Latest / The Science of Skin / Dr. Pearl Grimes: Treating pigmentary disorders.

Transcript

Dr. Pearl Grimes: Treating pigmentary disorders. · The Science of Skin

• 0:09
  SPEAKER_01: Hi, I'm Dr.
• 0:10
  SPEAKER_01: Patty Ferris.
• 0:11
  SPEAKER_01: I'm a board certified dermatologist, and I'm your host for this episode of Skin Care Confidential.
• 0:16
  SPEAKER_01: As a reminder, Skin Care Confidential is an offshoot of our medical meeting, the Science of Skin Care Summit, which we're going into year four on.
• 0:25
  SPEAKER_01: We're super excited because we're going to be in Austin, Texas again this year, November the 8th through the 10th.
• 0:30
  SPEAKER_01: We'll be at the Fairmont Hotel, and the Science of Skin Care Summit is for all healthcare professionals interested in learning about the science behind topical skin care and how to best utilize these products in your practice.
• 0:42
  SPEAKER_01: We also have a special esthetician track we're excited about.
• 0:45
  SPEAKER_01: This is year two for that, and that'll be on Saturday, November the 9th.
• 0:49
  SPEAKER_01: So November 8th through the 10th.
• 0:51
  SPEAKER_01: And if you're interested, check us out at Science of Skincare Summit.com.
• 0:55
  SPEAKER_01: So I am really excited today to invite my dear friend and colleague, Dr.
• 1:01
  SPEAKER_01: Pearl Grimes.
• 1:02
  SPEAKER_01: Dr.
• 1:02
  SPEAKER_01: Grimes is the founder and director of the Vitiligo and Pigmentation Institute of Southern California and the Grimes Center for Medical and Aesthetic Dermatology.
• 1:11
  SPEAKER_01: She is without a doubt a pioneer and a leading key opinion leader on vitiligo and pigmentary disorders.
• 1:18
  SPEAKER_01: She's a clinical researcher and a highly sought-after speaker, and we've shared podiums and been around the world together speaking on subjects from pigmentation to topical skincare.
• 1:29
  SPEAKER_01: She's got all the expertise we need for this particular podcast.
• 1:33
  SPEAKER_01: She's published 175 articles, abstracts, and two textbooks, including one that you're very well known for, which is aesthetics and cosmetic surgery for darker skin types.
• 1:44
  SPEAKER_01: And that's used by dermatologists and plastic surgeons all over the world.
• 1:47
  SPEAKER_01: She's a member of all the good societies and has received so many accolades and awards.
• 1:52
  SPEAKER_01: I can't even read those all.
• 1:53
  SPEAKER_01: Or we take up all the time on the podcast, girl.
• 1:56
  SPEAKER_01: I want to talk to you about some of your philanthropic ventures at the end.
• 1:59
  SPEAKER_01: So I'm going to save those for later.
• 2:03
  SPEAKER_01: But let's just jump into it because we're going to talk about pigmentation, hyperpigmentation, and hypopigmentation, specifically vitiligo, a little bit later.
• 2:12
  SPEAKER_01: But last year you published an interesting paper that was up, was meant to update the Fitzpatrick uh classification of skin color.
• 2:20
  SPEAKER_01: And you published this with Bill Coleman and Kanvita Marijuala, and you proposed a new scale that was called the skin of color and ethnicity scale.
• 2:29
  SPEAKER_01: So, what prompted y'all to look at Fitzpatrick skin typing and how does your scale differ from what we traditionally use?
• 2:36
  SPEAKER_00: So, so Patty, that's a great question.
• 2:39
  SPEAKER_00: You know, several years ago, Bill Coleman approached me and he said, Pearl, we're getting all these articles in the journal, and we're struggling with whether or not we should use Fitzpatrick's scale, whether or not we should use race, ethnicity.
• 2:59
  SPEAKER_00: So we need a common scale that is relevant for all skin types.
• 3:07
  SPEAKER_00: Certainly from a historical perspective, if we go back to 1975-76, when Fitzpatrick, our revered Dr.
• 3:17
  SPEAKER_00: Fitzpatrick, proposed his scale.
• 3:20
  SPEAKER_00: It was not proposed or meant to be used for how we use it today.
