Latest / Skin Anarchy / Dr Angelo Landriscina MD FAAD

Transcript

Dr Angelo Landriscina MD FAAD · Skin Anarchy

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• 0:35
  SPEAKER_03: Hi guys, welcome back to Sweet Trier Anarchy.
• 0:37
  SPEAKER_03: This is your host, Ecta, and today I have Dr.
• 0:40
  SPEAKER_03: Angelo Landristino with me.
• 0:42
  SPEAKER_03: I'm sure you've seen him all over social media, uh, YouTube, Instagram, TikTok.
• 0:46
  SPEAKER_03: He makes the best videos.
• 0:48
  SPEAKER_03: I'm obsessed.
• 0:49
  SPEAKER_03: Um, so welcome, Dr.
• 0:50
  SPEAKER_03: Landristina.
• 0:51
  SPEAKER_03: I'm so glad you have the time to come on to our little show.
• 0:58
  SPEAKER_01: Thank you for having me, and thank you for your kind words.
• 1:02
  SPEAKER_03: My pleasure.
• 1:03
  SPEAKER_03: Yeah, I will actually really um really wanted you to come on because I feel like you're one of the most um candid people, um, especially on the TikTok.
• 1:11
  SPEAKER_03: Like all the dermatologists I follow with TikTok, I I love your videos because they're very like sarcastic, but like just to the point.
• 1:18
  SPEAKER_01: I mean, yeah, I think the thing that's um interesting about I think the the space that I um inhabit on social media, like there's there's a lot of derms on TikTok or on Instagram um by now, but I think that um uh my personality maybe comes out uh more when I'm like public facing in that way than it does even like with my patients.
• 1:48
  SPEAKER_01: Um it's funny because it came up the other day when I was talking to one of my patients.
• 1:53
  SPEAKER_01: I said, you know, I feel like people who find me on social media and then make an appointment, I think that they're expecting me to like, you know, walk in and be like posing and like joking around and being, you know, any any which way that they think that I am from social media, and I'm almost afraid to disappoint them with the fact that like they're having a regular doctor's appointment.
• 2:18
  SPEAKER_01: Um, hopefully a really good doctor's appointment, but you know, like it's it's not their personal TikTok video with you.
• 2:26
  SPEAKER_01: Exactly.
• 2:26
  SPEAKER_01: You know, I'm actually very serious when it comes to my day job.
• 2:32
  SPEAKER_01: So um, but yeah, like in that way, TikTok and social media in general has been like a really good creative outlet.
• 2:40
  SPEAKER_01: I think um a lot of other physicians that are that are, you know, doing similar things to me probably would would say the same that, you know, um our daily job may be um a little bit heavy sometimes.
• 2:54
  SPEAKER_01: So it's a great way to, you know, provide education to a wider audience as well as you know get creative and have some fun.
• 3:02
  SPEAKER_03: Right, right.
• 3:03
  SPEAKER_03: And I think it also makes it um less intimidating to like approach dermatologists, I feel like, um, for a lot of people.
• 3:11
  SPEAKER_03: I I think like, you know, if you see your favorite doctor on a social media platform, you like, you know, it becomes more real.
• 3:18
  SPEAKER_03: Like I can go to this person and you know, actually consult them for professionally, you know what I mean, for actual medical advice.
• 3:24
  SPEAKER_03: I think that's that's awesome.
• 3:26
  SPEAKER_01: Yeah, I mean, um, us physicians are people too.
• 3:30
  SPEAKER_01: Um, and I think, you know, even being inside the profession um, you know, throughout my career, I feel like it's been hard sometimes because you look around and um everybody's like projecting this image of perfection in a way.
• 3:47
  SPEAKER_01: Um and I think that uh, you know, I almost wish that I had more role models that were, you know, real in that way, you know.
• 3:56
  SPEAKER_01: Um all of my my favorite mentors have been people who are um, you know, big personalities and are who they are 24-7.
• 4:04
  SPEAKER_01: So I think that's that's part of the reason why um I am where I am now.
• 4:09
  SPEAKER_03: Yeah.
• 4:10
  SPEAKER_03: No, it makes sense.
• 4:11
  SPEAKER_03: And I actually want to um roll it back a little bit and have you kind of talk about your career journey and why you went into medicine, how you picked dermatology as your as your specialty.
• 4:21
  SPEAKER_03: I really you know, I want to know um like the whole path because I think medicine is something that it's such a grueling, you know, we know it's such a grueling pathway, career path, and no one really gets to, you know, understand how much goes into it at every step.
• 4:36
  SPEAKER_01: So yeah, I mean, I always say um that you could tell that I was a weird teenager because when I was 16, I already wanted to be a dermatologist.
• 4:46
  SPEAKER_01: Um for a lot of people, you know, the the typical path is that you decide that you want to be a physician first and then you find your specialty.
• 4:56
  SPEAKER_01: But for me, like dermatology, for better or worse, really always was the goal.
• 5:02
  SPEAKER_01: Um, the reason for that was kind of twofold.
• 5:06
  SPEAKER_01: Um I grew up in um South Brooklyn in New York, and um uh a lot of the people that you know lived in my community were um, I don't want to like characterize where I come from, but like, you know, um think about like the Jersey Shore.
• 5:28
  SPEAKER_01: Think about those people.
• 5:29
  SPEAKER_02: Yeah, yeah.
• 5:30
  SPEAKER_01: A lot of a lot of them.
• 5:32
  SPEAKER_01: So um tanning was was a big thing for my people.
• 5:36
  SPEAKER_03: Huge, yeah.
• 5:37
  SPEAKER_03: Everyone's orange.
• 5:39
  SPEAKER_01: Yeah.
• 5:40
  SPEAKER_01: So um I started to think about, I was like, okay, you know, I'm not that old.
• 5:46
  SPEAKER_01: So when I was a teenager, we already knew that um that sun exposure and tanning beds, especially tanning beds, um, increase one's risk for skin cancer greatly.
• 5:58
  SPEAKER_01: So I said to myself, you know, um people wouldn't do something um detrimental to their health um in order to like make their liver look better, or you know, like they weren't superficial about their other organs.
• 6:17
  SPEAKER_01: So what was different about this risk factor?
