Latest / Voyage Clinics Podcast / What Does Your Skin Actually Need? | A Simple Guide to Skincare

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What Does Your Skin Actually Need? | A Simple Guide to Skincare · Voyage Clinics Podcast

• 0:13
  Speaker 1: Welcome to the Voyage Clinics Podcast. I'm your host, Dr.
• 0:15
  Speaker 1: John Sanders, family physician. As always, the objective of our
• 0:20
  Speaker 1: podcast is just to bring light and wisdom to the
• 0:23
  Speaker 1: community in the healthcare space. Today, welcome our sweet guests,
• 0:28
  Speaker 1: Scott and Darcy. Thank you. We're going to talk about
• 0:31
  Speaker 1: skincare today. I'm pretty excited about that.
• 0:33
  Speaker 2: Me too.
• 0:35
  Speaker 1: Yeah, welcome, welcome, welcome.
• 0:36
  Speaker 3: I could talk about skin care for a long time.
• 0:37
  Speaker 4: Yeah, get ready.
• 0:39
  Speaker 1: Let's do some introductions. Scott, tell us about you.
• 0:42
  Speaker 3: I'm Scott Webster. I'm a nurse practitioner. I went to
• 0:46
  Speaker 3: UVU right here in Orem for my undergraduate degree, and
• 0:48
  Speaker 3: I went straight to the University of Utah and got
• 0:50
  Speaker 3: a doctorate degree at the U. That was over 10
• 0:54
  Speaker 3: years ago. And as soon as I got into— while I
• 0:57
  Speaker 3: was at the university, I got into skin care by— I
• 1:00
  Speaker 3: did a— residency, basically. It was only like a month long,
• 1:05
  Speaker 3: but at the University of Utah, I did a clinical
• 1:07
  Speaker 3: experience at a dermatology office, and I loved it, and
• 1:09
  Speaker 3: that was my thing. And so after I got out
• 1:12
  Speaker 3: into clinical practice and graduated, I looked for opportunities to
• 1:16
  Speaker 3: get into the dermatology space, and I moved out to
• 1:18
  Speaker 3: Washington State, and I got in with kind of a
• 1:21
  Speaker 3: big dermatology practice there that did a residency for DOs,
• 1:27
  Speaker 3: and part of their model was hiring nurse practitioners, physician assistants,
• 1:31
  Speaker 3: And then they spent kind of a long time training.
• 1:33
  Speaker 3: Like I didn't see any patients for six months. And
• 1:35
  Speaker 3: I just kind of went through like a crash course
• 1:40
  Speaker 3: with the residents, the DO residents doing dermatology stuff. And
• 1:44
  Speaker 3: it was really, really great. And then their model was
• 1:48
  Speaker 3: to put guys like me or gals like me out
• 1:52
  Speaker 3: into communities that didn't have any dermatology services. And that
• 1:56
  Speaker 3: worked for them because then their residents and their surgery
• 2:00
  Speaker 3: centers became kind of this big referral center. And so
• 2:04
  Speaker 3: professionals like me would go out to communities that need
• 2:06
  Speaker 3: dermatology services that no dermatologist was ever going to go to.
• 2:10
  Speaker 3: And we got to see all kinds of interesting skin things.
• 2:13
  Speaker 3: And then when we needed help and we sent patients
• 2:16
  Speaker 3: into the Mohs Surgery Center for serious skin cancers or
• 2:21
  Speaker 3: in the Northwest, we had some big academic centers, the
• 2:23
  Speaker 3: Seattle Center. um, cancer care lines, a lot of stuff.
• 2:26
  Speaker 3: So the university of Washington and then just South OHSU
• 2:30
  Speaker 3: in Oregon, uh, they have some really, really great academic
• 2:33
  Speaker 3: centers that we were able to send some pretty interesting
• 2:36
  Speaker 3: patients to. I got a lot of great experience.
• 2:39
  Speaker 1: That's cool. What was the rural community that you were serving?
• 2:42
  Speaker 3: So if you're familiar with Washington, the Puget sound right
• 2:46
  Speaker 3: at the South tip of the Puget sound is the
• 2:47
  Speaker 3: capital of, um, of Washington Olympia. And, and between there
• 2:53
  Speaker 3: and like Portland, uh, is a lot of farming communities.
• 2:56
  Speaker 3: And so I was kind of right in the middle
• 2:57
  Speaker 3: of that in Centralia and Chehalis. And it's a big
• 2:59
  Speaker 3: enough community that they need dermatology, but it's not big
• 3:03
  Speaker 3: enough for most dermatologists to go there and open up
• 3:08
  Speaker 3: an office, but it's perfect for somebody like me.
• 3:10
  Speaker 1: That's really cool. So that's what we did.
• 3:11
  Speaker 3: We opened up an office there and I went around
• 3:14
  Speaker 3: and met all the medical professionals in the hospital and
• 3:16
  Speaker 3: I started getting referrals immediately from rheumatologists, from the emergency room,
• 3:20
  Speaker 3: all the family doctors I got to know. It was
• 3:22
  Speaker 3: a really great experience, but Um, but I got, uh,
• 3:26
  Speaker 3: I sort of jumped straight into the deep end thereafter,
• 3:29
  Speaker 3: just doing a little bit of training.
• 3:30
  Speaker 1: That is so cool. I have family in both those
• 3:33
  Speaker 1: towns in Olympia and Centralia. That's really cool. It's beautiful.
• 3:37
  Speaker 1: What a fun journey into kind of your interest space. It's,
• 3:40
  Speaker 1: it's fun as a family docs also have like different
• 3:43
  Speaker 1: things they're interested in. And often I have like two
• 3:47
  Speaker 1: nurse practitioners that work with me and one is a
• 3:49
  Speaker 1: super nerd and like, headaches and neurology and like pots
• 3:53
  Speaker 1: and all this cool stuff and the other one's like
• 3:54
  Speaker 1: a super nerd in all these areas we just have
• 3:57
  Speaker 1: interests and we kind of do that i i would
• 3:58
  Speaker 1: probably do i like a lot of like sports medicine
• 4:01
  Speaker 1: and things like that i also love dermatology i train
• 4:04
  Speaker 1: in florida so lots of lots of skin and then
• 4:06
  Speaker 1: rural medicine and um so that's really cool that you
• 4:09
  Speaker 1: know even in primary care specialists like like you know
• 4:12
  Speaker 1: nurse practitioners family physicians um We can kind of sub-specialize
• 4:17
  Speaker 1: a little bit and kind of take interest in a
• 4:19
  Speaker 1: thing and just kind of nerd out about it. That's cool.
• 4:21
  Speaker 3: I think it's so valuable to get to know people
• 4:23
  Speaker 3: and know people's interests. And when you have a colleague
• 4:26
  Speaker 3: that's a specialist or has an interest in a specific area,
• 4:29
  Speaker 3: when you get that patient, it's always nice to have friends.
• 4:32
  Speaker 2: Yeah.
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  Speaker 3: Yeah, yeah, yeah, yeah.
• 4:33
  Speaker 1: Darcy, talk to us about you.
• 4:35
  Speaker 2: So my name is Darcy Gonzalez. I have been a
• 4:39
  Speaker 2: licensed esthetician since 2021. Um, I got into my own
• 4:44
  Speaker 2: skincare journey as an acne teen. Um, I always really
• 4:48
  Speaker 2: struggled with acne, tried all these different kinds of topical
• 4:51
  Speaker 2: medications was on Accutane.
• 4:54
  Speaker 5: I went through the whole thing.
• 4:54
  Speaker 2: Um, and I kind of came at a point in
• 4:58
  Speaker 2: my life where I was like, I don't know what
• 4:59
  Speaker 2: I want to do. And I kept looking at my
• 5:01
  Speaker 2: skin thinking like, is this what's preventing me from like
• 5:04
  Speaker 2: finding a job or like finding work?
• 5:06
  Speaker 5: A purpose, if you will.
• 5:07
  Speaker 2: So I was like, instead of making this my quote
• 5:10
  Speaker 2: unquote negative quality, I'm going to learn more about it,
• 5:14
  Speaker 2: you know, and take matters into my own hands and
• 5:16
  Speaker 2: kind of go to school and see what I can
• 5:18
  Speaker 2: do to help myself and help other people. So my
• 5:22
  Speaker 2: whole approach is to treat things a little bit more
• 5:24
  Speaker 2: progressively than aggressively and learn to love yourself along the way.
• 5:29
  Speaker 2: So I went to school and then as soon as
• 5:32
  Speaker 2: I graduated, I opened my own business and And I
• 5:35
  Speaker 2: was mainly focusing on lashes and brows at that time
• 5:38
  Speaker 2: because it was something that there is some theory to it.
• 5:41
  Speaker 1: Right.
• 5:41
  Speaker 2: But I didn't feel like I had the whole knowledge
• 5:44
  Speaker 2: of skin care that I wanted to have in order
• 5:46
  Speaker 2: to help other people. So while I was doing the
• 5:48
  Speaker 2: lashes and the brows, I really honed in in the
• 5:51
  Speaker 2: back in the back.
• 5:54
  Speaker 4: Hello, what's the word?
• 5:55
  Speaker 5: Behind the scenes.
• 5:56
  Speaker 4: There we go.
• 5:57
  Speaker 2: Behind the scenes to get some other education on multicultural skin,
• 6:02
  Speaker 2: advanced acne treatments and things like that. It really helped
• 6:05
  Speaker 2: me a lot. And I found out that a lot
• 6:07
  Speaker 2: of what I was missing was the self-care. I wasn't
• 6:09
  Speaker 2: really taking care of my skin the way I should
• 6:11
  Speaker 2: have been taken care of. And finding out those simple
• 6:16
  Speaker 2: answer is actually helped me, um, again, to treat my
• 6:19
  Speaker 2: own acne, but to help other people too. So I think, um,
• 6:22
  Speaker 2: helping people feel confident in their skin is like just
• 6:24
  Speaker 2: one of the best things that you can do for someone. Um,
• 6:27
  Speaker 2: so I've, yeah, I have a big passion for just
• 6:30
  Speaker 2: increasing confidence in other people and, um, you know, that
• 6:34
  Speaker 2: they say what goes around comes around. So by helping
• 6:37
  Speaker 2: other people, it's given me more confidence too. And I
• 6:39
  Speaker 2: think that's what makes me, um, excited to come to
• 6:42
  Speaker 2: work every day is because, you know, like, I don't
• 6:45
  Speaker 2: really feel like I'm working. I'm just like connecting with
• 6:47
  Speaker 2: other people and figuring things out so that they can
• 6:50
  Speaker 2: kind of love themselves again.
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  Speaker 5: That's been a big part of my life.
• 6:53
  Speaker 1: Oh, I love that. I love your approach and how
• 6:56
  Speaker 1: holistic you are in helping people kind of. And with
• 7:00
  Speaker 1: the emotional state, I think hair and skin are probably
• 7:03
  Speaker 1: the two most emotional things. Oh, totally. Like chemo people
• 7:08
  Speaker 1: that lose their hair. Like it is tremendously emotional for folks.
• 7:12
  Speaker 1: And skin like, It's a big deal. And yeah, I
• 7:16
  Speaker 1: love that you're addressing both of those things as you're
• 7:18
  Speaker 1: trying to help folks along this journey and being holistic there.
• 7:21
  Speaker 1: It's so cool.
