just red light

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 I was accurate in saying that I don't have any relationship to any red light mask companies or products but um this podcast is sponsored by juv which makes medical grade panels for red light and near INF red light and I do own one of those and I use I have a small portable one I use and then I have a panel I stand

in front of so that includes my face and then I'll turn around and so do a whole body um panels juv is a good company it's been around for a while and you know most of the experts in laser and photobiology you know agree that panels are the way to go if you if you want red light it's interesting when um people see and hear about red light and near infrared light therapies I think a lot of people think oh this is kind of like nextstage biohacking but there was a Nobel Prize given for photobiomodulation

for the treatment of Lupus in the early 1900s so this is you know a long-standing thing the use of light of particular wavelengths or combinations of wavelengths of which red light and blue light are of course in order to Target different layers within the skin to get some desired effect yeah yeah light has been around for a long time I have a phototherapy unit in my practice and which we use narrow band ultraviolet be light to treat conditions like psoriasis to treat conditions like Vitiligo there's a very strong immunomodulatory effect of light on the skin

it actually suppresses overactive immune activity it can help increase vascularity in the skin it can improve blood flow so depending on the wavelength you pick 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 has always been interesting to me in that we use UV light to treat certain conditions and we assume UV 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 light

therapy for is patients with Vitiligo which is this autoimmune condition in which your immune system attacks the cells that produce our color and the standard treatment is certain creams that suppress the immune system in the Skin phototherapy ecer Laser which is a UV laser and then now the new world of um immunotherapies by pill form the Jack Inhibitors have made a huge difference but if we thought and I go back on this tangent because the more we think about it the less we know if we think UV is truly dellarious then patients with Vitiligo should

have an 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 UV exposure over time so it goes to tell us that there's so much about light and skin we don't understand so much about sun and UV and skin we don't understand and a 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 patient in the early 90s the number one cause

of death for transplant patients that was not related to their transplant was metastatic skin cancer and this was in patients who were strictly Sun protected so we we talk about you know biology photobiology LED UV and skin health and there's so much we don't know as we gather more data and look at populations and cohorts so I don't know why I brought that up as a tangent but well I think it's a very relevant because the relationship between immune system function and skin is very clear and these conditions that you're referring to Vitiligo acne psoriasis

eczema Etc have interesting relationships to the immune system so that's actually a perfect segue for what I'd like to talk about next sure so let's start with psoriasis what is the story with psoriasis what is it what can make it worse what can make it better psoriasis is like the quintessential skin condition I have it myself on my elbows and knees and for about a hundred years it was thought to be a problem a rash that is caused by too much skin turnover or excess skin proliferation and for a hundred years we treated it the

same way we gave medicines that basically took the skin off what we call katol litics we found that that wasn't very effective and some people can be hospitalized and it can be life-threatening if psoriasis involves the entire body usually looks like red patches or plaques with kind of a silvery scale on the surface and starts usually elbows and knees or the scalp um but can involve pretty much the entirety of the body and what we found in the last 30 years with a lot of elegant studies and a lot of very very nice basic science

um research is that it's actually due to overactivity of our Skin's immune system so there's overactivity of certain inter lucans which are these messenger that our immune cells produce that makes the skin turn over faster than it should and this Epiphany was remarkable because we found that instead of targeting the skin we can Target the immune system and we can eradicate or treat psoriasis entirely and in the '90s and early 2000s that targeting was very crude it was a very umbrella approach we suppressed the entire immune system and ran into the consequences of that so

medications that we gave for that increased risk for infections and you know skin cancers Etc now we have amazing drugs that Target one or two molecules messenger molecules of our immune system and clear up people's psoriasis I mean we have drugs now you take three times a year and you could have head to toe psoriasis and be completely clear it tends to run in families there is a very strong hereditary or genetic component to it and it tends to be associated with arthritis psoriatic arthritis um so psoriasis is like the quintessential skin condition that people

