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Skincare Through the Ages - Episode 1: The Foundations of a Regimen · The Science of Skin

0:00
SPEAKER_02: The Skincare Through the Ages series is sponsored by Neutrogena.
0:03
SPEAKER_02: To learn more about the products mentioned in the episodes, please visit the link in the description.
0:14
SPEAKER_03: Hello and welcome to the Science of Skin Podcast, formerly known as Skincare Confidential.
0:20
SPEAKER_03: My name is Dr.
0:20
SPEAKER_03: Ted Lane.
0:21
SPEAKER_03: I am a board-certified dermatologist in Austin, Texas, and your host for today.
0:25
SPEAKER_03: I am joined by two amazing dermatologists, Dr.
0:28
SPEAKER_03: Peter Leo.
0:29
SPEAKER_03: Peter, how are you?
0:30
SPEAKER_01: I'm doing great.
0:31
SPEAKER_01: Thank you so much for having me.
0:32
SPEAKER_03: Awesome.
0:33
SPEAKER_03: And Dr.
0:33
SPEAKER_03: Heather Willie Lloyd.
0:35
SPEAKER_03: Heather, it's so great to see you.
0:37
SPEAKER_00: It's great to see you.
0:38
SPEAKER_00: Thank you also for having me.
0:40
SPEAKER_03: Peter is in Chicago.
0:42
SPEAKER_03: Heather is in Miami.
0:43
SPEAKER_03: And they are two amazing dermatologists, but also skincare experts, which is great because today we are kicking off our skincare through the ages podcast series sponsored by Neutrogena.
0:57
SPEAKER_03: And our first episode, Dr.
0:59
SPEAKER_03: Leo and Dr.
0:59
SPEAKER_03: Willie Lloyd, we're really going to focus on the foundations of a skincare regimen that pretty much underlie the regimen for any age.
1:08
SPEAKER_03: And really, there's kind of four, three or four things that should be considered, right, Dr.
1:14
SPEAKER_03: Leo, if you could just walk us through what those are for a foundation, the foundational products of a skincare regimen.
1:20
SPEAKER_01: Again, thank you.
1:21
SPEAKER_01: This is so exciting because a lot of times we will go to a conference and everybody sort of wants to cut to the chase, meaning they want to get right to the prescription product.
1:30
SPEAKER_01: And many times it can be a powerful biologic or an oral medication, and as if that's the whole story.
1:35
SPEAKER_01: But I love that we're going back to the basics here and talking about exactly right.
1:38
SPEAKER_01: What is the foundation?
1:39
SPEAKER_01: And the foundation really is going to be things like cleansing, moisturizing, sun protection.
1:45
SPEAKER_01: These are going to be the things we're going to build everything on.
1:47
SPEAKER_01: And if they're not being done, sometimes the most powerful prescription treatments are not going to do their fullest or their best.
1:53
SPEAKER_01: And sometimes worse, if they're doing things that can be actually destructive or working against us with the wrong kinds of products, it's going to push against our regimen and make us that much less effective.
2:04
SPEAKER_03: Perfect.
2:05
SPEAKER_03: And Dr.
2:06
SPEAKER_03: Willary Lloyd, you know, while we talk about cleanse, moisturize, protect as foundational for any regimen, we can tweak those, right?
2:14
SPEAKER_03: For different ages.
2:16
SPEAKER_00: Definitely.
2:17
SPEAKER_00: So, you know, I tend to see, and it's great that we're all on this call because I tend to see adult women, and Peter, I know you tend to see kids.
2:25
SPEAKER_00: And really, we do need to tweak it because the adult women, their complaints are that they want a heavier moisturizer.
2:33
SPEAKER_00: As women get a little bit older into their 30s, 40s, and 50s, they often find, first of all, a lot of women have gotten away with not moisturizing.
2:42
SPEAKER_00: And even though they need to, it's something that all of a sudden they're in their 40s and they're like, wait a second, I have to moisturize now.
2:49
SPEAKER_00: It's not a choice, right?
2:51
SPEAKER_00: And so I definitely have seen those patients where I they really find that need to have a really effective moisturizer.
2:59
SPEAKER_00: It is something that becomes brilliantly obvious as women get older.
3:04
SPEAKER_00: So it's and women and men, I shouldn't say just women.
3:07
SPEAKER_00: I tend to see mainly women in my practice, but I think that we we need to tailor, tailor make your moisturizer based on the patient.
3:16
SPEAKER_00: And age definitely plays a big role in that.
3:19
SPEAKER_03: You know, in order for us to drive compliance with our patients for these regimen, the products that we recommend have to be cosmetically elegant.
3:29
SPEAKER_03: In other words, our patients will will want to use them and continue using them because they feel so good on their skin.
3:38
SPEAKER_03: Peter, as as as Dr.
3:39
SPEAKER_03: Willie Lloyd said, you you really focus on children mainly in your primarily atopic dermatitis practice, your practice focused on eczema.
3:47
SPEAKER_03: Uh what do you think in terms of you know the products that you recommend and the galenic, the, the, the properties of the of them such that they will drive um compliance?
3:58
SPEAKER_01: It is just such an important piece.
4:00
SPEAKER_01: It is the little secret that everybody kind of knows, but is often easy to forget and easy to kind of push past.
4:07
SPEAKER_01: Oh, just pick a gentle moisturizer.
4:09
SPEAKER_01: Oh, try any of these, they're fine.
4:10
SPEAKER_01: But I really think you do that at your own risk.
4:13
SPEAKER_01: If you can find a product that the patient likes to use, right?
4:16
SPEAKER_01: First of all, if they hate to use it, all bets are off.
4:19
SPEAKER_01: You're in big trouble.
4:19
SPEAKER_01: If they're neutral about it, fine.
4:21
SPEAKER_01: Maybe you'll get through if you keep coaching.
4:23
SPEAKER_01: But if you find a product that the patient likes to use or loves to use, you've just won the game.
