Latest / The Science of Skin / Dr. Carl Thornfeldt: Skin barrier research with the goal of improving skin health.

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Dr. Carl Thornfeldt: Skin barrier research with the goal of improving skin health. · The Science of Skin

• 0:09
  SPEAKER_00: Hi, I'm Dr.
• 0:10
  SPEAKER_00: Patty Ferris.
• 0:11
  SPEAKER_00: I'm a board certified dermatologist and I'm the co-host of Skincare Confidential.
• 0:16
  SPEAKER_00: So I'm really excited today to have a good friend of mine, as well as somebody who really is a legend in the skincare business, and that's Dr.
• 0:23
  SPEAKER_00: Carl Thornfeld.
• 0:25
  SPEAKER_00: I'm going to read his bio because it's fairly prolific, and I certainly don't have time to memorize all this stuff, but you're quite accomplished.
• 0:33
  SPEAKER_00: Interesting because I always learn so much about people who I've known a long time, which Carl and I have been friends probably what, 20, 25 years?
• 0:40
  SPEAKER_01: Yes.
• 0:41
  SPEAKER_00: I think so.
• 0:42
  SPEAKER_00: We share a love of skin care, which is how we met years ago at the AAD.
• 0:47
  SPEAKER_00: Anyway, you received your medical degree from Oregon Health Sciences and completed a surgical internship at the Naval Hospital in San Diego.
• 0:56
  SPEAKER_00: You were then stationed in the U.S.
• 0:58
  SPEAKER_00: Navy submarine base in Scotland and practiced as a GP there for three and a half years.
• 1:04
  SPEAKER_00: You came back to the States and did a residency in dermatology then at UC San Diego and moved to southwest Idaho where you practiced as the only dermatologist for 10 counties spread over 30,000 square miles for over 30 years.
• 1:20
  SPEAKER_00: That's a story in and of itself.
• 1:23
  SPEAKER_00: Unbelievable.
• 1:28
  SPEAKER_00: The geographics of it, you know, just that alone.
• 1:31
  SPEAKER_00: That's just that's awesome.
• 1:32
  SPEAKER_00: You have 22 patents that were granted to you.
• 1:35
  SPEAKER_00: You've published extensively scientific articles, chapters, and textbooks, but most of these have been on cosmeceutical delivery systems, natural products, and unique dermatologic therapies.
• 1:47
  SPEAKER_00: In addition, you published a book, which I was not aware of, The New Ideal in Skin Health, separating fact from fiction.
• 1:54
  SPEAKER_00: And you spent 35 years researching abnormalities in the skin barrier, delivery systems, herbals, and topical therapies for skin diseases.
• 2:03
  SPEAKER_00: You founded Epiance's Inc., and you are the producer and the worldwide distributor of Epiance Skin Care Line, which is what we're going to talk about today.
• 2:12
  SPEAKER_00: And after years of skin barrier research and really seeing firsthands on your own patients with skin diseases, when you developed your skincare line, you quickly began to see how much of a difference this made in your own patient population.
• 2:27
  SPEAKER_00: So with that, I'm going to welcome you to Skin Care Confidential and tell you how excited I am to hear about your journey.
• 2:34
  SPEAKER_00: So Ambiance is really your baby.
• 2:37
  SPEAKER_00: You started in 2002.
• 2:39
  SPEAKER_00: You were way ahead of the curve back then.
• 2:41
  SPEAKER_00: You were talking about the barrier, honestly, before most dermatologists were really talking about the barrier.
• 2:49
  SPEAKER_00: I know you worked with Peter Elias, who was, you know, again, another legend in this area.
• 2:54
  SPEAKER_00: So tell me about how that sort of guided you into developing a skincare line in case you didn't have enough to do because you were taking care of all these patients.
• 3:04
  SPEAKER_01: Right, right.
• 3:05
  SPEAKER_01: Well, the good thing is I never required much sleep, Patty.
• 3:07
  SPEAKER_01: So that was excellent.
• 3:09
  SPEAKER_01: Made it happen.
• 3:10
  SPEAKER_01: But the one of the reasons I didn't require much sleep is because I had bad atopic dermatitis when I was a child up through the teens and intermittent episodes of exfoliated erythroderma.
• 3:20
  SPEAKER_01: And even though my dad was the second board certified allergist in the state of Oregon and was chairman of pediatrics at the med school for a while in Portland, even then I was in and out of the hospital on various kinds of uh medications that resulted in uh long-term effects.
