Latest / The Science of Skin / Understanding Dermatoporosis

Transcript

Understanding Dermatoporosis · The Science of Skin

• 0:09
  SPEAKER_00: So we have two fabulous dermatologists who are going to join me on stage, and we're going to focus on dermatoporosis, which I think we've talked a little bit about, we've talked around it, but now we're really going to focus on it.
• 0:21
  SPEAKER_00: From a clinical standpoint, so these amazing PhDs have one have done just a wonderful job, and now it's our turn to make it relevant clinically.
• 0:30
  SPEAKER_00: So on stage and not PhDs, right.
• 0:33
  SPEAKER_00: And on stage with me, I've got two amazing dermatologists, like I said.
• 0:36
  SPEAKER_00: So Dr.
• 0:37
  SPEAKER_00: Ablon, Glenis Ablon is a native Californian board-certified dermatologist with many years of experience with in surgical aesthetic and aesthetic dermatology as well as medical dermatology.
• 0:48
  SPEAKER_00: She completed her residency training in Baylor College School of Medicine in Houston, Texas, just up the road.
• 0:55
  SPEAKER_00: And Dr.
• 0:56
  SPEAKER_00: Harper is a board-certified dermatologist as well.
• 0:58
  SPEAKER_00: She's the owner of Dermatology and Skin Care Center at Birmingham in Birmingham, Alabama.
• 1:02
  SPEAKER_00: She's the founding director of the American Acne and Rosacea Society, organized in 2005, and she served as the president from 2017 to 2019.
• 1:11
  SPEAKER_00: She is truly an acne and rosacea expert.
• 1:13
  SPEAKER_00: She lectures nationally and internationally.
• 1:15
  SPEAKER_02: Why are you up here?
• 1:16
  SPEAKER_02: Exactly.
• 1:16
  SPEAKER_02: That's a bit of a question.
• 1:17
  SPEAKER_02: So what am I doing up here, Cut?
• 1:19
  SPEAKER_00: Right.
• 1:19
  SPEAKER_00: Well, we're going to focus on dermatoporosis, but I think what we should do first, guys, is explain what dermatoporosis is.
• 1:26
  SPEAKER_00: I think I think there are lots of different terms that are being used for that sagging, crepey skin that we all don't want.
• 1:34
  SPEAKER_00: But how do you define it?
• 1:35
  SPEAKER_00: Glenis, why don't you go first?
• 1:36
  SPEAKER_01: I think that when we started, we were looking at each other going, dermatoporosis.
• 1:40
  SPEAKER_01: Have we heard that term?
• 1:41
  SPEAKER_01: And that was about a year ago and we were having this conversation.
• 1:43
  SPEAKER_01: And it's actually a term that's in the literature.
• 1:45
  SPEAKER_01: You can find about 10 years ago there's a paper published on it.
• 1:48
  SPEAKER_01: But for me, it's just that that skin that's changing.
• 1:51
  SPEAKER_01: It's that skin where a patient comes in and it's fragile and there's atrophy and there's lacerations and there's tissue damage.
• 1:59
  SPEAKER_01: They define it as something someone in the ages usually over 75, but I'm I've got a bruise here from the little dog I pet yesterday.
• 2:06
  SPEAKER_01: So I mean, the bottom line is our skin changes as we go through menopause, as we go through the hormonal changes, our skin changes.
• 2:13
  SPEAKER_01: So I think that even though it's defined in a certain way, to me, the dermatoporosis is that damaged cell, that aging cell, that that skin that's not quite itself and uh is changing.
• 2:23
  SPEAKER_00: Osteoporosis of the skin.
• 2:25
  SPEAKER_02: Yes, and I would add, how many of you know the word dermatoporosis and could come up with a definition of it?
• 2:31
  SPEAKER_02: There you go.
• 2:32
  SPEAKER_02: Yeah, that's exactly where we were about a year ago.
