Latest / The Science of Skin / Learn about the role of moisturizers for optimizing barrier function by expert Dr. Jim Del Rosso, DO.

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Learn about the role of moisturizers for optimizing barrier function by expert Dr. Jim Del Rosso, DO. · The Science of Skin

• 0:08
  SPEAKER_00: Hi, I'm Dr.
• 0:09
  SPEAKER_00: Patty Ferris.
• 0:10
  SPEAKER_00: I'm a board certified dermatologist, and I'm your host for this episode of Skincare Confidential.
• 0:16
  SPEAKER_00: We are so excited today to have Dr.
• 0:18
  SPEAKER_00: Jim Delraso with us.
• 0:20
  SPEAKER_00: Jim's a board certified dermatologist.
• 0:22
  SPEAKER_00: He's definitely one of the most well-known and well-respected authorities on dermatologic therapeutics.
• 0:28
  SPEAKER_00: And he has lectured and published extensively on the subject of moisturizers and barrier repair, which is what this episode is going to be about.
• 0:36
  SPEAKER_00: But before we start, I want to tell everybody a little bit about Jim and his accomplishments.
• 0:41
  SPEAKER_00: Jim is research director of JDR Dermatology in Las Vegas.
• 0:46
  SPEAKER_00: He's the senior vice president and clinical of clinical research and strategic development at advanced dermatology and cutaneous surgery in Maitland, Florida.
• 0:56
  SPEAKER_00: He's been in practice for 36 years.
• 0:58
  SPEAKER_00: Jim, I think you and I are neck and neck on that one.
• 1:01
  SPEAKER_00: He's a past board member of the American Academy of Dermatology.
• 1:04
  SPEAKER_00: We served on the board together and had great fun.
• 1:07
  SPEAKER_00: And he's one of the original co-directors of the fall and winter clinical dermatology meetings, which many dermatologists attend in their very valued meetings.
• 1:16
  SPEAKER_00: Now, what most people may not know about Jim Delrosso is that he probably could have taken the role of Elvis Presley away from Austin Butler, who I think is up for an Academy Award this year.
• 1:28
  SPEAKER_00: Jim Delroso is an amazing guitar player, a fine singer, and I've heard him imitate Elvis, and believe me, Austin Butler's got nothing on Jim D.
• 1:39
  SPEAKER_00: So Jimmy D, welcome to Skincare Confidential.
• 1:42
  SPEAKER_01: Well, Patty, that's very nice.
• 1:44
  SPEAKER_01: But Austin ha what he has on me is he has looks, he's thinner, and he he can move a heck of a lot better than I can.
• 1:54
  SPEAKER_01: I don't know.
• 1:55
  SPEAKER_00: I'm not sure I buy that, but that's okay.
• 1:57
  SPEAKER_00: That's your story, and you're sticking to it.
• 1:58
  SPEAKER_00: Yep.
• 1:59
  SPEAKER_00: Anyway, Jim, we're really excited to tap into your expertise on this subject of moisturizers and barrier repair.
• 2:06
  SPEAKER_00: And this is a very hot topic right now.
• 2:09
  SPEAKER_00: You turn on TV and people are talking about ceramides and moisturizers, and you can't go on social media without seeing you know derms everywhere talking about this subject.
• 2:18
  SPEAKER_00: So why don't we sort of start basic with the anatomy of a moisturizer?
• 2:22
  SPEAKER_00: How does it work?
• 2:23
  SPEAKER_00: How does it benefit the skin?
• 2:26
  SPEAKER_01: Well, I think one of the things that's important to recognize, and just uh you know quickly, but I I got into this probably in the you know probably about 2002, 2003, when I I was already in my career for quite a while, and I was invited actually by Jim Leyden uh to a meeting, and I didn't know exactly what it was going to be about, but I got to know him.
• 2:49
  SPEAKER_01: He said, Jim, you're gonna love this.
• 2:51
  SPEAKER_01: And I went to a meeting.
• 2:52
  SPEAKER_01: It happened to be with Unilever, but it wasn't really about product develop about products, it was all about the stratum corneum and the epidermis, physiology, and then how does it retain moisture and barrier functions?
• 3:08
  SPEAKER_01: And I'm sitting there and I'm listening to these stratum corneologists, you know, these people that are really getting into the weeds on this, thinking, here I am, I'm years out.
• 3:19
  SPEAKER_01: I think I'm pretty well accomplished in dermatology, pretty knowledgeable, and I didn't know squat about the basics, the fundamentals of how it all works.
• 3:30
  SPEAKER_01: So I got into it, started writing some articles, uh, and and uh and it is an article in 2011, I'll just bring to people's attention that still has all the basic fundamentals, where I took everything together and put it in one try to put it in one place, and I really think what you say about going to the back to the fundamentals, and it's it's open access, it's it's in J C A D.
• 3:52
  SPEAKER_01: Look under my name, and the second author is Levin L E V I N, and you'll find it.
