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All Skincare Great and Small with Dr. Adam Friedman · The Science of Skin

• 0:09
  SPEAKER_00: Hello and welcome to Skincare Confidential, the podcast supporting the Science of Skincare Summit.
• 0:15
  SPEAKER_00: My name is Dr.
• 0:16
  SPEAKER_00: Ted Lane.
• 0:16
  SPEAKER_00: I am a board-certified dermatologist and your co-host for today.
• 0:20
  SPEAKER_00: Patty Ferrist is my other co-host.
• 0:23
  SPEAKER_00: She is not available, but we have a wonderful guest with us, Dr.
• 0:28
  SPEAKER_00: Adam Friedman, everybody.
• 0:29
  SPEAKER_00: Dr.
• 0:29
  SPEAKER_00: Adam Friedman is the, I have to look at his bio because there's about 17 lines here.
• 0:35
  SPEAKER_00: So he is, of course, a board-certified dermatologist.
• 0:38
  SPEAKER_00: He's the professor, professor and chair of dermatology and the residency program director, the director of translational research, the director of supportive oncodermatology in the Department of Dermatology at George Washington School of Medicine and Health Sciences.
• 0:54
  SPEAKER_00: In addition, this is really important for what we're going to talk about today.
• 0:58
  SPEAKER_00: He is a member of the editorial board of Precision Nanomedicine.
• 1:03
  SPEAKER_00: Dr.
• 1:03
  SPEAKER_00: Adam Friedman, thank you so much for being with us.
• 1:06
  SPEAKER_02: Thanks so much, Dr.
• 1:08
  SPEAKER_02: Lane.
• 1:08
  SPEAKER_02: It's a pleasure to be here.
• 1:09
  SPEAKER_02: And thank you for keeping that short.
• 1:11
  SPEAKER_02: It's like one of the most awkward.
• 1:12
  SPEAKER_02: I'm sure you get this too.
• 1:13
  SPEAKER_02: Like in your conference, when someone's introducing you or like, just get to it.
• 1:16
  SPEAKER_02: Come on.
• 1:16
  SPEAKER_02: You did my time.
• 1:17
  SPEAKER_02: Yeah.
• 1:18
  SPEAKER_02: No, thank thank you so much.
• 1:19
  SPEAKER_02: I'm excited to be here.
• 1:21
  SPEAKER_00: So uh everybody, if you don't know Dr.
• 1:23
  SPEAKER_00: Friedman, he is uh just involved in so many things in dermatology.
• 1:28
  SPEAKER_00: Um one of the the things that I am uh kind of most proud of him for is all of the volunteerism that he does within dermatology and how he he really works with industry and with his residents to give back to the community.
• 1:42
  SPEAKER_00: And I I think you're a true leader in that.
• 1:45
  SPEAKER_00: One of the many aspects that you're a true leader in our in our space, Adam.
• 1:48
  SPEAKER_00: But in terms of giving back, it's really impressive.
• 1:51
  SPEAKER_00: It it can you give us just a an overview of what you're doing with your residents and and all the industry that you work with?
• 1:57
  SPEAKER_02: Yeah, I you know, uh it's amazing how when you have uh uh such a horrible situation like the pandemic, there could be so many silver linings.
• 2:04
  SPEAKER_02: And I think one of the major uh positives come out of that was being able to identify major areas of need in the DC area.
• 2:14
  SPEAKER_02: Um and from that, several programs emerged that are interconnected.
• 2:18
  SPEAKER_02: Um, one was establishing a free clinic, but a unique clinic in that it was its purpose was to provide care through telemedicine, but more importantly, educate uh a demographic in DC where there was no dermatologist, how to effectively use telemedicine to access uh dermologic care, specifically at GW.
• 2:38
  SPEAKER_02: Um and to your point about how do you do this effectively and how can industry play a role?
• 2:44
  SPEAKER_02: Well, uh industry is an incredible partner from grants to uh sponsorships and philanthropy because these things do not pay for themselves, obviously.
• 2:53
  SPEAKER_02: And especially when you think about taking time away and buying down time to step away from clinical duties that our revenue generates for a department, um, you need to be able to uh offset that as well as to really support the stakeholders, whether it be your community partners, um, various uh different resources to make these happen.
• 3:12
  SPEAKER_02: And so we've now are several years strong into this free clinic.
• 3:16
  SPEAKER_02: Um we'd actually just had one uh the other day at our partner, Pennsylvania Avenue Baptist Church, uh, where we're focusing on not just skin disease like psoriasis most notably, but atopic dermatitis as well.
• 3:28
  SPEAKER_02: We're also screening for comorbidities.
• 3:30
  SPEAKER_02: We're checking blood pressure, uh, finger sticks, as we know that these are systemic diseases and we're taking care of the skin piece, but we can't ignore the comorbidities.
• 3:39
  SPEAKER_02: Uh, and a part of this is also, once again, education.
• 3:41
  SPEAKER_02: So we have a health fair that's part of this.
• 3:43
  SPEAKER_02: We also have a medical student developed and really run an armed uh program called Learn to Derm, which is we have these free health fairs and school curricula where we go into schools and educate middle school and high school students about most notably, and I know you love this, skincare myths, of which there are too many to count, but also how do we make them ambassadors for their community to really bring good and basic information uh to really start things off with respect to good skincare?
• 4:08
  SPEAKER_02: And I'd love to say it's pure altruism, but it it's it's really some of the greatest highlights of my week.
• 4:13
  SPEAKER_02: So I get a lot out of it.
• 4:14
  SPEAKER_02: It's so much fun, and I think I learn a lot.
• 4:16
  SPEAKER_02: And I think I know our students and residents learn a ton uh doing these various activities on many levels.
• 4:22
  SPEAKER_02: So it is a a two a bi-directional uh benefit.
• 4:26
  SPEAKER_02: Um it really is such a wonderful thing, um, you know, and it's such a way to mix up your week as well.