• 3:26
  SPEAKER_00: He really proposed that scale for use in PUVA therapy, uh, for sensitivity to ultraviolet light and dosing with oral soral and photo chemotherapy.
• 3:42
  SPEAKER_00: So as time evolved, Fitz's scale became a proxy scale for classifying all skin types.
• 3:52
  SPEAKER_00: Right.
• 3:52
  SPEAKER_01: And it's used widely in research.
• 3:54
  SPEAKER_00: Yes, there's no question about it.
• 3:57
  SPEAKER_00: It really is our global scale.
• 4:00
  SPEAKER_00: Now, why has it evolved as the global scale?
• 4:04
  SPEAKER_00: I think one key reason is it's so easy to use.
• 4:08
  SPEAKER_00: But we, as clinicians and researchers, we've come to understand the good about fits is scale, the ease of use, but we also know the negatives.
• 4:21
  SPEAKER_00: While there is a consensus that it's a pretty good scale in classifying skin types for your lighter shades of pigment and using fits is scale, your individuals with skin types one, two, or three.
• 4:35
  SPEAKER_00: But when we get into skin of color, that's when the rubber hits the road.
• 4:41
  SPEAKER_00: And we know that it's not so great at classifying your darker skin types.
• 4:47
  SPEAKER_00: So Bill Cavita and I, we asked several questions.
• 4:52
  SPEAKER_00: Should we keep fits and scale?
• 4:54
  SPEAKER_00: Okay.
• 4:55
  SPEAKER_00: Because it's easy.
• 4:56
  SPEAKER_00: Should we should we modify it?
• 4:59
  SPEAKER_00: So after much deliberation and consulting with other physicians, we decided, why throw the baby out with the bathwater?
• 5:09
  SPEAKER_00: Why not try to fix it?
• 5:12
  SPEAKER_00: And in fixing it, this is what we did.
• 5:16
  SPEAKER_00: We added ancestral classifications.
• 5:20
  SPEAKER_00: What is your what is your your family origins?
• 5:24
  SPEAKER_00: Then we looked at how the individual ages, how do they scar?
• 5:31
  SPEAKER_00: How do they, what is the tendency for the propensity for hyperpigmentation?
• 5:37
  SPEAKER_00: So we included that, which I think is really important for cosmetic procedures, uh, whether or not, you know, your reactivity to procedures.
• 5:50
  SPEAKER_00: And then we decided we needed to expand skin types four.
• 5:56
  SPEAKER_00: We we expanded it to a 4A, 4B because it needed to be broader, and we expanded 5A, 5B, we left skin type 6.
• 6:08
  SPEAKER_00: So we we felt that that would be a broader scale with more relevance for day-to-day practice.
• 6:16
  SPEAKER_00: Now, having said that, there are many groups now looking at modifying or changing, developing even newer scales for skin type classification.
• 6:33
  SPEAKER_00: If you asked me where are we going in the future, I think the future will involve an AI colorimetry scale that becomes totally objective.
• 6:45
  SPEAKER_00: I think it will be a device-driven methodology of classifying skin types, or it may be a combination, but we're not there yet.
• 6:56
  SPEAKER_00: But that was that that was our basis for using for expanding Fitz's scale rather than tossing it out.
• 7:07
  SPEAKER_00: And I think that wherever we go in classifying skin type, it has to be easy, otherwise, our colleagues become patriots, will not engage it and they will not use it.
• 7:23
  SPEAKER_01: Yeah, well, that was a lofty goal because you're right, it it could use some clarification, especially with darker skin types.
• 7:32
  SPEAKER_01: And sort of in the same vein, you know, hyperpigmentation is such a huge problem.
• 7:37
  SPEAKER_01: And as you mentioned, the propensity for it is so important for us to know.
• 7:41
  SPEAKER_01: We've all been fooled, that's for sure, by patients you don't think are going to hyperpigment, and then they do.
• 7:47
  SPEAKER_00: Absolutely.
• 7:48
  SPEAKER_00: And that's one reason, Patty, ancestry is so important too.
• 7:53
  SPEAKER_00: So wherever we go, I don't I don't think anything replaces just being that good doctor who gets a little bit of, yeah, gets a little bit more information.