• 3:57
  SPEAKER_01: You could print it if if it's of interest.
• 4:00
  SPEAKER_01: It gets into actually what the basics are.
• 4:04
  SPEAKER_01: And with a moisturizer, I think one of the first things is that moisturizers are not formulated to add water, they're formulated to retain water, a moisture level in the stratum corneum in the epidermis to help the skin, which has its own ways of doing that, but sometimes it's compromised, right?
• 4:25
  SPEAKER_01: It gets compromised either by external environment or by or by a disease state or both, like a topic dermatitis is the poster disease, but it's not the only one by far.
• 4:35
  SPEAKER_01: So I think it's really important, and the formulations have some core fundamental characteristics, but then we start adding in all these designer additives and things that you know sometimes they make a difference, and sometimes we we're wondering what they're really doing, right?
• 4:53
  SPEAKER_01: And and you've done a lot with that on the cosmosutical side, especially.
• 4:57
  SPEAKER_01: Oh yeah.
• 4:57
  SPEAKER_00: Oh yeah.
• 4:58
  SPEAKER_00: So maybe uh teasing out uh the humectants and you know the b um different components that people might be looking for.
• 5:07
  SPEAKER_00: I think that would be very helpful.
• 5:08
  SPEAKER_01: Well, you know, it I could design a study, and this is where it gets tricky, because I I think dermatology clinicians they're getting much more facile, and what is IL 17 doing, and now Janus kinase enzymes or interleukin 4, or you know, all we're getting into the weeds of all this pathophysiology of disease, but it it when you look at a moisturizer study, you sort of lost because you never really got that training, right?
• 5:38
  SPEAKER_01: I I could design a moisturizer study to look for something that I want a certain outcome that can in some ways be misleading, because I can show you that something that's truly protectant may be giving the best result in terms of reducing transepidermal water loss over and above another moisturizer which is formulated to do other things, but it's just not reaching that target within a certain period of time, right?
• 6:07
  SPEAKER_01: So I can design studies to to pre-design the outcome, pre pre-figure out the outcome.
• 6:14
  SPEAKER_01: And that can be somewhat misleading.
• 6:16
  SPEAKER_01: I I think with moisturizers, first of all, we we want something that's occlusive in there, and petrolatum, obviously, white petrolatum is the standard.
• 6:25
  SPEAKER_01: It just sits on the surface and it basically blocks the transepidermal water walls.
• 6:32
  SPEAKER_01: Right.
• 6:32
  SPEAKER_01: But there are there are several other agents that we add in.
• 6:36
  SPEAKER_01: There are some fractionated petrolatum that are mixed in with other things, like lanolin alcohol and other things with light mineral oil, uh which which pharmaceutical grade, mineral oil, not industrial grade.
• 6:49
  SPEAKER_01: That's the one that you're gonna see as cometogenic or whatever.
• 6:53
  SPEAKER_01: Or some other uh, you know, uh protective amollium type agents that can prevent that transepidermal water loss.
• 7:01
  SPEAKER_01: But that alone is not gonna be enough.
• 7:04
  SPEAKER_01: You need humectancy, right?
• 7:05
  SPEAKER_00: You need some I was just gonna ask you.
• 7:07
  SPEAKER_00: A lot of people, I think, get confused about humectants because humectants are really bringing moisture from the dermis up, right, to into the stratum corneum.
• 7:16
  SPEAKER_01: Right.
• 7:16
  SPEAKER_01: So if you think about you have I'm sure you you've had this, we've all had this countless time.
• 7:22
  SPEAKER_01: I'm drinking more water because my skin is dry.
• 7:25
  SPEAKER_01: Well, if it's it's getting evaporated out, it's you know what good is it?
• 7:29
  SPEAKER_01: It's it's what good is it?
• 7:30
  SPEAKER_01: So the skin has a certain amount of physiologic transepidermal water loss, which is normal.
• 7:36
  SPEAKER_01: And when that increases, that's what that's when it gets into trouble.
• 7:39
  SPEAKER_01: So it really detects that transepidermal water loss very effectively.
• 7:44
  SPEAKER_01: But if you're bringing moisture up from the subcutaneous tissue into the dermis, now into the epidermis, you need a certain level.
• 7:54
  SPEAKER_01: There's actually a gradient in the stratum corneum, but you need a certain water level so that the enzymes, they're hydrolytic enzymes, right?
• 8:02
  SPEAKER_01: So they need a critical amount of water to get desclimation.
• 8:06
  SPEAKER_01: And we want to desclimate single cells so nobody's seeing us.
• 8:10
  SPEAKER_01: But when when they when when they get when they get, yeah, we don't you don't want to be sitting there, you know, in a romantic date, and you know, and and the person's going, What the you I'm watching this person discremating.
• 8:22
  SPEAKER_01: Exactly.
• 8:23
  SPEAKER_01: What the heck is going on, right?
• 8:25
  SPEAKER_01: Um, you know, that you the person might make you sweat, but you don't want them to make you declimate, right?