• 4:32
  SPEAKER_02: So it's it's been great.
• 4:33
  SPEAKER_02: So I thank you for bringing that up.
• 4:35
  SPEAKER_00: Oh no, of course.
• 4:36
  SPEAKER_00: I mean, Adam, I think when I when I think of you and your career, the other thing that really pops up in my mind is how you have more than anyone I know been able to bridge academia and industry and being able to successfully work with both in a parallel fashion, although you integrate the two, but most don't, right?
• 4:54
  SPEAKER_00: Many of the academics that I speak with, and and this is not to to denigrate anybody in academia, I certainly have much respect, but most academics tend to focus on academics and don't don't tend to work with industry very well, and they certainly don't invite industry in to work with their residents.
• 5:10
  SPEAKER_00: And then those of us who are not in academia, yes, we enjoy our academic appointments, but by far we we spend more time with our work with industry.
• 5:17
  SPEAKER_00: You you have really been able to meld the two.
• 5:20
  SPEAKER_00: How did you do that?
• 5:21
  SPEAKER_00: And and was that something, was that a focus as you kind of joined GW from the very beginning?
• 5:26
  SPEAKER_02: So I I think I was I was fortunate not to be handed the keys to the kingdom, so to speak, coming out of residency.
• 5:32
  SPEAKER_02: And I'll explain why that's really important.
• 5:34
  SPEAKER_02: So um I trained at Albranstein College of Medicine.
• 5:36
  SPEAKER_02: I had an incredible experience, um, you know, chief of the vision who I literally take a bullet for, uh, Steve Cohen at the time, who's now at Cornell.
• 5:44
  SPEAKER_02: Um great training, but there really wasn't a lot of engagement with industry.
• 5:48
  SPEAKER_02: But being in the New York area, having colleagues at other institutions who were, um, and and really kind of having someone kind of facilitate that, which I think is really important.
• 5:56
  SPEAKER_02: You know, having someone be your inputsman and speak for you and kind of open those doors is important.
• 6:01
  SPEAKER_02: While many doors were open at Einstein, that piece really wasn't.
• 6:04
  SPEAKER_02: And I was really curious about what that looked like and what are the different opportunities to collaborate.
• 6:09
  SPEAKER_02: Um, at that time, a big focus for my career coming out of residency, I had a lab and getting funding for it.
• 6:16
  SPEAKER_02: And if anyone has tried to get NIH funding, uh, one knows that you get more pink slips than uh than white slips in terms of like getting rejections for God knows why.
• 6:25
  SPEAKER_02: And and so I looked at industry as a one of many mechanisms for accelerating our joint mission, but certainly for research.
• 6:32
  SPEAKER_02: But because I didn't have someone to like pass the baton to me, it really forced me to start at the ground level.
• 6:38
  SPEAKER_02: And that's really what I encourage going into, for example, meeting with reps, getting a coffee, just talking about dermatology without any expectation whatsoever, just to be able to meet people to show, um, starting with reps and then regional managers and pull in at the time, I think the term MSL didn't even exist, but whatever the MSLs were of that time, and just kind of meeting people.
• 6:58
  SPEAKER_02: I I will tell you, it took about five years of just giving my time and not having that expectation, being like, oh, you're on the clock, how much are you paying me for for this meeting?
• 7:08
  SPEAKER_02: Right.
• 7:09
  SPEAKER_02: Um, before someone came to me and said, Hey, we'd love for you to, we, you know, we love what you think, we love, we love, love your ideas, we'd love to have you part of the advisory board.
• 7:17
  SPEAKER_02: It took a while, but it actually ended up working out better because there wasn't this sense of um, you know, I was doing this for some, you know, underhanded reason or I had some unrealistic expectation.
• 7:31
  SPEAKER_02: Rather, and I would argue anyone who is interested in working with industry, you know, I think it's first and foremost important to show what is your mettle, what is your worth, what is your fund of knowledge.
• 7:40
  SPEAKER_02: You know, yes, coming out of a residency, we're all dermatologists and we're all dermatologists.
• 7:45
  SPEAKER_02: So, how do you set yourself apart?
• 7:47
  SPEAKER_02: And it starts with talking about your interests, what disease states, what areas, you know, you mentioned advocacy and community engagement.
• 7:52
  SPEAKER_02: You know, I think you can be a jack of all trades and have a lot of interests.
• 7:55
  SPEAKER_02: You can focus on one thing, but just share it and give your feedback, and then it will turn around and come back to you.
• 8:02
  SPEAKER_02: And so, in thinking about it, starting to meet people who could make those decisions about, oh, you're doing this wound healing animal model that could help us understand how this works, or um, you're doing this skin irritation model in mice.
• 8:15
  SPEAKER_02: We have this product that we claim helps with irritation, but we don't know how that works.
• 8:18
  SPEAKER_02: Can you help us?
• 8:19
  SPEAKER_02: And that's where these industry-sponsored um uh grants and and funds came for funding basic science research.
• 8:26
  SPEAKER_02: But then as I move town to GW, I will say that without the partnerships of industry supporting our educational programs, especially like grand rounds, crazy codachromes, um disease state specific conferences, they would not have happened.
• 8:44
  SPEAKER_02: You know, there's no, there's not this magical pot of money in in academia that, like, oh, you have an idea for an$80,000 conference.
• 8:51
  SPEAKER_02: Here you go.
• 8:52
  SPEAKER_02: Right.
• 8:53
  SPEAKER_02: Enjoy.
• 8:53
  SPEAKER_01: Yeah.
• 8:54
  SPEAKER_02: You know, so so I think that there are ways to partner that aren't dirty.
• 8:58
  SPEAKER_02: There are ways to partner that brings in rather than excludes.
• 9:03
  SPEAKER_02: And and I'll say that, you know, a lot of the a lot of the industry members who have attended those events, they learn a lot too.