• 2:35
  SPEAKER_02: So the word may be relatively new.
• 2:37
  SPEAKER_02: Yes, it's been in the literature, but we haven't seen it either, so don't feel alone on that.
• 2:41
  SPEAKER_02: But the word is new, but the condition is not new.
• 2:44
  SPEAKER_02: So this is that atrophic skin, the dermis has thinned, the epidermis has thinned.
• 2:50
  SPEAKER_02: I do like osteoporosis of the skin.
• 2:53
  SPEAKER_02: That's a good way to think about it.
• 2:55
  SPEAKER_02: It is most common on the forearms, the hands, the shins, the pre-sternal area, the scalp.
• 3:01
  SPEAKER_02: And then I know what you're thinking.
• 3:02
  SPEAKER_02: You're thinking, well, haven't we just always called that senile purpura or photodamage?
• 3:08
  SPEAKER_02: This does include that, but it also includes everybody's favorite crepey skin.
• 3:12
  SPEAKER_02: And so think about where people will show us crepey skin in clinics, sometimes up in sun-protected areas here, or even on the back side that's been sun-protected for most of a lifetime.
• 3:22
  SPEAKER_02: So just think of it as that thin atrophic skin where you start to see bruising, you may see pseudoscars, you may see lacerations on the skin.
• 3:31
  SPEAKER_02: And I agree, you know, I think it's in full tilt by the time you hit 70, but probably starts in many cases as early as 40.
• 3:40
  SPEAKER_01: And as we talked about, I think the biggest thing is, and I'm I know I'm going to skip your questions, but the biggest thing is that we may not have great things in the past to treat it.
• 3:49
  SPEAKER_01: And I think prevention is really, really important.
• 3:52
  SPEAKER_01: So our whole goal is what can we do?
• 3:54
  SPEAKER_01: And that's what we do in everything in dermatology.
• 3:55
  SPEAKER_01: I think if we can prevent the precancers or the cancers, if we can prevent that change in the skin or the aging or the sagging, everything we can do preventive, of course, is a lot better for the patient, a lot less trauma, and it kind of gets us ahead of the eight-bomb.
• 4:08
  SPEAKER_00: Well, Glennus, I think that aligns exactly with this regenerative session, right?
• 4:11
  SPEAKER_00: With the idea of what can we do now to to bank the collagen, to improve the elastic tissue, to reduce the number of senescent cells ongoing so that we maybe don't achieve dermatoporosis ever or until we are at the end of our health and skin span.
• 4:26
  SPEAKER_00: So that's really interesting.
• 4:28
  SPEAKER_00: Um, you know, I don't know that we're able to do much about it at this point.
• 4:32
  SPEAKER_00: I we see patients all the time complaining of saggy saying, how many patients do we how many people saw patients today or yesterday?
• 4:39
  SPEAKER_00: Yes, right?
• 4:39
  SPEAKER_00: We see it all the time.
• 4:41
  SPEAKER_00: What can you do for this, Doc?
• 4:42
  SPEAKER_00: I'm so tired of these skin lacerations, my skin tears so easily, my puppy clawed me, and now my skin is torn.
• 4:48
  SPEAKER_00: It's forever the same story.
• 4:50
  SPEAKER_00: And everybody asks the same question with the answer being there's really not that much, right?
• 4:54
  SPEAKER_00: I don't know, Julie, what do you say?
• 4:56
  SPEAKER_02: I would say historically we've tried things like ammonium lactate, we've used topical retinoids, but those are not terribly practical, in particular the topical retinoids.
• 5:05
  SPEAKER_02: We're talking about wide surface areas here.
• 5:07
  SPEAKER_02: Uh so I think that we haven't had what we've needed to treat this.
• 5:11
  SPEAKER_02: I had a guy in clinic recently, he is 90, and I was having to cut off a squamous cell carcinoma on his forearm.