• 8:31
  SPEAKER_01: So, so you know, if you want to do it physiologically, and when you lose that water level, those enzymes get sluggish, and now the corneocytes clump, and that's what we see is scaling, right?
• 8:42
  SPEAKER_01: Right in dry skin.
• 8:44
  SPEAKER_01: The scaling is one of the first things that we see.
• 8:46
  SPEAKER_01: So the humectant, things that we add like hyuronic acid, glycerin, other agents that are umectants, propylene glycol in low concentrations, and some other agents that can be added in.
• 9:00
  SPEAKER_01: And propylene glycol is it it keeps rearing its head as a bad word, right?
• 9:06
  SPEAKER_01: That we that keeps coming up.
• 9:07
  SPEAKER_01: Oh, yeah.
• 9:07
  SPEAKER_01: But it's used.
• 9:08
  SPEAKER_01: It's used in low concentration.
• 9:09
  SPEAKER_01: Of course it is.
• 9:10
  SPEAKER_01: Of course it is.
• 9:10
  SPEAKER_01: So it it retains water you in the stratum corn.
• 9:16
  SPEAKER_01: Right?
• 9:16
  SPEAKER_00: Which is where you occlusive lays on top and holds it in, stops the transepidermal water loss.
• 9:21
  SPEAKER_00: So those are the unity gang between those two is right, I think.
• 9:25
  SPEAKER_01: Exactly.
• 9:26
  SPEAKER_01: And if you only use the humectant and you didn't have the occlusive, it's not enough.
• 9:32
  SPEAKER_01: Because you're pulling, you know, you you need you need the fundamental combination of both those things.
• 9:38
  SPEAKER_01: But sometimes we'll look at formulations and we'll say, well, you know, why does it have a few different humectins?
• 9:45
  SPEAKER_01: Because some of these things are now going to be concentration dependent, right?
• 9:49
  SPEAKER_01: You say, oh, I got a great umectin.
• 9:50
  SPEAKER_01: I'm going to load it with glycerin or glycerol.
• 9:54
  SPEAKER_01: It's going to get too sticky when the concentration.
• 9:57
  SPEAKER_01: So now the really good formulators who are just like my grandmother could never tell me how she made her spaghetti sauce.
• 10:06
  SPEAKER_01: The formulators, they could, they don't want to tell you.
• 10:09
  SPEAKER_01: They they keep a little bit back on their secret.
• 10:12
  SPEAKER_01: It's like Luke's gumbo formula.
• 10:14
  SPEAKER_00: They make it nice, not sticky, and they put those emollients in there to give it the nice slip on the skin, and that's sort of the icing on top of the cake, in my opinion.
• 10:23
  SPEAKER_01: Yeah, it gives it, but it's just the right amount.
• 10:26
  SPEAKER_01: Um so they'll add in other other other.
• 10:31
  SPEAKER_01: So you have a couple of players in there doing the same thing because when they're together in lower concentrations, they get the job done, they support each other, but the formulation you don't have a contact dermatitis level of an ingredient or an irritation level or a stickiness or greasiness of some of these.
• 10:52
  SPEAKER_00: It gets that cosmetic elegance when they use it.
• 10:55
  SPEAKER_01: That is the final outcome has to be the person's gonna like the way it feels on their skin.
• 11:01
  SPEAKER_01: Absolutely.
• 11:02
  SPEAKER_01: And if it has a bad smell, forget it.
• 11:04
  SPEAKER_01: It's gone.
• 11:04
  SPEAKER_00: Yeah, forget about it for right.
• 11:06
  SPEAKER_00: Talk about some of the buzzwords, Jim.
• 11:08
  SPEAKER_00: I mean, let's talk about ceramides.
• 11:10
  SPEAKER_00: You can't turn TV on, can't turn on social media without people touting ceramides.
• 11:14
  SPEAKER_00: What do those do in moisturizers?
• 11:17
  SPEAKER_01: Well, ceramides became a very important buzzword, but a realistic one, because you know, within that stratum corneum, you have the the corneocytes, the keratinocytes, and the corneocytes, which are the bricks, they talk about them as the bricks, but the mortar in between is the lipids that are organized.
• 11:38
  SPEAKER_01: It's an organized layer of lipids.
• 11:39
  SPEAKER_01: But I remember Matt Zyrus had a meeting one time, and he was exactly right.
• 11:44
  SPEAKER_01: He said it's not bricks and mortar, it's like bricks and peanut butter, or or you know, it's it's not fixed like a block.
• 11:56
  SPEAKER_00: You think of bricks and mortar.
• 11:57
  SPEAKER_01: Right.
• 11:57
  SPEAKER_01: So you think it might be peanut butter or something in there that but it's still controlling the water loss there.
• 12:05
  SPEAKER_01: But ceramides are significant component of that lipid layer.
• 12:09
  SPEAKER_01: Now they have to be the right, you know, chain length of ceramides.