• 7:22
  Speaker 2: And I think it's also important to remember that like you're, yeah,
• 7:25
  Speaker 2: sometimes you can get some skin issues and stuff like that,
• 7:28
  Speaker 2: but that reflects a lot of what's happening inside, right?
• 7:30
  Speaker 2: Like I used to be like, oh, I hate these pimples,
• 7:32
  Speaker 2: but I'm like, what an awesome thing thing that your
• 7:35
  Speaker 2: body can communicate to you. Yes, it's kind of annoying
• 7:37
  Speaker 2: in the way it communicates to you, but it gives
• 7:41
  Speaker 2: you kind of a direction of like, hmm, maybe I
• 7:43
  Speaker 2: should be drinking more water. And that's just a part
• 7:45
  Speaker 2: of taking care of yourself, you know? So it's kind
• 7:47
  Speaker 2: of cool to see the different things that you learn
• 7:49
  Speaker 2: along the way when you're going through skincare journeys and
• 7:52
  Speaker 2: stuff like that.
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  Speaker 3: The unfortunate thing about acne is that although it can
• 7:58
  Speaker 3: happen kind of all throughout the lifespan, it tends to
• 8:02
  Speaker 3: attack a relatively emotionally volatile time in our life.
• 8:08
  Speaker 2: Sure.
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  Speaker 1: Vulnerable.
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  Speaker 5: Yeah. I was going to say that too.
• 8:11
  Speaker 3: Getting to know yourself, you're figuring out social interactions. Like you're,
• 8:16
  Speaker 3: there are a lot of awkward parts about being a
• 8:18
  Speaker 3: teenager and a young adult anyways.
• 8:20
  Speaker 1: Yeah.
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  Speaker 3: And then you got to pile acne on top of it.
• 8:23
  Speaker 1: It's not fair. It's not fair. It's not fair.
• 8:25
  Speaker 5: I am grateful.
• 8:27
  Speaker 2: Scott and I talk about this a lot, but it's
• 8:29
  Speaker 2: awesome to kind of be in this time and age
• 8:31
  Speaker 2: where people are starting to decorate their acne and kind
• 8:34
  Speaker 2: of celebrate their skin no matter what stage you're in.
• 8:36
  Speaker 1: Right.
• 8:36
  Speaker 2: So the star pimple patches are really fun. And again,
• 8:41
  Speaker 2: like I'm just a big advocate for like, don't let
• 8:43
  Speaker 2: a pimple get in the way of your fun activities and.
• 8:46
  Speaker 5: Stuff like that.
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  Speaker 2: The people who care about you don't care about a pimple,
• 8:49
  Speaker 2: you know.
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  Speaker 1: I love that. So you guys are the dynamic duo
• 8:52
  Speaker 1: at Clear Skin Utah.
• 8:53
  Speaker 4: Yes.
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  Speaker 1: Kind of newer to the scene. How long have you
• 8:56
  Speaker 1: guys been open?
• 8:57
  Speaker 3: Yeah, we opened about three-ish months ago. So I've been
• 9:00
  Speaker 3: in this area. I grew up in Utah. And so
• 9:03
  Speaker 3: after I lived in Washington for a while and practiced
• 9:05
  Speaker 3: and got some good experience in dermatology there, I had
• 9:07
  Speaker 3: always sort of intended to come back to Utah. And
• 9:09
  Speaker 3: I did. And I've been practicing in dermatology clinics here.
• 9:14
  Speaker 3: And I find it so rewarding to help people with
• 9:17
  Speaker 3: acne and their skin care. I decided to open my
• 9:20
  Speaker 3: own office where I could sort of specifically do the
• 9:23
  Speaker 3: thing that I enjoy and that I find the most
• 9:25
  Speaker 3: rewarding for my practice. And so we did. So right
• 9:28
  Speaker 3: up here on 800 North, we're close to UVU, we're
• 9:30
  Speaker 3: close to BYU, we're close to a whole bunch of humongous..
• 9:33
  Speaker 1: Close to Voyage Clinics.
• 9:34
  Speaker 3: We're right next to Voyage Clinics. We've got some great
• 9:37
  Speaker 3: partnerships with the surrounding medical professionals. But we've got a
• 9:43
  Speaker 3: lot of patients here.
• 9:45
  Speaker 1: Tell me about how you guys operate differently, because this
• 9:48
  Speaker 1: is different, right? At a dermatologist's office, you won't get this.
• 9:52
  Speaker 1: And I think this is so valuable, by the way,
• 9:54
  Speaker 1: that you have a holistic approach with a team... esthetician
• 9:58
  Speaker 1: plus clinician, being able to kind of address things on
• 10:02
  Speaker 1: both sides of the fence. Super cool. Talk to me
• 10:04
  Speaker 1: about that approach.
• 10:05
  Speaker 3: Yeah, I think it's a unique thing. And to be honest,
• 10:09
  Speaker 3: I'm not sure why it doesn't happen more. In my experience,
• 10:15
  Speaker 3: over the last decade in different parts.
• 10:17
  Speaker 1: Of the.
• 10:19
  Speaker 3: Kind of there are two professional places where you get
• 10:25
  Speaker 3: skin care. You can go to the dermatologist. That's a
• 10:28
  Speaker 3: skin care expert. That's their wheelhouse solidly. And dermatologists are
• 10:32
  Speaker 3: so good at treating acne. But in every dermatology office
• 10:36
  Speaker 3: that I've worked at, dermatologists sort of, they get kind
• 10:39
  Speaker 3: of tunnel vision a little bit into this medical modality.
• 10:43
  Speaker 3: To be fair, a lot of patients who show up
• 10:45
  Speaker 3: to a dermatology office are expecting a prescription treatment, and
• 10:48
  Speaker 3: that's fine. There's nothing wrong with that, and a lot
• 10:49
  Speaker 3: of people need that.
• 10:51
  Speaker 1: But the other option— Are you talking about like Accutane
• 10:53
  Speaker 1: or just all the meds?
• 10:53
  Speaker 3: Accutane, prescription antibiotics, topical retinoids, antibiotics.
• 10:59
  Speaker 1: The typical standard treatments.
• 11:00
  Speaker 3: Typical standard treatments, which are good and very effective, and
• 11:03
  Speaker 3: there's a lot of data to support those, and a
• 11:05
  Speaker 3: lot of people need those. But in my experience, most
• 11:08
  Speaker 3: patients walk in and they've got a bag of skincare
• 11:10
  Speaker 3: things that they've tried and they want to show them
• 11:12
  Speaker 3: to me and they want to know what their skincare
• 11:14
  Speaker 3: should be. And nobody comes to the dermatologist and says,
• 11:18
  Speaker 3: put me on something for the rest of my life.
• 11:21
  Speaker 3: The first thing they think is, how do I get
• 11:23
  Speaker 3: my acne clear? And then where do I go from there?
• 11:25
  Speaker 3: When do I stop this stuff? And I think that's
• 11:30
  Speaker 3: a piece that gets missed a little bit. So the
• 11:33
  Speaker 3: other Professionals that will market themselves as acne experts are estheticians.
• 11:39
  Speaker 3: And I have seen dermatology offices build a kind of
• 11:43
  Speaker 3: a sister business that's like a med spa that's mostly
• 11:46
  Speaker 3: for cosmetic treatments, facials, microneedling, laser stuff, which is great.
• 11:54
  Speaker 3: But I've never, for some reason, seen the two collaborating
• 11:57
  Speaker 3: in the same office and like give a comprehensive evaluation
• 11:59
  Speaker 3: to the same patient at the same time.
• 12:01
  Speaker 1: Yeah.
• 12:01
  Speaker 3: Like, here's what we're going to do now. Here's what
• 12:03
  Speaker 3: we're going to do in the future. And a lot
• 12:04
  Speaker 3: of the esthetician models that I've seen that I think
• 12:07
  Speaker 3: do a great job at what they do. But I
• 12:10
  Speaker 3: find that their marketing is almost competitive to the dermatology
• 12:15
  Speaker 3: model where it's like the dermatologist has given you. you know,
• 12:19
  Speaker 3: prescriptions and stuff. And when you're done messing around with
• 12:21
  Speaker 3: the dermatologist, come talk to us and we'll help you
• 12:23
  Speaker 3: with long-term control.
• 12:24
  Speaker 1: Yeah. Instead of being complimentary, they're like a little bit
• 12:26
  Speaker 1: of conflict there. Yeah, sure.
• 12:28
  Speaker 3: And I see the two as two sides of the
• 12:31
  Speaker 3: same coin. You two need to collaborate and talk. And so,
• 12:37
  Speaker 3: and I discussed this with some dermatologists and I never
• 12:40
  Speaker 3: really got a good answer for like, why don't we
• 12:43
  Speaker 3: put those two together? And so I'm trying. I couldn't
• 12:46
  Speaker 3: find a good reason not to. I think it's valuable
• 12:48
  Speaker 3: to patients. I think it adds a lot of value.
• 12:50
  Speaker 3: I think it adds a lot of reassurance to a
• 12:54
  Speaker 3: patient to get both sides, both professionals collaborating.
• 12:58
  Speaker 1: Well, let's talk about acne. Let's dive into it a
• 13:00
  Speaker 1: little bit. What should the average teenager be thinking about?
• 13:05
  Speaker 1: What are some of the basic fundamentals of skincare and moisturizers?
• 13:11
  Speaker 1: Let's start from scratch.
• 13:15
  Speaker 3: First of all, acne happens to the vast majority of people.
• 13:18
  Speaker 3: You're not alone. You're not the only person that this
• 13:20
  Speaker 3: happens to. And there are so many options. Does it
• 13:24
  Speaker 3: make me a bad person? Absolutely not. And it's not
• 13:28
  Speaker 3: going to last forever. It may last for a lot
• 13:31
  Speaker 3: longer than you want. But acne happens to almost everybody
• 13:34
  Speaker 3: at some point in their life, over 80%. Far and away,
• 13:37
  Speaker 3: acne is the most common diagnosis at a dermatology clinic everywhere.
• 13:42
  Speaker 3: But as far as skincare goes, I feel like that's
• 13:45
  Speaker 3: right in Darcy's wheelhouse.
• 13:47
  Speaker 1: My alley. Darcy, let's go to a sweet spot.
• 13:48
  Speaker 4: Yes, yes, yes.
• 13:49
  Speaker 2: So I always tell clients that they should be doing
• 13:52
  Speaker 2: at least a three-step routine where we are incorporating cleansing
• 13:56
  Speaker 2: the skin, moisturizing the skin to replenish any oils, healthy
• 14:00
  Speaker 2: oils and healthy nutrients that we might have removed with
• 14:02
  Speaker 2: our cleanser. And then, of course, our big one, sunscreen.
• 14:06
  Speaker 2: No one talks about how important sunscreen is. There's a
• 14:09
  Speaker 2: lot of benefits to our acne clients. with protecting your
• 14:12
  Speaker 2: skin from the sun. But as far as products go,
• 14:15
  Speaker 2: what's awesome and I think unique about us as well
• 14:18
  Speaker 2: is that we will kind of find what's best for
• 14:21
  Speaker 2: your budget. Some people do feel like they can afford
• 14:23
  Speaker 2: some more high-end products. And some people, you know, a
• 14:27
  Speaker 2: lot of teenagers and things like that, they are just
• 14:29
  Speaker 2: looking for the.