• 3:36
  SPEAKER_01: So I was very uh passionate to under to find out the underlying foundational problems.
• 3:43
  SPEAKER_01: Um and uh I was actually uh mountain climbing to relax one day and I was on on top of a uh 9,000-foot peak and uh noticed uh the difference in the environmental effects, the the way the sun felt, the wind felt.
• 3:57
  SPEAKER_01: And I'd been doing all this research with uh Dr.
• 4:00
  SPEAKER_01: Stoughton in uh topical steroids, uh topical clindamycin, uh, and uh even some work with uh with retinoids and so on.
• 4:09
  SPEAKER_01: And it just struck me that everything we were doing was actually um damaging the skin barrier, thinning the skin barrier.
• 4:16
  SPEAKER_01: And it struck me the purpose, the real true purpose of the skin barrier is protection from the environment.
• 4:23
  SPEAKER_01: And so then as I pondered this problem and I had been doing research in lipids, um I decided that we needed to have a group that just focused on uh epidermis from stratum corneum to basum membrane zone and really understand.
• 4:38
  SPEAKER_01: And I think our biggest discovery, and I founded this group with Peter, uh Peter Elias, uh a true giant in our industry, and because he was one of the only other people doing any lipid research at that point in time, and um so we uh put resources together and uh uh and used everything I had financially to help start this company.
• 5:03
  SPEAKER_01: And then we did nine years of basic research, and we found several uh major discoveries.
• 5:08
  SPEAKER_01: Number one uh is that the stratum corneum was actually a regulatory tissue and impacted the rest of epidermal function and even had impacts in basal membrane zone, which then would of course impact um the dermis.
• 5:22
  SPEAKER_01: Um we also found that it was um that the abnormality that any kind of disruption of that barrier um would absolutely trigger um chronic inflammation, the lymphocytic destructive inflammation.
• 5:37
  SPEAKER_01: Uh we found that the barrier was critical uh in uh the pathophysiology of 13 major um skin uh conditions uh and diseases.
• 5:48
  SPEAKER_01: Uh, and uh but we were focused on uh really trying to understand the underlying mechanisms and then focus on the mechanisms to prevent skin diseases that increase uh as we age, to prevent uh skin cancer, because I was seeing teenagers with skin cancers, a lot of them in my practice, uh which is high desert area, uh farming, ranching community.
• 6:14
  SPEAKER_01: And so that was our major focus.
• 6:16
  SPEAKER_01: Well, so as we made these discoveries and we started treating people for with um actinic keratosis and rosacea and sebarric dermatitis, uh other types of uh dermatitis, um a year after we did the clinical studies, uh, which we were then planning on going on into the prescription realm, um, people were starting to call me and say, Hey, I need more wrinkle cream.
• 6:39
  SPEAKER_01: I said, We didn't give you a wrinkle cream.
• 6:41
  SPEAKER_01: And they said, Yeah, but my family said the wrinkles went away.
• 6:44
  SPEAKER_01: So remembering what Albert Klingman had told me uh at one time in a meeting with uh Dr.
• 6:50
  SPEAKER_01: Stoughton, that he said, always listen to the patient.
• 6:53
  SPEAKER_01: So we went ahead then and did a study.
• 6:55
  SPEAKER_01: Uh, and sure enough, we found that our um products that contained the barrier repair impact or the uh and the anti-inflammatory uh modulation was very effective.
• 7:08
  SPEAKER_01: As a matter of fact, we were two to three hundred percent better than any alpha hydroxy acids, uh, salicylic acid, uh kinetin, and so that gave me the confidence that we should go into the prescription arena.
• 7:22
  SPEAKER_01: Our basic research, we found that there were five pathways involved in modulating uh barrier damage, uh, and we needed to upregulate all of those five pathways to get optimum barrier repair.
• 7:38
  SPEAKER_01: And we found that a three to one to one ratio of cholesterol, ceramide, and free fatty acid, of which 50% was linoleic acid, was critical for triggering the barrier repair.
• 7:50
  SPEAKER_01: Why do we know that?
• 7:51
  SPEAKER_01: Well, what we found was that when the skin was damaged for any reason, those were the first three molecules that were actually synthesized.
• 7:59
  SPEAKER_01: And within 45 minutes of injury, they were fully being synthesized.
• 8:04
  SPEAKER_01: We also found that there were seven pathways of inflammation, and since then, an eighth one was uh uh uh more recently with the aryl hydroxy receptor pathway.