• 12:12
  SPEAKER_01: They have they're they're formed physiologically, and in conditions that like atopic dermatitis, they cannot form the correct ceramides.
• 12:22
  SPEAKER_01: They have a deficiency in the physiologic ceramides, right?
• 12:26
  SPEAKER_01: They produce ceramides, but they're the wrong chain lengths, they're just not functioning as well, in addition to other problems.
• 12:32
  SPEAKER_01: So that's why the atopic individual, even when their skin looks normal, is losing more water.
• 12:38
  SPEAKER_01: That's one of the because they don't so then ceramides became really popular, and that's where we got most of our data.
• 12:45
  SPEAKER_01: Suddenly, people were studying atopic dermatitis, they're looking at everything that we're talking about, and atopic dermatitis became the the poster, the poster.
• 12:57
  SPEAKER_01: The poster child, really, for poster disease.
• 13:00
  SPEAKER_00: Yeah.
• 13:01
  SPEAKER_01: But ceramides they're not the only thing.
• 13:03
  SPEAKER_01: You need fatty acids, cholesterols, you need other components in there.
• 13:07
  SPEAKER_01: We we pay attention now to things that kind of maintain the natural diversity of the of the microbiome, people getting into these other areas, but functionally, ceramides are not, I don't think, are ever going to hurt.
• 13:21
  SPEAKER_01: There are conditions where you need them more, um, and they're not the only thing that you need.
• 13:26
  SPEAKER_01: But you're you're repleting the ceramides so that when the when the skin is compromised, you know, it it has to help itself.
• 13:36
  SPEAKER_01: Like you're flying from New Orleans, you get off the plane in Las Vegas, within an hour you could feel your skin getting dry and your nose cracking.
• 13:44
  SPEAKER_01: Absolutely, right?
• 13:45
  SPEAKER_01: And then you live in you know you live in New Orleans where you have a lot of you humidity and moisture.
• 13:50
  SPEAKER_01: So your and your enzymes that would normally correct, right, are kind of sluggish.
• 13:57
  SPEAKER_01: They're kind of sitting back, they're having a gumbo, they're sleeping, they're going to Pat O'Brien's.
• 14:02
  SPEAKER_01: They're like, wait, we have to work.
• 14:04
  SPEAKER_01: We have to start working.
• 14:05
  SPEAKER_01: That's right.
• 14:06
  SPEAKER_01: Right.
• 14:06
  SPEAKER_01: But they get a little sluggish.
• 14:08
  SPEAKER_01: But in some people, like atopics, they're not they're not as functional normal.
• 14:13
  SPEAKER_01: They're sluggish all the time, unfortunately.
• 14:15
  SPEAKER_01: So there is phalagrine, you know, that's why we we have you talk about another additive phalagrine degradation products like certain amino acids and and PCA and some other components that we put in there to help, because phalagrin is in the stratum corneum partially, that when you need to retain water, phalagrine breaks down into natural moisturizing factor, right?
• 14:41
  SPEAKER_01: And so companies make moisturizers to say we have components and natural moisturizing factor, because that's your body's natural umectin.
• 14:50
  SPEAKER_01: It breaks down the phalagrin into several different things, mostly amino acids, some sugars, other things, electrolyte, to be the natural umectin, right?
• 14:59
  SPEAKER_01: So now you're looking at additives in moisture.
• 15:02
  SPEAKER_01: Oh, so we have you know a certain component in here, um, and we have ceramides.
• 15:09
  SPEAKER_01: Well, you'll see the term this throws this term throws people off.
• 15:13
  SPEAKER_01: Pseudo ceramides.
• 15:15
  SPEAKER_01: Pseudosaramide.
• 15:16
  SPEAKER_01: It sounds like biosimilars, right?
• 15:19
  SPEAKER_01: Yeah, bioidentical.
• 15:21
  SPEAKER_01: Oh, yeah, yep.
• 15:22
  SPEAKER_01: You know, I I don't want the hydrox cookies, I want the real Oreo cookies, right?
• 15:27
  SPEAKER_01: But but you know, but the the fact of the matter is pseudo ceramides, that just means that they made a synthetic synthetic ceramide that functions like pretty much the same as a natural ceramide.
• 15:41
  SPEAKER_01: Now people debate, they split hairs, but pseudo ceramides, you know, function very well in moisturizers.
• 15:48
  SPEAKER_01: They're just trying to replicate as much of the natural physiology that they can.
• 15:53
  SPEAKER_01: As they can.
• 15:54
  SPEAKER_00: Yeah.
• 15:55
  SPEAKER_00: Talk a little bit about another thing we hear is kind of a buzzword, thermal spring water.
• 16:00
  SPEAKER_00: You know, we'll be going through the exhibit hall at the AAD, and there's all the companies that have thermal spring water, and I think a lot of people wonder what the value of those are.
• 16:11
  SPEAKER_01: Well, you know, you you go there and you know, depending on who you who where you are, you might have somebody dressed up with a white in a white coat or whatever, and they're giving you now this scientific discussion.