• 14:30
  Speaker 5: Best bang for the buck.
• 14:31
  Speaker 2: And I think that you can really get that with
• 14:34
  Speaker 2: some awesome products from like CeraVe, La Roche-Posay, Neutrogena.
• 14:38
  Speaker 5: Neutrogena.
• 14:39
  Speaker 2: Yeah. There's some awesome over-the-counter products that you can invest
• 14:42
  Speaker 2: your money into that doesn't have to, you know, make
• 14:44
  Speaker 2: you think, do I pay my bills or do I,
• 14:47
  Speaker 2: you know, have clear skin?
• 14:48
  Speaker 1: I've seen people spending like so much money a month
• 14:51
  Speaker 1: on skincare stuff.
• 14:52
  Speaker 3: If you have the disposable income.
• 14:54
  Speaker 4: Totally.
• 14:54
  Speaker 3: I don't want to say that's wrong, but. But it
• 14:58
  Speaker 3: doesn't have to be that way.
• 14:59
  Speaker 2: We definitely think of skincare as vehicles, right? You can
• 15:03
  Speaker 2: take a fancy Bentley or you can take a buggy.
• 15:06
  Speaker 2: Either way, you're going to get to your destination might
• 15:08
  Speaker 2: be a little bit, you know, slower or might be
• 15:12
  Speaker 2: a little bit quicker. You might be more comfortable with,
• 15:15
  Speaker 2: you know, either or. But the best thing is doing
• 15:18
  Speaker 2: what's best for you. You don't want to overcomplicate things
• 15:20
  Speaker 2: or make yourself go into a 15-step routine and invest
• 15:23
  Speaker 2: all the money and then not end.
• 15:25
  Speaker 5: Up doing it because it's overwhelming.
• 15:26
  Speaker 1: Are there aggressive cleansers that we should avoid and why?
• 15:30
  Speaker 2: I think that there is value in having cleansers that
• 15:33
  Speaker 2: are exfoliating and things like that, as long as you
• 15:36
  Speaker 2: are able to replenish with moisturizers and things like that.
• 15:39
  Speaker 2: So there's benzoyl peroxide cleansers or salicylic acid cleansers. And
• 15:45
  Speaker 2: those are pretty safe for the most part, depending on,
• 15:48
  Speaker 2: of course, the type of acne you're treating. as they
• 15:51
  Speaker 2: are not staying on for long periods of time, you're
• 15:53
  Speaker 2: just washing your skin, as long as you have balance
• 15:56
  Speaker 2: or that synergy with other ingredients and other products, most
• 15:59
  Speaker 2: of the time you'll be okay. Should every product that
• 16:02
  Speaker 2: you have in your skincare regimen be exfoliating?
• 16:05
  Speaker 5: Definitely not.
• 16:06
  Speaker 2: We want to make sure we have that balance to
• 16:08
  Speaker 2: ensure that your skin is getting proper exfoliation, but.
• 16:11
  Speaker 5: We're also replenishing.
• 16:12
  Speaker 1: Yeah.
• 16:13
  Speaker 3: The easy answer is It depends on the person. It
• 16:19
  Speaker 3: depends on the skin type. It's a unique challenge to
• 16:21
  Speaker 3: treat individual skin and not acne.
• 16:24
  Speaker 1: You know what I mean?
• 16:25
  Speaker 3: We often, at least in medicine, we say, you know,
• 16:29
  Speaker 3: treat the patient, not necessarily the condition, right? There are
• 16:32
  Speaker 3: a lot of different cleansers out there and some of
• 16:34
  Speaker 3: them are a lot more aggressive and some of them
• 16:37
  Speaker 3: are a lot more mild. It depends a little bit
• 16:39
  Speaker 3: on the acne, but it also depends on the person.
• 16:41
  Speaker 3: I'm going to recommend very different things for somebody who
• 16:43
  Speaker 3: comes in and they've got a long history of eczema.
• 16:46
  Speaker 3: You know, somebody comes in with eyelid dermatitis and they've
• 16:48
  Speaker 3: struggled to control that. I don't want to make that
• 16:50
  Speaker 3: worse by trying to, you know, giving them an aggressive
• 16:52
  Speaker 3: cleanser or exfoliant or something like that. So a little
• 16:56
  Speaker 3: bit depends on, I would say a lot depends on
• 16:58
  Speaker 3: the patient and a lot depends on the type of
• 17:01
  Speaker 3: acne we're treating. And I would say the most common
• 17:03
  Speaker 3: things that I run into, I would say the most
• 17:05
  Speaker 3: common thing that I run into when people are over
• 17:07
  Speaker 3: drying and irritating their skin is using high strength benzoyl peroxide.
• 17:11
  Speaker 3: You can get it over the counter very easily on
• 17:12
  Speaker 3: Amazon or Walmart for like up to 10%. To be
• 17:15
  Speaker 3: perfectly honest, the lower strengths, like down to four, two
• 17:17
  Speaker 3: and a half percent, they work really well. And they
• 17:21
  Speaker 3: don't dry out as much. So if you're dealing with
• 17:23
  Speaker 3: really comedonal acne, you got a lot of clogged pores,
• 17:25
  Speaker 3: you're dealing with a lot of bacne. Yeah, you can
• 17:28
  Speaker 3: probably get away with doing a higher percentage, but depends
• 17:31
  Speaker 3: on the person there. And then don't forget to moisturize.
• 17:35
  Speaker 3: A huge mistake that we make is we strip a
• 17:37
  Speaker 3: lot of oil off our skin and it can actually
• 17:38
  Speaker 3: be a little counterproductive because we're stripping all the oils off.
• 17:41
  Speaker 3: And then a lot of times, Partly hormones, but partly
• 17:45
  Speaker 3: kind of a compensatory function of our oil glands is
• 17:49
  Speaker 3: like we got to rehydrate the skin. And so sometimes
• 17:52
  Speaker 3: you can strip the skin so effectively of all the
• 17:54
  Speaker 3: oils that it produces more oil trying to make up
• 17:58
  Speaker 3: for that. So putting a good moisturizer on afterwards. is
• 18:00
  Speaker 3: actually more valuable than people give it credit for.
• 18:02
  Speaker 1: That's probably the most common thing I see with acne
• 18:05
  Speaker 1: is folks are overly aggressive on their stripping the oils
• 18:08
  Speaker 1: off and they're not moisturizing and they're using astringents.
• 18:11
  Speaker 2: Because people get nervous about moisturizing, right? They think that, oh,
• 18:15
  Speaker 2: I see oil, that must be the problem, right? And again,
• 18:18
  Speaker 2: it's just about having that balance. removing what needs to
• 18:21
  Speaker 2: be gone, washing all that. I always say washing all
• 18:24
  Speaker 2: that stress away at the end of the day, at
• 18:26
  Speaker 2: least once a day, you know, and then replenishing that
• 18:29
  Speaker 2: with moisturizer. Do I recommend cleansing day and night? If
• 18:33
  Speaker 2: you can, if it works for you, sure. You know,
• 18:35
  Speaker 2: and I think, again, that's what sets us apart is
• 18:37
  Speaker 2: that we will definitely accommodate your skincare routine for your
• 18:41
  Speaker 2: individual needs. There's people who work, you know, at night's.
• 18:45
  Speaker 2: And they're, you know, they don't want to see the sun.
• 18:47
  Speaker 2: Do they need to wear sunscreen? Of course, we'll always
• 18:49
  Speaker 2: recommend sunscreen to everyone. But your skincare routine is probably
• 18:52
  Speaker 2: going to look different than someone who works a nine
• 18:54
  Speaker 2: to five.
• 18:55
  Speaker 1: And that compensatory or the compensation of your skin with
• 18:59
  Speaker 1: a super overly aggressive dried out skin, it can make
• 19:03
  Speaker 1: acne actually worse with all the extra upregulation of all
• 19:06
  Speaker 1: the oil secretors and all that. It fights dirty.
• 19:09
  Speaker 3: It kicks you while you're down. You're trying to do
• 19:12
  Speaker 3: the right thing and it And it backfires.
• 19:15
  Speaker 1: That's right. That's right.
• 19:17
  Speaker 3: I got to mention with the sunscreen, a lot of
• 19:19
  Speaker 3: people have mixed feelings about sunscreen or they don't like
• 19:22
  Speaker 3: putting it on. And a lot of patients ask me, well,
• 19:24
  Speaker 3: I know you're telling me about sunscreen to prevent skin cancer,
• 19:26
  Speaker 3: but like I'm an acne patient. I'm young. I'm not
• 19:29
  Speaker 3: going to get skin cancer right now. You're kind of
• 19:31
  Speaker 3: right that sunscreen doesn't directly treat acne. But in my experience,
• 19:35
  Speaker 3: a lot of acne is very inflammatory and leads to
• 19:37
  Speaker 3: hyperpigmentation and scarring. And those complications are compounded by UV damage,
• 19:44
  Speaker 3: like significantly, and they're pretty hard to treat after. And
• 19:47
  Speaker 3: so when we recommend, when we when we're talking about
• 19:50
  Speaker 3: an acne routine and adding sunscreen to your routine, it's
• 19:54
  Speaker 3: mostly to help the healing process and minimize the secondary
• 19:59
  Speaker 3: effects of acne. And so we're always going to recommend
• 20:03
  Speaker 3: preventing skin cancer and Sunscreen is one of the most
• 20:06
  Speaker 3: effective ways of protecting, preventing skin cancer.
• 20:09
  Speaker 1: Even just the scarring alone. I didn't think about that,
• 20:11
  Speaker 1: but totally.
• 20:12
  Speaker 3: Scarring and hyperpigmentation specifically doesn't do well with UV.
• 20:16
  Speaker 2: And the zinc obviously can help a lot with inflammation too.
• 20:19
  Speaker 2: So there's benefits in the whole thing, right?
• 20:23
  Speaker 1: Totally. Can we speak to that a little bit? Just
• 20:25
  Speaker 1: some of the ingredients that we should be looking for
• 20:27
  Speaker 1: for face oil. Yeah, absolutely. Sunblock, sunscreen, like what are
• 20:32
  Speaker 1: the things that we should be looking for? What are
• 20:33
  Speaker 1: the things that we should be maybe not looking for?
• 20:36
  Speaker 2: Yeah.
• 20:36
  Speaker 3: So when we're talking about sunscreen specifically, there are two
• 20:40
  Speaker 3: broad types of sunscreen that we talk about. There are
• 20:43
  Speaker 3: physical blockers and there are chemical sunscreens. Chemical sunscreens are
• 20:47
  Speaker 3: typically a little bit more sheer. People like to put
• 20:49
  Speaker 3: them on because they don't have like a white cast.
• 20:51
  Speaker 3: And so they, cosmetically, they're a little bit better. Those
• 20:53
  Speaker 3: do a great job of like absorbing the UV so
• 20:55
  Speaker 3: that it doesn't damage the DNA and the nuclei in
• 20:58
  Speaker 3: your skin. And it's very effective at like preventing skin cancer.
• 21:00
  Speaker 3: But one of the concerns of chemical sunscreen is that
• 21:04
  Speaker 3: it's pretty detectable in the bloodstream. Like it's getting absorbed.