• 8:04
  unknown: Exactly.
• 8:06
  SPEAKER_01: That's so true.
• 8:07
  SPEAKER_01: Let's talk about starting with hyperpigmentation.
• 8:11
  SPEAKER_01: And like I said, we'll go to Vitilago.
• 8:13
  SPEAKER_01: Let's start with talking about how you approach your patients with darker skin types, particularly, you know, those with the skin types four and five.
• 8:22
  SPEAKER_01: When it comes to photoprotection, we've talked interestingly enough to some of the formulators and they've talked to us about how they're really looking at being very keen on looking at this group.
• 8:32
  SPEAKER_01: But how do you approach it as a clinician?
• 8:35
  SPEAKER_01: What do you advise your patients to use to protect their skin from solar radiation?
• 8:40
  SPEAKER_00: So, well, how do I advise my skin of color, my fours, fives, and my sixes?
• 8:47
  SPEAKER_00: So, for all of those groups, I clearly recommend photoprotection.
• 8:53
  SPEAKER_00: Certainly, if I again if I speak from a historical perspective, I think we have moved forward.
• 9:01
  SPEAKER_00: If I look at where we were five or 10 years ago with my skin of color patients and sunscreen use at where we are now, I think we have made substantial inroads in getting our skin of color patients to use sunscreens.
• 9:17
  SPEAKER_00: Right now, however, there are some interesting, I have I have several groups of patients.
• 9:23
  SPEAKER_00: One group will come in and they'll tell me, Oh my God, I'm gonna get skin cancer.
• 9:28
  SPEAKER_00: So I'm using my sunscreen every day.
• 9:31
  SPEAKER_00: Can you check me for those molds?
• 9:33
  SPEAKER_00: And my response is, okay, let's tease it out.
• 9:37
  SPEAKER_00: There are probably other things you're gonna get before you get skin cancer.
• 9:42
  SPEAKER_00: So you might, but it's less likely.
• 9:46
  SPEAKER_00: So let's tease out why it's important for you to use sunscreens.
• 9:53
  SPEAKER_00: So I walk them through how darker skin types age versus lighter skin types.
• 10:01
  SPEAKER_00: And when we age, there's a much greater likelihood that you will have pigmentation issues from aging.
• 10:11
  SPEAKER_00: You certainly, certainly, we know that ultraviolet visible light impacts collagen.
• 10:18
  SPEAKER_00: Um, so we talk about that, but one of the major things is just that tendency to get dyschromia.
• 10:26
  SPEAKER_00: And we see that maturational hyperpigmentation in men, and I think we see it in women too.
• 10:33
  SPEAKER_00: So, so that's the major conversation that I have.
• 10:38
  SPEAKER_00: I incorporate skin cancer, but I try to create a hierarchy and I walk them through ultraviolet and what happens with visible light.
• 10:49
  SPEAKER_00: So the final conversation is what type of sunscreen am I recommending?
• 10:54
  SPEAKER_00: So if I can get them to use it, I recommend a physical tinted blocker incorporating iron oxide, but we both know the issues related to those products and darker skin types.
• 11:12
  SPEAKER_00: So works for some and not others.
• 11:15
  SPEAKER_00: And the final comment is some sunscreen is better than no sunscreen.
• 11:20
  SPEAKER_01: Yes.
• 11:21
  SPEAKER_00: But I think in in in most instances, if you're not, if they're not wearing a sunscreen, by the time they come back, the response is Dr.
• 11:32
  SPEAKER_00: Grimes, I'm really good at wearing my sunscreen now.
• 11:36
  SPEAKER_01: And you're right.
• 11:37
  SPEAKER_01: This is something that really, like 20 years ago, we didn't talk about that much.
• 11:42
  SPEAKER_01: And you know, it started coming on our radar about 10 years ago with the whole thing with visible light.
• 11:47
  SPEAKER_01: And it's just so fascinating.
• 11:49
  SPEAKER_01: And you're right, the number one complaint is dyschromia.
• 11:53
  SPEAKER_01: It's it's uneven skin tone.