• 16:24
  SPEAKER_01: So we talked about ceramides can be in a lot of different formulations.
• 16:28
  SPEAKER_01: It's a good thing to have if you have a situation like A to P.
• 16:33
  SPEAKER_01: You can also have ceramides deficient or affected in severe dry skin, um, in in other disease states.
• 16:40
  SPEAKER_01: So they're not a bad thing to have in there, but they're not the only fix-it thing.
• 16:46
  SPEAKER_01: So we want to put some we want to put some other things in there.
• 16:49
  SPEAKER_01: It's nice, I think, to have antioxidants, ones that really do something.
• 16:53
  SPEAKER_01: We're learning about the importance of that for many, many reasons, right?
• 16:59
  SPEAKER_01: There was just a great article, it happened to be with um with polypodium leucotomus extract, the one that actually has a lot of the data on it, affecting benzopyrenes in air pollution.
• 17:11
  SPEAKER_01: So it's not only sun, it's not only using rough soaps and things, you know, bad bad skincare products or cleansers, but also the pollutants we're finding more and more and the damage they're creating.
• 17:24
  SPEAKER_01: So we want to neutralize those things.
• 17:26
  SPEAKER_01: So I am gonna, and I know you've been talking about antioxidants a lot longer than I have, because I was always concerned that they're in there, but they're not telling us whether they're even getting into the skin or doing anything, right?
• 17:38
  SPEAKER_00: But now we have some that I think we have some good data to suggest that they are helpful.
• 17:43
  SPEAKER_00: And you I'm glad you brought up pollution because that whole notion of the exposome, it's not just UV light anymore.
• 17:49
  SPEAKER_00: Right.
• 17:49
  SPEAKER_00: We've got pollution, we've got other things that we have to consider.
• 17:52
  SPEAKER_00: Visible light environmental aggressors.
• 17:54
  SPEAKER_01: Visible light, which ant which good antioxidants protecting it for darker skin, not only and infrared.
• 18:00
  SPEAKER_01: Yeah, so yeah, infrared.
• 18:02
  SPEAKER_01: You know, that that's that with we'll be we could go on and on with for this forever, but you know, going back to what you're saying about thermal spring water, yeah, this this term microbiome is a buzz phrase, and and everybody jumps on the train, right?
• 18:17
  SPEAKER_01: And and I believe there's definitely reality there, but I think we're still learning a lot more about it.
• 18:24
  SPEAKER_01: Uh and we we need to learn a lot more about it because it's extremely important.
• 18:29
  SPEAKER_01: But uh a simple example that we know of is people that have atopic skin, and then they're developing a flair of atopic dermatitis.
• 18:39
  SPEAKER_01: And I think it's even true if people are just going from quote normal to dry and they're getting barrier impairment.
• 18:46
  SPEAKER_01: The colonization of the skin changes, and especially in atopics, because they're deficient in their antimicrobial barrier.
• 18:54
  SPEAKER_01: The barrier is not only water, the barrier, there's several different parts of the of the epidermal barrier.
• 19:00
  SPEAKER_01: There's an antimicrobial barrier.
• 19:02
  SPEAKER_01: We have peptides that so if you get staph getting into a little cut or a virus, they neutralize, so they give you that immediate innate immunity.
• 19:11
  SPEAKER_01: So we know that in in certain conditions, and certainly they topic dermatitis, the microbiome on the skin surface changes, and you get a lot more staphly cocci, aureus, and epidermis, right?
• 19:27
  SPEAKER_01: And then all the other organisms diminish in number.
• 19:30
  SPEAKER_01: So the commensal competition, what makes it hard for a pathogen, you can cut you can culture my skin and find something that, oh wow, that shouldn't be there.
• 19:40
  SPEAKER_01: That doesn't mean I'm um infected, that just means you found it there.
• 19:45
  SPEAKER_01: But you have all these other organisms that are taking up space.
• 19:48
  SPEAKER_00: And that's taking up food, taking up space, taking up everything that needs to be a pathogen.
• 19:54
  SPEAKER_01: Exactly.
• 19:54
  SPEAKER_01: So that pathogen comes into the neighborhood and there's enough other people in the neighborhood say, get the heck out of here, you're not gonna take over, right?
• 20:02
  SPEAKER_01: But then if you have a situation where that changes and that pathogen's put into a situation where it could bully its way into the skin, right?
• 20:13
  SPEAKER_01: Right.
• 20:13
  SPEAKER_01: Um, and that is correlated with other things that happen that are tied to a flare.
• 20:21
  SPEAKER_01: So the diversity of the the quote normal microbiome, whatever range that might be, is extremely important.
• 20:29
  SPEAKER_01: So what they found with thermal spring water um in France and a in an area of France is that within that water there were certain concentrations of certain minerals and other components of that water, but it also had a certain microbial um uh content that would be a component to it that when that would be applied to the skin, helped to normalize individuals that had trouble maintaining enough diversity so they didn't have that pathologic state uh change, you know, that we're talking about.