see dermatologists and even rheumatologist for so these drugs that Target these specific interlukin seem like the most direct way to treat psoriasis some people for whatever reason have an aversion to prescription drugs I I'm um 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 psoriasis without having to quote andquot take anything yeah I should probably backtrack so psoriasis obviously comes in severity there's mild disease which majority of people have there's moderate and severe and generally speaking the most common things

that we treat mild uh psoriasis with is creams and lotions moisturizers sometimes low potency topical steroids or high potency topical steroids and then things like catalytics like salicylic acid that take that excess scale off we also know that there because it's an immune inflammatory condition that diet plays a big role in improving mild or moderate cases and we also know that weight loss plays a very big role in improving the appearance of psoriasis so as we lose weight as there's Improvement in insulin resistance and as we transition diets and Lifestyles from inflammatory to anti-inflammatory psoriasis

tends to clear without any intervention needed without any medical intervention needed if there's still continued you know rashes and skin activity then you look at topicals like you know cortisones um imoan like aquafor and Vaseline you know things with some sort of acid or retinoid to get rid of that excess scale that's the fundamental Cornerstone of treating psoriasis and then when it gets bad we talk about additional pharmacologic interventions also interestingly one of the earliest um conditions in which phototherapy was used is psoriasis we know that when we shine UV light on the skin that

it suppresses the Skin's immune system and clear psoriasis and that's an excellent way to treat it without pharmacologic intervention without any creams pills injections or otherwise medication it used to be used in the Dead Sea PE people would go lather in the mud in the Dead Sea and sit out in the sun and that was the first crude way to use phototherapy to treat psoriasis that was my question since the sun emits UV why not just get some additional sunlight exposure for psoriasis so you can I most dermatologists wouldn't recommend it I think it's actually

not a bad thing my psoriasis clears in the summertime and flares in the winter time the problem with pure sunlight is that it's a mix of rays right there's xrays gamma rays which generally don't penetrate the atmosphere there's UVC UVB UVA visible light infrared light so that heterogeneous light some have no improvement in psoriasis and some have great improvements so we were able to figure out which wavelengths make a big difference and it's around the 311 312 nanometer range but sunlight does clear people's psoriasis up that's why we see in Northern latitudes where there's less

Sun intensity the incidence of psoriasis is markedly higher than equatorial latitudes and patients will say their psorasis gets better when they're on a beach vacation and when they go back home their psorasis flares there's also some component with vitamin D as well but I think that's just secondary to the lack of UV exposure what about Vitiligo um this is something I did not cover in the solo episode about skin Health um but I got a lot of questions about um Vitiligo of course being this typically patchy um nonpigmented 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 Vitiligo is uh autoimmune meaning your immune system is attacking itself depigmentary skin disorder meaning it's a condition in which your immune system attacks and kills the melanocytes which are the cells that produce our Skin's color and we've found that it's an autoimmune from many basic science and elegant studies it's also very closely associated with other autoimmune conditions so patients tend to also have atopic dermatitis autoimmune thyroid disease autoimmune anemia there's some

sort of immune disasa that involves vialo patients and what happens is the immune system at first paralyzes these cells with you know immune activity attacking them and over time these cells no longer survive and die off the Cornerstone in treatment has always been you know some way to suppress the Skin's immune response when most of the time Vitiligo tends to be focal single areas or segmental unfortunately in certain cases it can be whole body or completely depigmenting very uncommon but we see this we treat it by doing things that'll help quiet the immune response in

the Skin So topical creams topical steroids Etc topical calcineurin Inhibitors which are you know non-steroidal anti-inflammatory medications we also use certain wavelengths of UV light to treat this ecer laser at 308 nmet uh UVB UVA and then the the Renaissance in Vitiligo has happened in the last three or four years with the identification of Jack Inhibitors which are these drugs that block the Janis kyes pathway and we found that the Jack St pathway plays a really important role in autoimmune mediation of melanocyte so new creams and actually oral medications have come out for patients who