4:27
SPEAKER_01: Now you have a patient who is actually looking forward to it and you get a whole host of other pieces.
4:32
SPEAKER_01: Not only do you get better adherence, they're going to do it because it feels good.
4:35
SPEAKER_01: I actually think the outcomes are going to be better, even if you control for the amount of use, because it is a positive mental piece.
4:41
SPEAKER_01: It's relaxing, it feels good.
4:42
SPEAKER_01: They they're telling themselves, hey, this is something that goes well with my skin.
4:46
SPEAKER_01: This feels good.
4:47
SPEAKER_01: So all of those pieces are going to help us get to where we want to go.
4:50
SPEAKER_01: At the end of the day, I always joke with my patients.
4:52
SPEAKER_01: I say, my ego is big, but it is not as big as my desire to get you better.
4:56
SPEAKER_01: So prove me wrong.
4:57
SPEAKER_01: Find something better.
4:58
SPEAKER_01: Teach me, but get let's get you better at the end of the day.
5:00
SPEAKER_01: So if I give you the wrong suggestion, tell me and let's find the right one for you.
5:04
SPEAKER_01: And I love that.
5:04
SPEAKER_01: And I think patients get a kick out of that too, because they realize the important part is doing something regularly and doing something that they like and feels good.
5:12
SPEAKER_03: You know, I think you're touching on the idea of skincare being self-care also.
5:18
SPEAKER_03: And and Heather, uh, you and I have talked about this quite a bit.
5:21
SPEAKER_03: You've lectured on this also.
5:23
SPEAKER_03: The idea that that taking care of oneself can actually improve your mental state, your well-being, and is is great overall for wellness.
5:33
SPEAKER_03: Just touch on that for us.
5:35
SPEAKER_00: So it's really interesting because, you know, in the in my age group of patients, the there are busy women who feel pulled in 4,000 different directions at the same time.
5:47
SPEAKER_00: So I tell my patients that skincare really is self-care.
5:52
SPEAKER_00: And if you take those, even if it's just five or 10 minutes at night to really take care of your skin, first of all, it will give you the clinical results that you want, right?
6:02
SPEAKER_00: But on top of that, it just is a little bit of a disconnect.
6:05
SPEAKER_00: You get to actually take care of yourself.
6:07
SPEAKER_00: I always say, no one is gonna take care of you except you, you know.
6:11
SPEAKER_00: So it's really a very important part of overall wellness is using skincare and having a nice skincare regimen that you love to use.
6:23
SPEAKER_00: Very good point, Peter, because you have to love it.
6:25
SPEAKER_00: But once a patient finds something that they love, I think it's really important for overall wellness.
6:30
SPEAKER_00: And there are studies that show that the use of a moisturizer head to toe can lower inflammatory markers systemically.
6:39
SPEAKER_00: So systemic markers of inflammation can be lowered, at least in one study, by using a topical moisturizer daily.
6:47
SPEAKER_00: Over in this study, it was like over 30 days.
6:50
SPEAKER_03: Uh, that's so important to highlight that moisturizing is actually regenerative, that it can actually make your skin function as a younger skin for the younger person.
7:00
SPEAKER_03: And so it's important to moisturize every day.
7:03
SPEAKER_03: The other aspect of moisturizing that I think we don't talk enough about is for our acneic patients, our patients with acne, they have a disrupted barrier.
7:12
SPEAKER_03: It's been well shown that the even the skin between acne bumps is disrupted.
7:18
SPEAKER_03: The the barrier is not working well, the the transepidermal water loss is is higher in these patients.
7:24
SPEAKER_03: And so it's important to moisturize normal skin, dry skin, of course.
7:29
SPEAKER_03: But even if you have a patient with oily skin and they're truly acneic, moisturizing is important.
7:36
SPEAKER_03: And we see that, Peter.
7:37
SPEAKER_03: You run trials and you see this in our acne trials in the vehicle arm of trials.
7:43
SPEAKER_03: It's really difficult for the active to show statistical significance because the vehicle arms do so well in acne trials.
7:52
SPEAKER_03: And I don't know, I kind of think it's because of barrier repair.
7:56
SPEAKER_01: It's a great point.
7:56
SPEAKER_01: And I often think about even if the barrier were okay initially in acne, and I totally agree.
8:02
SPEAKER_01: I think it's abnormal to some degree.
8:03
SPEAKER_01: In the presence of inflammation, it's abnormal.
8:05
SPEAKER_01: But inevitably, we're going to make it bad by putting on some of our products with the best intentions.
8:10
SPEAKER_01: Our retinoids are fantastic, but they are going to attack the barrier, particularly in the beginning, and make it very difficult.
8:15
SPEAKER_01: And again, the the difference between being able to push through and get past that especially initial phase of retinoid dermatitis and somebody giving up and saying, nope, this guy gave me something that didn't work for me, that can depend on the moisturizer and the cleanser and the support that we're giving.
8:30
SPEAKER_01: Moreover, if we have things that people perceive as gentle, and this is it kind of goes back to if you tell somebody or someone tells me, eat healthy, okay, what do you mean?
8:40
SPEAKER_01: Like that's a really complicated question.
8:41
SPEAKER_01: Eating healthy, I don't know.
8:42
SPEAKER_01: There's a lot of dietary advice, and there's a lot of different things that go against each other.
8:46
SPEAKER_01: Is I mean, certainly I think we agree processed stuff is probably not that healthy.
8:50
SPEAKER_01: Certain potato chips, okay, easy.
8:52
SPEAKER_01: But what about pasta?
8:53
SPEAKER_01: What about pizza?
8:54
SPEAKER_01: Don't get me started.
8:55
SPEAKER_01: Uh, we know these are important issues, but if you give me more specific things, that's much better.
8:59
SPEAKER_01: So saying pick a gentle cleanser, I've had many of my patients go get a natural soap, which sounds pretty good, but it actually is often animal fat or a plant fat that has now been saponified with a really alkaline material.