• 21:08
  SPEAKER_01: So, you know, a company there, La Roche per se is the company, they harvested a way to basically recreate that environment within some of their moisturizer products, which is not only not only the the the water itself, but also the prebiotic component, where they can har there's a certain prebiotic component that helps support the diverse microbiome you want, and not allow you know the the trouble kids to come into town and influence the neighborhood, so to speak.
• 21:43
  SPEAKER_01: So they did a very nice job with that, and they have good data on it.
• 21:46
  SPEAKER_01: And that's the thing that I would ask, Patty.
• 21:49
  SPEAKER_01: I don't know how you do it, but there's so many products, I it's hard to tell.
• 21:54
  SPEAKER_01: And I look for at least some core scientific information from a company.
• 22:00
  SPEAKER_00: That's exactly why we're here.
• 22:01
  SPEAKER_00: And you're giving you exactly what we're looking for.
• 22:05
  SPEAKER_00: You know, I I've looked at the La Roche-Possa studies as well and even had the opportunity to go there and see the patients treated with the thermal spring water.
• 22:13
  SPEAKER_00: I don't know if you've made that trip over the years, but it's quite an experience because we have patients with psoriasis and eczema who are getting nothing but balneotherapy, and it's pretty impressive.
• 22:22
  SPEAKER_01: It is.
• 22:22
  SPEAKER_01: And and you know, so you just brought up whether I'm going to go there.
• 22:26
  SPEAKER_01: Well, looking at miracle on ice behind me here.
• 22:28
  SPEAKER_01: Um I'm hoping for a miracle where maybe I'll get invited one day and I'll get to go.
• 22:33
  SPEAKER_01: But you know, maybe I'll just go on my own.
• 22:35
  SPEAKER_01: I'll just I'm gonna put a plug-in for you, Jill.
• 22:39
  SPEAKER_01: You know, not you know, to to recognize that there are certain companies and there are others.
• 22:44
  SPEAKER_01: And if I didn't mention somebody, you know, I apologize.
• 22:48
  SPEAKER_01: But there are certain companies that have spent the time when they've come up with products to talk to us why they have in there.
• 22:55
  SPEAKER_01: Galderma has done it with some of their therapeutic moisturizers for acne.
• 22:59
  SPEAKER_01: Um, buyer's doctor has done it.
• 23:05
  SPEAKER_01: Skin physics on antioxidants, you know, exactly.
• 23:09
  SPEAKER_01: A ton of work, you know.
• 23:10
  SPEAKER_01: The people that worked on on Cere V, which was really I mean Cetophil was the big player, right?
• 23:16
  SPEAKER_01: And and it's still a very good line, but Cere V really worked hard on that.
• 23:21
  SPEAKER_01: And we were there in the beginning, and worked with it and developed it, and they have data behind the product.
• 23:28
  SPEAKER_01: So ask for the data when the reps come in, ask them to look at it and try to become if this is not your area, it's hard like any other new area, but it's worthwhile to just be able to ask and think about a few questions.
• 23:42
  SPEAKER_01: You'll feel better when you're recommending something to a patient that you feel you understand why.
• 23:48
  SPEAKER_01: Not just that I know I have to give a patient a moisturizer, like I did earlier in my career.
• 23:53
  SPEAKER_01: I'd pick a few, think how it felt on it.
• 23:56
  SPEAKER_01: Seems okay, ask my nurse how does it feel on you, but not really know what if there were any fundamental things that it was doing where there was some scientific evidence.
• 24:07
  SPEAKER_01: Now, when I recommend these products, I feel good about it, just like I feel good about recommending a medication, a prescription medication, because I understand what it's doing.
• 24:16
  SPEAKER_01: So it just helps you feel better.
• 24:18
  SPEAKER_00: You know, moisturizers are the bread and butter of dermatology.
• 24:21
  SPEAKER_00: I mean, we are using moisturizers in all patients, whether they're cosmetic patients, medical patients, surgical patients.
• 24:28
  SPEAKER_00: So I think it's really important for people to understand.
• 24:31
  SPEAKER_00: I want to of course we've been jammering like we always do.
• 24:34
  SPEAKER_01: Yeah, yeah, but you know, I feel sorry for the people listening to some extent.
• 24:38
  SPEAKER_01: But I guess if they're still listening, they like what they're hearing.
• 24:42
  SPEAKER_01: But you you bring up a very important point.
• 24:44
  SPEAKER_01: I have to credit the the person who trained me, the main trainer Dave Horowitz.
• 24:49
  SPEAKER_01: He told me way back when, and we didn't have nearly the sophistication that that we have now, he would say to me, do not let a patient leave, regardless, without you giving them something to wash.
• 25:04
  SPEAKER_01: Everybody wants to know what to wash with, what to cleanse with.
• 25:07
  SPEAKER_01: Give them a recommendation.