have very refractory Vitiligo the immune component is very fascinating because understanding immune biology and the immune systems effect on skin health comes from studying these patients when patients have Vitiligo they lose all of their color so you would assume that they're much more susceptible to sunburns which they are but when you look at incidents of skin cancers they have a significantly lower incidence of skin 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 mutant changes that occur whether it's UV related Etc infection toxin whatever and patients who have V Lio have overactivity of these immune cells and over surveillance so they are able to clear a lot of these precancerous changes before they form into something so that played a big role in not only understanding how to treat viigo but some of our new medicines actually the medicines that won the Nobel Prize in 2018 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 Outer Outer sheath it's a um it's a reflection of so much that's going on internally and and we know that um intuitively 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 they'll look at uh their skin yeah um their stool obviously fussiness and mood and those things too but we seem to have developed an intuitive understanding that a shift in the

kind of like tone of the skin or some other features of the skin signal to us Wellness or lack of Wellness yeah the Skin's 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 to chronic illness acutely you can see changes in just like looking pal you know with palar looking gasly things like that but chronic illness as well you know when you used to go to the pediatrician and they would do this to look at your ey eyes

what they were looking for was the color of the conjunctiva if it was white or pale they knew you had iron deficiency you know when kids get handf foot and mouth syndrome and they have a high fever they lose their fingernails when college students are stressed out they lose their hair the body's amazing ability to tell you it's under stress is shown in the skin hair and nails what it does is it says why am I 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 it was finals week they'd come with clumps of hair and as soon as finals week passed uh usually took a few months their hair grew back it's awesome the Skin's a really cool biosensor and you can tell a lot it is so cool what about acne acne seems very common you know as uh we progress through puberty there seems to be more acne sometimes it's transient sometimes it's not yeah um what are

some things that people can do to prevent or reduce acne another quintessential Derm problem that is affects so many people um acne tends to be a condition that is bodal meaning we tend to see it in adolescence we tend to see it in 25 to 35 year olds and for the unfortunate group of people that bridge that Gap we see it anywhere from 12 to 35 acne is a condition that's usually seen by pimples you know what we call blackheads or white heads zits or boils and it's thought to be caused by three important things

it's an overproduction of sebum which is the oily stuff that comes out of your skin and that's dictated by your hormones your hormones will increase the output of sebum and that usually occurs in puberty but can also occur if you're taking medications like prednizone cortisol testosterone anything that is a hormone driver so sebum is the first cause sebum is the food for the a for the bacteria that cause acne so as there's more food the bacteria proliferate and in proliferation it recruits an immune response your immune system says hey 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 zit so in treating acne you got to treat all three components to get really effectively clear skin somehow reduce the SE get rid of the bacteria and calm the immune system down that's done with creams oral medications um of combination of both sometimes certain lasers can help eradicate the oil glands that feed the bacteria um but acne is a 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 excess in calories um because it will tend to push the insulin glucose regulation system more into the positive as opposed to let's just say higher levels of insulin in circulating blood glucose than one would observe at say maintenance calories or submain calories that you know overeating a little bit could cause acne um that any foods that promote increases in glucose and Insulin so sugary Foods um high glycemic foods um these sort things can that actually increase acne fried foods yeah so it's not the calor caloric deficit or the caloric Surplus it's the

glycemic index or the amount of insulin response so we know that high glycemic index foods will make acne worse in almost every study that we've looked at in sugary processed foods will flare your acne there's some component of that inflammatory response that not only drives even production and bacterial growth but actually worsens the Skin's immune response the Skin's immune response is a little feisty when you're eating pro-inflammatory things the other thing that I do hear a lot about is dairy and there's this misconception that Dairy causes acne what we really see when we looked at

a a really cool study that was done out of Penn State is that it's not so much whole fat dairy products but skim and nonfat dairy products that can make your acne flare and the reason for that is usually in the United States the there's an emulsifier that's put in nonfat or skim 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 glycemic response so it's usually sugary Foods non-fat skin um dairy products that will make your acne flare what about