• 5:18
  SPEAKER_02: And I want you guys, anybody who does any kind of surgery here, if I do an elliptical excision on that kind of arm, am I ever going to be able to get a suture to hold on that?
• 5:27
  SPEAKER_02: No.
• 5:28
  SPEAKER_02: And I just thought, what could I have given him?
• 5:30
  SPEAKER_02: You know, at this point, to be honest, I was suturing through sterile strips.
• 5:35
  SPEAKER_01: Yeah.
• 5:35
  SPEAKER_02: We did a try to try to, yeah.
• 5:37
  SPEAKER_01: I did a review article that's going to be published in the JDD on dermatoporosis.
• 5:41
  SPEAKER_01: And in my research, you know, we found the retinoids, we found the alpha hydroxy acids like the an lactam, we found DHE had been tried, vitamins like vitamin C had been tried, the matrochine peptides had been tried, but nothing was really great.
• 5:55
  SPEAKER_01: Uh I often tell patients that they have to be protective.
• 5:58
  SPEAKER_01: So, like when I go work at the shelter, I'm wearing long sleeves, gloves, and I still come out with wounds.
• 6:02
  SPEAKER_01: So I think that um we we have a need for this.
• 6:06
  SPEAKER_00: You know, it's interesting.
• 6:07
  SPEAKER_00: You mentioned a couple of hormones there that are probably part of the reason that the dermatoporosis develops, right?
• 6:13
  SPEAKER_00: So some of it is intrinsic aging, right?
• 6:15
  SPEAKER_00: We just can't get away from it.
• 6:16
  SPEAKER_00: There's extrinsic and intrinsic aging.
• 6:18
  SPEAKER_00: Both of them combine perhaps to form dermatoporosis.
• 6:23
  SPEAKER_00: That's a term that was first coined in 2007, by the way, hit the literature at that time, hasn't really hit clinical practice until pretty recently, honestly.
• 6:31
  SPEAKER_00: And I mean we're talking about it on stage now to bring it to the height of awareness.
• 6:37
  SPEAKER_00: But as you said, there hasn't been many things that we could do about it.
• 6:41
  SPEAKER_00: We recognize it, it's horrible, and and how do we treat it?
• 6:44
  SPEAKER_00: And I think with the regenerative technologies that we're talking about all today, there may be an opportunity, like I said.
• 6:50
  SPEAKER_00: But I think there's there's some research that was done recently that we should highlight in regards to two two ingredients that you've heard about, but probably don't even know that they do something like regenerative capabilities in the skin.
• 7:03
  SPEAKER_00: Glennis, what are those two?
• 7:05
  SPEAKER_01: You know, uh before I say it, we you know, we think of these senescent cells.
• 7:08
  SPEAKER_01: Let's let's talk about senescent cells for a second.
• 7:10
  SPEAKER_01: So senescent cells, and I love this analogy that it's like the bad apple in the bucket of apples.
• 7:15
  SPEAKER_01: Sure.
• 7:16
  SPEAKER_01: And you have that one bad apple, and hopefully you can grab that apple and get rid of it.
• 7:21
  SPEAKER_01: But if you aren't working properly or your skin's not working properly, and you can't, all of a sudden that bad apple spreads to the next bad apple, spreads to the next bad apple, and you have a bucket full of bad apples.
• 7:31
  SPEAKER_01: And so that's how I think, and that's how I explain to my patients about what's happening with senescence and senescent cells.
• 7:36
  SPEAKER_01: And so we know that it's that Jaguar notch one pathway that typically actually breaks down those senescent cells so that we can get rid of them out of our body.
• 7:45
  SPEAKER_01: But when you are advanced aging, that mechanism doesn't seem to be working right.
• 7:50
  SPEAKER_00: So the age of your senescent cells actually makes a huge difference.
• 7:53
  SPEAKER_00: Right.
• 7:53
  SPEAKER_02: And so that's where this And in senescent fibroblasts in particular that are not making the collagen, not making the elastin, not making the HA, and what's happening then to the dermis, it's getting smaller over time.