• 9:09
  SPEAKER_02: So it everybody wins.
• 9:11
  SPEAKER_02: Um, and then scaling up to what you were mentioning about, you know, health fairs, free clinics, creating those relationships.
• 9:18
  SPEAKER_02: And they are, I think some of my closest friends in dermatology are on the industry side.
• 9:23
  SPEAKER_02: You know, we're all just one team.
• 9:24
  SPEAKER_02: I hate that mentality of like, ooh, industry over there, we're over here.
• 9:28
  SPEAKER_02: Um, we're all people, we all went into these different fields for the same reason to help people.
• 9:32
  SPEAKER_02: And we're all people, we all have families, we all friends, we all have lives.
• 9:35
  SPEAKER_02: And so opening yourself up to that, one, you'll have a lot more fun, especially at conferences, which I know.
• 9:40
  SPEAKER_02: I mean, we we've you you and I have gone out many a times, and we will not get into that.
• 9:44
  SPEAKER_02: This is PG 13.
• 9:45
  SPEAKER_02: We don't need to go beyond uh that that that simple description.
• 9:49
  SPEAKER_02: But I think that then opens the door to have conversations with people who can make the decisions to fund a half a million dollar uh clinical program, to give a sponsorship to a health fair.
• 10:02
  SPEAKER_02: Um, you know, it it doesn't happen overnight.
• 10:04
  SPEAKER_02: If you want to do these things, it takes investment and time.
• 10:07
  SPEAKER_02: And I think that sense of immediate gratification, just kick it to the curb.
• 10:10
  SPEAKER_02: It's just not gonna happen.
• 10:11
  SPEAKER_02: You've got to put the time in to get to this point.
• 10:13
  SPEAKER_00: Well, I totally agree.
• 10:14
  SPEAKER_00: And I think it speaks to the fact that our specialty, and I I've, you know, I've never been another specialist in another specialty before, so I can't really speak to it, but I know that ours in particular seems to be a relationship-based specialty where you know because especially in dermatology, we need industry in order to push our to push the science forward.
• 10:35
  SPEAKER_00: And it it is a very much a symbiotic relationship between the dermatologist and industry, and so I completely agree with you.
• 10:41
  SPEAKER_00: We need each other, and I think there's a way to have that relationship that where it feels very collegial, uh, and it feels both business-like and friendly, but not sleazy.
• 10:51
  SPEAKER_00: And I think that some people think of industry as being quote unquote sleazy, and I can tell you I have never experienced that in any of my conversations or um my you know, anything that I've done with industries, it has felt very up and up and above board and in in dermatology.
• 11:09
  SPEAKER_00: So um, but you know, thank you, Adam.
• 11:11
  SPEAKER_00: And and so I think we've kind of set the foundation of what you've done, uh, both for philanthropy purposes and how you've reached where you are in your career.
• 11:18
  SPEAKER_00: But it's interesting because, you know, I mentioned your you know, lots of what you do, but there's also this the skincare side, which is why you're, you know, in addition to being a buddy and in addition to being somebody that I really look up to, I think You just want to hang out?
• 11:32
  SPEAKER_00: I mean, I thought that's I know, I know, and but we don't need a podcast for that, Adam.
• 11:37
  SPEAKER_00: Really true.
• 11:39
  SPEAKER_00: Suburban.
• 11:42
  SPEAKER_00: You have um you have the skincare focus that you're working on as well, which really I believe started with your dad, right?
• 11:49
  SPEAKER_00: There was some research that started with your father.
• 11:51
  SPEAKER_00: Can you go through that?
• 11:52
  SPEAKER_00: I mean, we're talking about C BD today, guys.
• 11:54
  SPEAKER_00: I didn't even I haven't even mentioned cannabidiol at all.
• 11:58
  SPEAKER_00: Yeah, sorry.
• 11:59
  SPEAKER_00: I you know, I just didn't Adam and I enjoy talking to each other so much.
• 12:02
  SPEAKER_00: So um, so let's let's go through kind of what the relationship or what what the uh how your your focus on CBD started and and the the some of the research your dad did and how you've kind of carried on with it.
• 12:16
  SPEAKER_02: Yeah, so I I think um, and there's there's so many different places I want to start here, but um I think from a skincare perspective, from you know, the focus of uh you know for you and of course your your conference, um I have always been interested in in delivery vehicles by accident.
• 12:32
  SPEAKER_02: So um to go to the point about my father, so my father uh is a scientist, uh MD PhD, but never did residency, was like, I love science and that's it.
• 12:41
  SPEAKER_02: Um we were working together on uh actually uh a program for artificial blood, which you're like, well, where are we going with this?
• 12:49
  SPEAKER_02: And to create fake blood, you need to understand how hemoglobin will go from a non-oxygenated to an oxygenated state, which happens very fast because of cooperativity.
• 12:58
  SPEAKER_02: I know people are having like flashbacks to med school, like, oh my God, I never thought I had to think about this again.
• 13:03
  SPEAKER_02: Um, but because it happens so fast, you can't see it happen.
• 13:06
  SPEAKER_02: And so we were using this technology called sol, which I think a lot of people have heard about now because there is a variation of this that is utilized to deliver some common ingredients.
• 13:16
  SPEAKER_02: There are some uh FDA-approved drugs that incorporate this overall type of technology, but we were using it to trap this, you know, hemoglobin in various states as it transitioned from oxygen to nox and or back and forth.
• 13:29
  SPEAKER_02: And then looking at this, you know, thinking about my career as a clinician and at the time interested in dermatology, I was like, well, you can put a protein in this gel, things go in and out of it.
• 13:40
  SPEAKER_02: Why can't we put something that's clinically relevant or a medicine in it?
• 13:43
  SPEAKER_02: And can we figure that out?
• 13:44
  SPEAKER_02: So actually, I started with melanin because you can see it, you know, you can kind of follow it, you can quantify it.