• 25:09
  SPEAKER_01: You're the dermatologist.
• 25:11
  SPEAKER_01: Where else if they can't depend on it from you, well, who else should they go to?
• 25:15
  SPEAKER_01: And that stuck with me and it's expanded into what we're talking about now.
• 25:20
  SPEAKER_01: So I think it's fundamentally advice.
• 25:22
  SPEAKER_01: Well, somebody else is gonna do it, and they're gonna give them something we didn't want that patient to use.
• 25:27
  SPEAKER_00: Absolutely.
• 25:27
  SPEAKER_00: Right.
• 25:28
  SPEAKER_00: You know, it's it's it's a hundred percent, and a lot of dermatologists, I think, are so busy taking care of sick people that they sometimes don't give the patients the time it takes, and it does take some time for you to go through a skincare regimen.
• 25:41
  SPEAKER_00: Right.
• 25:41
  SPEAKER_00: There's no doubt it takes time, and you know, you can have extenders help you with things like that too.
• 25:46
  SPEAKER_00: But I've always kept that near and dear to me because I, as you know, I'm such an enthusiast for topical skincare, and I love to just tell the patients everything that I know about them, and you know, I know you do too.
• 25:57
  SPEAKER_00: You've got so much experience.
• 25:58
  SPEAKER_01: And if all you do is say, I'm gonna have my nurse or I'm gonna have an esthetician come in and you say nothing about it, it loses the sense that it's really important to you as the clinician that they do it, right?
• 26:11
  SPEAKER_01: So I I do go through fundamental, you know, the fundamentals like you do and tell them why, why I exact want you to use this exact product and hopefully have something that shows the name of it so they don't get lost with a recommendation somewhere else, you know.
• 26:26
  SPEAKER_01: Yeah uh with who that have they see it in a pharmacy, a skincare aisle, or a store or whatever.
• 26:32
  SPEAKER_01: And then but I have to be on the same page with my staff, but I have a question for you, right?
• 26:40
  SPEAKER_01: I know you don't mind, you know.
• 26:41
  SPEAKER_01: Give give Patty a chance to get on stage, she's gonna rock it.
• 26:45
  SPEAKER_01: She's gonna rock.
• 26:46
  SPEAKER_01: So, you know, when you know me, I'm always on stage.
• 26:48
  SPEAKER_01: You're always on stage.
• 26:50
  SPEAKER_01: Um so when when you have, like, let's say an esthetician, I think a lot of clinicians have an aesthetician.
• 26:57
  SPEAKER_01: Oh, yeah.
• 26:58
  SPEAKER_01: I think they very likely have a disconnect that they don't even know what their aestheticians are recommending.
• 27:04
  SPEAKER_01: And if their esthetician is on the same page with what they think that person needs, maybe because they have rosacea or they have a fundamental skin problem, right?
• 27:15
  SPEAKER_01: And so that within the office, the recommendations are in harmony with each other, not just an aesthetician down the hall that's now selling their line.
• 27:26
  SPEAKER_01: You know, you know what I mean?
• 27:27
  SPEAKER_01: So how do you do that?
• 27:29
  SPEAKER_00: Well, it's very hard when you have somebody and you delegate it.
• 27:33
  SPEAKER_00: Personally, I always have kept control of skincare recommendations because I'm such an enthusiast of it.
• 27:39
  SPEAKER_00: But I do have friends who have aestheticians and they use them very successfully for skincare recommendation and you know, dispensing and keeping products in the hands of the patients.
• 27:50
  SPEAKER_00: But that requires the clinician to spend the time to educate that person to the level that you and I are talking about.
• 27:58
  SPEAKER_00: You know, you can't just say, you know, I'm gonna give you this line and you're gonna sell this line.
• 28:03
  SPEAKER_00: It just doesn't work that way.
• 28:05
  SPEAKER_01: Right.
• 28:05
  SPEAKER_00: So it becomes another thing the clinician has to be responsible for.
• 28:10
  SPEAKER_00: So and that is training staff.
• 28:11
  SPEAKER_01: Right.
• 28:12
  SPEAKER_01: And just just the same way that you would tell a patient, I want you to use this particular medication, right?
• 28:19
  SPEAKER_01: And it may be branded, and I want us to try to get the branded if we can.
• 28:24
  SPEAKER_01: I understand prices.
• 28:26
  SPEAKER_01: If it's oh yeah, if it's gonna fall back on you, let us know.
• 28:29
  SPEAKER_01: I understand cost for anybody.
• 28:31
  SPEAKER_01: But when you tell them specifically, this is the cleanser I want you to utilize, this is the moisturizer, this is how you integrate it with your other products step by step, and you're telling them that specific brand and you're looking them in the eye.
• 28:46
  SPEAKER_01: That's gonna carry a lot of weight with the vast majority of our patients.
• 28:50
  SPEAKER_01: It's coming from you.
• 28:51
  SPEAKER_01: Doc, I went to see Dr.
• 28:52
  SPEAKER_01: Farris.