• 8:06
  SPEAKER_02: And we think about senescent cells sometimes as being cells that are sleeping.
• 8:10
  SPEAKER_02: But I left what our speaker earlier said.
• 8:13
  SPEAKER_02: The correct definition is they're not dividing anymore.
• 8:16
  SPEAKER_02: They've reached the end of their multiple divisions, they're no longer dividing, but they're not doing nothing.
• 8:21
  SPEAKER_02: They're being bad apples.
• 8:22
  SPEAKER_02: They're secreting, they're secreting things that are inflammatory.
• 8:26
  SPEAKER_02: And and that inflammatory milieu is bad for the dermis, but it's also communicating with the epidermis.
• 8:32
  SPEAKER_02: So these senescent cells are causing problems.
• 8:34
  SPEAKER_02: They're thinning the dermis, they're thinning the epidermis, and I think Glenis is going to tell you how we're gonna manage that.
• 8:40
  SPEAKER_01: Well, so this amazing technology, they've actually combined this centella asiatica with mandelic acid, and they figured out that each alone didn't really do much.
• 8:51
  SPEAKER_01: But when they microdosed the combination, and we always love combination therapy, that was the ingredient, the magic sauce, if you will, that allowed the reversal of these senescent cells, and that you could get this new fibroblast formation and collagen formation and really change the skin.
• 9:09
  SPEAKER_00: Julie, it was interesting when they were going through the process of understanding how mandelic acid, for example, or scintel asiatica works on the skin, in in vitro, of course, on the on the keratinocytes and fibroblasts.
• 9:20
  SPEAKER_00: There's this concept of hormesis that that really kind of comes into play here.
• 9:24
  SPEAKER_00: It was mentioned a bit in one of the talks, I noticed.
• 9:27
  SPEAKER_00: But can you just help us define hormesis?
• 9:30
  SPEAKER_02: Well, really, I would rather Glynis do that.
• 9:32
  SPEAKER_02: So, what hormesis is, is that an ingredient could have one mechanism at a high dose, but almost the complete opposite mechanism at a low dose.
• 9:42
  SPEAKER_02: So you might be tempted to say, oh, I know mandelic acid or I know Cintella asiatica, but there's a difference because of the way they're also dosed here.
• 9:51
  SPEAKER_02: So it's not just the active ingredients, it's this microdosing of both of them together that has been shown to have synergism here.
• 9:59
  SPEAKER_00: Yeah, the the idea that there's such low concentrations, I mean the mandelic acid in particular, it's it's an alpha hydrosy acid.
• 10:05
  SPEAKER_00: It's a very large alpha hydroxy acid.
• 10:07
  SPEAKER_00: So it does some very superficial exfoliation.
• 10:10
  SPEAKER_00: But what we're really using it for is to ensure a low pH, right?
• 10:14
  SPEAKER_00: We're ensuring the acid mantle with a very low concentration of the mandelic acid, as well as breaking down some of the corneodesmosomes to make to ensure that we can get better concentration of the syntella asiatica and the mandelic acid itself through the epidermis.
• 10:29
  SPEAKER_00: But scintella asiatica at very low doses, I don't know that any of us thought it was going to do much, Glenis, did you?
• 10:35
  SPEAKER_00: No, I I really didn't.
• 10:36
  SPEAKER_00: And that's why the data was really surprising.
• 10:38
  SPEAKER_00: Yeah.
• 10:39
  SPEAKER_00: Very exciting, but very surprising.
• 10:40
  SPEAKER_00: Very surprising.
• 10:41
  SPEAKER_00: I think it surprised everybody altogether.
• 10:43
  SPEAKER_00: Yeah.
• 10:43
  SPEAKER_00: So that synergy of those two ingredients then was found to have some pretty interesting effects on fibroblasts, right?
• 10:51
  SPEAKER_01: Proliferation of the fibroblasts, stimulation of new cell proliferation.
