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Cancer Treatment and the Skin Barrier with Dr. Barbara Paldus of Codex Labs · Skin Anarchy

• 0:00
  SPEAKER_00: Hey guys, welcome back to another episode of Skin Anarchy.
• 0:02
  SPEAKER_00: This one is very, very special because we're going to be talking about a topic that I rarely hear discussed in this industry, and that is, you know, the role of cancer treatments when it comes to understanding what they do to the skin and the gut.
• 0:16
  SPEAKER_00: And so this is a very important topic.
• 0:17
  SPEAKER_00: Cancer treatment is designed to target cancer cells, as many of you know, but it can also affect some of the body's most important protective systems.
• 0:25
  SPEAKER_00: And two of those systems are the skin barrier and the gut barrier.
• 0:28
  SPEAKER_00: And they're often overlooked until symptoms begin interfering with everyday life.
• 0:33
  SPEAKER_00: So things like dryness, itching, redness, peeling, nail problems, digestive discomfort, changes in your microbiome can all become part of the treatment experience.
• 0:42
  SPEAKER_00: So what is happening biologically is what we want to explore today.
• 0:46
  SPEAKER_00: Today we're going to talk about the supportive care for the skin and gut during cancer treatment.
• 0:51
  SPEAKER_00: But before we begin, an important disclaimer for everybody this podcast is for general education only.
• 0:56
  SPEAKER_00: It is not medical advice, diagnosis, or a substitute for care for an oncology team.
• 1:02
  SPEAKER_00: Cancer patients should speak with their oncologist, oncology nurse, radiation team, dermatologist, or dietitian before using a new skincare product, wound treatment, probiotic, prebiotic, or dietary supplement.
• 1:13
  SPEAKER_00: So joining us today is Dr.
• 1:14
  SPEAKER_00: Barbara Palladus.
• 1:15
  SPEAKER_00: Welcome back, Dr.
• 1:16
  SPEAKER_00: Paladus.
• 1:16
  SPEAKER_00: I am so excited to have this conversation with you.
• 1:18
  SPEAKER_01: Hi, Ecta.
• 1:19
  SPEAKER_01: It's great to be back.
• 1:20
  SPEAKER_00: It's wonderful to have you.
• 1:21
  SPEAKER_00: And I want to start um with the deceptively simple question of what is the skin barrier?
• 1:26
  SPEAKER_01: I love that question.
• 1:28
  SPEAKER_01: We always go through that question.
• 1:29
  SPEAKER_01: So I know.
• 1:30
  SPEAKER_01: Many people imagine the skin barrier as a single wall covering the body, but in reality, it's actually a defense system, which is important in this context of cancer.
• 1:39
  SPEAKER_01: So we all know it keeps the water in, it keeps irritants and pathogens out, so it prevents infections, but it also participates in immune defense.
• 1:48
  SPEAKER_01: It communicates with our nervous system, like pain and itch and feeling hot, and provides home for, you know, the microbiome, our diverse community of microorganisms that we love and live with us.
• 1:58
  SPEAKER_01: And so if we look at it as five interconnected barriers, we go from the physical to the chemical to the microbial to the immunological and to the neurosensory.
• 2:08
  SPEAKER_00: Oh wow, that's that's a lot.
• 2:09
  SPEAKER_00: And I want to go through these actually one at a time.
• 2:11
  SPEAKER_00: So what is the physical barrier?
• 2:13
  SPEAKER_00: Let's start there.
• 2:14
  SPEAKER_01: So this is the outermost layer of the skin.
• 2:16
  SPEAKER_01: It's called the stratum corneum because it's made out of corneocytes.
• 2:19
  SPEAKER_01: These kind of they look like horns or dragon scales and they're flattened cells.
• 2:23
  SPEAKER_01: It's often compared to bricks and mortar, right?
• 2:25
  SPEAKER_01: The skin cells are the bricks and the lipids like ceramides are the mortar.
• 2:29
  SPEAKER_01: And this is the structure that, when it's healthy, it limits water loss and prevents allergens and pathogens and irritants from coming in.