• 8:15
  SPEAKER_01: Um but we found that these eight pathways of inflammation um occurred, and these were pathways that that were actually only two were affected by antioxidants, the rest were by other anti-inflammatories, and that's they they set up a whole series of cascades that resulted in an imbalance in matrix metalloproteinases and their TIMPS.
• 8:38
  SPEAKER_01: Uh, and so then that was what would trigger the destructive um chronic inflammation, um, usually two to three weeks um after the injury.
• 8:47
  SPEAKER_01: Um so then it was all right, if this really works, then we should test it truly in an aging model.
• 8:55
  SPEAKER_01: And about that time, uh right around that time, uh emollient tretinoin 0.05% was approved.
• 9:02
  SPEAKER_01: So we went ahead and did a study um with a double-blinded prospective controlled clinical trial um against uh tretinoin emollient plus its lactic acid moisturizer.
• 9:14
  SPEAKER_01: Uh and we used our uh renewal um uh face cream uh and we combine and and then we also um came up uh I shouldn't say we, but I came upon the idea that um why not use the delivery routes that are already there?
• 9:32
  SPEAKER_01: In other words, use the pores.
• 9:34
  SPEAKER_01: Well, we wanted to make sure that the pores were uh cleaned out well enough because we were understanding then uh that there was that there was a actually a defect down in the follicle that resulted in what a lot of people see as acne as characteristic.
• 9:50
  SPEAKER_01: Uh, and we wanted to penetrate that, so I developed the lytic products as actually a delivery tool to make sure we cleaned out the uh the pores so we could get um optimization of the renewals down deep and have that impact.
• 10:04
  SPEAKER_01: Well, the fact of the matter is in a six-month uh clinical trial, um we found uh that there was statistically significant increase in uh glycosaminoglycans in the epidermis of our renewal and lytic compared to the tretinoin and lactic acid.
• 10:22
  SPEAKER_01: And then we also found that we had a highly statistically significant increase in superiority of dermal um rejuvenation uh and dermal thickening compared to the tretinoin uh lactic acid combo.
• 10:37
  SPEAKER_01: And we had no irritation.
• 10:38
  SPEAKER_01: We had nobody develop any irritation.
• 10:40
  SPEAKER_01: 40% of the retinoid people uh developed in irritation, indicating.
• 10:45
  SPEAKER_00: And that was that was the original RENOVA, right?
• 10:48
  SPEAKER_01: The 0.05 Renova.
• 10:51
  SPEAKER_01: We basically exploded the concept that you had to have um inflammation to get a beneficial uh regenerative.
• 11:00
  SPEAKER_00: Yes, which which which has has uh subsequently also been proven by others, but you guys were again ahead of the curb.
• 11:06
  SPEAKER_00: So tell us what is in renewal facial cream and what is lit in the lytic line, you know, those ingredients to sort of the hero ingredients.
• 11:18
  SPEAKER_01: It was really important for us to do was to um uh to prevent the development of tachyphylaxis uh because the environmental insults and your metabolism continues uh throughout.
• 11:30
  SPEAKER_01: And so uh we found working with Dr.
• 11:32
  SPEAKER_01: Stoughton that if we had two molecules blocking each receptor site, we could reduce it by over 90 percent.
• 11:38
  SPEAKER_01: Um so we have a series of the uh three key barrier lipids, cholesterol, ceramide, and linolaic acid, and other uh bulk um fatty acids, in a proper ratio.
• 11:51
  SPEAKER_01: We found the ratio was really critical, and we were the first uh ones that actually discovered that.
• 11:56
  SPEAKER_01: So that's one component.
• 11:58
  SPEAKER_01: Secondly, um we have the anti-inflammatory component, which was um extracts of multiple herbs, because what we found is the synthetic anti-inflammatories did not block the pathways well enough, and we wanted to actually block all those different pathways, but because that required complex formulations, we went to the herbal arena, um, where they not only have the actives, which are secondary metabolites, but they also have um entourage molecules that help provide stability and delivery.
• 12:29
  SPEAKER_01: So we have that herbal fraction there.
• 12:31
  SPEAKER_01: And the in the renewal, the the key ones that we found was the extracts of metal foam, flax, um, also a specific extract of avocado, rosa canina, but one of the big actors is date and then specific apple extracts and safflower.
• 12:50
  SPEAKER_01: Now, these extracts uh have different purposes, and we have different extracts for different specific purposes.
• 12:56
  SPEAKER_01: So, like safflower has a component for free fatty acid, but it also has a component uh that provides transferosomes for delivery of more difficult molecules.