• 10:55
  SPEAKER_00: Yeah.
• 10:55
  SPEAKER_00: Yeah.
• 10:55
  SPEAKER_00: It was reduction in the number of senescent fibroblasts in particular.
• 10:58
  SPEAKER_00: So SASPs, all that good stuff.
• 11:00
  SPEAKER_00: All the reduction of the senescent associated secretory profile.
• 11:03
  SPEAKER_00: So all of those inflammatory markers were decreased as we dose the skin or these keratinocytes and fibroblasts with the very low dose of mandelic acid and syntella asiatica.
• 11:14
  SPEAKER_00: So it's a really interesting story.
• 11:16
  SPEAKER_00: All of a sudden, we're able to use two ingredients that are well known in skin care at extremely low concentrations and show that they can decrease the number of senescent fibroblasts.
• 11:26
  SPEAKER_00: They can decrease the amount of SASP, of senescent associated secretory profile, the inflammatory.
• 11:32
  SPEAKER_00: Say that fast.
• 11:33
  SPEAKER_00: I was glad I got it at once.
• 11:35
  SPEAKER_00: And then that in turn has all of the beneficial effects of reversing or at least delaying the idea of dermatoporosis.
• 11:43
  SPEAKER_00: So now we are taking regenerative medicine and applying it to a condition that is absolutely so common, we talk about it every day, and that's what's exciting.
• 11:52
  SPEAKER_01: And can I tell you that we got a few samples?
• 11:54
  SPEAKER_01: I gave it to my nurse's dad, who is 85.
• 11:57
  SPEAKER_01: He put it on his arms for a month and he had, you know, significant senile purpose, again, probably a good version of dermatoporosis, and his arms had healed in a month of use where he was he couldn't believe they were the same arms.
• 12:12
  SPEAKER_01: It was that dramatic.
• 12:13
  SPEAKER_01: And again, for in my mind, the way I would employ I would apply it in my practice would be to a younger patient as well, right?
• 12:19
  SPEAKER_01: Where I could be preventive and not just treat the condition itself once it's already evolved.
• 12:24
  SPEAKER_00: I agree.
• 12:25
  SPEAKER_00: So you can use it on your older patient with dermatoporosis.
• 12:28
  SPEAKER_00: And per your anecdotal report there, we saw some improvement in an 85-year-old with skin tearing already.
• 12:33
  SPEAKER_00: Right.
• 12:34
  SPEAKER_00: Julie, what do you think?
• 12:35
  SPEAKER_02: I I'm most excited about using it in those older patients.
• 12:39
  SPEAKER_02: But I think the big challenge and the best opportunity is to get it to the younger people.
• 12:44
  SPEAKER_02: You know, and Glennis and I were talking, it's analogous to when you have, if you have a young male come in and everybody in his family goes bald and he knows he's his hair is getting thin and he comes in.
• 12:54
  SPEAKER_02: You don't say, oh, you know, go home and come back when your hair's gone, and then we'll work on it.
• 12:58
  SPEAKER_02: Most of us are glad he's there early, right?
• 13:01
  SPEAKER_02: Because it's easier to maintain that and maybe grow some hair back then before he's too far gone.
• 13:06
  SPEAKER_02: I'm not saying anyone is too far gone for this, but I think the opportunity is to get to people early.
• 13:12
  SPEAKER_02: And I was thinking maybe, maybe the door to get to that is the number of times people come in and say, Can you do anything about crepey skin?
• 13:20
  SPEAKER_02: You know, and they're showing us younger people are showing us areas on their skin where they just don't like the texture anymore.
• 13:25
  SPEAKER_02: They're not really bruising yet.
• 13:26
  SPEAKER_02: They don't have pseudoscars or lacerations.
• 13:29
  SPEAKER_02: So that may be an opportunity for us to kind of get in the door with a product that I think is going to be uh a great value, that's not going to be cost prohibitive, that's gonna be widely available, um, and that many, many of our patients will be able to benefit from.