• 13:50
  SPEAKER_02: You know, as that melanin would come out of these gels, you can use a spectrophotometer to see how much was there.
• 13:56
  SPEAKER_02: And so um, that also was part of how I even got interested in dermatology was oh, melanin's so cool.
• 14:02
  SPEAKER_02: We could do some kind of stuff with it.
• 14:03
  SPEAKER_02: Um, but then ultimately we had these gels, these gooey, wet, you know, jello-like things that you can mash up, I guess, but weren't really um palatable from an application standpoint.
• 14:14
  SPEAKER_02: And one day I was just like, you know, what if we dried it out?
• 14:16
  SPEAKER_02: What would happen if we threw in a lyophilizer and what a lifeline is?
• 14:19
  SPEAKER_02: It looks like this big device with these big um kind of jars and it sucks all the air out.
• 14:24
  SPEAKER_02: And I was expecting to get like a nugget, this like a black nugget.
• 14:27
  SPEAKER_02: And when I came back, it was a fine powder.
• 14:30
  SPEAKER_02: And I was like, that's weird.
• 14:31
  SPEAKER_02: What is this?
• 14:32
  SPEAKER_02: And I would argue it's those that's weird moments that really will set you on two paths.
• 14:38
  SPEAKER_02: One is that's weird and go on with life, or that's weird, what is that?
• 14:42
  SPEAKER_02: Let's figure it out.
• 14:43
  SPEAKER_02: That is science in a nutshell.
• 14:44
  SPEAKER_02: And so I went to our analytical imaging facility, I had them scan it with electromicroscopy, and sure enough, we had nanoparticles.
• 14:49
  SPEAKER_02: And now all of a sudden, I'm a nanotechnologist.
• 14:52
  SPEAKER_02: And so the next piece of advice I would give, which my father gave me, was if you're gonna be involved in a field, especially a lot of people don't know about it, know everything about it.
• 15:01
  SPEAKER_02: And so I was a med student at the time, I read prolifically about everything there was about nano, and there wasn't a whole lot, truthfully.
• 15:07
  SPEAKER_02: And so I really created this like layer-in-layer of kind of brand that I am a nanodermatologist.
• 15:15
  SPEAKER_02: And my research then incorporated everything nanotechnology and delivery of actives that we know about, but also using nano to stabilize things that are very difficult to deliver.
• 15:23
  SPEAKER_02: I mean, great example, vitamin C.
• 15:24
  SPEAKER_02: We know it's so difficult to deliver.
• 15:26
  SPEAKER_02: Um, gaseous molecules, you name it.
• 15:28
  SPEAKER_02: And so this started a career from roughly 2005 to 2015 at Einstein, working in a lab and evaluating many different technologies, incorporating nanotechnology to treat a whole host of things in mice.
• 15:42
  SPEAKER_02: Those, those very fortunate mice, skin infections, wound healing, you know, irritation models, you name it.
• 15:48
  SPEAKER_02: Now, to the CBD part, just like that surprise, you have nanoparticles, um, same thing, fell into it.
• 15:56
  SPEAKER_02: Didn't have this like Doc Brown moment of hitting my head on the, you know, on the toilet and seeing the flux capacitor.
• 16:03
  SPEAKER_02: Um, one of my former residents, Liz Robinson, who I'll definitely give a shout-out to, because it wouldn't have been for her, I would never have thought of any of this, came into my office one day, super excited, showing me a JID paper she published with the great Vicky Wirth, who is now actually a collaborator, um, using a synthetic cannabinoid uh in a preclinical model to suggest that it would be useful for dramatomycitis.
• 16:24
  SPEAKER_00: Perfect for inflammatory diseases.
• 16:26
  SPEAKER_00: Okay.
• 16:26
  SPEAKER_00: Yeah.
• 16:27
  SPEAKER_02: I was like, wow, who knew?
• 16:29
  SPEAKER_02: Like uh reefer madness.
• 16:31
  SPEAKER_02: That's awesome.
• 16:32
  SPEAKER_02: And and I'm talking to her, and she's like, yeah, you know, it's really great, but really hard to deliver topically.
• 16:37
  SPEAKER_02: And I was like, okay, I got something for that.
• 16:40
  SPEAKER_02: Let me read it in my back pocket.
• 16:42
  SPEAKER_02: And that's how it started.
• 16:44
  SPEAKER_02: And so we started working with different cannabinoids, seeing if we can encapsulate them, the particles, and we did.
• 16:49
  SPEAKER_02: We used fluorescence to show that they're getting in and penetrating the skin.
• 16:54
  SPEAKER_02: Um, and it's escalated from there.
• 16:55
  SPEAKER_02: And so we've explored different avenues.
• 16:57
  SPEAKER_02: You know, we have uh a nanoparticle formulation of anandomide, which is the endocannabinoid you and I are making right now for a lot of different reasons.
• 17:05
  SPEAKER_02: And we showed that we could treat an animal model, a mouse model, of lupus, of skin lupus, and that works really well.
• 17:09
  SPEAKER_02: We published this in experimental dermatology, but really the big leap, which no, not many have taken, is human studies, you know.
• 17:18
  SPEAKER_02: And and I know you you're very aware of the explosion of CBD products that hit the market once it became legalized with the farm bill.
• 17:26
  SPEAKER_02: All hype, no evidence.
• 17:28
  SPEAKER_02: Right.
• 17:28
  SPEAKER_02: And that hurt the field tremendously.
• 17:30
  SPEAKER_02: And this is not the first time it's happened where you get super excited, but no one takes the time to do the research, and then these fall short because probably they're not being delivered in the right concentration, the right way, or is it even CBD in there?
• 17:41
  SPEAKER_02: We know that a lot of these products don't even have what's written on the label.
• 17:44
  SPEAKER_02: There have been several papers on that.
• 17:46
  SPEAKER_02: So the goal here was to reinvigorate the space, light a fire under it, but also show in humans that there is a biological impact.