• 6:21
  SPEAKER_01: Why did people treat this differently and why were they willing to take that risk in order to change their appearance?
• 6:29
  SPEAKER_01: And the conclusion that I came to, um, which I think still informs everything that I do to this day, is that um the skin isn't just a our largest organ, it is also, you know, as the most superficial organ, um a social organ in a way.
• 6:50
  SPEAKER_01: Um it plays a really important role in our social functioning.
• 6:57
  SPEAKER_01: Um, so when people look at us without thinking, they're already making judgments about who we are as people, about our personal health, our age, our ethnicity, all of those things.
• 7:11
  SPEAKER_01: Um, and you know, I always say that that could manifest in beautiful ways.
• 7:16
  SPEAKER_01: So if you think about um the ways that we use hair, skin, and nails to express ourselves, um, that could be really meaningful.
• 7:26
  SPEAKER_01: But on the flip side of that, um, if somebody is suffering with a chronic skin disease, these patients that I see, they're not just suffering with itch or pain.
• 7:39
  SPEAKER_01: Um they're also going through the world with people treating them differently based on judging them on their skin and what they see.
• 7:48
  SPEAKER_01: Um, I can't.
• 7:50
  SPEAKER_03: There's a huge psychology component to that too.
• 7:52
  SPEAKER_03: You know, that's yeah, you make an excellent point here.
• 7:54
  SPEAKER_03: Yeah.
• 7:55
  SPEAKER_01: Yeah.
• 7:55
  SPEAKER_01: So I mean, um, I'm seeing it a lot now.
• 7:59
  SPEAKER_01: Even many patients are coming to me with hand dermatitis because it's the winter and there's a pandemic going on, so people are really washing their hands a lot.
• 8:09
  SPEAKER_01: So that's a diagnosis that I'm seeing even more than I used to.
• 8:13
  SPEAKER_01: And, you know, that's a part of your body that you really can't hide.
• 8:16
  SPEAKER_01: And um, one of my patients the other day was telling me about how he was hyper-aware of how people were treating him.
• 8:22
  SPEAKER_01: You know, when he went to the store and handed over his credit card, like people didn't want to come into contact with him, didn't want to touch him, were like afraid, and he could see it because they didn't know if he had contagious disease.
• 8:35
  SPEAKER_01: And so that was that whole concept was was basically the starting point for me because I said I wanted to be the one to help these people.
• 8:50
  SPEAKER_01: Um, in addition to that, I mean, I myself, um, when I was younger suffered with like nodulocystic acne.
• 8:58
  SPEAKER_01: So I um basically You went through it.
• 9:01
  SPEAKER_03: You went through your own, yeah.
• 9:03
  SPEAKER_03: Yeah.
• 9:03
  SPEAKER_01: Yeah.
• 9:04
  SPEAKER_01: Yeah.
• 9:04
  SPEAKER_01: So I I had been through it myself.
• 9:07
  SPEAKER_01: I had various dermatologists that helped me, but um, I think suffering with a skin disease like that um also, you know, kind of motivated me to go for it.
• 9:18
  SPEAKER_01: So um, you know, when I I went to college, um I said that I wanted to be a dermatologist.
• 9:27
  SPEAKER_01: And I still remember at my orientation, um, my advisor was like, okay, so then you should be pre-med.
• 9:34
  SPEAKER_01: And um, I guess I started and just never stopped.
• 9:38
  SPEAKER_01: Um went through, yeah.
• 9:41
  SPEAKER_01: So I went through, got my bachelor's.
• 9:44
  SPEAKER_01: Um I, you know, then went to medical school at the Albert Einstein College of Medicine here in New York.
• 9:50
  SPEAKER_03: Um, that's amazing.
• 9:52
  SPEAKER_03: I love Albert Einstein, amazing research.
• 9:55
  SPEAKER_01: Yeah, so um I also did dermatology research there, um focused on um nanoparticle drugs and uh wound and burn healing mostly.
• 10:08
  SPEAKER_01: Um, so I did a year fellowship kind of in the middle of my med school education.
• 10:14
  SPEAKER_02: Yeah.
• 10:15
  SPEAKER_01: And um then went on to my dermatology residency, um, which I finished in 2020.
• 10:22
  SPEAKER_01: And now here I am, board certified and um, you know, living my dream.
• 10:29
  SPEAKER_03: That's amazing.
• 10:31
  SPEAKER_03: I really, you know, I think it's it's so funny because when all of it happens, you know, you can look back and have this um, you know, this perspective.
• 10:38
  SPEAKER_03: But yeah, I just want to say out there for everybody who doesn't know, like dermatologists have some of the highest board scores in medicine, like to get into dermatology programs.
• 10:47
  SPEAKER_03: And I think um that's actually a big reason I wanted you to kind of go into it because it is a very, very um competitive field, as most medicine is, but you know, I think it's important for people to know that.
• 10:58
  SPEAKER_01: Okay, so one thing that I would like to say about that though is um, you know, I I try to mentor a lot of med students, and you know, for me, I um, you know, the struggle is real.
• 11:14
  SPEAKER_01: And for me, um, you know, when I was in high school, I was always the straight A student.
• 11:19
  SPEAKER_01: I was at the top of my class.
• 11:21
  SPEAKER_01: In college, I graduated with honors.
• 11:24
  SPEAKER_01: I was like all like super high GPA, all of that.
• 11:27
  SPEAKER_01: That's what got me into medical school.
• 11:29
  SPEAKER_01: And then you arrive at medical school, and basically everybody is like that.
• 11:35
  SPEAKER_01: Everybody is an overachiever and super smart.
• 11:39
  SPEAKER_01: And so, you know, the number that that could kind of do on your psyche when you you're saying to yourself, you know, I want to be in basically the most competitive specialty, and I have all my work cut out for me, and you know, I'm being compared to all of these people, it gets it's difficult, not just from a time-spent standpoint, not just from um, you know, the work that you have to do, but um, it is really grueling and difficult.
• 12:11
  SPEAKER_01: And um, you know, just one thing that I would say to people out there who are thinking of doing it, or maybe people who are going through med school right now and don't think that they can.
• 12:21
  SPEAKER_01: I mean, I was told at one point by one of my deans, like, oh, you would be a great applicant for internal medicine.