9:10
SPEAKER_01: And now it's it's pretty harsh, even though it's natural and it's simple.
9:14
SPEAKER_01: I like that, but it may be really a bad fit for their skin.
9:17
SPEAKER_01: Whereas if we're looking for something that is designed to fit into this kind of a treatment regimen, we can pick something, for example, that is formulated for this exact context that we know has also been tested, tried and true, which is really important too.
9:30
SPEAKER_03: Love this so much.
9:31
SPEAKER_03: Let's put a pin in uh moisturizing with retinoids because we need to get back to that.
9:36
SPEAKER_03: But I think you're you just pivoted to cleansers for us.
9:39
SPEAKER_03: And and knowing that our sponsor for this episode series is Neutrogena, I'd really like to focus on the hydro boost line of products that they have produced.
9:48
SPEAKER_03: Um, I I am biased towards these products.
9:50
SPEAKER_03: I've just run a clinical trial incorporating these products and uh alongside a uh uh procedures like aesthetic procedures.
9:59
SPEAKER_03: And so I have been highly engaged with these products for the last few months.
10:02
SPEAKER_03: So I really uh know how well they work.
10:05
SPEAKER_03: But in terms of cleansers, Heather, when you are, you know, looking at your patients and deciding what kind of everybody needs to wash their face, you've got to remove, at the very least, you have to remove the dirt, grime, pollution that occurs throughout the day, but also in the morning, right, Heather?
10:21
SPEAKER_03: I mean, we know what happens to skin overnight.
10:24
SPEAKER_00: Yes.
10:25
SPEAKER_00: So I think that this is so important.
10:26
SPEAKER_00: And Peter brought up this very good point about when people buy alkaline, um, you know, cleansers that are alkaline.
10:34
SPEAKER_00: And there was a study, I always quote a study, that showed that acne patients, their pH was way higher in the normal skin, not the acne-affected skin.
10:43
SPEAKER_00: The normal skin of acne patients was significantly higher than normal patients.
10:47
SPEAKER_00: And in some of these acne patients, the pH on their skin was like 10 and 11.
10:51
SPEAKER_00: It was crazy.
10:52
SPEAKER_00: These numbers are crazy.
10:53
SPEAKER_00: It's like a very specific kind of graph.
10:55
SPEAKER_00: So it was so moving when you see those images.
10:58
SPEAKER_00: And that shows us the importance that we have to use pH balance cleansers and moisturizers, but specifically cleansers, because in for our acne patients, for all of our patients, but for our acne patients, they definitely have this impaired barrier.
11:13
SPEAKER_00: They definitely have an altered pH that is consistent with an impaired barrier.
11:18
SPEAKER_00: And cleansers are the first step in a skincare routine.
11:21
SPEAKER_00: And so that simple, simple thing is a gentle pH balance cleanser, which hydrobuceline is really has a nice effective cleanser of, you know, that meets all of that, kind of checks all the boxes.
11:33
SPEAKER_00: It's a great product for that.
11:34
SPEAKER_00: And I'm always amazed by my acne patients who come in and they'll say, oh, um, you know, I had acne, but I used this great gentle cleanser and it got better.
11:47
SPEAKER_00: And I didn't understand why they got better until I learned that research on that altered barrier of acne patients and that their skin has an altered barrier, higher pH.
11:59
SPEAKER_00: And so I think the gentle cleanser kind of normalizes the skin a little bit.
12:03
SPEAKER_00: Obviously, as dermatologists, we're going to give them prescriptions, but I think we underestimate the power of a really good cleanser, moisturizer, that hydroboost moisturizer is really perfect for acne patients.
12:16
SPEAKER_00: It checks, talking about checking all the boxes, you know, it's lightweight for the oily, some they're two uh hydroboost products, but the gel cream is great for patients who are acne prone, have oily skin, and they are going to be compliant.
12:32
SPEAKER_00: So we get the benefit of the barrier being restored, but also that it's cosmetically elegant.
12:38
SPEAKER_00: And patients absolutely love that product.
12:41
SPEAKER_01: I was going to add that piece exactly.
12:43
SPEAKER_01: That it's a two-punch situation.
12:45
SPEAKER_01: The first punch is it's got to do what we want it to do, right?
12:47
SPEAKER_01: It's got to be gentle yet effective.
12:49
SPEAKER_01: It can't irritate.
12:50
SPEAKER_01: So that's part one.
12:51
SPEAKER_01: And then part two, the second punch is does the patient like it?
12:54
SPEAKER_01: And in the past, I've recommended gentle cleansers that don't feel that great.
12:57
SPEAKER_01: They don't seem to rinse completely, they don't foam.
12:59
SPEAKER_01: People really like the feeling of foam up.
13:01
SPEAKER_01: I think I we all do too.
13:02
SPEAKER_01: It's actually very nice.
13:03
SPEAKER_01: So to find something where Neutrogena has sort of threaded that needle, very effective, very tolerable, but also cosmetically elegant, that's what I'm talking about.
13:16
SPEAKER_02: The Skincare Through the Ages series is sponsored by Neutrogena.
13:20
SPEAKER_02: For over 90 years, Neutrogena has advanced skin health for all skin types, with formulation expertise that combines scientifically proven ingredients and innovative technologies to deliver maximum efficacy and an unparalleled aesthetics experience.
13:36
SPEAKER_02: That's beauty to a science.
13:38
SPEAKER_02: To learn more about the products mentioned in the episodes, please visit the link in the description.
13:49
SPEAKER_03: Guys, you've just brought up so many great points.
13:51
SPEAKER_03: Let's dissect that for a second.
13:53
SPEAKER_03: So in acne patients, we know that they've lost their acid mantle.
13:56
SPEAKER_03: And when you lose your acid mantle, there's a certain enzyme called beta-glucoserebrosidase that is responsible for lipid processing in the keratinocytes in the in the top layer of your skin as well as in the corneocytes, the dead layer of the skin.