rosacea 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 Rosa maybe directly but certainly indirectly by you know impeding some aspects of the microbiome disrupting sleep rosacea gets worse but what are things that people can do um dos and don'ts that is for rosacea um if it's mild rosacea like excessively uh Ruddy cheeks or um superficial riding capillaries that um seem to bother a lot of people I I know that it bothers a lot of people because

they asked about this quite a lot questions when I when I solicited for questions so R rosacea commonly known as adult acne tends to come in four flavors the first form is the redness form what we call aritic form or the rudiness broken blood vessels redness of the cheeks and flushing that's by and far the most common form there's also the papulopustular form which is the pimple form which is what we think about an adult acne there's also the fitus form which is the enlargement of the nose that kind of looks like toad skin we

used to think it was a sign of alcoholism or Sailors or um you know construction workers that would have these enlarged nose we we thought it was a product of their environment that's actually a form of rosacea and then there's ocular rosacea which affects the Eyes by and far the two most common that I we see people in in practice for is the redness form redness and flushing or the pimple form you're absolutely right in that alcohol can contribute to it and worsen it for two reasons one alcohol itself is a vasodilator and acetal ahid

is a much more potent vasodilator so when you drink you flush also chronic impairment of the gut microbiome and lifestyle changes that make you drink more probably will exacerbate your rosacea but things that trigger the redness include UV light because of vasod dilation uh spicy foods hot beverages emotions life stressors all the things that make you flush what triggers the breakouts is a little bit different and why that's important is how we treat them so what triggers breakouts is thought to be both organisms that live on our skin including bacteria and certain might mites but

also immune disregulation in our skin that we don't really understand or just now elucidating um how the immune system in the skin becomes dysfunctional to show those breakouts in terms of treating redness we have some creams that are okay at temporarily blanching those vessels out but they're not great and they're 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 dermatologist for redness generally there's a discussion about laser destruction of those blood vessels when we talk about breakouts or pimple

form of rosacea we have excellent medications in terms of both creams and oral medications that suppress both the bacterial and might growth as well as the immune response in the skin so you kind of have to take a look at what form you have and what will be the best treatment eczema umbrella term for what we generally consider as atopic dermatitis or what used to be you know colloquially ter termed as sensitive skin in childhood and that's a very prominent skin condition also dictated by the immune system but in two forms eczema tends to be

caused by three major prongs the first prong is a genetic barrier defect in the Skin So patients with eczema tend to have a microscopic weave of their skin that's not as tight as somebody without eczema and that's usually defined by a gene called fagron that's the first reason to develop eczema the second reason is an environmental allergen or trigger that's able to get through these weaves easier because of this genetic change the third thing is an aarant immune response to these triggers so patients with eczema 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 Cornerstone in treating eczema is treating these three things why dermatologists make a big stink about moisturize moisturize moisturize for Eczema is to seal that barrier with a moisturizer because we're basically putting the mortar back in between the bricks which are the skin cells to seal the skin off to not allow the environmental allergen to get in that's the first the second is to avoid environmental triggers so fragrances preservatives

seasonal allergies pollin things that trigger that immune response we try to mitigate now obviously trying to control environmental pollens is hard but using things like we talked about earlier you know fragrance-free cleansers fragrance-free detergents fragrance free skin care products nonpreserved based skincare products will mitigate the environmental triggers and then the third thing is just calming the immune system down and that can be done in a variety of ways most commonly it's topical medications like topical steroids that dampen the immune system in the skin and when eczema is really really bad there are uh biologic medications

that control certain inter lucans and they've made an incredible advancement in in eczema control people we can control patients for life with some of these injectable medicines a couple things that you taught me that I just want to pass along in short form and please correct me if I have this wrong uh one if you can avoid popping pimples definitely avoid it because it can cause damage recruitment of these Matrix Metallo proteases which essentially digest some of the deeper layers of the skin leave scars yeah yeah totally so it's I mean it's very gratifying and

you want to do it there's like some subconscious desire to like pop a pimple I have it myself anytime I see a pimple I'm like man I got to I want to get at this thing I think is to eradicate the infection type of thing you know even if it's not an infection I think possibly like a like a evolutionary reason yeah very very possible um the reason we don't want to do that um and the reason why we always say don't pick at your skin is when there's an in immune response in the skin