• 11:56
  SPEAKER_00: Absolutely, and it's a major issue for individuals with skin of color in how we age, and particularly those individuals with skin types five and six.
• 12:08
  SPEAKER_01: Yeah.
• 12:09
  SPEAKER_00: And that dyschromia and you know, and gravity sets in, you know, jowl formation.
• 12:15
  SPEAKER_00: So, you know, the we know that it has its deleterious effects on collagen as well.
• 12:22
  SPEAKER_00: It just happens at a slower rate.
• 12:26
  SPEAKER_00: That's the only difference.
• 12:27
  SPEAKER_00: But it happens, and while you don't get coarse lines and fine lines, but again, collagen is damaged and jowl formation.
• 12:36
  SPEAKER_01: Or sagging.
• 12:37
  SPEAKER_01: Yeah.
• 12:38
  SPEAKER_01: Interesting.
• 12:39
  SPEAKER_01: You wrote an article not all that long ago.
• 12:41
  SPEAKER_01: I think it was in JAD on post-inflammatory hyperpigmentation, another huge problem in our darker skin type patients.
• 12:49
  SPEAKER_01: So talk about you know the pathogenesis of that and how do we approach it from a topical skin care standpoint?
• 12:57
  SPEAKER_00: So, certainly when it comes to post-inflammatory hyperpigmentation in darker skin types.
• 13:04
  SPEAKER_00: And if we look at the likelihood of your skin of color or darker, darker skin individual developing post-inflammatory versus our lighter skin compatriots, we know that it's much more common in darker skin types.
• 13:22
  SPEAKER_00: Why?
• 13:23
  SPEAKER_00: Darker skin, while it is it ages at a slower rate, we know that given probably that increased content of epidermal melanin to begin with, when the skin is injured by any mechanism, acne, drug eruption, any form of inflammation, the downstream effect outcome can be post-inflammatory hyperpigmentation.
• 13:55
  SPEAKER_00: So mechanistically, what is happening with that epidermal, dermal injury, there are multiple pathways that are involved.
• 14:06
  SPEAKER_00: We know that inflammation can trigger an increase in cytokines, chemokines, epidermal growth factor, uh, TNF alpha, interleukin one and six, leucotrienes, prostaglandins, all having the capacity to drive pigmentation.
• 14:31
  SPEAKER_00: And if you look at what is happening with PIH versus what we see in melasma, in many of these in many of the pathways that are driven by different diseases, you can see an increase in melanocyte proliferation as well as an increase in melanogenesis, damage to the basement membrane, increase in melanophagis in the dermis, fibroblasts can be damaged.
• 15:02
  SPEAKER_00: And so it's a pretty complex pathway, and we still have so much to learn.
• 15:08
  SPEAKER_00: And there's some really interesting new data, new science, which suggests that in your darker skin types, there may be this low level of chronic inflammation, okay, that occurs in the skin and with any other form of injury, again, triggering that cascade to drive hyperpigmentation.
• 15:33
  SPEAKER_00: So it's pretty fascinating.
• 15:35
  SPEAKER_01: Totally fascinating.
• 15:37
  SPEAKER_00: How do we treat it?
• 15:38
  SPEAKER_00: We treat it, you know.
• 15:40
  SPEAKER_00: If you ask Pearl, do we have a different treatment for post-inflammatory hyperpigmentation versus melasma?
• 15:48
  SPEAKER_00: I think the treatments merge, they overlap, we use the same tools.
• 15:54
  SPEAKER_00: But I think if you do tease out the pathways, we probably need to be a little bit more aggressive in using agents that really are effective in damping down inflammation rather than just focusing on agents that lighten the skin.
• 16:15
  SPEAKER_00: That's the take-home message for me when I really look at the pathways involved.
• 16:21
  SPEAKER_01: So, what um particular agents are good anti-inflammatories that you might incorporate for a patient with PIH?
• 16:29
  SPEAKER_00: Certainly, we we have topical corticosteroids that we can cycle on and we can cycle off.
• 16:37
  SPEAKER_00: We look at anti-inflammatory agents, antioxidants.
• 16:41
  SPEAKER_00: We've got a slew of those.