14:10
SPEAKER_03: When beta-glucoserebrosidase is not working well, the amount of lipids in your barrier is impaired.
14:16
SPEAKER_03: It's decreased.
14:17
SPEAKER_03: And so at that point, we really need to start looking at cleansers that not only avoid disrupting the barrier further, avoid removing lipids, but also moisturizers that can replace those lipids while your skin is trying to regain the ability to make its own lipids, right?
14:35
SPEAKER_03: And Peter, as we know, the cleansers have a really tough task.
14:39
SPEAKER_03: Um when you are an acne patient, for example, or uh gosh, anybody that has a slightly impaired barrier, and the cleanser's whole responsibility is to remove the excess sebum, dirt, debris, pollution from the skin, it has to do so, but be very gentle at the same time.
14:57
SPEAKER_03: And that's a huge, that's a very tough task for a cleanser, in my view.
15:03
SPEAKER_03: How how do you think Hydro Boost does it so well?
15:05
SPEAKER_01: I mean, I I always tell the story how I learned about the Hydro Boost line.
15:09
SPEAKER_01: And it was one of those things where when I first learned about it, I thought, well, this kind of sounds too good to be true.
15:15
SPEAKER_01: It's super lightweight, it's super elegant.
15:17
SPEAKER_01: Like, I don't know if we really have this.
15:19
SPEAKER_01: And then I came to learn about the development process and the formulation process, and it kind of is a breakthrough.
15:24
SPEAKER_01: I mean, it really is.
15:24
SPEAKER_01: I kind of joke, I say it's sort of it defies the physics of formulation.
15:28
SPEAKER_01: I mean, it doesn't actually, we really know it follows those rules, but it's so brilliant that it really is a next level.
15:34
SPEAKER_01: So it manages to do those things to be extremely gentle, be extremely supportive, but also quite effective.
15:40
SPEAKER_01: I mean, I can tell you because not only do I recommend them a lot, but I use them.
15:43
SPEAKER_01: I actually enjoy using the products.
15:45
SPEAKER_01: And I'm I'm not really a super product person in terms of my own skincare.
15:49
SPEAKER_01: I'm actually a little bit picky.
15:50
SPEAKER_01: So when I try something personally, I don't usually make that rule it out because I'm pickier, I think, than some of my patients.
15:56
SPEAKER_01: But when I find something that I like, I think, wow, okay, this passed my test.
15:59
SPEAKER_01: So I have a feeling even my pickiest patients are going to like it.
16:01
SPEAKER_01: And that's usually where I get the experience.
16:03
SPEAKER_01: And they just do.
16:04
SPEAKER_01: So they've just found a way to crack the code of all of those pieces at once.
16:08
SPEAKER_01: And of course, it's not just the moisturizer uh or the cleanser, but it's all the line, which is what's so cool about it too.
16:14
SPEAKER_01: It kind of carries the same DNA throughout.
16:15
SPEAKER_00: I just have to say one thing, which is so interesting because the Hydro Boost cleanser is currently in my bathroom right now, too, which is so funny.
16:23
SPEAKER_00: And it's it's interesting because as a woman, I need to get off.
16:27
SPEAKER_00: I don't wear a lot of makeup, but because I never figured out how to do that.
16:30
SPEAKER_00: But um, but you know, it's important for women that they um we they need to remove their makeup, right?
16:38
SPEAKER_00: So you really do have to have an effective cleanser for a woman who's wearing makeup.
16:42
SPEAKER_00: It can't really be too, it has to truly cleanse, do the job of cleansing and removing these oil-based foundations and concealers and so forth without drying out that 40-something or 50-something year old woman's skin.
16:59
SPEAKER_00: And Hydroboost is really effective at doing that.
17:01
SPEAKER_00: So I think it's just so interesting that we uh both have that cleanser in our back.
17:07
SPEAKER_03: You know, it's amazing, cleanser, actually, because it's a foaming cleanser.
17:11
SPEAKER_03: And usually with foaming, you think, oh my gosh, a high concentration of surfactants to cause the foaming.
17:16
SPEAKER_03: And surfactants are those chemicals which strip the barrier of its lipids as well.
17:21
SPEAKER_03: And so, you know, we tend to try and avoid foaming cleansers, but but the the um neutral the the hydroboost cleanser is is foaming, and and we know that our patients like a foaming cleanser as well.
17:34
SPEAKER_03: They like the the feel.
17:35
SPEAKER_03: I think we have been taught via commercials on TV or social media that foaming means it's working better as a cleanser, although we know it's absolutely not what that means, but um you know it's really nice that it fits the needs and desires of our patients, but it does so you know, so gently.
17:51
SPEAKER_03: It's there's a couple of technologies in the Hydro Boost uh cleanser, there's the HMP technology and and um the the nature surf technology, and both of them are are ways to um kind of use surfactants and and highlight the the pros of surfactants by limiting the cons of a surfactant.
18:12
SPEAKER_03: And and I think Neutrogena has done that really well.
18:15
SPEAKER_03: But um, Heather, you you started talking about the Hydra Booze line of moisturizers, and as you said, there's there's two.
18:21
SPEAKER_03: I actually think, Heather, there's three now.
18:23
SPEAKER_03: They just added another one.
18:24
SPEAKER_03: They've got a water gel, a gel cream, and a water cream.
18:29
SPEAKER_03: So there's it's a line of three, um, which is wonderful because it meets, you know, they go from richer to lighter, um, which across the country can be really important and per patient desires can be really important.
18:41
SPEAKER_03: But can you just talk quickly about how you decide which one of these hydroboost moisturizers you'll recommend for a patient?
18:49
SPEAKER_00: So the gel cream is a little bit lighter than the water cream.
18:55
SPEAKER_00: And I know that might be confusing because you hear water and you think water means that it's lighter, but actually the water cream is a heavier compared to the gel cream.
19:04
SPEAKER_00: So I think of the gel cream for my acne-prone patient, um, oily skin on a retinoid, needs really effective moisturization, but doesn't want a heavy feel.