• 13:06
  SPEAKER_01: So we use both of those extracts to do that.
• 13:09
  SPEAKER_01: So when we get our raw materials, we go through an enrichment process and we get we only use pharmaceutical grade uh and so they're highly purified, but we actually go through an enrichment process and then we combine it with a third component, which is the delivery component, and that's um we pioneered uh several drug delivery technologies uh and we utilize those.
• 13:33
  SPEAKER_01: So we actually in the renewal we have three different delivery systems.
• 13:36
  SPEAKER_01: So we can get one targeted to the stratum corneum, one to the basin membrane zone, and another to the uh granular layer and and uh uh those other middle strata uh of the epidermis.
• 13:49
  SPEAKER_01: So it's really not a specific hero ingredient, it really is the combination in the proper ratio, working on all eight inflammatory pathways, inhibiting those, and and uh activating all five of the barrier repair pathways.
• 14:06
  SPEAKER_01: We also provide the precursor uh compounds and elements to continue to activate um the rejuvenation process.
• 14:15
  SPEAKER_01: So it's not just putting it on, but we actually stimulate the processes um to trigger continual repair.
• 14:22
  SPEAKER_00: That's so fascinating.
• 14:25
  SPEAKER_00: And what about lytic?
• 14:26
  SPEAKER_01: Hundreds of experiments.
• 14:28
  SPEAKER_00: I know you I know y'all, but you've been working at it for a long time.
• 14:31
  SPEAKER_00: And lytic, what is it that cleans out the pores basically?
• 14:35
  SPEAKER_01: In the lytic, we actually uh use a uh salicylate that has been uh modified in the sense that um we use uh we combine it with uh uh mineral and fatty acid so that it produces a um not only more complete penetration um but has a uh penetrating effect that's um somewhat slower but very predictable.
• 15:00
  SPEAKER_01: Uh and by doing that combination, we don't get the irritation with it.
• 15:04
  SPEAKER_01: Uh and we don't get, we we can really target the the uh comedolytic area with it.
• 15:10
  SPEAKER_01: Yes, it will take off uh uh excessive scaling, so we found it was very effective in treating uh hypertrophic actinic keratosis uh and several and many of the inflammatory diseases like uh uh Kevner responses from psoriasis and that sort of thing, but it really is targeted primarily for the um for the follicle.
• 15:31
  SPEAKER_00: Interesting.
• 15:32
  SPEAKER_00: Now you have your own manufacturing facility, right?
• 15:37
  SPEAKER_01: Yes.
• 15:38
  SPEAKER_00: Which is highly unusual for those who don't know.
• 15:41
  SPEAKER_00: Even some of the big major cosmosceutical companies, cosmetic companies, use contract manufacturers.
• 15:47
  SPEAKER_00: So what might you know really what motivated you to do that?
• 15:51
  SPEAKER_00: That's a huge investment and something that mm even big companies don't know.
• 15:56
  SPEAKER_01: Well, Patty, because I had 22 U.S.
• 15:58
  SPEAKER_01: patents, we were spending millions of dollars policing those patents.
• 16:04
  SPEAKER_01: And I came to the point where I thought, you know what, a more efficient way to do it would be to um actually have our own manufacturing because then we can use our patent, because at that time when we set this up, we had a number of patent pending technologies, not only for delivery, but also for these uh the molecules that actually worked on the various receptors for the um uh inflammation uh and the barrier repair.
• 16:31
  SPEAKER_01: Um and so I wanted to make sure we could protect those.
• 16:34
  SPEAKER_01: Uh and I knew we didn't have the the finances because I'd used all my retirement every dime I had on this, that um I knew we couldn't afford to do the uh patent protection.
• 16:46
  SPEAKER_01: Um so, and then the other thing was too that what we found with the uh herbal ingredients is that there is a wide variation in the quality of the uh ingredients in the sense the amount of the actives and the way it was processed to maintain functionality.
• 17:04
  SPEAKER_01: Uh, and that's one of the big problems with natural products.
• 17:07
  SPEAKER_01: And so this way we are able to make sure we have the high quality, we assay them all that we as we get in these raw materials.
• 17:15
  SPEAKER_01: As I said, we go through an enrichment process, um, and so we make sure that we know exactly how much actives we have in each particular one of those fractions.
• 17:25
  SPEAKER_01: And frankly, we had uh suppliers try to bamboozle us with um uh uh faulty uh uh products.