• 16:43
  SPEAKER_00: We've got green tea, we've got risk veratrol, we've got, I could give you a long list, but whatever it may be, I think it needs to be anti-inflammatory, and it probably needs to have an effect on cutaneous oxidative stress as well.
• 17:00
  SPEAKER_01: Yeah, so that's botanical certainly perfect there.
• 17:04
  SPEAKER_01: Vitamin C, lots of topicals you could use there.
• 17:08
  SPEAKER_01: So in melasma, now again, I know you recently wrote a really great article with a bunch of people on melasma in darker skin types.
• 17:18
  SPEAKER_01: I find it's particularly challenging in the darker skin types.
• 17:22
  SPEAKER_01: And of course, they're more prone to it.
• 17:24
  SPEAKER_01: So it's a sort of a catch-22, but how do you approach those patients?
• 17:28
  SPEAKER_01: Um, even talk about photoprotection a little bit as well as treatment options for darker skin types.
• 17:36
  SPEAKER_00: So, melasma for me, Patty, is more frustrating than vitiligo.
• 17:41
  SPEAKER_00: Now, why do I make that statement?
• 17:43
  SPEAKER_00: Because if I repigment vitiligo, I don't have to worry about it uh dissipating in a week or two.
• 17:53
  SPEAKER_01: Melasma will come right back at you.
• 17:56
  SPEAKER_00: Is so whimsical and so capricious.
• 17:59
  SPEAKER_00: I can have a patient looking fabulous one week and they could come in the next.
• 18:04
  SPEAKER_00: Oh, Dr.
• 18:05
  SPEAKER_00: Crans, get my skin.
• 18:07
  SPEAKER_00: What happened?
• 18:08
  SPEAKER_01: Girl, do you remember telling me years ago, Patty?
• 18:11
  SPEAKER_01: Never tell a patient with melasma you can cure them.
• 18:14
  SPEAKER_01: Never say those words.
• 18:16
  SPEAKER_00: I remember that.
• 18:18
  SPEAKER_01: I took it to the bank.
• 18:20
  SPEAKER_00: That's the first conversation that I have with my patients.
• 18:23
  SPEAKER_00: I tell them, look, there is a substantial likelihood that I will make you better.
• 18:30
  SPEAKER_00: But this is a chronic condition.
• 18:33
  SPEAKER_00: I cannot cure it.
• 18:34
  SPEAKER_00: We're moving forward, we have more treatments, but with the current technology, we cannot cure you.
• 18:42
  SPEAKER_00: So why do I make that statement?
• 18:44
  SPEAKER_00: What is I like to talk about the trifecta of melasma, and that trifecta is uh genetics.
• 18:53
  SPEAKER_00: I think at least 50% plus of patients with melasma, our database suggests that they have someone else, a first or second degree relative with melasma.
• 19:06
  SPEAKER_00: There is the issue of ultraviolet visible light exposure driving this and hormonal influences.
• 19:14
  SPEAKER_00: So if I package all of that, what do I think is happening?
• 19:18
  SPEAKER_00: I think I have to call this a photosensitive disorder, driven on that genetic predisposition.
• 19:26
  SPEAKER_00: Uh, and we forget about genetics.
• 19:28
  SPEAKER_00: I think that Med, if you go outside, I go outside, versus the patient who is going to get melasma, the triggers are different for those individuals.
• 19:42
  SPEAKER_00: So it's complex.
• 19:44
  SPEAKER_00: We have changes in the epidermis, we have changes in the dermis.
• 19:51
  SPEAKER_00: Those melanocytes are hypertrophic.
• 19:54
  SPEAKER_00: We know they're multiple players, melanocytes, keratinocytes, we go to the dermis, mast cells, endothelial cells, fibroblasts.
• 20:06
  SPEAKER_00: So it's so complex, but the current data suggests that it really is a phenotype of photoaging.
• 20:14
  SPEAKER_00: Now, if we look at where we are today, what's the beauty?
• 20:18
  SPEAKER_00: What's the good thing about melasma?
• 20:21
  SPEAKER_00: You know, we have historically relied on hydroquinone.
• 20:25
  SPEAKER_00: It's a 17-year-old drug.
• 20:28
  SPEAKER_00: And if you said, Pearl, could you live without hydroquinone?