19:17
SPEAKER_00: Whereas the water cream is more for someone who wants more, a heavier feel to their cream.
19:24
SPEAKER_00: It's none of them are heavy.
19:25
SPEAKER_00: They all feel very cosmetically elegant.
19:28
SPEAKER_00: They don't feel like, you know, oily, like they're weighing down the skin.
19:31
SPEAKER_00: They truly provide hydration.
19:34
SPEAKER_00: That like the definition of hydration when I think of Neutrogena's line.
19:39
SPEAKER_00: Um, so when I think of the water cream, I think of someone who wants something a little bit heavier.
19:45
SPEAKER_00: And then the third one you mentioned is the um water gel.
19:50
SPEAKER_00: What's the third one that you mentioned?
19:51
SPEAKER_03: Yeah.
19:52
SPEAKER_03: The water gel.
19:53
SPEAKER_03: Yeah.
19:53
SPEAKER_00: I think that's the lightest of them all.
19:55
SPEAKER_00: In my practice, I'm using for my acne patients the gel cream.
20:01
SPEAKER_00: And then for my patients who want something a little bit heavier, the water cream.
20:06
SPEAKER_03: Peter, any anything else that you would say about how you decide which one to recommend?
20:11
SPEAKER_01: Yes.
20:11
SPEAKER_01: And just for our listeners, again, I think that's great to know just to think about like the water gel is the lightest weight.
20:16
SPEAKER_01: They say it's weightless.
20:18
SPEAKER_01: And on the other hand, is the water cream, which is the most rich.
20:21
SPEAKER_01: And then in the middle is that gel cream kind of a hybrid.
20:24
SPEAKER_01: I usually, because I see so many sensitive patients, I start with water cream.
20:27
SPEAKER_01: And then if if and that seems to be perfect for my patients, it's compared to what I'm normally recommending.
20:32
SPEAKER_01: It's like an order of magnitude lighter on the skin, but it's still really effective.
20:36
SPEAKER_01: Uh, I'm quite impressed by its power of moisturization and barrier repair.
20:40
SPEAKER_01: And then if somebody wanted something lighter, I would go to gel cream.
20:43
SPEAKER_01: I haven't really used much of the water gel, but that would be fun for maybe a patient who just wants absolutely lightweight.
20:48
SPEAKER_01: They don't want to feel anything on their skin.
20:50
SPEAKER_01: It's a little bit outside of my patient population, so I focus on that water cream.
20:54
SPEAKER_00: Right.
20:54
SPEAKER_00: That's it.
20:55
SPEAKER_00: I would say maybe like an oily teenager, like that patient.
20:59
SPEAKER_00: I have a lot of adult women, as I've mentioned.
21:01
SPEAKER_00: So I'm between the water cream and the gel cream, also.
21:05
SPEAKER_03: Yeah.
21:06
SPEAKER_03: I mean, Heather and I both practice in the South.
21:08
SPEAKER_03: And so we're dealing with hot, humid weather.
21:11
SPEAKER_03: And so for us, probably the water cream with the lipids and the natural moisturizing factors, all that involved, are a bit too much for our patients during the summer.
21:19
SPEAKER_03: Um, which Heather in Miami, it's always summer, but in Austin, we get a little bit of winter.
21:24
SPEAKER_03: Uh, and so I might switch to the water cream for my patients in the cooler weather, uh, except for those with disruptive barriers because of inflammatory disease, Peter, to your point.
21:34
SPEAKER_03: Um, guys, you know, we I said let's put a pin in the retinoids.
21:37
SPEAKER_03: Can we circle back to that quickly?
21:39
SPEAKER_03: Because we're talking about the moisturizers.
21:41
SPEAKER_03: And they, you know, uh Neutrogena did a wonderful study on ex vivo skin looking at, you know, we talk about applying moisturizers alongside retinoids.
21:51
SPEAKER_03: And when I say retinoids, I mean like a prescription strength retinoid, like tretinoin, for example, or uh the over-the-counter type retinoids, which can either be retinol or retinaldehyde.
22:00
SPEAKER_03: For most people, um, they looked at whether it's okay to put the moisturizer on first before a retinoid or after, or before and after.
22:11
SPEAKER_03: And Peter, can you just kind of review just high level what those results were?
22:16
SPEAKER_03: Because I think it's very insightful for the practicing dermatologist.
22:20
SPEAKER_01: It is so cool.
22:21
SPEAKER_01: And first of all, I just have to say it is so great to see this kind of research being done because this, again, is beyond compatibility.
22:27
SPEAKER_01: It's not just is it going to cancel it out or cause some problem?
22:30
SPEAKER_01: It's really showing us an optimization strategy for these patients.
22:33
SPEAKER_01: So I love it.
22:34
SPEAKER_01: I absolutely love it.
22:35
SPEAKER_01: So my understanding is that the open-faced sandwich, meaning we put the moisturizer first, then our retinoid on there, was extremely effective and also very tolerable.
22:44
SPEAKER_01: When we close the sandwich, when we do moisturizer, medicine moisturizer again, we see maybe a little bit of a loss of efficacy.
22:51
SPEAKER_01: It's probably more tolerable.
22:53
SPEAKER_01: And I love knowing that whole spectrum.
22:55
SPEAKER_01: So of course, I think we we we can empower ourselves and our patients with this.
22:59
SPEAKER_01: If they're really sensitive, maybe you would start with a closed sandwich and tell them it's not going to be as effective potentially, but it's going to be potentially more buffering.
23:06
SPEAKER_01: And then when we're ready, we can go to that open sandwich, which is incredible.
23:10
SPEAKER_01: Did I get that right, Ted?
23:11
SPEAKER_01: Does that sound right?
23:12
SPEAKER_03: Yeah, I uh it is right in that they looked at both a retinol, which is in their rapid wrinkle repair, and they also looked at prescription prescription strength retinoid as a tretinoin.