• 17:33
  SPEAKER_01: And when when we could we were doing our formulation, I'd get a call, Doc, you better come and take a look at this formula, say something's wrong, and we could find out that they were doing all kinds of substitutions.
• 17:44
  SPEAKER_01: And the other thing is I also have a basic research foundation, and there we're doing a lot of uh very early herbal work, and we found that in looking at the major suppliers, the differences in potency of the bioactives that we used uh ranged as high as 1,400% difference in the different suppliers.
• 18:06
  SPEAKER_01: I mean, there's a huge variation.
• 18:08
  SPEAKER_01: Um, and and then also what we found is that uh as we were working on delivery systems for these and so on, we found that there was a great difference in the the amount of delivery based on the amount of these entourage molecules, which really hasn't gotten the press just until just recently.
• 18:26
  SPEAKER_01: But we've been doing work in entourage molecules for 20 years.
• 18:29
  SPEAKER_00: I was gonna say explain that explain that a little bit.
• 18:33
  SPEAKER_00: I I understand it because I've heard of it before when it comes to things like CBD, there's big entourage effect with lots of botanicals, but explain that to the listeners because that's a concept we don't talk about much.
• 18:44
  SPEAKER_01: Yeah, sure.
• 18:45
  SPEAKER_01: The the major active components of herbs that actually give them the name herb because it's a medicinal botanical, um, are secondary metabolites.
• 18:54
  SPEAKER_01: And there's about 50,000 secondary metabolites that have been uh identified in different plants.
• 19:01
  SPEAKER_01: Um, but one of the things that we found that there was we couldn't have an explanation for why tonics would work better.
• 19:07
  SPEAKER_01: And as we analyzed why the tonics would seem to work better than the purified secondary metabolites, we found that there were other elements and compounds that actually were stabilizing and would improve uh the interaction so that the different actives within the Malu of the herbal extract didn't damage each other, uh, didn't negate the effect and so on.
• 19:34
  SPEAKER_01: Uh, because many, you know, with these active ingredients, they will, I mean, chemistry happens, Patty, and they will undergo chemical reactions.
• 19:42
  SPEAKER_01: So these molecules uh that provide that.
• 19:45
  SPEAKER_01: And I first was exposed to that with ricin, you know, the second most potent weapon of mass destruction.
• 19:51
  SPEAKER_01: I was extracting that in the 80s, uh, and we were using it um for uh cancer treatment.
• 19:56
  SPEAKER_01: Um, but I was extracting from castor bean, and I kept thinking, why isn't the ricin, it's so potent, destroying the castor bean?
• 20:03
  SPEAKER_01: Well, it turns out it was bound to the azolates.
• 20:06
  SPEAKER_01: And so that's where I started looking at the azolates and ended up with the first patent for azolate gas for treatment or rosacea.
• 20:13
  SPEAKER_01: Uh, and then we found that it also had certain uh uh delivery, some of these azlates had delivery components as well.
• 20:20
  SPEAKER_01: And so that's the really one of the key ingredient differences between our renewal facial cream and the intensive nourishing cream, is we added azolates that would have impacts on some of these other pathways, and then a couple of peptides that we could deliver as well.
• 20:34
  SPEAKER_01: So they there's a lot of different functionalities in these herbal extracts.
• 20:40
  SPEAKER_01: And so the standard way of steam distillation actually destroys most of the uh antioxidants in it, um, a good portion of it.
• 20:49
  SPEAKER_01: And um, so uh what we what we really worked on, particularly with the new extraction methodologies we invented in 2019, um, was to preserve um these uh uh these entourage molecules.
• 21:04
  SPEAKER_01: And what we found was as we were doing all these assays against uh disease state markers, we found actually additional therapeutic functionalities where they actually have impacts on what we believe are going to be other diseases uh that we're working on for later.
• 21:21
  SPEAKER_01: So it's very exciting work to see how these things work, but it's it's a very complex process.
• 21:26
  SPEAKER_01: And um, we were so surprised to see the amount of difference in functionality between different commercial carriers and realize that a lot of it had to do with the manufacturing and the extraction methodology.
• 21:40
  SPEAKER_00: So, do you make the extracts yourself in your facility or are you more testing the extracts?
• 21:46
  SPEAKER_01: We get uh pharmaceutical grade extracts from uh companies that have specific ones, and and some of them are made from real small companies.
• 21:56
  SPEAKER_01: And then when we've identified that there's a particular molecule that We need and the natural extract does not have enough concentration in that, then we will augment with that particular molecule into that.