• 17:54
  SPEAKER_02: And so, talk about good timing here.
• 17:56
  SPEAKER_02: Our paper, our clinical trial that um I had the good fortune of working with Dr.
• 18:00
  SPEAKER_02: Brian Berman, who was a long-standing mentor, actually, uh I believe was uh my my father's roommate in college, talk about weird connections and dermatology brought us all back together again.
• 18:09
  SPEAKER_02: Um, we did a clinical trial of 19 individuals, internalized control, so each individual has their own control.
• 18:15
  unknown: Okay.
• 18:15
  SPEAKER_02: And we showed that nano, our nano CBD could prevent the expected DNA mutations and skin injury that ultraviolet aeration, when exposed, especially at higher doses, here three times the minimal thermal dose, we could prevent that injury.
• 18:30
  SPEAKER_02: Well, and this is inhuman.
• 18:31
  SPEAKER_02: So this is really a first ever kind of moment.
• 18:34
  SPEAKER_02: So I am so excited that we happened just to set this up.
• 18:37
  SPEAKER_02: You heard it here first with Dr.
• 18:43
  SPEAKER_02: Lane.
• 18:44
  SPEAKER_00: Finally, I get the I get it.
• 18:45
  SPEAKER_00: I get the first pitch.
• 18:46
  SPEAKER_00: Finally, awesome.
• 18:48
  SPEAKER_02: Okay.
• 18:49
  SPEAKER_02: Like check that off the bucket list.
• 18:52
  SPEAKER_02: Yeah, no, this the pay so the paper job was that little violin.
• 18:59
  SPEAKER_02: Yeah, you know, the the yeah, the the paper just uh posted online on Tuesday, so yesterday.
• 19:04
  SPEAKER_02: Uh 24 hours.
• 19:06
  SPEAKER_02: So this has been a culmination of three years.
• 19:09
  SPEAKER_02: Um, several generations of med student fellows.
• 19:12
  SPEAKER_02: I want to get, you know, Erica McCormick, who just matched at NYU Durm, um, really did the yeoman's work on this, and my Mosuzan fellows, Sarah Zim and Cleo Whiting, really carried over the finish line.
• 19:22
  SPEAKER_02: But like so many people were involved, and it takes a village to accomplish something not just difficult, but really kind of you know, new territory.
• 19:30
  SPEAKER_02: Like this is kind of been this hasn't been done before.
• 19:32
  SPEAKER_02: So really exciting.
• 19:33
  SPEAKER_02: And I thought once again, the big thing here is it sets the tone to do more.
• 19:38
  SPEAKER_02: We have so much work to do.
• 19:39
  SPEAKER_02: We're in it's it's in its infancy, and I think there's a lot of promise from the over-the-counter space, especially, let alone RX.
• 19:46
  SPEAKER_02: Um, we just need to know how to do it.
• 19:48
  SPEAKER_00: Yeah.
• 19:48
  SPEAKER_00: And do we know how it works?
• 19:50
  SPEAKER_00: Like, what's the mechanism of action in terms of uh protecting from the sun and making sure that we don't get those DNA mutations?
• 19:58
  SPEAKER_02: Yeah.
• 19:58
  SPEAKER_02: So I think you know, one one thing.
• 20:00
  SPEAKER_02: I definitely want to be clear this is not a replacement for sunscreen.
• 20:03
  SPEAKER_02: I, you know, someone mentioned that to me.
• 20:04
  SPEAKER_02: I'm like, no, no, no, no, no, no, definitely not.
• 20:06
  SPEAKER_02: Thank you for saying that.
• 20:07
  SPEAKER_02: What I'm looking at, because yeah, no, sunscreen is our greatest partner to prevent the harmful effects of both UVA and UVB.
• 20:15
  SPEAKER_02: Um, what it's more of, you know, it's funny, the way I thought about it initially is this is a oops type of product in that um you get exposed, maybe you didn't protect yourself well enough, you apply it after the fact.
• 20:26
  SPEAKER_02: Because that's actually kind of what we did here.
• 20:28
  SPEAKER_02: So individuals were applying this for a couple weeks, and then they were irradiated, no sunscreen, you know, irradiated three times their personal MED, mineral ethanol dose, and then they applied the product.
• 20:39
  SPEAKER_02: So this wasn't about blocking ultraviolet radiation, specifically UVA, but rather can we prevent and my guess, because CBD does a lot in our skin, I think it's important to kind of step back of how do cannabinoids even work in the human system.
• 20:53
  SPEAKER_02: Yeah, we're gonna talk about that for sure.
• 20:54
  SPEAKER_02: Yeah, you know, the the endocannabinoid system, which is our internal cannabinoid system, is comprised of three things the goods, what we make, like anandamide, which is what we studied for lupus, the receivers, and there are two historic receivers, CB1, CB2 receptors.
• 21:09
  SPEAKER_02: CB1 is in our nervous system, that's what THC binds to and makes us feel all right, all right, all right.
• 21:15
  SPEAKER_02: And then CBD binds to C B2, amongst other cannabinoids, and that's more the receptor for the immune system and inflammation.
• 21:24
  SPEAKER_02: And they sound kind of mutually exclusive, and that's not true.
• 21:26
  SPEAKER_02: We know there's actually a lot of overlap between, but even more complicated is we know cannabinoids can bind to G protein coupled receptors, of which there are tons.
• 21:35
  SPEAKER_02: And this is probably why something like CBD has so many activities and could, for example, influence itch or pain, even though it doesn't work on the central nervous system, because it can work through like vanillinoid receptors or gapapentinoid receptors, things like that.
• 21:52
  SPEAKER_02: Um, but I think in this case, my guess is the biggest impact is the fact that cannabinoids can activate the results.
• 22:00
  SPEAKER_02: Resolven pathway.
• 22:01
  SPEAKER_02: And the name really tells you everything you need to know.