23:22
SPEAKER_03: They used both of those.
23:24
SPEAKER_03: And whether they applied the water gel or the gel cream first, either first before a retinoid or after a retinoid, so known as the half sandwich, it didn't mitigate the the efficacy of the retinoid itself in doing what it's supposed to do to the skin.
23:40
SPEAKER_03: And they had a couple of markers that they looked at, molecular markers, uh, to show that the retinoid was doing the beneficial things that it's supposed to do.
23:48
SPEAKER_03: However, when they did either the water gel or the gel cream first, and then retinol or prescription strength retinoid, and then the moisturizer over it, we saw that those molecular markers were decreased as compared to when you put the retinol or tretinone by itself.
24:04
SPEAKER_03: So you're exactly right.
24:05
SPEAKER_03: Half sandwich, okay, doesn't affect the efficacy, let's say, in this study, full sandwich may mitigate that efficacy a bit.
24:14
SPEAKER_03: But like you said, sometimes we need to do it, you know.
24:16
SPEAKER_03: But I think if we can get by, Heather, if we can get by with a half sandwich based on this data, that's probably what we should do.
24:24
SPEAKER_00: Yes.
24:24
SPEAKER_00: And I would say in my practice, I never did the whole sandwich.
24:28
SPEAKER_00: Okay.
24:29
SPEAKER_00: I always would say, you know, apply your moisture.
24:31
SPEAKER_00: I I typically tell my patients to apply the retinoid first and the and then the moisturizer on top.
24:37
SPEAKER_00: But I also would say to them, but if you prefer to apply the moisturizer first, it's okay.
24:42
SPEAKER_00: And it doesn't matter because it doesn't change efficacy.
24:45
SPEAKER_00: So very rarely do I did I ever really recommend moisturizer, retinoid moisturizer.
24:52
SPEAKER_00: So for my practice, it this um study kind of it goes with what I currently do, which is always open face, always open face.
25:00
SPEAKER_00: But I do think you're right.
25:03
SPEAKER_00: If there's someone who really, really needed a lot of extra moisture, they couldn't tolerate a retinoid.
25:09
SPEAKER_00: And we all have those patients who come in who say, I can't use retinoids.
25:12
SPEAKER_00: They walk in the door, can't do it.
25:14
SPEAKER_00: I've never, that might be a patient where we might be able to talk about that closed sandwich uh that might improve tolerability, even though they might lose a little bit of that efficacy.
25:24
SPEAKER_03: Look, I think it's so important for us to have this data, like Dr.
25:27
SPEAKER_03: Leo mentioned, and and you were pointing out as well, um, Dr.
25:30
SPEAKER_03: Willowly Lloyd, is in that we have so many of our patients who get a lot of information, misinformation, unfortunately, from social media.
25:38
SPEAKER_03: And and I know, Dr.
25:40
SPEAKER_03: Willowly Lloyd, you are so active on social media and you really spend a lot of time educating people and trying to dispel these myths.
25:47
SPEAKER_03: And kudos to you because we need that.
25:49
SPEAKER_03: Um, what's what's your handle on Instagram and TikTok?
25:52
SPEAKER_00: It's Dr.
25:53
SPEAKER_00: HeatherMD on both.
25:55
SPEAKER_03: Dr.
25:55
SPEAKER_03: Heather MD on both.
25:56
SPEAKER_03: Thank you.
25:57
SPEAKER_03: Yes.
25:57
SPEAKER_03: Um, Peter, I'd ask for yours, but I don't think you're very active.
26:00
SPEAKER_01: No, I'm not.
26:01
SPEAKER_01: It's all about pizza.
26:02
SPEAKER_03: It's all about pizza.
26:03
SPEAKER_03: Okay.
26:04
SPEAKER_03: Well, that's I like that.
26:06
SPEAKER_03: Um, I just got hungry.
26:07
SPEAKER_03: Uh so uh Heather, you know, I have patients who come in all the time who have seen something, I mean, beef tallow, for example.
26:15
SPEAKER_03: Oh my gosh, the amount of time I've suddenly started talking about beef fat that people are putting on their face is ridiculous in my view.
26:22
SPEAKER_03: But when you have this data to show, like, look, when you put the water gel or the gel cream before or after, it does great.
26:28
SPEAKER_03: And we have this amazing technology behind the hydroboost cleanser.
26:32
SPEAKER_03: All that allows us to quickly say, forget about the beef tallow.
26:35
SPEAKER_03: We've got great data for these products.
26:37
SPEAKER_03: And I think that's what you do on social media.
26:40
SPEAKER_00: Yeah, I spent a lot of time educating.
26:42
SPEAKER_00: I did a study where we looked at hashtags like acne treatment, rhosacea treatment, psoriasis treatment, eczema treatment, and we found that only 16.8% of the top 100 videos.
26:55
SPEAKER_00: So when your patient types in eczema treatment, only 16.8% of those videos are made by board-certified dermatologists.
27:03
SPEAKER_00: And so I think that creating content online is really important if you enjoy it.
27:08
SPEAKER_00: If you don't enjoy it, I understand completely.
27:10
SPEAKER_00: But if you enjoy it, we we really do need derms creating this type of educational content because that means that the vast majority of the time, the patient will be getting information.
27:21
SPEAKER_00: It may be accurate, but it may be not so accurate, right?
27:25
SPEAKER_00: And so I deal with that all the time.
27:27
SPEAKER_00: And in my practice, I'm always quoting studies.
27:30
SPEAKER_00: I always tell patients, you know, and a study said, like for example, the open sandwich and the closed sandwich, I will quote that study and say, you can put your moisturizer first and the retinoid on top, or the retinus first, and the moisture, you know, the moisturizer on top.
27:43
SPEAKER_00: And it doesn't matter, you'll still get the same efficacy.
27:46
SPEAKER_00: So I love to quote studies with my patients and kind of dispel some of these myths that we see online.