• 2:36
  SPEAKER_00: That's really interesting.
• 2:37
  SPEAKER_00: And so, you know, what about the chemical barrier?
• 2:39
  SPEAKER_01: So this is where we have our natural moisturizing factors, our lipids, the acidity that basically determines the skin pH, antimicrobial substances.
• 2:49
  SPEAKER_01: So basically things that our microbiome makes so that other bacteria can't colonize us, so it's protecting itself and us.
• 2:55
  SPEAKER_01: And these basically maintain hydration, but also they discourage these harmful organisms from taking over.
• 3:00
  SPEAKER_01: The problem then is, as we've discussed before, when you use all these harsh cleansers or super hot water, or you're constantly exfoliating and you're removing too much oil, that chemical environment and the pH is disrupted.
• 3:11
  SPEAKER_00: And the microbial barrier, is that the skin's microbiome?
• 3:15
  SPEAKER_00: Exactly.
• 3:16
  SPEAKER_01: So it's basically our community of not just bacteria, but fungi, viruses, other microorganisms.
• 3:21
  SPEAKER_01: And it's not a sterile environment.
• 3:23
  SPEAKER_01: We don't want it to be sterile.
• 3:24
  SPEAKER_01: We want it to be balanced.
• 3:26
  SPEAKER_01: Um, most of the resident organisms are totally harmless.
• 3:29
  SPEAKER_01: They're beneficial to us, but they compete with the harmful organisms.
• 3:32
  SPEAKER_01: But more importantly, is they communicate with our immune system.
• 3:35
  SPEAKER_01: And so the goal of supportive skin care, especially in the context of oncology, is not to actually eliminate every microbe, it's to really preserve that balanced environment.
• 3:45
  SPEAKER_00: So, where does the immune barrier really fit into this?
• 3:48
  SPEAKER_01: So our skin also has immune cells and those and as well as signaling molecules, and these recognize any injury and threats.
• 3:56
  SPEAKER_01: So when the barrier gets damaged, so say you cut yourself or you get a pathogen on top of your skin, the immune system can then respond with inflammation based on those immune cells in your skin.
• 4:06
  SPEAKER_01: And you know, that's your typical you get the red bump, you get the heat, swelling, itching, burning, rashes.
• 4:13
  SPEAKER_01: So inflammation, I mean, it's a process that's meant to be protective in the right context.
• 4:17
  SPEAKER_01: But obviously, if it goes on for too long or it's excessively painful, that's discomfort.
• 4:22
  SPEAKER_01: That can then further disrupt the barrier, especially during long-term cancer treatment.
• 4:27
  SPEAKER_00: Now, you mentioned the nervous system earlier.
• 4:29
  SPEAKER_00: What is the neurosensory barrier?
• 4:31
  SPEAKER_01: So deeper in our skin, um we have a dense network of nerves.
• 4:35
  SPEAKER_01: And those are what allows us to feel temperature, touch, burning, itching, pain.
• 4:40
  SPEAKER_01: And those nerves cells also interact with the immune cells.
• 4:44
  SPEAKER_01: And that helps explain why, you know, when you feel itchy, it's not just in your head, it's actually a biological signal.
• 4:51
  SPEAKER_01: Um, that involves nerves.
• 4:52
  SPEAKER_01: It they're connected to your brain, the immune activity, and the relative kind of health and condition of your skin barrier.
• 4:59
  SPEAKER_01: So, for example, if you're itchy or something's burning, then scratching can provide momentary relief.
• 5:04
  SPEAKER_01: But the problem is it creates microtears and these tiny injuries that then increase the inflammation and risk of infection.
• 5:10
  SPEAKER_01: And so all of that is important to minimize if you're on immunosuppressive therapy.
• 5:16
  SPEAKER_00: Now, does the age of the cancer patient influence how well their skin is going to recover?
• 5:21
  SPEAKER_01: Absolutely.