• 13:45
  SPEAKER_00: They showed in some ex vivo data that they can increase with the use of this product, it increases the thickness of the dermis by 5%, I think, which is absolutely clinically meaningful.
• 13:56
  SPEAKER_00: It sounds like it's such a small amount.
• 13:57
  SPEAKER_01: And that was in day 28.
• 13:59
  SPEAKER_00: Day 28.
• 14:00
  SPEAKER_01: That's what that was about one month, but I was one month.
• 14:02
  SPEAKER_01: Absolutely.
• 14:02
  SPEAKER_00: And so that is clinically meaningful, and I think that kind of alludes to what you were just talking about with your patient.
• 14:08
  SPEAKER_00: Because we know collagen takes months to make, right?
• 14:11
  SPEAKER_00: It's not like we can just make collagen all of a sudden, but the extracellular matrix perhaps is something that can be produced with the hyaluronic acid and the different gags.
• 14:20
  SPEAKER_00: Maybe that's what we're seeing as a reason.
• 14:22
  SPEAKER_01: And frequently in the elderly, lotions are being put on, creams are being put on, and wow, if we could have something that could really change the skin and be protective and support the skin.
• 14:32
  SPEAKER_01: Right.
• 14:32
  SPEAKER_01: I mean, I was dealing with my parents' wounds when they were alive constantly, you know, and that's just as their child.
• 14:39
  SPEAKER_01: So again, I love this idea for my patients.
• 14:41
  SPEAKER_00: So I think that there's a place then, Julie, for the young, the younger, what what age would you tell people?
• 14:46
  SPEAKER_00: You know, it's probably time to start thinking about this as your moisturizer.
• 14:49
  SPEAKER_00: 12.
• 14:49
  SPEAKER_00: I was kidding.
• 14:50
  SPEAKER_00: I started to say kidding.
• 14:51
  SPEAKER_00: Young kidding.
• 14:52
  SPEAKER_00: Young is relative.
• 14:53
  SPEAKER_02: Young is relative.
• 14:54
  SPEAKER_02: But I mean, really, probably late 30s, early 40s.
• 14:57
  SPEAKER_00: 40s, yeah.
• 14:58
  SPEAKER_00: That's what I was thinking too.
• 14:59
  SPEAKER_00: You know, use this twice a day, have sunscreen over it for specifically.
• 15:03
  SPEAKER_00: Make sure you're wearing your sunscreen to to really focus on that extrinsic part of the aging process as well.
• 15:08
  SPEAKER_02: And obviously, this is also a great moisturizer.
• 15:11
  SPEAKER_00: Yeah.
• 15:11
  SPEAKER_02: You know, this is also, it's not just getting rid of senescent cells and and all of the bad that goes with that.
• 15:18
  SPEAKER_02: This is a good barrier repair cream, good moisturizer.
• 15:21
  SPEAKER_01: Because we also we also know, actually, in my research, the hyalurosome, which is a new organelle that we found, which contains hyaluron acid or produces hyaluronic acid, um, and also has uh the heparin like growth factor.
• 15:33
  SPEAKER_01: So that actually is found to be often deficient in people with derumatoporosis.
• 15:38
  SPEAKER_01: So something again, giving them that moisture back is critical.
• 15:42
  SPEAKER_00: So we're thinking about starting it early on, 30s to 40s years of age, can can years of age, continuing and applying it over time.
• 15:51
  SPEAKER_00: But I think what's happening in medicine right now is so interesting in regards to the GLP 1 agonists.
• 15:56
  SPEAKER_00: Because I don't know if you all have seen this, and maybe some of you have seen it as well.
• 16:00
  SPEAKER_00: I mean, what 30 to 40 percent of the US population has been on or is on a GLP 1 agonist.
• 16:05
  SPEAKER_00: That's the data right now.