• 21:07
  Speaker 3: As far as we know, it seems to be pretty
• 21:08
  Speaker 3: safe and it doesn't cause a lot of problems. Skin
• 21:10
  Speaker 3: cancer does cause problems. And so As a general dermatology professional,
• 21:15
  Speaker 3: I'm always gonna recommend whatever sunscreen you'll wear that you
• 21:18
  Speaker 3: like consistently, I'm okay with it. There are a couple
• 21:21
  Speaker 3: of considerations with chemical sunscreen that a lot of people
• 21:25
  Speaker 3: don't think about. First of all, has nothing to do
• 21:28
  Speaker 3: with your skin or your health, but a lot of
• 21:31
  Speaker 3: chemical sunscreens like Avobenzone and Oxybenzone aren't that safe for
• 21:34
  Speaker 3: aquatic life. So like in Hawaii, they can't sell it there.
• 21:38
  Speaker 3: And so if you're gonna be around bodies of water
• 21:39
  Speaker 3: and you're going to the beach, Wearing a mineral sunscreen
• 21:42
  Speaker 3: is going to be better for aquatic life. So that's
• 21:45
  Speaker 3: one kind of consideration that I recommend. A lot of people,
• 21:48
  Speaker 3: they come see me and it's like, well, we're going
• 21:50
  Speaker 3: on this vacation. You know, we chit chat a little
• 21:52
  Speaker 3: bit about, you know, what they're doing in their life.
• 21:55
  Speaker 3: And when I recommend sunscreen, I always try to take
• 21:57
  Speaker 3: into account where they're going to use the sunscreen.
• 22:00
  Speaker 1: And the mineral sunscreens are going to be your zinc
• 22:02
  Speaker 1: and titanium oxide?
• 22:03
  Speaker 3: Zinc oxide, titanium dioxide. Those are the main ingredients in
• 22:08
  Speaker 3: the United States that we use. In some other countries,
• 22:10
  Speaker 3: there are some pretty effective ones like iron, an iron
• 22:14
  Speaker 3: molecule that's pretty effective. And hopefully we start to see
• 22:17
  Speaker 3: a little bit of movement in what ingredients are available
• 22:20
  Speaker 3: in the United States for better sunscreen. But zinc oxide
• 22:23
  Speaker 3: and titanium dioxide are fantastic ingredients. And these days, back
• 22:26
  Speaker 3: when we were kids, it was like the surfer nose, right?
• 22:28
  Speaker 3: You put it on, it's just a white paste. These days,
• 22:31
  Speaker 3: they like micronize and they encapsulate the molecules so it's
• 22:36
  Speaker 3: less reflective and it doesn't look so bad.
• 22:37
  Speaker 1: It's like nanoparticles. Super small. It almost goes on clear, honestly.
• 22:42
  Speaker 1: I've seen them like.
• 22:43
  Speaker 3: Five and a half. And they'll tint them. And so
• 22:45
  Speaker 3: people with different skin types can use it very comfortably.
• 22:49
  Speaker 3: which I like. And I think that's really important. I
• 22:51
  Speaker 3: love skin lines that have different tint levels for different
• 22:54
  Speaker 3: skin types. I think that's important. My Mexican heritage is
• 22:57
  Speaker 3: thanking them.
• 22:58
  Speaker 1: Yeah. You and me both.
• 22:59
  Speaker 3: You just can't see it.
• 23:00
  Speaker 1: Yeah. You're not Mexican, bro.
• 23:02
  Speaker 3: Uh, I think I have a little bit of Native
• 23:06
  Speaker 3: American way back. My great grandmother, I think was like
• 23:09
  Speaker 3: an eighth Native American. I didn't get any of that.
• 23:13
  Speaker 1: So you were talking about like making sure that the minerals,
• 23:16
  Speaker 1: mineral ones are more for the beach. Spray on might
• 23:19
  Speaker 1: be if you're going swimming and trying to protect the wildlife. Yes.
• 23:22
  Speaker 3: But also, there are some specific conditions that do better
• 23:25
  Speaker 3: with physical blockers. And if you don't like sunscreen, an actual,
• 23:29
  Speaker 3: you know, hat, scarf, you know, cover up.
• 23:31
  Speaker 1: Sun shirts.
• 23:32
  Speaker 3: Sun shirts are very, very effective.
• 23:33
  Speaker 1: Those are great.
• 23:34
  Speaker 2: They have an awesome Korean, I believe it's like a
• 23:38
  Speaker 2: Korean or Japanese dollar store or something like that here
• 23:41
  Speaker 2: in Utah. And they sell the... like coolest tech for
• 23:45
  Speaker 2: protecting your skin.
• 23:47
  Speaker 3: Full face visors.
• 23:48
  Speaker 2: Yes. I got like a little visor hat thing and
• 23:50
  Speaker 2: it covers your face completely. I am someone that doesn't
• 23:53
  Speaker 2: like to use my expensive, nice sunscreen when I'm about
• 23:55
  Speaker 2: to go on a workout and I'm going to go
• 23:57
  Speaker 2: on a walk outside or something like that.
• 23:58
  Speaker 4: So I'll wear my nice visor. I wear like my
• 24:01
  Speaker 4: long sleeve.
• 24:03
  Speaker 2: They're like little sleeves that you can buy for when
• 24:05
  Speaker 2: you're wearing like short sleeves. I'm a little extra, you know,
• 24:08
  Speaker 2: and I know that 50 years or even 20 years
• 24:10
  Speaker 2: down the line, I will be thanking my younger self.
• 24:12
  Speaker 3: It's going to pay off.
• 24:13
  Speaker 5: It will pay off.
• 24:14
  Speaker 3: So I wanted to make special mention of a couple
• 24:16
  Speaker 3: of different conditions that do better with physical blockers like
• 24:19
  Speaker 3: the mineral sunscreens than the chemical sunscreens. Melasma is a
• 24:23
  Speaker 3: big one. When you're using chemical sunscreens, you still absorb
• 24:27
  Speaker 3: a lot of heat and it can worsen melasma. And
• 24:30
  Speaker 3: so physical blockers are better for that. So mineral sunscreens.
• 24:33
  Speaker 3: Also rosacea. That's another one where I always recommend mineral sunscreen.
• 24:37
  Speaker 1: Not chemical. Tell us what you mean by melasma.
• 24:40
  Speaker 3: So melasma is a pigmentary thing that happens. And we're
• 24:45
  Speaker 3: not even sure why totally. We think it's probably a
• 24:47
  Speaker 3: lot hormonal, partly genetic. Often happens as a result of
• 24:51
  Speaker 3: like birth control. Sometimes it happens to a lot of
• 24:53
  Speaker 3: women after they have kids. Pregnancy mask.
• 24:56
  Speaker 1: Pregnancy, they'll get it.
• 24:57
  Speaker 3: Yep, during pregnancy, they'll get it. And it's kind of
• 25:00
  Speaker 3: hard to treat, to be perfectly honest. It's a little
• 25:02
  Speaker 3: bit stubborn as far as the pigmentary disorders go.
• 25:04
  Speaker 1: I had a gown with a tiger stripe. It looked awesome.
• 25:06
  Speaker 4: Ooh, that's kind of cool.
• 25:07
  Speaker 3: Some people probably would pay for that one.
• 25:08
  Speaker 1: It was cool. It was pretty cool.
• 25:11
  Speaker 3: So, melasma typically shows up as kind of this speckled pattern,
• 25:16
  Speaker 3: usually along the forehead, often along the top lip. Usually,
• 25:19
  Speaker 3: it's this almost symmetric pattern. Having a unilateral melasma stripe
• 25:23
  Speaker 3: is pretty unusual. But when that starts to show up,
• 25:26
  Speaker 3: I always recommend physical mineral blockers, not chemical.
• 25:30
  Speaker 1: Yeah, that makes sense.
• 25:30
  Speaker 3: That's more effective.
• 25:31
  Speaker 1: That makes sense. One other thing that I'll tell folks
• 25:33
  Speaker 1: about the mineral blockers versus... chemical blockers is just that
• 25:37
  Speaker 1: UVA and B are both blocked. And instead of just
• 25:41
  Speaker 1: the UVB that causes the burn, UVA causes the aging
• 25:44
  Speaker 1: as well.
• 25:45
  Speaker 5: Cellular damage and such.
• 25:47
  Speaker 3: In general, if you'll tolerate them, I like mineral blockers better.
• 25:52
  Speaker 1: You bet.
• 25:53
  Speaker 3: But I will take chemical blockers if that's what you'll
• 25:57
  Speaker 3: wear because not wearing sunscreen is worse than either.
• 26:00
  Speaker 2: You bet.
• 26:01
  Speaker 1: That sounds good.
• 26:01
  Speaker 2: Also using SPF around 30 to 50. blocks over 95%
• 26:07
  Speaker 2: of those rays, you know, it's going to be beneficial.
• 26:09
  Speaker 2: People come in sometimes wearing 15 SPF and I'm like,
• 26:12
  Speaker 2: that's cute. And I appreciate you trying, but. We need
• 26:16
  Speaker 2: a little bit more protection, especially where we're at a
• 26:18
  Speaker 2: higher elevation. There's a lot more outdoor activities here in Utah. So,
• 26:21
  Speaker 2: you know, whatever you can manage is best, but definitely
• 26:24
  Speaker 2: that 30 to.
• 26:24
  Speaker 5: 50 is that sweet spot.
• 26:26
  Speaker 3: I'm an evidence-based guy, and SPF 30 is where statistical
• 26:32
  Speaker 3: reduction in skin cancer happens. 15 is just too low.
• 26:35
  Speaker 3: It doesn't block enough. So at least SPF 30. The
• 26:38
  Speaker 3: practical application that I tell my patients is you get
• 26:41
  Speaker 3: the most bang for your buck between like 30 and 80.
• 26:44
  Speaker 4: Mm-hmm.
• 26:45
  Speaker 3: You can get SPF 120, you can get SPF 200.
• 26:48
  Speaker 3: And in the lab, that may provide a little extra protection,
• 26:54
  Speaker 3: but you pay two or three times what you do
• 26:57
  Speaker 3: for the 40s and 50s. And in real world use,
• 27:00
  Speaker 3: it doesn't have that much more protection. And so you
• 27:03
  Speaker 3: get the sweet spot as far as like cost benefit,
• 27:06
  Speaker 3: you get the sweet spot is between like 30 and 80.
• 27:08
  Speaker 1: Okay.
• 27:09
  Speaker 3: So if you pay the same, you know, for 40
• 27:12
  Speaker 3: as you do for 80, get the 80, sure. And
• 27:14
  Speaker 3: then the next question that I get from patients is
• 27:16
  Speaker 3: on every sunscreen bottle, it's going to say reapply this
• 27:18
  Speaker 3: thing every two hours. I don't actually know anybody who
• 27:21
  Speaker 3: will reapply sunscreen every two hours because that's a lot,
• 27:24
  Speaker 3: especially if you're going to be outside all day. What
• 27:27
  Speaker 3: I tell patients is if you're not in the habit
• 27:29
  Speaker 3: of doing sunscreen, do it in the morning before you
• 27:32
  Speaker 3: go out and then do it again when you come
• 27:34
  Speaker 3: in for lunch. And then you get a lot of
• 27:36
  Speaker 3: the peak UV rays. And then hopefully if you're, If
• 27:40
  Speaker 3: you're truly going to be out all day until the
• 27:42
  Speaker 3: sun goes down, put it on again at dinner. But
• 27:46
  Speaker 3: for the vast majority of people, if you just get
• 27:48
  Speaker 3: a mineral sunscreen, moisturizer that you just put on in
• 27:51
  Speaker 3: the morning as part of your morning routine, you're getting
• 27:53
  Speaker 3: a lot of mileage out of that. And then if
• 27:55
  Speaker 3: you're going to be outside doing activities, come in for lunch,
• 27:57
  Speaker 3: put a little extra sunscreen on, and that's going to
• 27:59
  Speaker 3: do so, so much work.