• 12:28
  SPEAKER_01: Why don't you do that?
• 12:29
  SPEAKER_01: And I said, no, this is this was what I wanted to do.
• 12:32
  SPEAKER_01: So, you know, if you put the work in, it can it can happen for you.
• 12:38
  SPEAKER_01: Um I love that.
• 12:40
  SPEAKER_01: Yeah, and I mean, I think for me, it's like I got to where I am by like sheer power of will.
• 12:47
  SPEAKER_01: Like I made this happen.
• 12:49
  SPEAKER_01: Yeah, it was it was very difficult, but um, you know, for obviously my experience is just my experience, but you know, but what were your what were some of your hurdles?
• 13:01
  SPEAKER_03: I really want to know because obviously, like I, you know, I I understand I'm a woman in medicine, I get it, you know, I have my own hurdles, but I want you to tell us because people don't get to hear this, you know what I mean?
• 13:10
  SPEAKER_01: Like the the hard side of this, like oh yeah so yeah, I mean, um, what were some of the hurdles for me?
• 13:18
  SPEAKER_01: So I I would say like, you know, medical school was where, well, okay, let me take it back a little bit.
• 13:25
  SPEAKER_01: Like, um, you know, I came out of a working class family.
• 13:32
  SPEAKER_01: Um, you know, nobody in my family had had like even a graduate degree before.
• 13:38
  SPEAKER_01: Um, so you know, uh like my parents' generation were like the first people who went to to college and both families.
• 13:47
  SPEAKER_01: So, you know, uh I was kind of flying blind.
• 13:51
  SPEAKER_01: There's a lot of things about the process of becoming a physician that like you don't just know.
• 13:57
  SPEAKER_03: Um, you have to figure it out.
• 13:59
  SPEAKER_01: Yeah, and like back when I was doing it, it wasn't as easy as just like doing a Google search.
• 14:04
  SPEAKER_01: Like right now, there's a lot of great resources for people if that's something that they want to do.
• 14:09
  SPEAKER_01: I even made an entire YouTube video about my entire path from basically graduating high school to becoming a dermatologist, outlining it completely for anybody who wants to know about it.
• 14:21
  SPEAKER_01: But, you know, I think um in a lot of ways, I was almost like lucky to get through that.
• 14:28
  SPEAKER_01: But, you know, through college, it was like I was taking more than a full schedule because I wasn't just pre-med, I was also a Spanish major.
• 14:37
  SPEAKER_01: So, you know, I basically doubled up on my classes, I had a chemistry minor.
• 14:42
  SPEAKER_01: And um, you know, I super overachiever all the way.
• 14:47
  SPEAKER_01: Well, yeah.
• 14:48
  SPEAKER_01: And this was while um working anywhere from one to three jobs on the side in order to be able to, you know, support myself and push myself through.
• 14:57
  SPEAKER_01: You know, my parents did help me in the ways that they could, but and I got scholarships and all that stuff, but it was just like it was not easy for me.
• 15:06
  SPEAKER_01: Yeah.
• 15:06
  SPEAKER_03: Um sounds like it sounds like you really, you, you really had to grind to get what you wanted.
• 15:10
  SPEAKER_03: That's that's amazing.
• 15:12
  SPEAKER_03: Yeah.
• 15:13
  SPEAKER_01: Um, and then, you know, once I got into medical school, it became apparent to me that there were a lot of people that, you know, either they had a legacy at the school or their parents were physicians, or you know, like it had never even occurred to me before that so many people in medicine kind of have a leg up.
• 15:32
  SPEAKER_03: Yeah, connections.
• 15:33
  SPEAKER_03: I know.
• 15:34
  SPEAKER_03: And you know, actually, you know what's interesting to me that you bring that up because everyone is making this uh, you know, the whole idea of like Harvard and all these Ivy Leagues, you know, people are buying their kids spots or whatever, but it's like no one actually talks about that in medicine.
• 15:48
  SPEAKER_03: Isn't that funny?
• 15:49
  SPEAKER_03: That like, you know, there are these like things where it's like, you know, if your your mother or your father or uncle graduated from a medical school, you're more likely to get into that, you know, or a residency program or whatever.
• 16:01
  SPEAKER_01: Absolutely.
• 16:01
  SPEAKER_01: And I mean, I've seen it in action, and I think that's part of the reason why medicine in general lacks so much diversity.
• 16:09
  SPEAKER_01: Um, just because, you know, um, even you know, looking at dermatology as a specialty as a specialty, it has been classically um white male dominated, just like everything else in our society.
• 16:24
  SPEAKER_01: Um, tell me about it.
• 16:26
  SPEAKER_03: But I mean, not not all white males are made equal.
• 16:28
  SPEAKER_03: Let me just say that.
• 16:30
  SPEAKER_03: Yeah, but yeah, but it is, it is.
• 16:33
  SPEAKER_01: And now, you know, we're coming to um, you know, a time in dermatology's history where I think, you know, there are more women in training for dermatology right now.
• 16:46
  SPEAKER_01: But if you look at, you know, department chairs, people holding professorships, it's still male-dominated.
• 16:52
  SPEAKER_01: Um, so, you know, there is a reason for that.
• 16:55
  SPEAKER_01: A lot of it has to do with society in general.
• 17:00
  SPEAKER_01: Um, but uh, you know, just thinking about how that could potentially affect the way that we take care of patients.
• 17:07
  SPEAKER_01: I mean, we've seen it in action.
• 17:09
  SPEAKER_01: Like, I don't even have to get into it, but um, so yeah, I mean, it was, I always say, you know, whenever I talk about, you know, this topic or, you know, the difficulties that I went through to become a dermatologist, this is still with me being a, you know, white Latino, um, you know, kind of uh man.
• 17:37
  SPEAKER_03: So like it's just like even though But it's not, you know, honestly, um I think what it what needs to be brought up here is that it does medicine is one of the few fields I think where it doesn't matter in a lot of ways.
• 17:50
  SPEAKER_03: It does later on.
• 17:51
  SPEAKER_03: I mean, I I get you the politics is there later on, but like the heart you have to put in hard work, you know, and that doesn't matter what skin color you are.
• 17:58
  SPEAKER_03: So I I don't do too I don't you know what I mean.