• 22:04
  SPEAKER_02: The resolvin pathway is a system that shuts down inflammation and turns on repair.
• 22:11
  SPEAKER_02: We are so used to using things that are anti-inflammatory that block a signal, block a receiver, block one pathway, you know, in terms of maybe oral molecules or small molecule inhibitors.
• 22:21
  SPEAKER_02: This is different.
• 22:22
  SPEAKER_02: When you turn on the resolvent pathway, and it's been shown that cannabinoids combine to a particular G protein couple receptor that is a true resolvent receiver, a lot of different things happen.
• 22:33
  SPEAKER_02: Macrophases shift from the pro-inflammatory to kind of repair macrophages.
• 22:37
  SPEAKER_02: Neutrophils stop diapedesing out of the vessels into tissue.
• 22:41
  SPEAKER_02: Certain signals stop being made and kind of anti-inflammatory signals like IL-10 start being made.
• 22:47
  SPEAKER_02: So it's not like it's one particular thing.
• 22:50
  SPEAKER_02: Rather, it's a cacophony of activities that shut down inflammation and allow for repair.
• 22:56
  SPEAKER_02: And so what happens from UV radiation exposure?
• 22:59
  SPEAKER_02: Pro-inflammatory breakdown, upregulation of matrix metalloprotes that are just like yum yum yum yum, chopping away a connective tissue, and then inhibition or buildup.
• 23:09
  SPEAKER_02: CBD does the complete opposite of that.
• 23:11
  SPEAKER_02: So that's my guess.
• 23:12
  SPEAKER_02: So in this study, we more showed the effect.
• 23:16
  SPEAKER_02: We didn't really show to your point the exact mechanism because I think there are multiple.
• 23:22
  SPEAKER_02: And actually, it's funny you bring that up because I think that's what defines a JAD paper from a JID paper, in that JID is very interested in mechanism.
• 23:30
  SPEAKER_02: JAD is a clinical journal.
• 23:32
  SPEAKER_02: So we can propose multiple mechanisms based on decades of in vitro data.
• 23:38
  SPEAKER_02: I think it's probably a couple things, but at the end of the day, those couple things translate to a significant response, a significant protection with respect to preventing the DNA mutations we see in mitochondrial DNA, as well as uh keratinocyte cell death from UV exposure.
• 23:57
  SPEAKER_00: So it's interesting.
• 23:58
  SPEAKER_00: It's part of, I thought that you were going to say it's part of the prevent pathway.
• 24:01
  SPEAKER_00: When we think about antioxidants, we think about kind of the prevent pathway.
• 24:05
  SPEAKER_00: But with uh with the endocannabinoids, or the what you're talking about, it's really the repair pathway.
• 24:10
  SPEAKER_00: And so I wonder if there's an opportunity to combine those two ingredients as well and get an even you know higher response, although the resolvin pathway is not one that I'm familiar with, and so now I need to go do some research and learn about it.
• 24:23
  SPEAKER_00: Thanks for adding some some work on my uh plate, Adam.
• 24:26
  SPEAKER_00: You are so welcome.
• 24:28
  SPEAKER_00: But uh you know that's that's really amazing because again, in skincare now, we have a new pathway that we are targeting with a age-old ingredient that we never really understood, but of course has been used for generations and generations for its anti-inflammatory use.
• 24:43
  SPEAKER_00: I mean, you go to Colorado and all you find are are CBD, you know, balms and pastes and creams, which you know every patient in the Medicare population is smearing on their shoulders and knees.
• 24:55
  SPEAKER_00: So we know that there's an anti-inflammatory purpose, and what you're doing is is kind of elucidating the mechanism and and harnessing it for inflammatory diseases of the skin.
• 25:05
  SPEAKER_02: And to that point, um, there is even evidence that cannabinoids could be used for neoplastic disease, though I offer some caution because uh there is someone named Rick Simpson, and there's something called Rick Simpson oil, and um this uh wanted gentleman, because he is wanted by the authorities in the United States, um, pretty much said that his oil cures everything.
• 25:26
  SPEAKER_02: And that's a pretty dangerous statement.
• 25:28
  SPEAKER_02: And so do you have you have individuals who are treating cancer with their RSO, their Rick Simpson oil.
• 25:35
  SPEAKER_02: And while there is some in vitro data, so there is a paper showing that anandomide can, through different mechanisms, kill uh melanoma cells.
• 25:44
  SPEAKER_02: Um, there is some animal work, but that's about it.
• 25:46
  SPEAKER_02: You know, um actually there are a couple of journal of clinical investigation, JCI, like top-tier journals of animal models, myriam models of cancer using cannabinoids and synthetic cannabinoids, um, but that's as far as it's gone.
• 25:59
  SPEAKER_02: So we have to be careful about how we translate preclinical work to the human system because that could be very dangerous, and that's why this guy is um uh certainly a villain in the medical world.
• 26:09
  SPEAKER_02: Right.
• 26:09
  SPEAKER_02: Um so and that goes to a good point.
• 26:12
  SPEAKER_02: Vehicle matters, and somewhere Leon Kurtzik and I made fun of him the other day about this.
• 26:17
  SPEAKER_02: Somewhere he's like, who said that?
• 26:18
  SPEAKER_02: You know, because that's that's his trademarked line.
• 26:20
  SPEAKER_02: But it really does, especially with cannabinoids, because cannabinoids are big, they are lipophilic, they're gonna stay very superficial, maybe a little bit get through.
• 26:29
  SPEAKER_02: That's where nano delivery is so helpful.
• 26:32
  SPEAKER_02: And at a minimum, you break it down to scale, so to speak.
• 26:35
  SPEAKER_02: At the nanoscale, um, a these particles will sit more evenly on the skin, they'll have a higher resident transit time, meaning they'll sit on the skin longer.
• 26:43
  SPEAKER_02: So, at a minimum, you create a depot effect and kind of a gradient that pushes the CBD through, let alone the particles that can get through the hair follicle or even the skin itself.