• 28:01
  Speaker 1: Love it. Love it. So we talked about cleansers. We
• 28:04
  Speaker 1: talked about sunscreen. Let's talk about moisturizers for a bit.
• 28:07
  Speaker 1: Talk to us. There's Tico.
• 28:11
  Speaker 3: Moisturizers is a big one. There are a lot of
• 28:13
  Speaker 3: special moisturizers, lots of different ingredients.
• 28:15
  Speaker 1: I want you to talk about the Vaseline nighttime treatment.
• 28:19
  Speaker 1: I want you to go into all that.
• 28:21
  Speaker 4: Perfect.
• 28:21
  Speaker 2: Well, there's a lot of different types of moisturizers. I
• 28:24
  Speaker 2: personally tend to kind of mix and match a little bit.
• 28:27
  Speaker 2: There's some that are more like water-based that are more
• 28:30
  Speaker 2: of like a thinner jelly type or– just a little
• 28:35
  Speaker 2: bit less occlusive or less heavy, if you will. Those
• 28:38
  Speaker 2: are really, really great for people who are working out
• 28:41
  Speaker 2: a lot.
• 28:42
  Speaker 5: Maybe they don't like the.
• 28:43
  Speaker 2: Feel of heavier moisturizers, but I always like to sandwich
• 28:46
  Speaker 2: them with something that is a little bit heavier. CeraVe,
• 28:48
  Speaker 2: like I said, has a great range of different consistencies
• 28:52
  Speaker 2: and heaviness, depending on what you're liking. But I always
• 28:56
  Speaker 2: like to use the combination because we can use those
• 28:59
  Speaker 2: smaller molecules in our water-based hydrators is what They're kind
• 29:03
  Speaker 2: of more commonly known as to kind of penetrate deeper,
• 29:06
  Speaker 2: almost like a serum. And then we seal that hydration
• 29:09
  Speaker 2: in with like a heavier moisturizer. The slugging or that
• 29:13
  Speaker 2: Vaseline sensation.
• 29:16
  Speaker 5: Yes, definitely.
• 29:18
  Speaker 2: Yes, definitely more popular in Asian countries. But I love it,
• 29:22
  Speaker 2: especially for people who are trying retinols or retinoids. For
• 29:25
  Speaker 2: the first time, they can experience that dryness. I even
• 29:28
  Speaker 2: remember in Accutane, I was always just covered and I
• 29:31
  Speaker 2: was a very shiny girl.
• 29:33
  Speaker 1: Slug it up, baby. Slug it up.
• 29:35
  Speaker 2: However, if we're doing too much, right, anything if that
• 29:39
  Speaker 2: we're overdoing can eventually be a bad thing you know
• 29:42
  Speaker 2: you can get some milia around the eyes or something
• 29:44
  Speaker 2: like that if you're using products that are too heavy
• 29:46
  Speaker 2: maybe the skin isn't able to breathe the way it
• 29:48
  Speaker 2: should so having um you know, a day or two
• 29:52
  Speaker 2: a week that you're kind of dedicated to, like, you
• 29:55
  Speaker 2: know what, I'm not going to use any active ingredients,
• 29:57
  Speaker 2: nothing that's too exfoliating, and we're just going to put
• 29:59
  Speaker 2: some moisturizer on. And the tiniest little bit of Vaseline
• 30:02
  Speaker 2: or Aquaphor, Aquaphor is a little less occlusive. It's, I
• 30:06
  Speaker 2: think it's like 60% petroleum or something like that.
• 30:08
  Speaker 5: It's a little less.
• 30:09
  Speaker 3: It's got some lanolin.
• 30:10
  Speaker 2: Yeah, it's got some more breathability to it, if you will.
• 30:14
  Speaker 2: So that's really beneficial to apply at night to kind
• 30:16
  Speaker 2: of prevent trans-epidermal water loss. That sensation when we feel
• 30:21
  Speaker 2: it just a little drier in the mornings, it just
• 30:24
  Speaker 2: kind of creates that overnight mask in a really inexpensive way.
• 30:27
  Speaker 2: So I think it's a really beneficial thing for patients
• 30:29
  Speaker 2: to check in if they're feeling like they need that
• 30:32
  Speaker 2: extra hydration once or twice a week.
• 30:35
  Speaker 1: Yeah. So maybe a baby slug.
• 30:37
  Speaker 5: A baby slug. Exactly.
• 30:39
  Speaker 1: I mean, do you say like once a week you
• 30:41
  Speaker 1: should slug it up hard and then go gentle for
• 30:44
  Speaker 1: maybe a couple of times or not really?
• 30:45
  Speaker 5: I wouldn't say.
• 30:46
  Speaker 3: Depends on the patient.
• 30:48
  Speaker 1: Totally.
• 30:49
  Speaker 2: I think for most people, like the small amounts work great.
• 30:54
  Speaker 4: And, you know, you can always add more if.
• 30:55
  Speaker 5: You need it.
• 30:56
  Speaker 2: But again, it just kind of depends on the individual
• 30:58
  Speaker 2: and how they can tolerate it. Because I know that
• 31:00
  Speaker 2: the first time I did it, I grabbed like glob
• 31:02
  Speaker 2: of it and I just poured it put it all
• 31:04
  Speaker 2: over my face and I was like I don't know
• 31:06
  Speaker 2: how people do this you know I hated it I
• 31:09
  Speaker 2: remember like falling asleep and waking up and just seeing
• 31:12
  Speaker 2: like the oily stains on my pillows and I was
• 31:15
  Speaker 2: like what is happening here looking more into it I
• 31:18
  Speaker 2: was like oh less is more less is more yeah so.
• 31:22
  Speaker 3: So when we're dealing with certain situations like i recommend
• 31:25
  Speaker 3: vaseline for so many things just white petroleum jelly it
• 31:27
  Speaker 3: doesn't have to be the brand vaseline i like aquaphor
• 31:30
  Speaker 3: i like the cereve healing ointment i think those are
• 31:32
  Speaker 3: great that one's a good one um i recommend those
• 31:35
  Speaker 3: a lot for people who are dealing with with severe
• 31:38
  Speaker 3: dryness like we're talking eczema um eyelid dermatitis like there's
• 31:42
  Speaker 3: some areas um I've treated a lot of skin cancer
• 31:46
  Speaker 3: and a lot of surgical procedures, and I love white
• 31:48
  Speaker 3: petroleum jelly for wounds. I don't think you need anything fancy.
• 31:51
  Speaker 3: I've had patients who use Vaseline every day as their
• 31:54
  Speaker 3: general moisturizer, and they put a little bit on, and
• 31:56
  Speaker 3: they just put it all over, and they do fine.
• 31:58
  Speaker 3: And I've had other patients who use Vaseline one time,
• 32:00
  Speaker 3: and they have these huge breakouts because it's too occlusive
• 32:02
  Speaker 3: for them. So it kind of depends on the person.
• 32:05
  Speaker 5: Totally. And their environment, sorry.
• 32:07
  Speaker 3: And the environment, yeah. In Utah, we can get away
• 32:09
  Speaker 3: with it a little bit easier than you can in, like, Louisiana.
• 32:11
  Speaker 1: Yeah.
• 32:12
  Speaker 2: Yeah.
• 32:13
  Speaker 5: More humid places and stuff like that.
• 32:15
  Speaker 2: So if you're not careful too, a lot of people,
• 32:18
  Speaker 2: they do routines that are awesome and, or they have
• 32:21
  Speaker 2: skincare ingredients that are great, but maybe they're not using
• 32:24
  Speaker 2: them the right time of day. You know, I, they've
• 32:26
  Speaker 2: seen people who are like, well, after I work out
• 32:29
  Speaker 2: and I've sweat so much, I kind of feel dry.
• 32:31
  Speaker 2: So I just, you know, put some moist or put
• 32:33
  Speaker 2: some Vaseline on top of that. Well, now you're trapping
• 32:36
  Speaker 2: in your sweat and like the dirt and things like that.
• 32:38
  Speaker 2: So using products appropriately, um, and in the right time
• 32:41
  Speaker 2: definitely makes a difference too.
• 32:43
  Speaker 1: Teach us about those serums, the vitamin C and the
• 32:46
  Speaker 1: hyaluronic acid serums or whatever. Like talk to us about those.
• 32:49
  Speaker 3: When we're talking about moisturizers, the ingredients that I love,
• 32:53
  Speaker 3: I love ceramides.
• 32:54
  Speaker 5: Yes.
• 32:55
  Speaker 3: I love hyaluronic acid. I hardly ever use Vaseline for
• 33:00
  Speaker 3: my own face. I don't really need it. I don't
• 33:02
  Speaker 3: have a super dry skin type. I have lots of
• 33:04
  Speaker 3: people who do. I will use it on my feet
• 33:06
  Speaker 3: pretty regularly. My heels crack all the time. And so
• 33:08
  Speaker 3: I use Vaseline on my feet all the time. When
• 33:11
  Speaker 3: it comes to serums, the interesting thing about serums is
• 33:13
  Speaker 3: they have a lot of the same ingredients as the
• 33:14
  Speaker 3: moisturizers that we use. And you can jump into the
• 33:18
  Speaker 3: ingredients and serums that you like.
• 33:21
  Speaker 2: Well, first and foremost, I think it's also important to
• 33:23
  Speaker 2: remember kind of like the chemical structure, right? Serum, the
• 33:26
  Speaker 2: reason why serums work so well is because those molecules
• 33:28
  Speaker 2: are smaller. The consistency is a little bit, the viscosity
• 33:31
  Speaker 2: is a little thinner. So it can penetrate a little
• 33:33
  Speaker 2: bit deeper, which means that it's doing a little bit
• 33:35
  Speaker 2: of work way deeper down versus those moisturizers kind of
• 33:38
  Speaker 2: sit on the surface level. They still have benefits into
• 33:42
  Speaker 2: the skin, of course, but the serums are a little
• 33:44
  Speaker 2: bit more of a deeper treatment, if you will. So
• 33:48
  Speaker 2: vitamin C is a really good one. Antioxidant can help with,
• 33:51
  Speaker 2: you know, the dullness of the skin, fine lines and
• 33:54
  Speaker 2: wrinkles over time. But of course, it definitely has to
• 33:57
  Speaker 2: be formulated appropriately, has to be packaged appropriately because a
• 34:00
  Speaker 2: lot of people don't know that the sunlight and of course,
• 34:03
  Speaker 2: the way that it's packaged, if you're opening the container
• 34:06
  Speaker 2: a lot, oxygen is getting in there, then it no
• 34:08
  Speaker 2: longer becomes an antioxidant.
• 34:10
  Speaker 3: Vitamin, some of the ingredients are tricky. Vitamin C is
• 34:12
  Speaker 3: one of them. It's super, super basic and easy to get.
• 34:14
  Speaker 3: And I think we take it for granted a little bit.