• 18:01
  SPEAKER_03: Like I don't belittle your experience just because of your skin color.
• 18:03
  SPEAKER_03: You worked your butt off, you know what I mean?
• 18:05
  SPEAKER_01: Like everything that but what I'm saying is this I'm saying this was so hard for me, and that was even with all my privilege, yeah, it was difficult.
• 18:16
  SPEAKER_01: So just imagine um, you know, for you know, um black, indigenous, and people of color, for women, you know, how much more difficult it is.
• 18:29
  SPEAKER_01: Um, so yeah, I mean, I think, you know, um the difficulties are there.
• 18:39
  SPEAKER_01: Being compared to people, it is there.
• 18:42
  SPEAKER_01: Um, competing for a very small number of residency spots every year, like DARM applicants have to go through that.
• 18:51
  SPEAKER_01: Um, and that's while our specialty is is varied and we need to know a lot, and our boards are some of the hardest.
• 19:01
  SPEAKER_01: Like, if I tell you getting that board certification, passing that test, that is probably like, you know, one of the like crowning achievements of my life.
• 19:11
  SPEAKER_01: Like, I'm that is one of the hardest things that I've ever done.
• 19:14
  SPEAKER_01: But, you know, the actual doing of the job, um, in some ways is is not any more difficult, say, than something like internal medicine.
• 19:26
  SPEAKER_01: It's just that it is a very selective field because there are so few of us.
• 19:30
  SPEAKER_01: Um, and you know, there's uh I don't want to get, you know, into the weeds with this.
• 19:37
  SPEAKER_01: Like that's, you know, to the detriment of our patients in some ways, because there should be more dermatologists.
• 19:44
  SPEAKER_01: But yeah, it is one of the selective, if not the most selective, specialty, um, at least in the US.
• 19:52
  SPEAKER_03: So yeah, yeah, it is.
• 19:55
  SPEAKER_03: I want to actually ask you um a question about this.
• 19:58
  SPEAKER_03: The there's this new, I guess I don't know if it's a buzzword or what about you know, brown skin health versus Caucasian skin health.
• 20:06
  SPEAKER_03: And now, you know, in your professional opinion, is there a giant difference in the in the approach uh you know a professional takes when treating people of color versus not?
• 20:18
  SPEAKER_03: Because I really don't know in the research um that I've seen that there's nothing conclusive there.
• 20:22
  SPEAKER_03: So what are some of the hard you know the differences that you've noticed?
• 20:26
  SPEAKER_01: So I I would say, you know, from a research standpoint, there are, you know, some differences um that have been noted between, you know, lighter skin and skin that is more melanin-rich.
• 20:43
  SPEAKER_01: However, a lot of that research is old.
• 20:47
  SPEAKER_01: Um, and we need to really update our understanding when it comes to the clinical um, you know, scenario and the clinical truth of it, the things uh that you know most often are different are one, you know, cultural differences from patient to patient, two, differences in pigmentation and how that um affects uh, you know, the way that we treat different um disease states or conditions, and three, um, you know, genetic differences, and then lastly, you know, differences in things like hair texture.
• 21:28
  SPEAKER_01: Um one example that I will give you is um an entity called um central centrifugal psychiatricial alopecia.
• 21:38
  SPEAKER_01: That is something that I have to say, be able to say like right off my tongue.
• 21:44
  SPEAKER_01: Um the acronym for it is CCCA.
• 21:48
  SPEAKER_01: It is a type of scarring alopecia, meaning a hair loss that you know basically obliterates the hair structures.
• 21:56
  SPEAKER_01: So once hair has fallen out in this entity, it is gone for.
• 22:00
  SPEAKER_01: Forever.
• 22:01
  SPEAKER_01: Um, it primarily affects black women.
• 22:06
  SPEAKER_01: Um, so you know, it wasn't even really regarded as a true entity until like the 70s or 80s.
• 22:15
  SPEAKER_01: At that time, it was attributed to um hair styling practices, mostly because you know, the dermatology community did not understand um, you know, how um black people style their hair because most dermatologists were white.
• 22:32
  SPEAKER_01: So this was something that got ignored and almost blamed on patients in a way.
• 22:37
  SPEAKER_01: Fast forward to now, a lot of those practices that they were blaming it on, including hot combing, are not things that people typically do anymore.
• 22:45
  SPEAKER_01: Yet we're still seeing CCCA.
• 22:48
  SPEAKER_01: And in 2019, um, a study came out in the New England Journal where they found a gene that potentially could explain this.
• 22:57
  SPEAKER_01: Um, so you know, wrapped up in that one disease state, we have to understand the history of how our specialty has treated patients of color.
• 23:10
  SPEAKER_01: We have to understand this disease process that affects a very specific population.
• 23:16
  SPEAKER_01: We also have to understand how a lot of our treatments, especially things that we use for, you know, scalp conditions, were not designed um with black people's hair in mind.
• 23:30
  SPEAKER_01: Um, things that just don't work with all hair textures.
• 23:34
  SPEAKER_01: So um, you know, I talk about this just because uh hair disorders are like one of my one of my clinical interests and I love treating them, but just it just goes to show you that um having a cultural competency is very helpful because I can't tell you how many um patients have come to me with that disorder or other scalp disorders, and they tell me, oh, you know, this um doctor told me to use this um solution, but it really dries out my hair, or they wanted me to sh use this shampoo like every other day, but I only wash my hair once a week or every other week, um, just because you know my hair would break if I if I uh washed it that often.
• 24:22
  SPEAKER_01: And, you know, this is where you know, understanding of disease states um in different patient populations um, you know, comes into play.
• 24:31
  SPEAKER_01: Um, and I think it's really all of our responsibility because for so long, you know, in dermatology, these um disease states that affected racial and ethnic minorities were almost, you know, it was put on the um doctors from those ethnic groups that, like, oh, you should understand this or you need to take this up.
• 24:55
  SPEAKER_01: Like, skin of color is a thing that people of color need to spearhead.
• 24:59
  SPEAKER_01: And to me, I'm just like, no, we all need to know how to treat all patients.
• 25:05
  SPEAKER_03: Exactly.
• 25:06
  SPEAKER_03: Yes, 100%.