• 5:22
  SPEAKER_01: So we know that your skin renews itself more slowly as you get older.
• 5:26
  SPEAKER_01: Obviously, estimates are, you know, individual and they depend on the health and the body site and how the skin turnover is measured.
• 5:33
  SPEAKER_01: But what we know is that kids they renew their skin in two to three weeks.
• 5:36
  SPEAKER_01: Um, young adults, like in their 20s and 30s, have our kind of four to six weeks.
• 5:40
  SPEAKER_01: And then we also know that after 50, it can be two to three months.
• 5:44
  SPEAKER_01: So it really does depend on age because of how quickly our skin can renew itself.
• 5:48
  SPEAKER_01: And I think it's just important to know that the older you are, you have to take that into account after irritation or injury, and especially during cancer treatment, you know, that that age is definitely a consideration, but you also have to look at the type of treatment, the dose of the treatment.
• 6:03
  SPEAKER_01: Are you getting adequate hydration, nutrition, what is your medical condition, what other medications are you on, any pre-existing diseases like skin diseases, all of that can affect recovery.
• 6:14
  SPEAKER_01: So I think your earlier message at the beginning that it's complicated, it depends on the individual, and it really depends on your care team is really important here.
• 6:21
  SPEAKER_00: Yeah, and I mean, from everything you've explained, the real takeaway seems to be that the skin barrier is not just one wall, which I think a lot of times people have been saying, you know, in the past, it's just like this one, you know, barrier system, but it's really a living system.
• 6:34
  SPEAKER_01: Exactly.
• 6:35
  SPEAKER_01: And every part affects the other part.
• 6:37
  SPEAKER_00: So why do radiation therapy and systemic cancer treatments affect the skin?
• 6:42
  SPEAKER_01: So cancer treatments in general are targeted to address rapidly dividing cells, basically tumor cells, right?
• 6:48
  SPEAKER_01: Or they alter specific signaling pathways.
• 6:51
  SPEAKER_01: The problem is that even though they're designed to mostly affect cancer tissues, healthy tissues can also be affected.
• 6:57
  SPEAKER_01: So pretty much any tissue in your body that is continuously renewing itself, like your skin or your gut, will be affected by the cancer treatment.
• 7:06
  SPEAKER_01: So treatments will slow the repair, they also change inflammation, they can reduce your skin oil production, so your skin may get really dry, they can alter the way this immune system in your skin works, or they can disrupt the microbiome.
• 7:18
  SPEAKER_01: So the exact thing depends on the therapy you're undergoing.
• 7:22
  SPEAKER_01: So, for example, whether it's traditional chemotherapy, targeted therapy, immunotherapy, hormonal therapy, or just plain old radiation, they all produce different skin reactions.
• 7:31
  SPEAKER_00: So let's begin with radiation, dermatitis.
• 7:34
  SPEAKER_00: Can you walk us through what that is?
• 7:36
  SPEAKER_01: Sure.
• 7:37
  SPEAKER_01: So it's basically your skin reacting to the area that's been exposed to radiation for the specific cancer, like say skin cancer.
• 7:44
  SPEAKER_01: And it can range from just a mild redness and dryness and itching to more severe burning, peeling, feeling really tender, or in worst cases, skin breakdown or changes in skin color.
• 7:56
  SPEAKER_01: It usually develops gradually.
• 7:58
  SPEAKER_01: So it may not happen during your first treatment, but it can happen maybe on the second or the third one.
• 8:02
  SPEAKER_01: So timing, severity can vary, and you need to make sure your radiation team is monitoring you and monitoring that area because the care will depend on the reaction.
• 8:12
  SPEAKER_00: So, I mean, is it safe then to apply like a moisturizer to a radiation treatment area?
• 8:17
  SPEAKER_01: So, again, going back, as you said, you know, patients have to follow what the radiation center tells them to do.
• 8:23
  SPEAKER_01: But oftentimes they will recommend gentle moisturization in the supportive care.
• 8:28
  SPEAKER_01: Different centers can provide different specific guidance about which products are acceptable, when they can be applied, you know, when they can the timing relative to the treatment.