• 34:16
  Speaker 3: But when you're putting it on your skin, the vitamin
• 34:18
  Speaker 3: C actually needs to be formulated and treated right. Companies
• 34:21
  Speaker 3: that know what they're doing will do like an airless
• 34:22
  Speaker 3: pump so that every time you pump it, you're not
• 34:24
  Speaker 3: introducing more air into the bottle. And so there are
• 34:28
  Speaker 3: some interesting considerations that you need It needs to be
• 34:30
  Speaker 3: an opaque bottle or it needs to be kept out
• 34:32
  Speaker 3: of the sun. It can't be a thing like a
• 34:34
  Speaker 3: dropper that you're like opening all the time. That's kind
• 34:37
  Speaker 3: of a bad design. That's kind of a bad design
• 34:39
  Speaker 3: for the bottle, actually.
• 34:41
  Speaker 2: And then that goes back into like what skincare ingredients
• 34:44
  Speaker 2: are worth it or what products are worth it, right?
• 34:47
  Speaker 2: If it's not formulated correctly or it's not packaged correctly,
• 34:50
  Speaker 2: you're just wasting your money and throwing it down the drain, right?
• 34:54
  Speaker 2: But skincare ingredients like hyaluronic acid, kojic acid, well, hyaluronic acid, again,
• 35:01
  Speaker 2: is really, really good for hydrating. Kojic acid is really
• 35:04
  Speaker 2: good for targeting that pigmentation in the skin. I recommend
• 35:08
  Speaker 2: it a lot to my darker Fitzpatrick types. to just
• 35:11
  Speaker 2: incorporate into their skincare routines because a lot of the
• 35:13
  Speaker 2: times they're typically the ones that end up having more
• 35:18
  Speaker 2: visible scarring and.
• 35:19
  Speaker 5: Stuff like that.
• 35:20
  Speaker 2: So if we already have something placed into their skincare routine,
• 35:23
  Speaker 2: that it kind of catches it before it can really
• 35:25
  Speaker 2: get too bad. So if they cut themselves or they
• 35:27
  Speaker 2: do end up scarring, it's not going to be as,
• 35:32
  Speaker 2: I guess, as prominent as maybe it could have been,
• 35:34
  Speaker 2: or maybe it'll be a little bit easier to treat.
• 35:36
  Speaker 2: Especially when you have patients that are darker Fitzpatrick types,
• 35:40
  Speaker 2: Coming in to get chemical peels or more intensive treatments, microneedling,
• 35:44
  Speaker 2: whatever it may be, there is a chance that maybe
• 35:49
  Speaker 2: they do scar from a peel or from whatever treatment.
• 35:52
  Speaker 2: So again, having those as a prep before they start
• 35:55
  Speaker 2: doing these treatments is going to be way more beneficial
• 35:58
  Speaker 2: to see those awesome results that people tend to see.
• 36:01
  Speaker 2: So yeah, I think serums are a really good option.
• 36:04
  Speaker 2: Do you need a serum in your routine? No, you
• 36:07
  Speaker 2: don't have to have it in order to have great
• 36:09
  Speaker 2: skin and stuff like that. But again, if it's in
• 36:12
  Speaker 2: the budget, if you're willing to actually put it on
• 36:14
  Speaker 2: and be consistent with it, then it's something that you
• 36:17
  Speaker 2: can look into.
• 36:17
  Speaker 3: And if there's a specific thing that you're trying to treat,
• 36:20
  Speaker 3: because usually with the serums, it's a serum with a
• 36:22
  Speaker 3: specific ingredient in it that is better at treating a
• 36:25
  Speaker 3: specific thing than other ingredients.
• 36:28
  Speaker 2: Sure.
• 36:28
  Speaker 1: Example for that?
• 36:29
  Speaker 3: So like vitamin C, somebody comes in and they want
• 36:31
  Speaker 3: to brighten their skin a little bit. They feel like
• 36:33
  Speaker 3: maybe they've got a little bit of discoloration from sun exposure.
• 36:38
  Speaker 3: Vitamin C is great for that. Also kojic acid, azelaic acid.
• 36:41
  Speaker 3: But I don't just recommend serums for everybody. I don't
• 36:43
  Speaker 3: think everybody needs vitamin C. Not everybody's dealing with that.
• 36:46
  Speaker 1: I keep telling my daughters this and they just keep
• 36:47
  Speaker 1: buying it. I'm just kidding.
• 36:50
  Speaker 3: I often have people come in and their skin looks fantastic,
• 36:53
  Speaker 3: but they've got like a 15-step routine. And I think
• 36:56
  Speaker 3: it's unnecessary. I'm a little bit of a minimalist. And
• 36:58
  Speaker 3: so I'm not saying that what they're doing is wrong.
• 37:00
  Speaker 3: Their skin looks good. But I think we could probably
• 37:02
  Speaker 3: simplify some things.
• 37:04
  Speaker 1: In the age of capitalism, there are places in this
• 37:10
  Speaker 1: society we live in that are emotional and vulnerable. And
• 37:12
  Speaker 1: this is one of them. And anytime you have emotions
• 37:15
  Speaker 1: and vulnerability in a space, it creates capitalist opportunistic situations
• 37:20
  Speaker 1: that are really because they're like, oh, my gosh, I'm
• 37:23
  Speaker 1: so scared. I need to try this and this and
• 37:25
  Speaker 1: this and this. And so what I'm hearing is there
• 37:27
  Speaker 1: is some gimmickry, even in the bottles, like they're just
• 37:31
  Speaker 1: poorly designed and there's silliness. That's really good advice. Just
• 37:35
  Speaker 1: Korean skincare guys, come on, come on. The Koreans are
• 37:37
  Speaker 1: genetic cheaters anyway. Like their skin is incredible.
• 37:41
  Speaker 3: And they have some really awesome- The playing field isn't level.
• 37:43
  Speaker 1: The playing field is not level.
• 37:44
  Speaker 2: They have some awesome ingredients, you know, but I think
• 37:47
  Speaker 2: it kind of comes back to, you know, the environment
• 37:50
  Speaker 2: that you're in, what you're willing to put on. And again, like,
• 37:54
  Speaker 2: Do we need to have this complicated routine? It all
• 37:57
  Speaker 2: just depends on the person for sure. But it's not
• 37:59
  Speaker 2: something that's necessary in order to have.
• 38:01
  Speaker 1: I want you guys to give me some hard and
• 38:03
  Speaker 1: fast because it would be so much easier. Right. I
• 38:06
  Speaker 1: will say. Keep it simple. This, this and this.
• 38:08
  Speaker 2: Yes.
• 38:08
  Speaker 1: In general, 95 percent of the time. Otherwise, we might.
• 38:12
  Speaker 3: I will say Asian cultures, the thing that they do
• 38:14
  Speaker 3: better than anybody else is sun protection.
• 38:17
  Speaker 5: Yes.
• 38:17
  Speaker 3: They do not sunbathe.
• 38:18
  Speaker 1: That's why all those visors and hats. I lived in
• 38:20
  Speaker 1: Taiwan for a couple of years and they're like, no
• 38:23
  Speaker 1: sun for me.
• 38:24
  Speaker 2: And I get all the weird looks, but I'm like,
• 38:26
  Speaker 2: catch me in 20 years. Catch me in 20 years,
• 38:28
  Speaker 2: you know.
• 38:29
  Speaker 1: With your visor.
• 38:30
  Speaker 2: Exactly. With my visor and I'll still keep it going.
• 38:32
  Speaker 2: I actually saw a picture of, I think it was
• 38:34
  Speaker 2: Anne Hathaway. And it was like her on a yacht
• 38:37
  Speaker 2: and she's wearing like a swimsuit that covers like up
• 38:40
  Speaker 2: to her wrists and ankles and stuff like that.
• 38:42
  Speaker 5: And you know what?
• 38:43
  Speaker 3: She wants to keep that. That skin screen ready.
• 38:45
  Speaker 1: Exactly.
• 38:45
  Speaker 2: And then she was seen on a red carpet and
• 38:47
  Speaker 2: I'm like, of course, like the results pay off. And
• 38:49
  Speaker 2: like Scott said, it's so much more, it's way easier
• 38:52
  Speaker 2: to be preventative and protect your skin than having to
• 38:55
  Speaker 2: treat it later down the road.
• 38:57
  Speaker 3: Doesn't that apply everywhere in primary care? Everybody is like
• 39:00
  Speaker 3: $ 1 of prevention is worth $ 7 of care. The same
• 39:03
  Speaker 3: is true in skin.
• 39:04
  Speaker 2: Yeah.
• 39:04
  Speaker 1: Yeah.
• 39:05
  Speaker 2: And I think it's funny because a lot of people
• 39:07
  Speaker 2: forget like, that your skin is like a barrier for
• 39:11
  Speaker 2: your body. Like, I don't know. I feel like people
• 39:13
  Speaker 2: are like, oh my gosh, like skincare is such a
• 39:15
  Speaker 2: foreign thing. It's such a weird, you know, and I'm like,
• 39:17
  Speaker 2: it's like you said, there's a lot of things that,
• 39:19
  Speaker 2: you know, you can do for your skin, like drinking water.
• 39:22
  Speaker 2: Drinking water is like the most necessary thing for your organs,
• 39:25
  Speaker 2: you know, but people don't really think of drinking water
• 39:27
  Speaker 2: associated with your skin a lot. And even then, like
• 39:30
  Speaker 2: if you drink a lot of water, your body's priority
• 39:32
  Speaker 2: is to keep yourself alive, right? And so drinking water
• 39:36
  Speaker 2: alone isn't going to give you nice, nice skin. It's
• 39:39
  Speaker 2: going to help, but you still need to cleanse your skin.
• 39:41
  Speaker 2: You still need to moisturize and wear your sunscreen too.
• 39:44
  Speaker 3: Everybody needs a cleanser. Everybody needs a moisturizer. Everybody needs
• 39:47
  Speaker 3: to protect their skin from UV in some manner. And
• 39:49
  Speaker 3: if it's not sunscreen, it's got to be, you know,
• 39:51
  Speaker 3: hats and sleeves and that's okay. Does everybody need a serum?
• 39:54
  Speaker 3: Probably not. But if there are some specific skin concerns
• 39:56
  Speaker 3: that you're dealing with, a serum can be a great option.
• 39:58
  Speaker 1: Totally.
• 39:58
  Speaker 3: It can be low cost. It can be very effective.
• 40:00
  Speaker 2: Yeah.
• 40:01
  Speaker 3: And there are lots of different ingredients to choose from.
• 40:04
  Speaker 3: And if you're very diligent and you know what resources
• 40:08
  Speaker 3: to look at for accurate data-driven skin care, then great.
• 40:14
  Speaker 3: It is possible to go figure it out, but it's very,
• 40:16
  Speaker 3: very difficult to look at social media, see what other
• 40:19
  Speaker 3: people are using and then know what it's for and
• 40:21
  Speaker 3: if it's right for you.
• 40:21
  Speaker 5: Totally.
• 40:22
  Speaker 1: That's a great prompting to like maybe avoid social media
• 40:26
  Speaker 1: for all medical things. Yeah. There's so much false news
• 40:30
  Speaker 1: out there. Oh, totally. It's the age of misinformation. It's
• 40:34
  Speaker 1: really tough. It's really tough.