the immune system is trying to fix something and fight something and in doing so it recruits different enzymes the most common enzyme is what you exactly describe Matrix metaloproteinases which are these enzymes that eat apart collagen and elastin to allow it to remodel when you cause physical trauma in the skin you recruit a much larger immune response than what was warranted for that that insult so these mmps these Matrix Metallo protases enter at a much higher amount and they eat away the collagen and elastin that's what leaves an acne score now people are going to

pop their pimples whether we want to or not so if you're going to do it I don't recommend it but if you're going to 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 pain or induration you can use a warm compress to see if you can soften that and see if it'll expel itself pushing we don't recommend stretching can sometimes unroof a pimple 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't believe we're having this conversation but that's a skin health and appearance episode after all if they pop on their own then uh cleaning it with a gentle cleanser is probably the best way to go no um topical antibiotics is that right no don't use any hydron peroxide it's a common misconception thinking it fights things peroxide doesn't let wounds heal it just kills anything living so no peroxide and no topical antibiotics that are over the- counter most of these don't have any antibiotic properties anyway because most organisms are

resistant to them because of the widespread availability and use and two they cause a lot of um allergic contact dermatitis and rashes and people who are susceptible to them so we just say if it pops on its own leave it alone may want to put a little ointment on there if you have a sore but otherwise ignore it and what about the use of corticosterone cream like if somebody has a red bump and they're headed to an event or something and they want to you know um yeah eliminate some of the redness and bump so

a common thing we see a lot of people for it's like a day before their wedding or a day before a big social event they have a zit on their forehead and they say you know what can you do for me I need this gone so exact like we talked about topical corticosteroids and to a greater extent injectable intralesional corticosteroids suppress the immune response temporarily so you can use them cautiously if you have an event within the next you know day or two long-term use it causes multiple problems it causes thinning of the skin and

uh can increase the risk of the acne scar forming and you can have rebound acne from topical steroids used all over the face often times we see a lot of people who are in the public eye um asking for steroid injections of their acne I as a surgeon usually see a lot of the consequences of that so I tend not to utilize steroid injections for acne um the reason for that is if you place just a little too much and we're talking less than .1 milliliter difference you can have a permanent atrophic uh divot uh

in the skin that is only fixed by surgery so I see a lot of young patients that come in who had an acne spot injected here and now that divot is left and that's permanent if it's going to be done it should be done by a dermatologist 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 pimple that needs to be gone immediately you just got to know the risks assuming sterile technique and other safety measures in place are tattoos 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 you know stereotypes that are no longer true I think the challenge with tattoos is to things making sure that what is being placed underneath the skin is not an allergen we see this mostly with Reds that use cinemates they produce a lot of granulomatous reactions or foreign body reactions one making sure obviously they're using Clean safe equipment that's sterile you know you don't want the bloodborne pathogens the real challenge is surveying

for growths in patients who have a lot of tattoos it's hard to see small skin cancers form or changes and moles because usually the tattoos are of dark color so the surveillance part becomes a little bit more challenging so if you have a lot of tattoos just make sure to see your dermatologist and somebody who feels comfortable and confident in screening um but other than that no they're they've been around for hundreds and hundreds of years and I think they're fine if done correctly that's a good segue into surveying for skin cancers earlier you talked

about some of the more common forms of skin cancer um Squam cell carcinoma basil cell carcinoma but then there's the the one no one truly wants which is um melanoma melanoma yeah so I was taught to keep it eye on my moles yeah if they change change in Border change in size Etc uh to notify a dermatologist um I get my moles checked about I don't know I just had it done less than a year ago um but what about getting all skin checked I mean what do you this is your area of expertise so

so if you had a magic wand yeah um to help prevent skin cancers what would what would you have people do that's a great great question so obviously there are many forms of skin cancer but the three most common like we talked about basil cell carcinoma squa cell carcinoma and melanoma there are other types like Merkel cell and Etc but they're far less common now historically melanoma has been our number one killer for skin cancer until about a few years ago around 2018 when the Nobel Prize was won for the new drugs that treated melanoma