• 16:06
  SPEAKER_00: So you see this rapid weight loss, and it is defined clinically in for a dermatologist, we we see it as sagging skin.
• 16:14
  SPEAKER_00: You see the crapiness all of a sudden happen in these relatively young people as they have this dramatic weight loss.
• 16:19
  SPEAKER_00: It's interesting to me from that point of view as well.
• 16:22
  SPEAKER_00: You know, we're talking about these GLP 1 agonists in so many different ways in dermatology, but I think this there's an opportunity for us to perhaps prevent that in the GLP 1 agonist patient.
• 16:32
  SPEAKER_00: I don't know if you guys agree.
• 16:33
  SPEAKER_00: Perhaps, yeah, I don't know.
• 16:36
  SPEAKER_00: I don't know.
• 16:37
  SPEAKER_02: Is that is that a loss of HA and is it just volume loss?
• 16:41
  SPEAKER_02: I I don't know what the answer is, but you're right.
• 16:44
  SPEAKER_01: But again, it'd be worth a shot.
• 16:45
  SPEAKER_02: Yeah, yeah.
• 16:45
  SPEAKER_01: It's kind of like it's not designed for specifically just senile periphera, but if you have a patient and if it's working on this, perhaps I could put on my patient that's having post-treatment bruising.
• 16:55
  SPEAKER_01: You know, maybe these echimoses might get better as well.
• 16:57
  SPEAKER_01: So I think there's a lot of again opportunities.
• 16:59
  SPEAKER_00: You know, it's interesting also because this aligns with the skincare theme that's happening in 2024, which is skin care beyond the face, right?
• 17:05
  SPEAKER_00: Going beyond the face with your active ingredients to treat the declete, the neck, the upper arms, the knees.
• 17:11
  SPEAKER_00: We're places where people are not happy with the appearance of their skin.
• 17:14
  SPEAKER_00: This aligns with that as well.
• 17:16
  SPEAKER_00: So it may not just be for dermatoporotic effect, it may be for for truly, you know, I don't know, appearance effect.
• 17:24
  SPEAKER_02: Well, and it was interesting in the studies, um, one of the studies, they were testing it on the forearms, but also the neck.
• 17:30
  SPEAKER_02: And boy, they showed some really nice improvement with um, I don't know if the word would be firming of the neck, but uh, you know, I think it made all of us who looked at that, can we have some of that to put on the neck?
• 17:43
  SPEAKER_02: So I yeah, I think there's some opportunity here for sure.
• 17:46
  SPEAKER_00: That's when you go to the exhibitor hall and get all your examples, we do that all anyway, right?
• 17:50
  SPEAKER_02: Yes.
• 17:51
  SPEAKER_00: All right, well, guys, thank you so much.
• 17:53
  SPEAKER_00: This has been a really interesting overview of dermatoporosis.
• 17:56
  SPEAKER_00: And uh I want to thank uh the sponsor for this panel discussion is Gal Derma.
• 18:01
  SPEAKER_00: So thank you to Galderma for the sponsorship.
• 18:03
  SPEAKER_00: This will be uh published as an episode in Skincare Confidential as well, so we'll be available for download.
• 18:08
  SPEAKER_00: If you don't subscribe to Skincare Confidential, uh why?
• 18:13
  SPEAKER_01: Um and thank you.
• 18:16
  SPEAKER_01: You can actually get the product for sale out of your office, I think, January, something like that.
• 18:20
  SPEAKER_00: There you go.
• 18:21
  SPEAKER_00: So go speak to the Galderma folks and they may be able to help you with that idea as well.
• 18:25
  SPEAKER_00: Otherwise, we are done.
• 18:26
  SPEAKER_00: Thank you so much, everybody.
• 18:27
  SPEAKER_00: Let's head out there to the exhibitors and uh enjoy ourselves.
• 18:31
  SPEAKER_00: Thank you.
• 18:32
  SPEAKER_00: Let's get a picture.