• 22:08
  SPEAKER_01: And it's interesting how they're far more stable by doing it this way.
• 22:13
  SPEAKER_01: So that by having the entourage molecules in the herbal is much better than mixing a number of the synthetics together or putting in these other natural ingredients together.
• 22:24
  SPEAKER_01: So we found that that's a good base.
• 22:26
  SPEAKER_01: So we find a lot of using the herbal extracts for the base for other ingredients that are hard to deliver.
• 22:36
  SPEAKER_00: Right.
• 22:36
  SPEAKER_00: So one of the big buzzwords we're hearing a lot about now is like microbiome-friendly.
• 22:42
  SPEAKER_00: And, you know, we know that things that perturb the microbiome upregulate inflammation and cause skin sensitivity and dry skin and all those things.
• 22:50
  SPEAKER_00: And it would seem like your line would be right in line with that sort of philosophy of nurturing the microbiome and keeping the stratum corneum and the skin barrier happy and healthy.
• 23:05
  SPEAKER_00: Yeah.
• 23:05
  SPEAKER_01: It absolutely does, Patty.
• 23:06
  SPEAKER_01: It's a really the the real focus of Epions is to optimize the epithelium.
• 23:14
  SPEAKER_01: I mean, that's where the name Epions came from: one chance for an optimum epithelium.
• 23:18
  SPEAKER_01: And so absolutely, we provide the base for the optimization of microbiome function as well.
• 23:25
  SPEAKER_01: And uh, you know, 15 years ago, 10 years ago, we didn't really hear much about the microbiome.
• 23:31
  SPEAKER_01: But one of the things that was important, all of our anti-inflammatories that we screened had to have impact against um pathogenic microbes, whether they be yeast, parasite, and different kinds of bacteria.
• 23:46
  SPEAKER_01: So that was one of our criteria for the anti-inflammatories.
• 23:49
  SPEAKER_01: They had to modulate um the um uh or basically inhibit the antimicrobial disease-causing ones.
• 23:56
  SPEAKER_01: Well, subsequently, what we found is that actually we also upregulate some of the microbiome, the good microbiome as well.
• 24:03
  SPEAKER_01: We provide um some prebiotic for them, uh, and by providing the proper uh pH and so on, uh, by optimizing barrier function, we're finding that these that the the good probiotics that are really needed for optimal skin health, we actually upregulate as well.
• 24:22
  SPEAKER_00: That's totally fascinating.
• 24:24
  SPEAKER_00: I think this is an area that we're gonna see a lot more and hear a lot more from skincare companies about is the microbiome and how some products that we use affect it in a negative way, and others obviously in a positive way.
• 24:39
  SPEAKER_00: You mentioned prebiotics.
• 24:41
  SPEAKER_00: Um do you use any postbiotics, any of the bacterial lysates in your products, or are they primarily to date.
• 24:50
  SPEAKER_01: We haven't we I haven't felt the need to do that at this point in time.
• 24:54
  SPEAKER_01: Well, if you have the prebiotics science very carefully and uh see if there's something that's actually going to augment.
• 25:00
  SPEAKER_01: Now I mentioned earlier that there's an eighth pathway of inflammation that was worked out and published in 2018.
• 25:06
  SPEAKER_01: Um and it turns out um that uh and when we actually started studying that, that what we have already in the intensive nourishing cream and the renewal products um actually modulate that pathway as well.
• 25:20
  SPEAKER_01: And so we did the origin uh another uh series of studies on that and found we have a very good inhibition.
• 25:27
  SPEAKER_01: Not the most potent inhibition of that eighth pathway, but nevertheless, um a very good uh inhibition and uh new products coming.
• 25:35
  SPEAKER_01: Uh you know, there's things down the road.
• 25:38
  SPEAKER_00: The hits keep coming from you guys.
• 25:40
  SPEAKER_00: Exactly.
• 25:41
  SPEAKER_00: What is your most recent bond?
• 25:43
  SPEAKER_01: We have done, I'm sorry, Patty, uh sorry for interrupting you, but we have done 60 uh in vivo trials, and we've we've done um more than 20 um products, uh blinded uh clinical trials, and we have one underway going right now.
• 25:59
  SPEAKER_01: So, and so it's uh we'll continue uh continue to do that.
• 26:03
  SPEAKER_01: And one of the reasons I wanted to have my own re uh contract manufacturing or my own manufacturing facility is because it allows me to invent and start early stage of the of the formulation development so on on these products.
• 26:17
  SPEAKER_01: And I'm able to do that by having my own facility.