• 20:31
  SPEAKER_01: No, not a chance.
• 20:33
  SPEAKER_00: I still need it.
• 20:34
  SPEAKER_00: Yeah.
• 20:35
  SPEAKER_00: But we have, we are expanding our armamentarium of non-hydroquinone topical agents, which is so exciting.
• 20:48
  SPEAKER_00: And I think that these drugs actually make a huge difference.
• 20:52
  SPEAKER_00: How have I not so dependent on hydroquinone anymore?
• 20:57
  SPEAKER_01: Right.
• 20:58
  SPEAKER_00: I can use some of these agents in combination with retinoids, alpha hydroxies as my monotherapy lightener.
• 21:07
  SPEAKER_00: Uh, because we still have to have that combination of other agents that impact what's happening in the epidermis and the dermis.
• 21:17
  SPEAKER_00: But these agents work better than other ever.
• 21:20
  SPEAKER_00: What are they?
• 21:21
  SPEAKER_00: We continue to see niacinamide at varying levels in formulations.
• 21:27
  SPEAKER_01: I still like aliac acid, great choice.
• 21:32
  SPEAKER_00: Cysteamine.
• 21:33
  SPEAKER_00: Um, you know, it it works.
• 21:37
  SPEAKER_00: Um, some formulations have arbutin, which is just a you know, different derivative of hydroquinone, but it's still used.
• 21:46
  SPEAKER_00: Uh, there's the new formulation, new ingredient, uh Mallecel from La Roche Posey.
• 21:54
  SPEAKER_00: We published work on Malassacin, which is from Malassacea FUFR.
• 22:00
  SPEAKER_00: And that product is doing very well.
• 22:04
  SPEAKER_00: So we have a there's the new product, lotus seed extract, which impacts autophagy.
• 22:13
  SPEAKER_00: So we're seeing more and more of these non-hydrokinone formulations ingredients that really do have the ability to impact uh hyperpigmentation and the changes that we see in melasma.
• 22:30
  SPEAKER_00: And I think it's just gonna get better and better.
• 22:34
  SPEAKER_00: But you know, first conversation is photoprotection.
• 22:38
  SPEAKER_01: Yeah, you got to.
• 22:39
  SPEAKER_01: It is a new, it is a new world where we have lots of options.
• 22:43
  SPEAKER_01: And I love the combination products that they put together with various.
• 22:47
  SPEAKER_01: You're using a lot of tranhexamic acid as well.
• 22:50
  SPEAKER_00: Absolutely.
• 22:51
  SPEAKER_00: I use topical tranhexamic, and I think you know, topical tranhexamic is not so easy to formulate uh because there's an absorption issue, but I don't think the topical formulations work as well as systemic tranhexamic, but they can work.
• 23:09
  SPEAKER_01: That makes a lot of sense.
• 23:11
  SPEAKER_01: Let's turn for the last few minutes we've got to Vitiligo, because you've done so much in Vitiligo.
• 23:16
  SPEAKER_01: And much like we are with hyperpigmentation, we're just in a whole nother stratosphere of our understanding of the pathogenesis and the way to approach it.
• 23:23
  SPEAKER_01: So talk to us about some of the innovations.
• 23:26
  SPEAKER_01: I know you were part of a task force that wrote a positioning statement on how to diagnose it and how to treat it.
• 23:32
  SPEAKER_01: So as the expert for the experts, tell us, tell us what's new in vitiligo and what kind of exciting things are out there for treatment options.
• 23:41
  SPEAKER_00: So, number one, I think we probably have come to that consensus place of what is driving the destruction of melanocytes in vitiligo.
• 23:54
  SPEAKER_00: And I think it is a gamma interferon jackstat-driven pathway.
• 24:00
  SPEAKER_00: We know that CD8 lymphocytes release interferon gamma.
• 24:05
  SPEAKER_00: You have CXCl9 released from keratinocytes that recruits more CD8 lymphocytes that ultimately target and destroy melanocytes.
• 24:16
  SPEAKER_00: So I think it's a very exciting time for those of us who have been in the trenches with in vitiligo research and for patients as well, because so we at Ruxolitnib or Obsolora was the first FDA approved topical agent for vitiligo approved in 2022.