• 28:53
  SPEAKER_01: I didn't just go see XYZ person in the office.
• 28:56
  SPEAKER_00: They you're the expert.
• 28:57
  SPEAKER_00: They're looking for your advice.
• 28:59
  SPEAKER_00: I couldn't agree more.
• 29:00
  SPEAKER_01: Yep.
• 29:00
  SPEAKER_00: We have a short amount of time, but I want to ask you a couple of just like one hitters, one liners.
• 29:05
  SPEAKER_00: Sure.
• 29:05
  SPEAKER_00: Difference do pay some things patients ask us all the time.
• 29:08
  SPEAKER_00: Do you need a different moisturizer for your face than you need on your body?
• 29:12
  SPEAKER_00: That's a common question we get.
• 29:14
  SPEAKER_01: Not necessarily, but I also sense that there are some people that would be somewhat taken aback when you don't give them that recommendation.
• 29:22
  SPEAKER_01: Exactly.
• 29:23
  SPEAKER_01: They don't mind.
• 29:23
  SPEAKER_01: You wouldn't want a face moisturizer.
• 29:25
  SPEAKER_01: I'm gonna put that out there.
• 29:26
  SPEAKER_01: And there's a reason why eye cream.
• 29:28
  SPEAKER_00: That's my next question.
• 29:29
  SPEAKER_01: Eye creams could have the same formulation, but they have different concentrations because of different sensitivities on the eyelid.
• 29:36
  SPEAKER_01: So so I do kind of hand select, but there are certainly moisturizers that can be used on the face and the body and even the eyelids.
• 29:47
  SPEAKER_01: You know, there's some some of the basic ones, you know, simple cerebrim without additives, simple cream, cereb moisturizing lotion or cream and and several others.
• 29:58
  SPEAKER_01: Yeah, Tularian is a great formulation.
• 30:00
  SPEAKER_01: There are several, several ones, right?
• 30:02
  SPEAKER_00: Yeah.
• 30:03
  SPEAKER_00: Another question I think we get asked a lot is about layering products, like where does a moisturizer fit in?
• 30:08
  SPEAKER_00: If you're gonna put a serum on, then you're gonna put you gotta have a sunscreen on during the day.
• 30:12
  SPEAKER_00: You know, I I'm always been sort of of the mindset of simple is better, less layering.
• 30:18
  SPEAKER_00: I don't like to have to put too many things on.
• 30:20
  SPEAKER_00: So how do you sort of manage that in the practice?
• 30:22
  SPEAKER_01: So if I you know, if if I know that this formulation is a very good moisturizer with with good good sun protectance that I that I want it to have, I'll certainly that's easier for them to utilize it one step just just once a day.
• 30:38
  SPEAKER_01: People might ask, well, that you know, am I gonna use that at night?
• 30:42
  SPEAKER_01: They don't necessarily need the the sunscreen when it's start when it when it's dark out, right?
• 30:47
  SPEAKER_01: But you know, if it's gonna be easier for them to get one product, they can do it at night, but they're gonna go through it faster.
• 30:54
  SPEAKER_01: So economically, it still may be better to have you know one for the day, one for the night, so they're not wasting the sun.
• 31:01
  SPEAKER_00: Well, it's nice because a lot of lines do have the AMP versions, which is makes it really nice.
• 31:06
  SPEAKER_00: Same formulation, one with sunscreen and one without.
• 31:08
  SPEAKER_01: Right, exactly.
• 31:09
  SPEAKER_00: All right, well, look, we're gonna wrap it because we've taken up so much of your time.
• 31:13
  SPEAKER_00: But Jim, I'm so grateful for your expertise.
• 31:16
  SPEAKER_00: I've learned so much from you over the years.
• 31:18
  SPEAKER_00: You're one of my buddies, looking forward to seeing you soon.
• 31:21
  SPEAKER_01: Hopefully at another New Orleans Jazz Fest.
• 31:24
  SPEAKER_01: If we know that that's that's another story.
• 31:26
  SPEAKER_01: We could do a podcast.
• 31:27
  SPEAKER_01: We're so up or due for that.
• 31:29
  SPEAKER_00: We may just do a whole podcast on it.
• 31:31
  SPEAKER_01: Yeah, that's good.
• 31:31
  SPEAKER_01: So Patty, take care.
• 31:33
  SPEAKER_01: I feel like we just got started.
• 31:35
  SPEAKER_01: You got me revved up for the day.
• 31:36
  SPEAKER_01: Thank you so much.
• 31:37
  SPEAKER_01: I hope you gave some good general uh insights to your listeners, and congratulations on uh you and Ted on this podcast.
• 31:47
  SPEAKER_01: And um I'm happy to see you having so much success.
• 31:51
  SPEAKER_00: Well, we appreciate your contributions, of course, to the meeting as well as here.
• 31:55
  SPEAKER_00: Thanks so much, everyone.
• 31:57
  SPEAKER_00: Have a great day.