27:53
SPEAKER_00: Uh, I do spend quite a bit of time with my very savvy patients who are skincare gurus when they, you know, who come in with their big bag of skincare and they say, I saw this online, and I so I bought these five serums.
28:08
SPEAKER_00: And a lot of times that's just disruptive to the barrier and not helpful.
28:12
SPEAKER_00: And I always tell patients we have to get back to basics.
28:15
SPEAKER_00: And I say, I feel so bad you spent all this money, but it's not necessary.
28:18
SPEAKER_00: You need to cleanse, moisturize, and protect.
28:21
SPEAKER_00: So I do spend a lot of time in clinic talk about that, and then also online.
28:25
SPEAKER_03: Peter, we we just finished up at our meeting, the Science of Skin Summit, and and um Neutrogena uh helped to sponsor some residents coming in, um, young dermatologists, dermatologists in training.
28:37
SPEAKER_03: And you were involved in the formulation workshop that we had, uh, where you were really trying to teach the the up-and-coming dermatologists about what's involved in formulating different products.
28:48
SPEAKER_03: And I think they kind of came with their prejudices and knowledge, you know, gaps as well to that.
28:55
SPEAKER_03: Uh, and it was so great for Neutrogena to kind of sponsor that and allow us to give them the right information as they launch their careers.
29:03
SPEAKER_01: It's so true.
29:04
SPEAKER_01: And I think part of it is that just talking about the importance of formulation, talking about the importance of choosing good products that have the research, that have the evidence behind them, that's a big piece for many of us, I think just to think about how important it is.
29:18
SPEAKER_01: But then to see their faces light up when they saw the level of sophistication, right?
29:23
SPEAKER_01: I mean, when you look at some of the studies and some of the just the resource, the science going into this, these feel very much like a drug development type process.
29:30
SPEAKER_01: I mean, there's all these considerations, there's all of this incredible science.
29:34
SPEAKER_01: So to look at that and then see some of the halo ingredients, some of the halo products that pop out and how transformative they can be.
29:41
SPEAKER_01: I mean, I feel like we're in great hands with the future of dermatology, in some ways, better than what we were taught.
29:46
SPEAKER_01: I mean, this is the next level to understand what goes into the products instead of dismissing them and saying pick a simple moisturizer and a good cleanser or something.
29:54
SPEAKER_01: This is really the next level.
29:55
SPEAKER_01: And I'm just so grateful to Science of Skin Summit for bringing that to the fore and making that an important part because we know it's it's critical for all of us.
30:03
SPEAKER_03: You know, one thing we've talked about, well, we've talked about the cleanse and the moisturize um for the last half hour, guys.
30:09
SPEAKER_03: And I think we could probably go for at least another half hour just talking on that because of how important it is.
30:14
SPEAKER_03: But we're we need to spend some time talking about the protect, and uh, which is of course the SPF, right?
30:19
SPEAKER_03: Not protect not only means protecting the barrier, but also protecting the skin from pollution and the exposome as much as we can.
30:26
SPEAKER_03: And SPF is such an important part of that.
30:29
SPEAKER_03: Um, Heather, you know, there's uh Hydroboost does have a product with SPF.
30:34
SPEAKER_03: Um, can you just talk about the hyaluronic acid moisturizer with that broad spectrum SPF 50?
30:40
SPEAKER_00: So when we talk about sunscreens, Neutrogena really has mastered sunscreens.
30:46
SPEAKER_00: They really, when it comes to sunscreen, they know what they're doing.
30:50
SPEAKER_00: They create really cosmetically elegant formulas, but also have great broad spectrum coverage, which is so important for my patients because I'm really very concerned about UVA protection, uh, because my patients tend to have hyperpigmentation, and we know that that long wave UVA is the one that's most responsible for hyperpigmentation and that that drives melanogenesis when it comes to UVA and UVB.
31:16
SPEAKER_00: So I am very, very impressed with all of Neutrogena sunscreens, but the benefit of the hydro boost sunscreen is that it is lightweight, easy to use, completely clear.
31:28
SPEAKER_00: For my patients, that's a big issue.
31:30
SPEAKER_00: If a person doesn't want to put on their sunscreen, they're not going to use it.
31:33
SPEAKER_00: It doesn't matter what we say, it doesn't matter how important we say it is, you have to want to put on your sunscreen every single day.
31:41
SPEAKER_00: And I'm speaking from personal experience.
31:43
SPEAKER_00: You have to want to put it on.
31:44
SPEAKER_00: I'm a dermatologist, right?
31:46
SPEAKER_00: So I do think that that hydrobuced sunscreen is so effective because not only does it have the great sunscreen technology that we're used to from Neutrogena, but also it's very cosmetically elegant.
31:58
SPEAKER_03: Totally agree, Peter.
31:59
SPEAKER_03: There's the, you know, it's a free of everything, just about except what you'd want in a sunscreen, right?
32:05
SPEAKER_03: No fragrance, no mineral oil, no avobenzone, all of the things you would probably think that the consumer would want to avoid.
32:11
SPEAKER_03: Neutrogena has has rightfully removed those.
32:15
SPEAKER_03: Is this a product that you usually recommend for your for your patients?
32:18
SPEAKER_01: It's absolutely up there.
32:20
SPEAKER_01: And again, it just it's a testament to the brand strength.
32:23
SPEAKER_01: When patients like one product in a brand and there's plenty of great products to like, then I think they're much more excited about trying other ones.
32:30
SPEAKER_01: It's like, okay, well, you didn't like the last sunscreen you tried.
32:33
SPEAKER_01: Why?
32:33
SPEAKER_01: Oh, because it was too sticky and it looked really gross on your skin.
32:36
SPEAKER_01: Sure, why don't you try this one?
32:38
SPEAKER_01: You like this Hydro Boost line, anyways.
32:40
SPEAKER_01: And the patient's like, great.
32:41
SPEAKER_01: And then, of course, we are, we actually get a pretty good amount of samples.
32:44
SPEAKER_01: So I can give them a sample and let them try it.