• 26:20
  SPEAKER_00: Yeah, how many products are in your line?
• 26:23
  SPEAKER_01: Uh how many SKUs?
• 26:25
  SPEAKER_01: See, it's uh a little bit less than 30.
• 26:30
  SPEAKER_01: So right around right around 30.
• 26:32
  SPEAKER_00: And you do you distribute only through physicians' offices or are you direct to consumer as well?
• 26:38
  SPEAKER_00: I think you're direct-to-consumer now.
• 26:40
  SPEAKER_01: Um we for years we only uh distributed through physicians' offices and med spas where they had lasers and and a uh uh you know a physician uh overseeing it.
• 26:53
  SPEAKER_01: Um but uh then a couple of years ago we um went to controlled uh website and we have a couple people that uh that that uh sell uh like lovely skin.
• 27:07
  SPEAKER_01: Uh and um and then um we also were having so much trouble with diverters, um, and then uh that's been one of the biggest uh problems.
• 27:19
  SPEAKER_01: And um so we actually went on uh a preferred program with Amazon uh last year, and that has really had a big impact in reducing diverters.
• 27:28
  SPEAKER_00: Yeah, diversion's a huge problem for everybody.
• 27:31
  SPEAKER_01: It's a huge problem, and and uh it was like whack-a-mole for a number of years.
• 27:35
  SPEAKER_01: We spent millions of dollars trying to stop it on our impossible, even people have entire you know, organizations to try to stop it, and they can't do it.
• 27:48
  SPEAKER_00: Well, that's such a fascinating story.
• 27:50
  SPEAKER_00: We're almost out of time.
• 27:51
  SPEAKER_00: I know you're kind of a renaissance guy as well, in terms of you do a lot of outdoor activities, and you you've to me you you're kind of a well-rounded, you you're sort of a brainy guy and a little bit of a we call ourselves the skincare nerds, you know, who really likes to get down in the weeds and look at it.
• 28:14
  SPEAKER_00: But you also do a lot of outdoor stuff.
• 28:16
  SPEAKER_00: How'd you end up in Boise, Idaho?
• 28:18
  SPEAKER_00: Are you from that area?
• 28:20
  SPEAKER_01: Uh no, I actually grew up in the Columbia Gorge, but I've been a uh uh very active for a long time, uh, mountain climbing, uh skiing, uh started skiing at four.
• 28:31
  SPEAKER_01: Uh I've done uh 54 peaks over 11,000 feet, including 23 14ers.
• 28:36
  SPEAKER_01: Um, and uh done some triathlons, uh a lot of uh cycling and and uh road road races and things like that over the years.
• 28:46
  SPEAKER_01: Been very active, uh athletic all my life.
• 28:49
  SPEAKER_01: And and uh so um, but one of the reasons I did that, Patty, was because I itched so bad.
• 28:55
  SPEAKER_01: And um so one of the reasons I didn't sleep much is because I had so much itching.
• 28:59
  SPEAKER_01: So my parents would um buy uh would would get phone books from all over the country, and so I would memorize phone books for uh hours every night to help fall asleep.
• 29:09
  SPEAKER_01: And then during the day I found that I itched less if I um did a uh a good workout in the cool of the morning or the cool of the evening.
• 29:18
  SPEAKER_01: Um so solitary workout, and that would really help uh a lot in the itching.
• 29:23
  SPEAKER_01: So a lot of it was uh a necessity, but then I was fascinated with just the challenge uh preparing, you know, my my own climbing adventures.
• 29:30
  SPEAKER_01: We trained for four months before we'd go, and um, so it was always great to uh have an opportunity to do that.
• 29:36
  SPEAKER_01: And I also did some open water swimming across big lakes and so on.
• 29:40
  SPEAKER_01: I enjoyed that as well.
• 29:41
  SPEAKER_00: So um so interesting.
• 29:44
  SPEAKER_00: So interesting.
• 29:45
  SPEAKER_00: You've you've live you're living a full life, that's for sure, and you're still at it, still at it, right?
• 29:50
  SPEAKER_01: And the other reason we set up in Boise, Idaho was frankly that I wanted to be close to my practice.
• 29:56
  SPEAKER_01: My practice is 60 miles west from here.
• 29:58
  SPEAKER_01: Um, but I also wanted um uh we have uh really good quality people for uh uh work ethic, and um I wanted to make sure that we could the products that I developed, my patients could afford.
• 30:12
  SPEAKER_01: Because at the end of the day, the whole reason I did Epions was to make me a better doctor.