this year we expect three times as many deaths in the United States from sell carcinoma than we do melanoma but nobody talks about that we lose a patient every about 62 minutes to melanoma but one every 37 minutes to Sasol carcinoma first and foremost the thing that you want to look for in terms of skin cancer risk and predisposition is look at family history your family history in your genetics plays the largest role in predisposition for skin cancer development if you can gather a family history you can understand your risk in developing it and it

can help dictate your screening now if you can't get a family history or you don't know your family history not a problem generally we recommend an annual skin exam by a good reputable board certified dermatologist and that includes every square inch of your skin including you know your hair between your toes in the genital area we can develop a skin cancer anywhere Bob Marley died of a melanoma on his toenail that was thought to be a soccer injury you know Jimmy Buffett died of a Merkel cell carcinoma one of these rare types that occur in

Sun exposed areas anybody can get them obviously there's predispositions in higher risk populations but it's such an easy non-invasive 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 as and in the mouth due to HPV and we see this a lot in younger and younger patients probably in the last month I've operated on six or seven young patients

under the age of 40 with sisol carcinomas caused by HPV in the genital region this is obviously not Sun driven it's not something you can put sunscreen or take a you know product to protect you from but it's something that's easily monitored or surveyed so I would say at the 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 melanoma clinic this is something that was really hard for a lot of dermatologists and patients to follow

when they when they're covered with moles see which one is changing there are tools that can be utilized including whole body photography mole mapping and some new AI based softwares that basically track the moles and look for changes as you feed the software more and more pictures from the patients it's fascinating a lot of the stuff is developing from our our well I should say my alma moer but up at Stamford is these AI based um 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 a year if you have a lot of moles you inherently have a slightly increased risk for melanoma now we always use these terms interchangeably melanoma skin cancer basil squamous Etc importantly to know for every one melanoma there's 10 non-melanoma skin cancers that's namely basil cell and squa cell about 5 million Americans will be diagnosed with one of the non- melanomas this year alone five million 5 million it's a big number yeah it's about one in four uh one in four Americans at some point in their lifetime will

develop a skin cancer encroaching one in three Americans by the end of their by the end of 2030 so it's a lot majority of these are not life-threatening but they're functionally and cosmetically disfiguring they arise on sun exposed areas so surveillance is really important for the HPV that eventually becomes Squam cell carcinoma yeah is the HPV vaccine effective even at older ages yeah great question so the we are seeing HPV become a real problem in many cancers in the body not just the original cervical cancer which was the number one killer in young women for

cancer until the vaccine came out but we're seeing it now as the number one cause of throat cancer in young adults and sexually active adults uh in significantly increased risk of sasel carcinomas in Sun protected areas immunosuppressed patients the vaccine the gardisil vaccine which which treats or builds immunity to HPV covers the strains that cause cancer 16 18 31 33 and so on I recommend anybody who is either sexually active or anybody who you know in population literally anyone should get vaccinated the new um guidelines have extended the age up until I think late 40s

for both men and women it used to be only for young young women because the cervical cancer risk but now we found that so many things are implicated with HPV that the the on label use is up to the late 40s so if if you have any concern I I highly recommend getting the vaccine as I recall planters warts yeah which are these warts that burrow a kind of root into the bottom of the foot they're very painful that actually um can be caused by HPV it's a form of HPV and it's not sexually transmitted

it's um locker room transmitted yeah so HPV comes in about 200 strains or like 190 strains strains one two and four for example cause warts on the hands and feet what you see like gym goers and kids you know they get warts HPV 6 and 11 for example cause genital warts HPV strains 16 18 31 and 33 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 highrisk strains but because of cross antigenicity we