• 24:41
  SPEAKER_00: And I think getting that approval ushered in a new paradigm.
• 24:53
  SPEAKER_00: So they're much more likely to prescribe it rather than telling a patient, you know what, there's nothing that can be done for your vitilangle.
• 25:04
  SPEAKER_00: So there's nothing I can do.
• 25:06
  SPEAKER_00: So at least even if they don't spend the time with the patient, they'll go on and give them the prescription.
• 25:13
  SPEAKER_00: So that no doubt is a major step forward.
• 25:17
  SPEAKER_00: We still have an enormous amount of work to do because care is still, there are a number of insurance companies that still consider vitiligo cosmetic.
• 25:27
  SPEAKER_00: You know, they don't reimburse it for treatment.
• 25:31
  SPEAKER_00: So we still have so much work to do.
• 25:34
  SPEAKER_00: And you know, I'm president of the Global Vitiligo Foundation.
• 25:39
  SPEAKER_00: So we're constantly addressing all of these.
• 25:42
  SPEAKER_00: Now, I will say I'm gonna I'll make the statement that we're at this amazing watershed place.
• 25:51
  SPEAKER_00: What do I mean by that?
• 25:53
  SPEAKER_00: There are multiple new drugs, some of them JAC inhibitors, that are in phase three clinical trials for vitiligo.
• 26:03
  SPEAKER_00: So a number of these drugs probably will be FDA approved in the next one to two years.
• 26:11
  SPEAKER_00: So we're gonna have multiple new treatments.
• 26:14
  SPEAKER_00: There's a new topical drug that's in phase two.
• 26:18
  SPEAKER_00: Uh, it's what they call a BET inhibitor.
• 26:22
  SPEAKER_00: So that's being investigated as a topical agent.
• 26:26
  SPEAKER_00: It inflammate, it inhibits pro-inflammatory cytokines.
• 26:30
  SPEAKER_00: So there's much to be excited about, much in development.
• 26:36
  SPEAKER_00: So we're going to continue to see this paradigm shift in how we approach vitiligo, but we're still in the trenches, fighting the war of moving beyond it being cosmetic, because if we don't, then that's going to impact the access to all of these new drugs and development.
• 26:58
  SPEAKER_01: It's such a problem for us in dermatology because if they think it's on the skin, they just think it's a cosmetic problem.
• 27:04
  SPEAKER_01: I mean, look at the problem with acne and rosacea.
• 27:08
  SPEAKER_01: I mean, these are all conditions that need to be treated, and it's a daily battle for the dermatologist.
• 27:14
  SPEAKER_00: The carriers, I think they just have a deaf ear to the burden of skin diseases.
• 27:22
  SPEAKER_01: I think you're probably right about that.
• 27:24
  SPEAKER_01: I mean, I don't know how we get, I mean, the AAD is so active when it comes to advocacy, but it does seem sometimes to fall on deaf ears.
• 27:34
  SPEAKER_01: It gets very frustrating.
• 27:36
  SPEAKER_00: We we we have to just keep we have to fight it and fight it and fight it and continue to make inroads.
• 27:43
  SPEAKER_01: I agree a hundred percent.
• 27:45
  SPEAKER_01: You mentioned the International Vitaligo Society, and I know you started that camp this year because I saw it on social media.
• 27:53
  SPEAKER_01: So tell me about it's Camp Victory, isn't it?
• 27:56
  SPEAKER_00: Yes, yeah.
• 27:57
  SPEAKER_01: Tell me about it.
• 27:59
  SPEAKER_00: You know, if you asked me, Patty, what am I?
• 28:04
  SPEAKER_00: Some of the things in my life that I'm most proud of.
• 28:07
  SPEAKER_00: I can honestly tell you that camp and continuing that camp is one of the things that I'm most proud of.
• 28:15
  SPEAKER_00: You know, I'll tell you the story behind the camp.
• 28:18
  SPEAKER_00: And the story begins even before I assumed my presidency of the Global Vitaligo Foundation.
• 28:25
  SPEAKER_00: I was at our support group meeting in 2023, uh, before the World Congress, and I left that meeting feeling, oh my God, we have to do something special for kids.