• 30:17
  SPEAKER_01: Uh could keep in mind when I went into practice, the the gold standards for treatment of dermatitis had a 56% success rate with Litex, and I felt we could do better than that, and that was one of the stimulators, and so um I wanted to make sure that our cost of goods was such that we could be able to have cost-effective products um for people in my practice, and uh and so that that was really that was your motivation.
• 30:45
  SPEAKER_01: Yeah, that was my motivation.
• 30:46
  SPEAKER_01: So we defied a lot of paradigms uh to uh develop uh Epiance and bring the product to the market.
• 30:54
  SPEAKER_01: But I mean, Patty, how many people are able to start with a theory, you do basic research for uh nearly a decade, uh, and then make products for several years, you know, develop product development for several years, and then work in the put it in clinical trials.
• 31:10
  SPEAKER_01: It works.
• 31:10
  SPEAKER_01: Then you introduce it in the market and people love it.
• 31:13
  SPEAKER_01: I mean, how many people get that opportunity at once?
• 31:15
  SPEAKER_00: That's yeah, that that's a that's a home run for sure.
• 31:18
  SPEAKER_00: Home run in our business.
• 31:20
  SPEAKER_00: And you helped all your patients as well.
• 31:22
  SPEAKER_01: Oh, absolutely.
• 31:23
  SPEAKER_01: Absolutely.
• 31:24
  SPEAKER_01: These are game changers for patients as far as reducing side effects of prescription products.
• 31:28
  SPEAKER_01: And what about post-procedure, Carl?
• 31:30
  SPEAKER_00: Have you looked at these products post-procedure?
• 31:34
  SPEAKER_01: Yes, we have.
• 31:35
  SPEAKER_01: Uh we actually uh uh did a study with uh it's uh uh a cream or it's a combination that we use after procedures, uh, and we showed interesting, we treated for four days.
• 31:47
  SPEAKER_01: We compared it with uh the um uh aquaphore and the uh Proc uh the uh acetic acid soaks uh and we treated for four days.
• 31:56
  SPEAKER_01: At at the end of day one, the aquaphor acetic acid soak had performed better, but at day two um we were comparable.
• 32:05
  SPEAKER_01: At day four, we were statistically superior in reducing all the inflammation uh and so on.
• 32:11
  SPEAKER_01: But what was interesting, we then did no treatment for the next four weeks.
• 32:15
  SPEAKER_01: We analyzed the patients then at four weeks on seven uh anti-aging uh or aging parameters, photoaging parameters, and we found statistical significant superiority or highly statistically significant superiority of our kit compared to the uh standard treatment.
• 32:34
  SPEAKER_01: So, in other words, we were activating repair processes that were just exactly right and kept it going, and kept it going for four weeks.
• 32:44
  SPEAKER_01: And so um we we've done, you know, that's the kind of study.
• 32:48
  SPEAKER_01: We had we had a feeling that was gonna happen because when we did a study against uh a prescription lac hydrin, uh, and again we treated for four days, we continued to have um statistically superior uh hydration uh and functionality, even 10 days after stopping treatment.
• 33:06
  SPEAKER_00: Totally fascinating.
• 33:08
  SPEAKER_00: Well, I'm gonna wrap it because we're a little bit over time, but I'm gonna tell the audience that we're super excited that Dr.
• 33:14
  SPEAKER_00: Carl is gonna be at the Science of Skin Care Summit this year.
• 33:18
  SPEAKER_00: Our meeting is gonna be held in Austin, Texas, November 8th through the 10th at the Fairmont Hotel.
• 33:23
  SPEAKER_00: So for all the rest of you skincare nerds out there, join Carl and I, we're gonna have a good time for sure, and we look forward to hearing your talk, which I think is gonna be on botanicals and botanical extracts.
• 33:33
  SPEAKER_00: And thanks for joining me today, and especially for joining us at the meeting this year.
• 33:38
  SPEAKER_00: It's always great to see you.
• 33:40
  SPEAKER_01: Thank you so much, it's such a pleasure, real pleasure.
• 33:43
  SPEAKER_01: And if you want to have me on again, I'll I'll gladly welcome the opportunity to see you.
• 33:47
  SPEAKER_00: I think I think we may have more to talk about.
• 33:49
  SPEAKER_00: Thanks, everybody.
• 33:50
  SPEAKER_00: Have a great day.
• 33:52
  SPEAKER_00: Bye bye.
• 33:53
  SPEAKER_01: Bye bye.