• 25:08
  SPEAKER_03: So yeah, I completely agree.
• 25:10
  SPEAKER_03: And I love that you brought up the topic of hair because I think um now with social media, at least this is what I've noticed.
• 25:17
  SPEAKER_03: Um, you know, correct me if I'm wrong, that hair care and hair health is really starting to come um more, I guess, you know, to the forefront.
• 25:25
  SPEAKER_03: Um, because, you know, now a lot of the dermatologists, for example, that we find on Instagram or, you know, they're they're starting to talk more about it.
• 25:33
  SPEAKER_03: So in terms of dermatology, when did you start really seeing um like is is hair something that's taught like in the like the baseline curriculum, or is it something that's evolved to include that in the specialty?
• 25:46
  SPEAKER_03: I'm I that's always confused me.
• 25:48
  SPEAKER_01: Yeah, so dermatologists, we are not just skin doctors, we're really doctors of the integumentary system, which includes hair, um, skin, and nails.
• 26:00
  SPEAKER_01: Um I'm sure that you had not been seeing a lot of dermatologists talk about hair care on social media before because it's almost this inside thing within dermatology that many dermatologists like lament treating patients with hair loss.
• 26:18
  SPEAKER_01: Um they joke about like, oh, the thing that the patient, you know, you've had your whole visit, and the thing that they will tell you when they're going out the door, when you're going out the door is, oh yeah, my hair's falling out too.
• 26:29
  SPEAKER_01: Like, you know, like it's always an afterthought for the patient, but it's something that's difficult to treat.
• 26:35
  SPEAKER_01: Um I kind of relish the challenge of treating patients with hair loss.
• 26:42
  SPEAKER_01: Um the reason for that is like so often people suffer in silence and wonder if it's something that they're doing, like that is the reason that they're they're they're suffering so much.
• 26:53
  SPEAKER_01: Um and I just find it really gratifying when I'm able to help people with a disease process that could like so um profoundly impact them.
• 27:07
  SPEAKER_03: Yeah, absolutely.
• 27:08
  SPEAKER_03: And honestly, uh I want to ask you because I I don't know much about hair um health in general.
• 27:14
  SPEAKER_03: What are some of the top reasons for for hair loss um if you were to name off something?
• 27:21
  SPEAKER_03: Is it universal like can you do that um overall, or is that not very plausible?
• 27:26
  SPEAKER_01: So I mean, you know, the the most common um cause of hair loss is a type of hair loss called androgenic alopecia.
• 27:36
  SPEAKER_01: So that's you know, colloquially known as male pattern or female pattern hair loss.
• 27:42
  SPEAKER_01: Um it's really more of a trait than it is a disease process.
• 27:47
  SPEAKER_01: So you could think of um, you know, all of our hair follicles having androgen receptors on them.
• 27:54
  SPEAKER_01: Androgen is a family of hormones, um, typically you know thought of as male hormones, so um hormones like testosterone or DHT.
• 28:06
  SPEAKER_01: And so um all of us have a certain sensitivity in our hair follicles to those hormones, and it varies from person to person.
• 28:18
  SPEAKER_01: So the way that I put it to my patients is, especially to my um, you know, uh XX patients who come to me with this type of hair loss, I say, look at men.
• 28:29
  SPEAKER_01: You see some men in their 20s losing their hair, you see some men in their 90s who still have their hair.
• 28:36
  SPEAKER_01: And the reason for that is all of those men probably fall within a range of their androgen levels.
• 28:42
  SPEAKER_01: It's just that their hair has a different sensitivity to those hormones.
• 28:47
  SPEAKER_01: And the same is true in women, it's just that it tends not to manifest as early just because not as much of that hormone is around.
• 28:56
  SPEAKER_01: Um so that is the most common uh cause of hair loss in people in the population overall.
• 29:08
  SPEAKER_01: Um, and I think that there's there's just like a lot of um misunderstanding about it.
• 29:15
  SPEAKER_01: I think there's like a lot of a lack of understanding about you know what could cause hair loss or hair shedding um within, you know, the general population.
• 29:24
  SPEAKER_01: And I've seen, especially on TikTok, oh my god, TikTok, the the the amount of misinformation about um hair loss and even just hair functioning.
• 29:38
  SPEAKER_01: Like, I I don't expect the general public to have a good understanding of hair, skin, and nail biology.
• 29:46
  SPEAKER_01: Like, I get that, but it's just like people do know quite a bit about skin from baseline, even if they're just skincare enthusiasts, it's like they learn about things like you know, your epidermis versus your dermis, about the fact that we have collagen in our dermis, about pigmentation.
• 30:03
  SPEAKER_01: They know about all these things.
• 30:05
  SPEAKER_01: Even enthusiasts, even people who talk about hair care, know next to nothing about hair biology, about how our hair grows, about why our hair sheds.
• 30:17
  SPEAKER_01: Um, so I don't know.
• 30:19
  SPEAKER_03: It's kind of an uphill battle, but um I'm No, but that's an excellent point that you're making because I think um, you know, this actually takes me back to some of the um conversations I've had with um, you know, some of my female colleagues about just that they don't like talking about their hair.
• 30:34
  SPEAKER_03: For example, um, you know, one of my African-American colleagues, she's you know, expressed to me before about how, you know, it's it's just not something you want to talk about.
• 30:42
  SPEAKER_03: It's something that you take care of.
• 30:43
  SPEAKER_03: It's a personal thing going through, but but you know, there the stigma that I've um, you know, that they've kind of relayed these different people have told me there's a stigma about talking about hair care and making it a more streamlined topic.
• 30:57
  SPEAKER_03: And I'm wondering, you know, where that all comes from, which uh which really leads me back to the whole psychology of, I guess, you know, dermatology, right?
• 31:04
  SPEAKER_03: Like the psychology associated with the field.
• 31:07
  SPEAKER_01: Yeah, I mean, I think that there's, especially when it comes to hair loss, a like a large amount of shame that goes into talking about it that I think is um unnecessary.
• 31:20
  SPEAKER_01: Um, certain, you know, skin conditions have become a little bit more destigmatized.
• 31:27
  SPEAKER_01: Like people are openly talking about acne on the internet and their journey with acne and acne positivity and all of that, but it's just like so many people hide their hair loss or are embarrassed to talk about it.