• 26:51
  SPEAKER_02: So, how you deliver is so important.
• 26:53
  SPEAKER_02: You know, I would argue the the active ingredient is maybe 40% of the whole thing.
• 26:58
  SPEAKER_02: It's it's more about are you actually getting it to where it needs to be?
• 27:01
  SPEAKER_02: And that's where I think a lot of even pharmaceutical development, why these things cost so much money, especially our topicals.
• 27:06
  SPEAKER_02: Think about a lot of the topicals of late and their novel vehicles are probably more important than the novel active ingredient.
• 27:13
  SPEAKER_02: Right.
• 27:13
  SPEAKER_02: Yeah.
• 27:14
  SPEAKER_00: Yeah, it's interesting.
• 27:15
  SPEAKER_00: I think that skincare companies are focusing both on novel ingredients, but also how to deliver age-old ingredients.
• 27:22
  SPEAKER_00: We just did a podcast with uh Glowfarm, and they have a novel vehicle delivery system as well, and they've just put HA in there now, but of course the plans are to put other ingredients in there.
• 27:31
  SPEAKER_00: Just when you have a vehicle that can deliver, you really are open.
• 27:37
  SPEAKER_00: The entire ingredient list of dermatology is open to you, essentially.
• 27:41
  SPEAKER_00: And so if the world is your oyster, how do you focus and make the pearl?
• 27:45
  SPEAKER_00: And I think that's what you are.
• 27:47
  SPEAKER_00: You're really going novel delivery system, novel ingredient, and uh, you know, you're doing two things that are really interesting with with the work that you're doing.
• 27:56
  SPEAKER_02: I want to harp on something you just said, which is, I think, probably one of the most common downfalls of junior investigators, of early companies, in that if you have something that can do so much, spreading yourself too thin.
• 28:08
  SPEAKER_02: And and I I listen, I am a great example of that.
• 28:12
  SPEAKER_02: It's so easy to spread yourself thin.
• 28:14
  SPEAKER_02: But I think that if you are interested in coming up with something, if you want to be an inventor, you're working on something, and and and sky's the limit of applications, stay focused.
• 28:24
  SPEAKER_02: Diluting your efforts will, at the end of the day, undermine you.
• 28:27
  SPEAKER_02: Even if the greatest thing, you still got to get across the finish line.
• 28:29
  SPEAKER_02: So that that is such a good point.
• 28:31
  SPEAKER_02: The the best of ideas can be undermined by um, you know, uh invest in inventor ADHD.
• 28:38
  SPEAKER_00: Yeah.
• 28:39
  SPEAKER_00: Adam, you you work a lot.
• 28:41
  SPEAKER_00: I want to just pivot now because you work a lot in oncodermatology, and we have not, in on this podcast, we have not focused on oncodermatology.
• 28:48
  SPEAKER_00: Um, can you kind of explain that field to us?
• 28:51
  SPEAKER_00: And I know there's a lot of work being done, especially by some French skincare companies, on on uh on that, and so I'd I'd love to kind of hear about that from you.
• 29:00
  SPEAKER_02: Yeah, so supportive oncodermatology, I guess, would still kind of be considered fledgling, a term coined by Mario Lacateur, uh, who is uh a mentor and friend of mine in New York.
• 29:10
  SPEAKER_02: And and the idea here is simple is that with especially the advanced therapies that are life-saving, but even historic chemotherapies, there are expected hair, skin, and nail side effects that are so disabling that some patients won't even pursue treatment.
• 29:24
  SPEAKER_02: Um, and let's wrap our head around that, that the dermatologic complications of a life-saving drug will actually win the day and prevent them from getting care.
• 29:34
  SPEAKER_02: And so what has been developed is this field where we're focusing on how do we educate, how do we prevent first and foremost, but also how we treat when these things come up.
• 29:43
  SPEAKER_02: And with the litany of new targeted therapies, immunotherapies, small molecule inhibitors, um, you know, every day there's a new side effect that really comes up.
• 29:50
  SPEAKER_02: I mean, not that frequent, but you you get the gist.
• 29:52
  SPEAKER_02: Get the idea.
• 29:53
  SPEAKER_02: So, so um, it's really fun.
• 29:55
  SPEAKER_02: And and I I can't take credit for you know being like, oh, this is a great idea.
• 29:58
  SPEAKER_02: You know, Beth McClellan, who's now the chief of dermatology at Einstein, uh, who actually came over when I was still there, this was her thing, her area.
• 30:07
  SPEAKER_02: I'm like, wow, this is really cool.
• 30:09
  SPEAKER_02: No one knows what on earth they're doing, and there's so many things to learn and figure out.
• 30:13
  SPEAKER_02: And then I left.
• 30:14
  SPEAKER_02: I remember her being like, great, you just brought me in and now you're leaving.
• 30:16
  SPEAKER_02: Thanks for that, Adam.
• 30:18
  SPEAKER_02: And I come down to GW and they had a huge focus on the cancer center.
• 30:22
  SPEAKER_02: I was like, well, as a new program director and kind of a building department, you got to go where the money is, you gotta go where the focus is.
• 30:28
  SPEAKER_02: So I'm like, how do I be, you know, work in the auspices of the cancer center doing something unique and support of onchodermatology was it.
• 30:35
  SPEAKER_02: And so that's where we really grew.
• 30:37
  SPEAKER_02: And to kind of circle back to the industry partnership, um, LaRoche Posey, who I've had the pleasure of working with for a long time, and the first point of contact was actually through their grant program, um, which they have every year, which I'd recommend any resident or someone a year or two out, and you have a research idea that needs a couple bucks to get off the ground.
• 30:55
  SPEAKER_02: Very low-hanging fruit, ladies and gentlemen.
• 30:57
  SPEAKER_02: Um, really, really uh a great opportunity.
• 31:00
  SPEAKER_02: Um, you know, I received this as a second-year resident and literally locked my claws in them.