see that patients who get vaccinated their warts go away and we saw this in the hospital and Transplant patients who were covered with warts because of their immunosuppressed effect when we would vaccinate them their warts would get better so warts on their fingers warts on their planters warts on their feet yeah transplant patients and anybody who is immunosuppressed um they have a tough time fighting plantor warts you know finger warts any sort of viral based um condition because their immune system is pressed 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 and eradicating it now I'm not saying go get a vaccine because you have a plantar wart that's silly and Overkill usually you know warts we treat with you know freezing in office procedures easy things but cler warts 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 strain 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 too yeah I know it's going to Garner a lot of questions I think yes absolutely there was a new study that showed that um uh an mRNA vaccine and that is already pretty controversial was shown to improve melanoma 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 it's to teach the immune

system hey this is bad next time you see this go attack it it's like showing a blood hound a steak and then going on the hunt The Blood Hound now knows what to sent 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 going to be revolutionary we see it for brain tumors we see it for gly blastoma incredible changes with dendritic cell vaccines we see it for melanoma now and in the future may be used for all uh skin cancers

with an asterisk depending on how much we can activate the immune system to Target it fascinating and uh 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 you know it's Anatomy its physiology what it reflects in terms of our internal workings health or in some cases challenges with health we talked about various conditions such as psoriasis acne eczema dandruff as it's sometimes called uh and what we can do you know the

the RO of nutrition avoiding certain things like excess alcohol nicotine Etc 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 schedule to come talk to us I really appreciate it and I want to voice my appreciation both for myself and for those listening and viewing I know people will have many many questions so we will refer them to your uh social

media accounts and and links to your clinic and so forth so that they can have those questions addressed and who knows maybe we get the chance to work with you appreciate in the meantime I just want to say thank you for this public education gift that you've given us um I'm thinking about skin very differently now and I plan to do and not do certain things uh in light of today's convers ation no pun intended so thank you for the opportunity I'm incredibly grateful to be here I think I think teaching is really important having

evidence-based discussions is really important challenging Dogma 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 know seeing patience and also you know challenging you know the status quo on certain things so thank you for the opportunity it's been a lot of fun there's a lot to talk about skin you can probably talk for a decade if you let me but I appreciate it thank you well we will certainly bring you back to further the discussion meanwhile thank you ever

so much Dr solman thank you thank you for joining me for today's discussion about how to improve and protect your skin with Dr Teo solomani 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 zeroc cost way to support us in addition please subscribe to the podcast on both Spotify and on Apple and on both Spotify and apple you can leave us up to a five-star review please check out the

sponsors mentioned at the beginning and throughout today's episode that's the best way to support this podcast if you have questions for me or comments about the podcast or topics or guests you'd like me to consider for the hubman Lab podcast please put those in the comments on YouTube I do read all the comments for those of you that haven't heard I have a new book coming out it's my very first book it's entitled protocols an operating manual for the human body this is a book that I've been working on for more than 5 years and

that's based on more than 30 years of research and experience and it covers protocols for everything from sleep to exercise to Stress Control protocols related to focus and motivation and of course I provide the scientific substantiation for the protocols that are included the book is now available by pre-sale at protocols book.com there you can find links to various vendors you can pick the one that you like best again the book is called prot protols an operating manual for the human body if you're not already following me on social media I am hubman lab on all

social media platforms so that's Instagram Twitter now known as X threads Facebook and Linkedin and on all those platforms I cover science and science related tools some of which overlaps with the content of the hubman Lab podcast but much of which is distinct from the content on the hubman Lab podcast again that's hubman lab on all social media channels and if you haven't already subscribed to our neural network newsletter our neural Network newsletter is a zeroc cost monthly newsletter that includes protocols which are brief 1 to three page PDFs which summarize various things that you

can do in order to for instance optimize neuroplasticity and learning or optimize your sleep or improve dopamine regulation again all available at completely zero cost you simply go to hubman lab.com go to the menu tab in the top right corner scroll down to newsletter and provide us your email to obtain the newsletter and I'd like to point out that we do not share your email with anybody once again again thank you for joining me for today's discussion about skin health and appearance with Dr teao solomani and last but certainly not least thank you for your

interest in science [Music]