• 31:41
  SPEAKER_01: Um, so you know, I think that that's something that's changing.
• 31:45
  SPEAKER_01: Um, I've been happy to see that there are some influencers that are like sharing their stories about, you know, their hair loss and what they went through.
• 31:56
  SPEAKER_01: Um, I just hope that, you know, content about the science around it maybe like catches on a little bit more just because there is so much in for misinformation about like um, you know, what could cause your hair to fall out or things that you can do to treat your hair loss that, you know, um I would love to be able to cut through that noise.
• 32:16
  SPEAKER_03: Uh yeah, and I agree with you.
• 32:18
  SPEAKER_03: I actually want to shift focus a little bit to skincare, um, you know, like just skincare brands and stuff, because I want to get your opinion about what you think about the industry right now.
• 32:28
  SPEAKER_03: Um, do you think that it's going in a more positive direction in terms of really referencing more um dermatologists such as yourself and and specialists in this field, or do you, you know, how do you feel about it overall?
• 32:39
  SPEAKER_03: The skincare and, you know, I guess hair care industry now.
• 32:43
  SPEAKER_01: I mean, you know, when it comes to skincare, I think we've got to really um we're we're at a very interesting juncture because um people have never had more options than they do right now.
• 32:55
  SPEAKER_01: Um, I almost feel as if the market is going to reach some semblance of like saturation very soon.
• 33:02
  SPEAKER_01: Um, and we're gonna see a bubble burst.
• 33:05
  SPEAKER_01: But um, you know, if you're the type of person who says, and this is something that I hear all the time, hey, you know, I can't find a sunscreen that doesn't break me out.
• 33:16
  SPEAKER_01: Yeah, I could tell you 100% with 100% certainty, you know, you just haven't tried the right one.
• 33:23
  SPEAKER_01: There are so many options for you out there.
• 33:26
  SPEAKER_01: So, you know, that is a great thing.
• 33:29
  SPEAKER_01: Um, uh, when it comes to, you know, just like the social media landscape, I'm happy to see that through 2020 and now this year, um, that a lot of the bigger influencers are, you know, becoming the the real experts.
• 33:44
  SPEAKER_01: Like more of us derms are involved.
• 33:46
  SPEAKER_01: There's so many cosmetic chemists also who are out there giving good education, getting a lot of good traction.
• 33:54
  SPEAKER_01: Um I think the unfortunate thing when it comes to the industry as a whole is um, you know, a lot of the fear-mongering that has gone on and that comes from certain brands that you know they're just marketing ploys.
• 34:10
  SPEAKER_01: Um, they know that the science doesn't support some of the the claims or talking points that they have, but they know that fear sells.
• 34:18
  SPEAKER_01: Um you know, one of one of the examples that I always give about like how this could go south is the whole controversy around parabens.
• 34:28
  SPEAKER_01: Um you know, even the um, you know, larger companies um, you know, putting the free from parabens claim on their their products knows that you know there's there's really nothing wrong with parabens.
• 34:44
  SPEAKER_01: Um the research around it, because they are now one of the most researched um ingredients in all of skincare, shows their safety.
• 34:56
  SPEAKER_01: However, um, you know, in the early 2000s when it first started being pulled from products um due to um some you know poorly composed data.
• 35:08
  SPEAKER_01: I won't even call it research because it was not truly research.
• 35:12
  SPEAKER_03: Yeah, yeah.
• 35:13
  SPEAKER_01: It kind of forced brands to go with um preservative systems that were not as well studied.
• 35:21
  SPEAKER_01: Um, so you know, one of the things that I bring up, I wrote a blog post about this on my own website.
• 35:28
  SPEAKER_01: Around the time that paraben started to be removed from skincare, we started to see the rise of um these preservatives called methyl isothiazolanone and methyl chloroisothiazolanone.
• 35:40
  SPEAKER_01: Yes, those are two words that I need to know how to say.
• 35:43
  SPEAKER_01: Um and, you know, we started to see rampant contact dermatitis from these ingredients.
• 35:53
  SPEAKER_01: So it just goes to show you that doing fear mongering like that, throwing the baby out with bathwater, in a sense, um, can lead to bigger problems down the road.
• 36:04
  SPEAKER_01: However, yeah, you know, we still have brands out there that, you know, I don't know.
• 36:11
  SPEAKER_01: I don't want to, I don't want to make a blanket statement because clean beauty means something different to each brand and to each person.
• 36:19
  SPEAKER_01: Um but, you know, if all you have is fear mongering, if that's all you have to sell your products is by saying what's not in them, um, then you know, I would say maybe you need to rethink your strategy.
• 36:33
  SPEAKER_03: No, absolutely.
• 36:34
  SPEAKER_03: And I think that you make such an excellent point about that.
• 36:37
  SPEAKER_03: And I also, I mean, you know, I would like to add that a lot of the clean beauty that I'm noticing, um, you know, it's fine if if you say that everything is coming from, I I don't know, your organic sources or whatever, you know, whatever the claims are.
• 36:51
  SPEAKER_03: But I just want to say that um the companies out there that are saying we're clean beauty, but we're also science-backed, it's also a marketing ploy because anytime you do any kind of lab bench research, you have to have some sort of an extract that you're using, you know what I mean?
• 37:09
  SPEAKER_03: Like when you're actually conducting the research.
• 37:11
  SPEAKER_03: So, you know, the formulations, and I always wonder like um about how much disconnect there really is, even though now that you know people are saying, well, now more sinker lines are are research backed.
• 37:24
  SPEAKER_03: But then it's like, how do how do you apply that research to the actual formulation of your product?
• 37:29
  SPEAKER_03: And and you know, that's where I get stuck with clean beauty.
• 37:33
  SPEAKER_01: You know, I would I would say the type of clean beauty that I would like to see is um beauty that is um cleaner and better for our environment.
• 37:43
  SPEAKER_01: Um, one of the things that I've noticed just in my time, you know, being a social media content creator is like the rampant consumerism that comes about as a result of people becoming hobbyists or like um consuming the content that some of us put out there.
• 38:02
  SPEAKER_01: I want more people to think about the environmental impact of their skincare and of everything in general.