• 31:05
  SPEAKER_02: I'm like, um, we're gonna be friends for life, guys.
• 31:07
  SPEAKER_02: And, you know, now we are.
• 31:08
  SPEAKER_02: And so I've been lucky, you know, folks like Tyler Steele and G.
• 31:11
  SPEAKER_02: Cologne, who I've known for a really long time.
• 31:14
  SPEAKER_02: Um, you know, Tyler has a unique interest in this area.
• 31:17
  SPEAKER_02: LaRoche Posey has a unique interest in the area.
• 31:20
  SPEAKER_02: Actually, in Europe, they have uh a hospital that people go to that insurance pays for um to really uh use thermal spring waters to mitigate and treat some of these consequences.
• 31:30
  SPEAKER_02: And this is nuts.
• 31:31
  SPEAKER_02: Actually, insurance is there will pay for consultations with cosmetic camouflage artists and nurses to give guidance on how to manage these side effects.
• 31:40
  SPEAKER_02: So we are way behind here.
• 31:42
  SPEAKER_02: It's unbelievable.
• 31:43
  SPEAKER_00: Yeah.
• 31:44
  SPEAKER_02: We could do so much better.
• 31:46
  SPEAKER_02: And, you know, in in seeing that there's such a need, and there's you know, you always need funds to get things going.
• 31:51
  SPEAKER_02: We partner with Lorsch Pose, and they've been giving us um unrestricted funds to support this program, support research.
• 31:57
  SPEAKER_02: You know, we published several papers um on this subject matter.
• 32:01
  SPEAKER_02: Um, and so we have this great partnership where we also can get patient suffering free over-the-counter products.
• 32:07
  SPEAKER_02: You know, yes, there are prescription therapies that we know can be useful depending on the eruption.
• 32:11
  SPEAKER_02: Um, but at the centerpiece, probably of all chronic diseases or inflammatory diseases, even temporary ones, good skin care is at the root.
• 32:20
  SPEAKER_02: You can do all this other fancy bells and whistles.
• 32:22
  SPEAKER_02: If you are not doing the basics, gentle cleansing, if at all, moisturizer damn skin and purposeful moisturizer selection, it's for naught.
• 32:30
  SPEAKER_02: And so being able to provide, especially under served patients who have limited means, um, you know, substantial samples really is very impactful.
• 32:40
  SPEAKER_02: Um, and it certainly has grown.
• 32:42
  SPEAKER_02: Actually, taking it now several years forward, we are now running, we're a site for a clinical study on a topical agent that is targeting the papilloplus eruption of EGFR inhibitors, um, which is actually a discovery that was made at EW, had nothing to do with just randomly at EW licensed to HOF therapeutics, and now it's in phase three studies, which we are are one of the sites for.
• 33:06
  SPEAKER_02: And it would, if it comes to fruition, will be the first FDA-approved therapy for this side effect of a really heavily used uh class of medications.
• 33:16
  SPEAKER_02: That's um so so that speaks to another kind of way to interface with industry, um, doing, you know, being a site for a phase three.
• 33:22
  SPEAKER_02: So I know I know you do a lot of clinical trials, um, but also at the same time, uh, starting from scratch and suggesting studies.
• 33:29
  SPEAKER_02: And once again, LaRoche Passai has supported investigator-initiated research, um, both for myself, but also for medical students working with me, which can really make a very big difference in terms of the trajectory to getting into dermatology, having mentored projects, publications, and and at the end of the day, it it does cost money and we shouldn't expect students just to take the hit.
• 33:49
  SPEAKER_02: And so that's another great way to partner with industry to really provide support for the next, next generation of dermatology as well.
• 33:58
  SPEAKER_00: Yeah, thanks, Adam.
• 33:59
  SPEAKER_00: I mean, uh, I didn't realize that Pharma was getting involved in actually dealing with the the adverse effects of the novel treatments for the skin, which is amazing and it shows the investment that's you know being made.
• 34:12
  SPEAKER_00: I remember early in my career, we when we these first these types of treatments first started becoming available, we would see these patients and there wasn't much data out there, and we would treat them like we would treat other papillar postural uh eruptions or um sebereic-like eruptions, you know, and just kind of try everything.
• 34:30
  SPEAKER_00: But now there's so much data on it, and there's a lot for us to learn.
• 34:35
  SPEAKER_00: Uh, and so I would I would tell dermatologists out there in residents, if you are interested in this field, there is a lot of data now.
• 34:41
  SPEAKER_00: There's a lot of publications as Dr.
• 34:42
  SPEAKER_00: Friedman was talking about, and and and you can educate yourself as to the best ways to really support these patients.
• 34:49
  SPEAKER_00: Because as you said, you know, this can be a rate-limiting step in their treatment.
• 34:53
  SPEAKER_00: Uh, as you can imagine, they become they can become very uncomfortable, and they can really limit how how the the dosing and the frequency and whether they can even be on these medications, which could be life-saving or not.
• 35:04
  SPEAKER_00: So thank you for that.
• 35:05
  SPEAKER_00: And I can't believe it, but we reached the end of our time already.
• 35:09
  SPEAKER_00: Already?
• 35:10
  SPEAKER_00: Already.
• 35:10
  SPEAKER_00: I know, I know.
• 35:11
  SPEAKER_00: Well, um, everyone, thank you so much for for listening.
• 35:14
  SPEAKER_00: Um, my name is Dr.
• 35:15
  SPEAKER_00: Ted Lane.
• 35:16
  SPEAKER_00: I have been interviewing Dr.
• 35:17
  SPEAKER_00: Adam Friedman, uh, the chief of dermatology, the chair at at um George Washington University.
• 35:25
  SPEAKER_00: Uh, please, if you enjoyed the podcast, please share it, download it, and of course subscribe to Skincare Confidential.
• 35:31
  SPEAKER_00: And thank you.