• 28:40
  SPEAKER_00: And so when I assumed my presidency, I teamed up with Mona Gohara.
• 28:46
  SPEAKER_00: I said, Mona, this is my vision.
• 28:48
  SPEAKER_00: You got to help me.
• 28:49
  SPEAKER_00: And she said, Pearl, I'm totally on board.
• 28:52
  SPEAKER_00: So Mona was my partner in this.
• 28:55
  SPEAKER_00: I had spoken to Tyler during the World Congress.
• 28:58
  SPEAKER_00: I said, Tyler, I need your help.
• 29:00
  SPEAKER_00: So both of these individuals were at ground zero for me, and we raised the money.
• 29:07
  SPEAKER_00: And fast forward, at Camp Victory for Children with Vitaligo, we had 29 children and 29 parents, which is something unique for camps.
• 29:19
  SPEAKER_00: Uh, usually don't they you don't bring a parent?
• 29:22
  SPEAKER_01: It's it's a drop, it's a drop-off.
• 29:24
  SPEAKER_00: Yeah, no, no, no, no, no, because we had both.
• 29:28
  SPEAKER_00: And why did we do that?
• 29:30
  SPEAKER_00: Because we knew that the burden of vitiligo is so as that is as great in the parents as it is in the children.
• 29:38
  SPEAKER_00: And this was our golden opportunity to impact and address both.
• 29:43
  SPEAKER_00: And we did something else that was very unique.
• 29:46
  SPEAKER_00: We had we brought in 10 psychologists, counselors from around the country.
• 29:52
  SPEAKER_00: And so we had these counseling sessions as well for the children, the parents, and then we brought them all together.
• 30:00
  SPEAKER_00: And uh, no, it was it was emotional, it was empowering, it was enlightening.
• 30:08
  SPEAKER_00: And I'll tell you, one little boy said, These some of these kids had never met another child with the Ben Lago.
• 30:14
  SPEAKER_00: And one little boy said, Oh my god, I'm with my tribe.
• 30:21
  SPEAKER_00: Oh, and we had a mascot called Little Victory, and there were little victories, there were teddy bears.
• 30:29
  SPEAKER_00: So every kid got a little victory, and then some kids we had these gigantic teddy bears, but we call them little victory too.
• 30:37
  SPEAKER_00: And I have this amazing photo of one little boy taking little big victory on the plane with him, and he buckled him up in the seat next to him.
• 30:48
  SPEAKER_00: So, anyway, it was it was wonderful.
• 30:51
  SPEAKER_01: Where was the camp in LA?
• 30:52
  SPEAKER_00: It was in Indianapolis.
• 30:54
  SPEAKER_00: Oh, in Indianapolis, and because that's where our main meeting was, and so we attached the camp to the main meeting.
• 31:02
  SPEAKER_00: Uh yeah, exactly.
• 31:03
  SPEAKER_00: And so we're gearing up now for 2025.
• 31:07
  SPEAKER_01: Oh, that's great.
• 31:08
  SPEAKER_01: That's such a great story.
• 31:10
  SPEAKER_01: I love it.
• 31:10
  SPEAKER_01: Look, we are out of time.
• 31:12
  SPEAKER_01: I knew this was gonna go like that because you're a wealth of knowledge and Pearl, you've taught all of us so much over the years.
• 31:20
  SPEAKER_01: I love you as a friend, as a mentor, as a colleague, and thank you so much for joining me today.
• 31:27
  SPEAKER_01: I hope you have a great day.
• 31:29
  SPEAKER_00: Look, hey, we know where we stand in each other's lives.
• 31:34
  SPEAKER_00: Absolutely.
• 31:35
  SPEAKER_00: So it's been my honor, my pleasure, my joy to join you this morning and have this phenomenally exciting conversation and interchange.
• 31:47
  SPEAKER_00: So thank you.
• 31:48
  SPEAKER_01: Well, thank you.
• 31:49
  SPEAKER_01: And I'm gonna get you to Science of Skincare Summit one year.
• 31:52
  SPEAKER_01: It's on my on my bucket list, Pearl Grimes.
• 31:55
  SPEAKER_01: Check.
• 31:56
  SPEAKER_00: Absolutely.