• 38:10
  SPEAKER_01: But, you know, one of the clean trends that I would love to see is brands being a little bit more transparent about the environmental impact and the carbon footprint of the products that they're putting out there.
• 38:23
  SPEAKER_03: Yeah, yeah, absolutely.
• 38:25
  SPEAKER_03: I agree.
• 38:25
  SPEAKER_03: And I think that there's a lot more, I mean, there's a lot more sustainability talk now, anyways, and skincare.
• 38:31
  SPEAKER_03: I'm noticing that.
• 38:32
  SPEAKER_03: Um, I just don't know how many, you know, how much of a difference it's really making because at the end of the end of the day, you still have a crap ton of packaging, you know.
• 38:40
  SPEAKER_03: So it's like, you know, we can I I I just wonder with the marketing.
• 38:44
  SPEAKER_03: It's like, you know, these trends come up like like what you just said, sustainability or transparency or inclusivity.
• 38:50
  SPEAKER_03: And then at the end of the day, um they're just words, you know, and and there's really not a lot to show for it.
• 38:56
  SPEAKER_03: So we'll see.
• 38:58
  SPEAKER_03: Hopefully, you know, I agree with you though.
• 38:59
  SPEAKER_03: I agree with you.
• 39:00
  SPEAKER_03: I think sustainability is very important.
• 39:04
  SPEAKER_03: Yeah.
• 39:04
  SPEAKER_03: So um, I want to actually ask you what your favorite skincare products are, if you have any to, you know, what you recommend to your patients.
• 39:12
  SPEAKER_03: Um, you know, if somebody comes in, say it's like, you know, um, I'll give you an example of a patient, I guess.
• 39:17
  SPEAKER_03: Um, you know, young man, 17 years old, breaking out.
• 39:21
  SPEAKER_03: Is there's like a cleanser on the market that you really like that's like very gentle or some sort of a over-the-counter treatment that you would recommend for people?
• 39:30
  SPEAKER_01: Well, it's funny um that you say that because I have like so many handouts that I keep in clinic that have like product recommendations.
• 39:38
  SPEAKER_01: My recommendations to you know my patients on a day-to-day basis tend to be um more on the drugstore end of things because um, you know, I want to make sure that everything's accessible for all of my patients.
• 39:55
  SPEAKER_01: Um, you know, in my personal life and on my social media, it's funny that you say this because I just put up a TikTok video earlier today.
• 40:05
  SPEAKER_01: It's like a um holy grails challenge, I call it, but I put some of my favorite products of all time into that video.
• 40:14
  SPEAKER_01: And I never shut up about this cleanser.
• 40:16
  SPEAKER_01: It's the La Roche-Pose Telarian.
• 40:19
  SPEAKER_01: I have it next to me.
• 40:21
  SPEAKER_03: I think I saw your TikTok.
• 40:22
  SPEAKER_03: We can talk about that.
• 40:23
  SPEAKER_03: I saw that.
• 40:24
  SPEAKER_01: It's the hydrating gentle cleanser.
• 40:26
  SPEAKER_01: That so that's one that I often recommend to patients.
• 40:29
  SPEAKER_01: You could find it in the drugstore.
• 40:31
  SPEAKER_01: It's not like the cheapest drugstore product, but like that is one of my favorite gentle cleansers that works for almost all skin types.
• 40:38
  SPEAKER_01: That is on my acne sheet of like if you need a gentle cleanser that's not gonna inflame your acne even more.
• 40:44
  SPEAKER_01: That's the one to go to.
• 40:46
  SPEAKER_01: And you know, I have products of different price points.
• 40:49
  SPEAKER_01: So, you know, in my holy grail lip product is Aquifor, like super cheap, easy to use.
• 40:56
  SPEAKER_01: Um, but at the same time, you know, my holy grail serum is the skin suitable CE Ferrulic for$166.
• 41:05
  SPEAKER_01: And this brings up, you know, a point that I want to talk about a little bit more in some of my content.
• 41:11
  SPEAKER_01: Um I tweeted something like last week about the CE Farulic serum.
• 41:18
  SPEAKER_01: And people somebody asked me, is it worth it?
• 41:21
  SPEAKER_01: And I was just like, okay, like that concept of worth it, like I think we need to get rid of.
• 41:28
  SPEAKER_01: Um, people are so used to having like a yes no about everything, even like some of this, the content that I'm seeing on TikTok right now of people just like, oh, like I went to Target and I'm just gonna tell you yes no if you should get these things or if they're worth it.
• 41:43
  SPEAKER_01: Honestly, it's like that is a$166 serum.
• 41:47
  SPEAKER_03: Yeah.
• 41:48
  SPEAKER_01: I have gotten it for free a few times.
• 41:51
  SPEAKER_01: I love it.
• 41:52
  SPEAKER_01: Would I spend my own money on it?
• 41:54
  SPEAKER_01: I mean, it's hard to say just because like I'm drowning in products right now that are sent to me to test out, and I have so many things to test.
• 42:02
  SPEAKER_01: But you are able to get the benefits of vitamin C at any which price point you want.
• 42:08
  SPEAKER_01: So that is, yes, it is one of the most cosmetically elegant serums.
• 42:14
  SPEAKER_01: They did all the research.
• 42:15
  SPEAKER_01: There are a lot of like products that claim to be dupes out there, they are not truly dupes, like you cannot copy their patent, so it is not the same thing.
• 42:25
  SPEAKER_03: Right.
• 42:25
  SPEAKER_03: Yeah.
• 42:26
  SPEAKER_01: And just the finish on their products is beautiful.
• 42:28
  SPEAKER_01: I feel like it makes my skin look so good.
• 42:30
  SPEAKER_01: So, you know, if if you're more of a luxury price point sort of person and you could afford it, yes, it's worth it.
• 42:38
  SPEAKER_01: But like, I'm not gonna tell you to like skip a meal or scrimp and save to get a$166 serum when um, you know, my like mid-price, not even mid-price, it's actually cheaper, like the Nuturium vitamin C complex serum, which I talk about a lot too.
• 42:58
  SPEAKER_01: I think it's like$22 or something.
• 43:00
  SPEAKER_01: And that is a great vitamin C serum.