• 40:35
  Speaker 3: There are some ingredients that are sort of are fads
• 40:39
  Speaker 3: like peptides right now are a huge deal orally as
• 40:42
  Speaker 3: well as topically. And there's a little bit of evidence,
• 40:45
  Speaker 3: but man, the biggest bang for your buck is stuff
• 40:49
  Speaker 3: that's been around for a long time.
• 40:50
  Speaker 2: Yeah.
• 40:51
  Speaker 1: Comedones, large pores, blackheads.
• 40:54
  Speaker 2: Yeah.
• 40:55
  Speaker 1: What kind of things can folks use for those kinds
• 40:57
  Speaker 1: of that kind of skin, like larger pores and lots
• 41:00
  Speaker 1: of blackheads?
• 41:00
  Speaker 3: Boily skin types, lots of blackheads.
• 41:02
  Speaker 1: Yeah.
• 41:03
  Speaker 3: A lot of that stuff is genetics driven. And so, unfortunately,
• 41:09
  Speaker 3: we're not into gene editing yet, or maybe fortunately. But
• 41:12
  Speaker 3: there are some pretty simple over-the-counter things that you can do.
• 41:16
  Speaker 3: I think that far and away the most value is
• 41:20
  Speaker 3: going to be a cleanser that has a gentle ingredient
• 41:24
  Speaker 3: like low-strength benzoyl peroxide. Salicylic acid I think is fantastic.
• 41:30
  Speaker 3: If you can't tolerate those, that's okay. Just get a
• 41:32
  Speaker 3: regular cleanser. But retinoids, retinol, retinoids.
• 41:36
  Speaker 2: Money.
• 41:37
  Speaker 3: You cannot beat the effectiveness, the cost effectiveness of those.
• 41:41
  Speaker 3: The products that I like over-the-counter, a lot of people
• 41:42
  Speaker 3: will get kind of pretty fancy retinols from different, like
• 41:45
  Speaker 3: in serums and stuff. I don't think you can do
• 41:48
  Speaker 3: better than just regular old adapalene gel over-the-counter.
• 41:52
  Speaker 5: Yeah.
• 41:52
  Speaker 3: You don't have to get a different brand, but just
• 41:54
  Speaker 3: adapalene gel, it's like 0.1%. I think that's a great
• 41:59
  Speaker 3: high-value product that you can get anywhere.
• 42:02
  Speaker 1: It's over-the-counter? Yep. Oh.
• 42:04
  Speaker 3: It didn't used to be, but it is now.
• 42:06
  Speaker 1: I didn't know. How long ago was that?
• 42:08
  Speaker 3: It's been several years now, but the higher strength, so
• 42:11
  Speaker 3: like the 0.3% is still prescription strength.
• 42:13
  Speaker 1: The tretinoin? Of adapalene. Adapalene, okay, gotcha.
• 42:17
  Speaker 3: Yep, so when we talk about retinoids, I feel like
• 42:20
  Speaker 3: this is a big thing that not a lot of
• 42:23
  Speaker 3: consumers understand. And to be honest, maybe not a lot
• 42:26
  Speaker 3: of providers who don't prescribe it all the time. Retinoids,
• 42:30
  Speaker 3: when we say retinoids, like that's a whole class of medications.
• 42:34
  Speaker 3: That includes things like Accutane. isotretinoin that you take orally.
• 42:37
  Speaker 3: It's super strong. We give similar medications like seriatine, tazeratine,
• 42:44
  Speaker 3: stuff like that for like systemically for tazeratine. I said tazeratine,
• 42:48
  Speaker 3: that's a topical one. There are several retinoids that you
• 42:50
  Speaker 3: can take orally that are prescription strength that are very
• 42:52
  Speaker 3: strong that we don't give to people for acne. Accutane
• 42:55
  Speaker 3: is an example that we give for acne, but you
• 42:57
  Speaker 3: can get them topically at prescription strength. Tretinoin is one.
• 43:00
  Speaker 3: Tazeratine is one. Adapalene is one. That's a synthetic one.
• 43:03
  Speaker 3: It's a little more stable in sunlight. It's kind of nice.
• 43:06
  Speaker 3: But you can get them over the counter. And the
• 43:07
  Speaker 3: confusing thing is that they come in a bunch of
• 43:09
  Speaker 3: different names. So like retinol is a retinoid. And you
• 43:13
  Speaker 3: put it on, you can get a different strength. But
• 43:15
  Speaker 3: when you get it over the counter, it's a pretty
• 43:16
  Speaker 3: low strength. Adapalene is a synthetic one. It's in the
• 43:19
  Speaker 3: same class. I think it's great. I think it's probably
• 43:23
  Speaker 3: cheaper and more effective than a lot of the fancy pants,
• 43:25
  Speaker 3: cosmeceutical retinol serums.
• 43:27
  Speaker 1: And they're cheaper than Mexico. Now, I went to Mexico
• 43:30
  Speaker 1: and I was pricing out some retinols and Good RX
• 43:34
  Speaker 1: use them, and you can get tretinoin for like $ 30 for, yeah,
• 43:37
  Speaker 1: really cheaper than a lot of the Mexican pumps.
• 43:39
  Speaker 3: Yeah, so they're— Used to be really expensive.
• 43:42
  Speaker 1: They used to be really expensive.
• 43:43
  Speaker 3: They can still be very expensive. When you get the
• 43:45
  Speaker 3: generic stuff, the tretinoin, I think it's very— I think it's
• 43:47
  Speaker 3: easy to manufacture. You've got to know how to use it, though.
• 43:51
  Speaker 3: Tretinoin specifically is UV unstable, so you put it on
• 43:54
  Speaker 3: in the morning, and I've had lots of patients come
• 43:56
  Speaker 3: in doing that. It's not effective. You walk out in
• 43:59
  Speaker 3: the sun, and it immediately denatures the molecule, and it's
• 44:01
  Speaker 3: not working. I don't know if this is the right
• 44:02
  Speaker 3: place to talk about it, but that's an interesting story
• 44:04
  Speaker 3: about when they were testing back in the, I don't
• 44:07
  Speaker 3: even think it was that long ago. I want to
• 44:09
  Speaker 3: say like the 70s or 80s when they were testing tretinoin. Theoretically,
• 44:14
  Speaker 3: they thought it was going to be this game changer
• 44:15
  Speaker 3: for acne. And when they were testing it, it didn't
• 44:17
  Speaker 3: work in any of the clinical trials. And the reason
• 44:20
  Speaker 3: was because it was coming, the manufacturer was providing it
• 44:22
  Speaker 3: in these clear bottles and it was just denaturing. And
• 44:26
  Speaker 3: then just by some quirk of manufacturing, just whatever was available,
• 44:29
  Speaker 3: they put it in opaque bottles one time and all
• 44:31
  Speaker 3: of a sudden it started to work. And they, I
• 44:34
  Speaker 3: think it was a good realization that they realized it
• 44:36
  Speaker 3: was unstable in UV light. But when tretinoin was being studied,
• 44:40
  Speaker 3: it didn't work at all when it was coming in
• 44:41
  Speaker 3: the clear bottles. And so when we put it on
• 44:43
  Speaker 3: in the morning, it's not working.
• 44:45
  Speaker 1: Right. Always at night. Yeah. Always at night. Yeah. That's good.
• 44:48
  Speaker 3: We always, I say always at night or before bedtime,
• 44:51
  Speaker 3: but that's, Kind of come back to burn me a
• 44:53
  Speaker 3: little bit on a couple of patients who work the
• 44:55
  Speaker 3: night shift. And when I said put it on before
• 44:56
  Speaker 3: you go to bed, they were putting it on in
• 44:57
  Speaker 3: the morning.
• 44:58
  Speaker 5: In the day, yeah.
• 44:59
  Speaker 3: Yep, yep, yep. And, you know, if they were sleeping
• 45:01
  Speaker 3: in a room and the window was open, that was ineffective.
• 45:04
  Speaker 3: And so just being aware of situational things like that
• 45:06
  Speaker 3: is important in certain cases.
• 45:09
  Speaker 1: Well, that's great. That's a great summary of a whole
• 45:11
  Speaker 1: bunch of other stuff. Anything else for skin stuff?
• 45:14
  Speaker 2: I would also say mandelic acid is a really big
• 45:17
  Speaker 2: one that's kind of made its way to a lot
• 45:20
  Speaker 2: of acne clinics that I've seen. It's a really, really
• 45:23
  Speaker 2: nice ingredient because it exfoliates, but it's also slightly more
• 45:26
  Speaker 2: hydrating than other ingredients, maybe like glycolic acid, or it
• 45:30
  Speaker 2: works a little bit stronger than salicylic acid.
• 45:34
  Speaker 4: So salicylic acid is also a good one that we
• 45:37
  Speaker 4: talked about.
• 45:37
  Speaker 2: I'm trying to think if there was another one that
• 45:39
  Speaker 2: I can think off the top of my head, but yeah,
• 45:41
  Speaker 2: I think just being more progressive, right? Again, we don't
• 45:44
  Speaker 2: want to be overly drying. So if you are using
• 45:46
  Speaker 2: a retinoid or anything like that, making sure that you're
• 45:48
  Speaker 2: on top of your hydration with a moisturizer either before
• 45:52
  Speaker 2: or after or both, you know, depending on what your
• 45:54
  Speaker 2: skin needs and not being afraid to take a break
• 45:58
  Speaker 2: for a day if you need to or a day
• 45:59
  Speaker 2: or two as you're starting off. Because a lot of people,
• 46:03
  Speaker 2: they'll go crazy. They wear every single night and some
• 46:06
  Speaker 2: people can tolerate that. But a lot of people who
• 46:08
  Speaker 2: are just barely starting out into like you know, skincare
• 46:11
  Speaker 2: and stuff like that, mostly can't. And again, you'll start
• 46:14
  Speaker 2: to see adverse reactions and people give up a little
• 46:17
  Speaker 2: bit too easily. You know, oh, it didn't give me
• 46:20
  Speaker 2: results in a day. It didn't give me results in
• 46:22
  Speaker 2: a week. So giving your skincare an opportunity to do
• 46:26
  Speaker 2: the work, you know, sometimes they say it can take
• 46:28
  Speaker 2: anywhere from a month to three months for those results
• 46:31
  Speaker 2: to start showing up.
• 46:32
  Speaker 3: My timeframe for results when I tell patients is six
• 46:36
  Speaker 3: to eight weeks. So when you're changing your skincare routine,
• 46:38
  Speaker 3: you're starting a new prescription, I am happy to see
• 46:41
  Speaker 3: you back in a month, but it may be too soon.
• 46:44
  Speaker 3: And if nothing is happening yet, we may just need
• 46:48
  Speaker 3: to give it more time. So my ballpark is six
• 46:50
  Speaker 3: to eight weeks. Typically, when you're changing your skincare routine,
• 46:52
  Speaker 3: starting a new prescription, it's very, very common in the
• 46:54
  Speaker 3: first two to three weeks to feel like things are
• 46:57
  Speaker 3: getting shaken up a little bit. You may get a
• 46:59
  Speaker 3: little bit of purging. And so you may have had
• 47:01
  Speaker 3: a lot of people give up in the first two
• 47:02
  Speaker 3: to three weeks because they feel like whatever the treatment
• 47:05
  Speaker 3: is that we're starting is making it worse, not better.
• 47:07
  Speaker 3: So we try to do a lot of education there.
• 47:10
  Speaker 3: Here's what to expect. Here's when I'm expecting to see results.