32:46
SPEAKER_01: And what's one one thing really nice is, of course, the same Hydro Boost technology that's serving us in terms of gentle cleansing and great moisturizing, it's there in the sunscreen too.
32:54
SPEAKER_01: So it really is something that meets the needs for a lot of my patients.
32:58
SPEAKER_03: I tend to to recommend more chemical than mineral sunscreens for my patients.
33:02
SPEAKER_03: I it's just that they just tend to be ones that my patients will like to use over and over and over.
33:08
SPEAKER_03: And the uh Hydro Boost sunscreen has that helioplex technology that uh is a combination of chemical filters that stabilize each other, but also give a kind of a broad spectrum, uh better UVA spectrum uh coverage to Dr.
33:24
SPEAKER_03: Willie Lloyd's point.
33:26
SPEAKER_03: Uh but within the Neutrogena line, my goodness, uh Neutrogena is a sunscreen brand, really, right?
33:32
SPEAKER_03: They have so many.
33:33
SPEAKER_03: So if you did not want to use that uh chemical sunscreen, you could absolutely use one of their mineral sunscreens.
33:39
SPEAKER_03: Their UltraShear line is full of wonderful, um, really cosmetically elegant mineral sunscreens as well.
33:46
SPEAKER_03: And I'm sure, Dr.
33:46
SPEAKER_03: Willie Lloyd, you you you recommend that all the time.
33:49
SPEAKER_00: Absolutely.
33:50
SPEAKER_00: I think that it's always like I mentioned, you want to put on your sunscreen, and Neutrogena really has mastered that.
33:56
SPEAKER_00: But as I mentioned, they've also mastered that coverage, that true broad spectrum coverage, which has become so important to me and my practice.
34:07
SPEAKER_00: You know, 20 years ago, when I was learning and was a resident a little over 20 years ago, we didn't really know how important that long wave UVA was.
34:17
SPEAKER_00: That's relatively new information.
34:19
SPEAKER_00: So you would recommend sunscreens for patients, and they would say, I'm using the sunscreen, but I'm still getting darker when I'm out in the sun, especially in Miami, and I'm reapplying every two hours.
34:29
SPEAKER_00: And little did we know how important that long wave UVA and visible light is for developing hyperpigmentation.
34:38
SPEAKER_00: And so as we've grown, and you know, Peter, you pointed that out, the residents are really so fortunate now because they're learning so much more about skincare that we didn't have an opportunity to learn.
34:48
SPEAKER_00: Honestly, you know, 20 years ago, there's so much science and technology in skincare.
34:54
SPEAKER_00: And when it comes to sunscreen, Neutrogena really has mastered that.
34:58
SPEAKER_00: They are definitely a sunscreen brand for me when it comes to facial sunscreens that give me the coverage that my patients need, but also that are cosmetically elegant.
35:08
SPEAKER_00: So it's very, very helpful to have a wide array of products to choose from.
35:13
SPEAKER_00: And like Peter said, if you don't like the what I recommend, no problem.
35:17
SPEAKER_00: You can try.
35:18
SPEAKER_00: There's so many sunscreen options in that Neutrogeno line for facial sunscreen that patients really have great results because they they stay consistent.
35:26
SPEAKER_03: Guys, we've had such a wonderful conversation.
35:28
SPEAKER_03: It's already been over a half an hour, if you can believe it or not.
35:32
SPEAKER_03: And you know, I just want to summarize, right?
35:34
SPEAKER_03: So we talked about the Hydro Boost cleanser, which is is foaming, which meets our patients' needs and desires, but it also has wonderful technology to ensure that we're not stripping the skin of any kind of lipids and further impairing the barrier, which is so difficult for a cleanser to do.
35:48
SPEAKER_03: But I think Neutrogena has has thread the needle there with the Hydro Boost cleanser.
35:52
SPEAKER_03: We then moved into the Hydro Boost line of moisturizers, of which there are three.
35:57
SPEAKER_03: And we talked about different patient types for each one of those moisturizers and the fact that you know they're they're fragrance-free, they they have uh there's one with lipids, there's there's a couple with natural moisturizing factor ingredients as well.
36:11
SPEAKER_03: Regardless, they certainly within that line of three different products could meet the needs of of nearly all, if not all, patients.
36:19
SPEAKER_03: And it makes it very easy to move from the cleanser to the moisturizer within the same line.
36:23
SPEAKER_03: And then finally, the hydro boost with SPF, which has the hyaluronic acid in it.
36:28
SPEAKER_03: Also, that SPF is is uh is something that you know we we absolutely recommend for every patient.
36:34
SPEAKER_03: This one has an SPF 50 in it, but again, Neutrogena is is so grounded in sunscreen formulation and development that if this is not one that you'd like to remind you to recommend to your patients, there are about 50 other products within the Neutrogena line that may fit the needs of your products.
36:53
SPEAKER_03: So within the Neutrogena line, there absolutely is enough for you to recommend within the cleanse, moisturize, protect.
37:00
SPEAKER_03: And as Dr.
37:00
SPEAKER_03: Leo and Dr.
37:01
SPEAKER_03: William Lloyd said, these are the foundations of any regimen uh and important for any age.
37:08
SPEAKER_03: So, Dr.
37:08
SPEAKER_03: Leo, Dr.
37:09
SPEAKER_03: Willie Lloyd, thank you again for being with us.
37:12
SPEAKER_00: Thank you.
37:12
SPEAKER_01: Thank you for having us.
37:14
SPEAKER_03: Awesome.
37:14
SPEAKER_03: So this was a Science of Skin podcast, formerly known as Skincare Confidential.
37:18
SPEAKER_03: I'm Dr.
37:19
SPEAKER_03: Sedlane.
37:19
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37:21
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37:24
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37:28
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37:29
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37:32
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37:38
SPEAKER_02: The Skincare Through the Ages series is sponsored by Neutrogena.
37:42
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37:59
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38:01
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