• 43:03
  SPEAKER_01: Like, I use that one too.
• 43:04
  SPEAKER_01: And I think, you know, if you don't have the money to, or don't even like, even if you do have the money and you can't bring yourself to spend over$150 on a product, by all means don't.
• 43:17
  SPEAKER_01: Like you can even, I have some vitamin C's that I like from the ordinary too, that are like eight dollars.
• 43:23
  SPEAKER_01: Go for that.
• 43:24
  SPEAKER_03: Speaking of the ordinary, I actually read your blog post about Neode, and I absolutely was in love with that blog post, by the way.
• 43:30
  SPEAKER_03: Um, I I love how you reviewed, I just Neode is my favorite brand.
• 43:35
  SPEAKER_03: I can honestly say that.
• 43:36
  SPEAKER_03: I love their it's exactly what you said in your post.
• 43:39
  SPEAKER_03: It's it's a very complex um, you know, formulation that they're working with.
• 43:44
  SPEAKER_03: It's it's technology.
• 43:45
  SPEAKER_03: And I want you to talk about how you feel about technology in, you know, I guess from the chemistry side in skincare, um, in terms of your, you know, just your experience with that.
• 43:56
  SPEAKER_01: Well, honestly, it's like it's not something that everybody knows.
• 44:00
  SPEAKER_01: needs.
• 44:01
  SPEAKER_01: However, um with a brand like Niod, um Niod, sorry, uh you could tell that a lot of thinking and love went into it.
• 44:14
  SPEAKER_01: So um Brandon, who was like the founder of um of Desium, apparently like Niod was like his baby.
• 44:22
  SPEAKER_01: That was his the first line.
• 44:25
  SPEAKER_01: And when he was told that everything that he was trying to do with it was too expensive, that's when he turned around and made the ordinary.
• 44:34
  SPEAKER_01: This is like a story that I'm telling secondhand.
• 44:36
  SPEAKER_01: I'm not an insider about this but like basically he was like oh you want me to do this for cheap?
• 44:42
  SPEAKER_01: You think that I can't do everything that I want to do and make it accessible and that's where the ordinary came from.
• 44:50
  SPEAKER_01: And it's interesting how you could see some of the products in the two lines mirror each other.
• 44:55
  SPEAKER_01: But I just think um you know when I look at something like this is another holy grail of mine their um multimolecular weight hyaluronic complex.
• 45:04
  SPEAKER_03: Yes that is a phenomenal product love it.
• 45:07
  SPEAKER_01: Like there I'm sorry yes there are some HA serums that come close but not like this.
• 45:15
  SPEAKER_03: Not like this.
• 45:16
  SPEAKER_01: It's just like the way that it is engineered with the different specific weights of the hyaluronic acid and the way that you can see almost an instant plumping effect from it because they have engineered it to basically plump the different layers of the epidermis I mean that um correlation there between the design the use of it the the effect that you're able to visually see that's like poetry.
• 45:46
  SPEAKER_03: I love that yes 100% I could not agree more.
• 45:51
  SPEAKER_03: And I think the entire brand is just crafted so beautifully like you said I mean what I remember uh when I first tried their voicemail mask I actually really really found like I'm a huge masking person.
• 46:02
  SPEAKER_03: I love masks so that was obviously like a product I had to try and I I remember thinking like whoever the chemists behind this are are very talented people.
• 46:10
  SPEAKER_03: You know what I mean?
• 46:11
  SPEAKER_03: And I and I feel like if you can say that about a uh a line a cosmetic line or a skincare line that that says something because that is acknowledging the science and the chemistry and the engineering that goes behind something like that.
• 46:24
  SPEAKER_01: Yeah and I mean even just the story um I think I don't know maybe in my personal life like I am a sucker for stories sometimes like I um I kind of worked slash moonlighted in like the fashion industry like as um doing some like assisting with styling while I was in college and you know fashion is like one of those things that like I always go back to and I love.
• 46:52
  SPEAKER_01: And it's funny because on Instagram like there's this like ongoing thing where my followers like um have been ragging on me for my love of like Marjella cabbie boots but like so much of like everything that Martin Margella did like the story behind it the obsession with certain uh themes like I get so into that I feel like those things are so meaningful and to be able to like wear a piece of clothing where like you're able to see or embody all of that like the same thing is true in skincare.
• 47:27
  SPEAKER_01: You can see the thought and the love that went into a product like that hyaluronic serum and appreciate that and feel that also if that doesn't mean anything to you you can literally buy anything and you know what maybe it's not gonna change anything for you.
• 47:48
  SPEAKER_01: You may have the same outcomes but you know for hobbyists like us um I think like it's just such a gratifying experience.
• 47:57
  SPEAKER_03: I completely agree.
• 47:59
  SPEAKER_03: And you know I just want to thank you so much.
• 48:01
  SPEAKER_03: This has been such a lovely conversation um thank you so much for making the time my pleasure thank you for having me um and everybody out there please um you know check check out this episode leave us some comments um you know I would love to hear what you guys thought if you have any questions for Dr.
• 48:18
  SPEAKER_03: Landersaney please please um uh you know leave them in the comments and we will definitely pass them along to him um and yeah let us know thank you so much doctor thank you bye bye bye hey guys so I hope you love that episode please make sure to hit subscribe if you're tuning in to us on any podcast platform we are available on so many different platforms so wherever it is that you're tuning in just go hit subscribe you'll be immediately notified when we publish new episodes this way you're able to tune in to amazing insights from experts brand founders industry leaders authors all the wonderful people that we host and that's very important for me because I love to hear from you guys and really understand what you love and what you want to hear more of.
• 49:08
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• 49:16
  SPEAKER_03: We also have a blog on Medium so if you're a reader and you love medium blogs check us out on Medium.
• 49:22
  SPEAKER_03: We publish some really great articles on there that do deeper dives than just what's available on the podcast and it's really a great place for all of you science geeks out there that want to learn a little bit more.
• 49:32
  SPEAKER_03: We go above and beyond with our research and making sure we're bringing you information that you usually probably won't hear about in other outlets.
• 49:39
  SPEAKER_03: So check us out leave us a comment leave us a review and we'll be back next time with another episode.
• 49:44
  SPEAKER_03: Thank you.