• 47:13
  Speaker 3: If we're not seeing results by this time point, let's
• 47:16
  Speaker 3: change something.
• 47:17
  Speaker 1: I love that. Yeah.
• 47:18
  Speaker 2: And I think the purging thing is something that people
• 47:20
  Speaker 2: get really nervous about having that initial breakout after starting
• 47:25
  Speaker 2: something new, because there's a lot of stuff that's already
• 47:27
  Speaker 2: been trapped in there, you know, and eventually it has
• 47:29
  Speaker 2: to come.
• 47:29
  Speaker 1: I made it worse and I quit after four days.
• 47:31
  Speaker 4: Exactly.
• 47:31
  Speaker 1: Yeah.
• 47:32
  Speaker 2: But that purging process, I think it's imperative to tell
• 47:35
  Speaker 2: new patients trying something new that you know, if we're
• 47:38
  Speaker 2: seeing a little purge breakout, not to fret, you know,
• 47:43
  Speaker 2: keep trying what you got to do. And then if
• 47:45
  Speaker 2: those breakouts persist and they continue to happen, then yeah,
• 47:48
  Speaker 2: there might be some, you know, tweaks that we need
• 47:50
  Speaker 2: to make into your routine. But that purging process is
• 47:53
  Speaker 2: necessary to get everything that's already been in there out. Yeah.
• 47:57
  Speaker 3: I love treating skin. I love helping people. I think
• 48:00
  Speaker 3: more people need to wear sunscreen. Be gentle with your skin.
• 48:04
  Speaker 5: Yeah.
• 48:05
  Speaker 4: And love yourself. I think, like I said, The skin
• 48:09
  Speaker 4: stuff can be so hard.
• 48:10
  Speaker 2: And I remember having someone close to me who had
• 48:14
  Speaker 2: never really dealt with acne before.
• 48:15
  Speaker 4: And all of a sudden, it started popping up all
• 48:17
  Speaker 4: over their back.
• 48:19
  Speaker 2: And they got a comment from one of their loved
• 48:21
  Speaker 2: ones that said, oh, like, look at you, pepperoni back
• 48:24
  Speaker 2: or something like that.
• 48:25
  Speaker 5: And they never wanted to go swimming anymore.
• 48:27
  Speaker 2: They never wanted to do like any, you know, no
• 48:29
  Speaker 2: tank tops or anything, you know. And it's such a
• 48:32
  Speaker 2: bummer that we have these things that come up on
• 48:33
  Speaker 2: our bodies that, you know, it can... It can ruin
• 48:36
  Speaker 2: your day just so fast. So just remembering that, like,
• 48:39
  Speaker 2: you know, you're on your own journey. And as long
• 48:41
  Speaker 2: as you love yourself the way that you are today,
• 48:42
  Speaker 2: acne and all, life's not going to be that bad.
• 48:46
  Speaker 5: You know?
• 48:46
  Speaker 1: I want to hug you right now, but I can't.
• 48:48
  Speaker 1: But we'll do it digital.
• 48:50
  Speaker 2: Okay.
• 48:51
  Speaker 1: That's beautiful. Thank you. Thank you guys so much for
• 48:53
  Speaker 1: joining me today. One last point I just want to
• 48:55
  Speaker 1: make about the peptides and skin. A lot of kids
• 48:58
  Speaker 1: are now messing around with like melanotan and stuff like
• 49:01
  Speaker 1: this and really, really dangerous and really not okay. I
• 49:05
  Speaker 1: talked to a dermatologist friend of mine not long ago,
• 49:07
  Speaker 1: actually on the podcast. And he's like, holy cow, like
• 49:11
  Speaker 1: we're in like the highest melanoma area in the nation.
• 49:16
  Speaker 1: Melanotan is just stimulating those melanocytes to grow.
• 49:19
  Speaker 2: So just.
• 49:20
  Speaker 1: Really setting you up for badness.
• 49:21
  Speaker 3: From what I understand about the data surrounding melanotan, I
• 49:26
  Speaker 3: don't think that we have hard data that taking melanotan
• 49:30
  Speaker 3: increases melanoma instances or susceptibility yet. I'm worried that it's
• 49:38
  Speaker 3: going to start to.
• 49:39
  Speaker 1: Well, it's not even approved.
• 49:41
  Speaker 3: It's not approved.
• 49:41
  Speaker 1: It's gray market. It's illegal. It's like experimenting in animals
• 49:45
  Speaker 1: and they're messing around with it in humans.
• 49:47
  Speaker 3: I think you're taking a huge, huge risk.
• 49:48
  Speaker 1: Just because there's no data doesn't mean that it's okay.
• 49:50
  Speaker 5: Right.
• 49:51
  Speaker 1: Yes.
• 49:51
  Speaker 3: So that's my, I'm a data-driven person and we don't
• 49:56
  Speaker 3: have that data yet. I'm worried that it's going to
• 49:58
  Speaker 3: come and then it's going to be too late for
• 49:59
  Speaker 3: a bunch of people who already took it. However, what
• 50:02
  Speaker 3: is for certain is when you take melanotan, you absolutely
• 50:06
  Speaker 3: stimulate melanocytes to create more pigment and And it changes
• 50:10
  Speaker 3: the appearance of some moles and it darkens the skin pigment.
• 50:14
  Speaker 3: That's what they're trying to do. But as a dermatology professional,
• 50:17
  Speaker 3: it makes it so much more difficult to identify melanoma.
• 50:21
  Speaker 3: That's one of the absolute biggest indicators of the long-term
• 50:26
  Speaker 3: outcome of the melanoma is going to be is how
• 50:29
  Speaker 3: early did we catch it and how far is it
• 50:31
  Speaker 3: spread already?
• 50:31
  Speaker 1: Yeah, totally.
• 50:32
  Speaker 3: Taking melanotan may do bad things in the future. But
• 50:37
  Speaker 3: in the near future, it's going to make it very
• 50:39
  Speaker 3: difficult to identify melanoma. And when we do, it may
• 50:41
  Speaker 3: be more progressed and the outcome may be worse. You
• 50:43
  Speaker 3: might need more treatment to get rid of it or
• 50:45
  Speaker 3: you might not be able to get rid of it.
• 50:47
  Speaker 3: I worry about melanotan. I don't know that it's worse
• 50:50
  Speaker 3: than just going out and getting in a tanning bed,
• 50:53
  Speaker 3: but I worry that it could be.
• 50:55
  Speaker 1: Yeah.
• 50:57
  Speaker 3: I don't recommend it.
• 50:59
  Speaker 1: And there's a reason. It's not approved.
• 51:01
  Speaker 3: I can't professionally recommend it, but I also personally don't
• 51:04
  Speaker 3: recommend it for a lot of practical reasons. But it's also...
• 51:08
  Speaker 3: Very experimental.
• 51:09
  Speaker 1: Yeah, super sketchy. Well, thank you guys. Sorry, didn't mean
• 51:12
  Speaker 1: to put that out there, a little side quest. But
• 51:15
  Speaker 1: I just think it's important for our kids to know, like,
• 51:17
  Speaker 1: don't mess with that stuff.
• 51:19
  Speaker 3: Like, do the spray tans, whatever. Do you have thoughts
• 51:21
  Speaker 3: on spray tans?
• 51:21
  Speaker 4: Oh, spray tans are fine. It's just a little..
• 51:23
  Speaker 3: I think spray tans..
• 51:24
  Speaker 2: Whatever.
• 51:25
  Speaker 4: But I think tanning boots..
• 51:26
  Speaker 1: I spray tan today.
• 51:27
  Speaker 5: Oh, there you go.
• 51:27
  Speaker 1: Nah, just kidding.
• 51:28
  Speaker 2: The tanning boots is where I really worry. Again, just
• 51:31
  Speaker 2: baking yourself. I always tell my clients that you are
• 51:34
  Speaker 2: a piece of bacon. If you go fry yourself... There's
• 51:37
  Speaker 2: not a way to unfry bacon.
• 51:39
  Speaker 1: Crispy, baby.
• 51:40
  Speaker 5: Crispy, yes.
• 51:41
  Speaker 2: But also, you're going to be leathery later. And a
• 51:44
  Speaker 2: lot of people come to us after the fact. How
• 51:46
  Speaker 2: can I fix my leathery skin? How can I fix
• 51:49
  Speaker 2: these wrinkles?
• 51:49
  Speaker 3: When we get a time machine, we'll be able to
• 51:52
  Speaker 3: go back and fix this.
• 51:54
  Speaker 2: Yeah.
• 51:54
  Speaker 1: Scary, scary.
• 51:55
  Speaker 2: Scary.
• 51:56
  Speaker 4: Protection is going to save you the most money at
• 51:59
  Speaker 4: the end of the day.
• 52:00
  Speaker 3: I support legislation for restricting minors having access to tanning beds.
• 52:06
  Speaker 3: I think it's actually a big, big deal that minors
• 52:09
  Speaker 3: can't smoke and they can't drink, but they can go
• 52:11
  Speaker 3: to a tanning bed.
• 52:12
  Speaker 2: Yeah.
• 52:12
  Speaker 1: Cook their bacon.
• 52:13
  Speaker 5: And again, most.
• 52:14
  Speaker 2: Of that damage, like long-term damage happens from when you're
• 52:18
  Speaker 2: a child, when you're growing up and you start to
• 52:20
  Speaker 2: get those intense sunburns as a kid.
• 52:22
  Speaker 4: I mean, it's where it all starts, you know?
• 52:25
  Speaker 1: Guys, where can folks find you? Tell us about your website.
• 52:29
  Speaker 1: Tell us how do they get a hold of Clear
• 52:31
  Speaker 1: Skin Utah.
• 52:32
  Speaker 3: Our physical office is on 800 North and Orem. Clear
• 52:34
  Speaker 3: Skin Utah is easy to find online. You can Google
• 52:37
  Speaker 3: search Clear Skin Utah and we'll pop up. Clearskinutah.com. When
• 52:41
  Speaker 3: you look up our office number, you can text the
• 52:43
  Speaker 3: office number. I think that's a big deal. I hate
• 52:44
  Speaker 3: calling companies. And if I can text somebody, that makes
• 52:47
  Speaker 3: access so much easier. We're trying to remove barriers. You
• 52:51
  Speaker 3: can find us on Instagram. You can find us on Facebook.
• 52:54
  Speaker 5: Clearskin, Utah for both of those two.
• 52:56
  Speaker 3: Clearskin, Utah.
• 52:57
  Speaker 2: Okay.
• 52:57
  Speaker 1: Well, we'll be sending some folks your way. I'm going
• 52:59
  Speaker 1: to send my son to come see you.
• 53:01
  Speaker 3: We're happy to see anybody. We do take some insurances,
• 53:04
  Speaker 3: but we also have very, very reasonable cash options. I
• 53:08
  Speaker 3: don't want money to be the reason that you can't
• 53:12
  Speaker 3: get help with your acne.
• 53:13
  Speaker 1: Sure.
• 53:14
  Speaker 2: Sure.
• 53:15
  Speaker 1: Well, thank you for joining me on the podcast. To
• 53:16
  Speaker 1: our listeners, I hope you learned some cool stuff as always.
• 53:19
  Speaker 1: And Don't forget to like and subscribe or just go
• 53:21
  Speaker 1: outside and hunt mushrooms because that's also very satisfying.