• 8:37
  SPEAKER_01: But I just want to just make clear the patients should not assume here that any quote, natural or over-the-counter product is safe for radiated skin by definition.
• 8:46
  SPEAKER_01: Like you should always ask your care team.
• 8:48
  SPEAKER_01: And you should also not place these products randomly on open wounds or skin that's kind of moist and peeling or any site where you suspect infection unless the clinical team approves them.
• 8:59
  SPEAKER_01: So again, very dependent on the person, the treatment, and the team.
• 9:02
  SPEAKER_00: That makes sense.
• 9:03
  SPEAKER_00: Now, what other skin changes can occur?
• 9:06
  SPEAKER_01: So this is a lot of different things.
• 9:08
  SPEAKER_01: So you can just have your standard like dryness, itching, flaking, or you can have like the redness burning, rashes, and then it can get worse, right?
• 9:16
  SPEAKER_01: You can have the changes in melanation, the skin color.
• 9:18
  SPEAKER_01: So darker areas, darker skin can become lighter, lighter skin can become darker.
• 9:23
  SPEAKER_01: You can be very sensitive to sunlight.
• 9:25
  SPEAKER_01: You can have pressure injuries.
• 9:26
  SPEAKER_01: So people, for example, who have limited mobility can feel like they have pressure on their skin.
• 9:31
  SPEAKER_01: You can get crusting, blister-like, acne-like eruptions.
• 9:35
  SPEAKER_01: And then we go to kind of the hand foot syndrome, which is a whole different thing, and nail and cuticle changes, like they can yellow, they can become brittle, and then we all know about the hair loss.
• 9:45
  SPEAKER_00: So talking about the hand foot syndrome, the Palmer plantar, erythro dystesthesia, what is that exactly?
• 9:51
  SPEAKER_00: God, I'm glad you said that because that's a mouthful for me.
• 9:56
  SPEAKER_01: I'm just gonna call it hand foot syndrome.
• 9:58
  SPEAKER_01: Yeah, much easier.
• 10:00
  SPEAKER_01: Those are when um your hands and feet get red, they swell, they can tingle, they can burn, they might peel, you might get pain on the palms or the soles of your feet.
• 10:10
  SPEAKER_01: And because those are the parts of your body that experience the most friction and your feet especially have the pressure because they're carrying your weight or they get heat, the symptoms, you know, they can interfere with walking, putting on your shoes, exercising, cooking, like pretty much handling everyday objects.
• 10:26
  SPEAKER_01: So it's really redness, swelling, and then it goes gets kind of worse from there.
• 10:30
  SPEAKER_00: So if you start noticing, like if patients start noticing this, what should they realistically do?
• 10:35
  SPEAKER_01: Again, they should tell their oncology team, especially they should not wait for the symptoms to become more severe because then the team can recommend management and also adjust the treatment.
• 10:46
  SPEAKER_01: They may be advised to like put their feet up to reduce friction and pressure, or you know, to leave their feet in the air, you know, as they're putting them up to avoid excessive heat.
• 10:55
  SPEAKER_01: But again, this is a clinical.
• 10:56
  SPEAKER_01: I just want to make sure that everyone understands a lot of this is about the clinical team.
• 11:01
  SPEAKER_01: And what we're gonna talk about is like supportive care, but everything needs to be vetted by the clinical team.
• 11:06
  SPEAKER_00: Yeah, no, that makes a lot of sense.
• 11:08
  SPEAKER_00: And I I can really echo that for our audience.
• 11:10
  SPEAKER_00: I mean, obviously it's a very, very complex topic.
• 11:13
  SPEAKER_00: So definitely involve your oncology team in this.
• 11:15
  SPEAKER_00: But um, you know, I want to talk about nails also, Dr.
• 11:17
  SPEAKER_00: Baldas, because I know they can become very brittle, cracked, discolored.
• 11:21
  SPEAKER_00: You know, there's a lot of changes.
• 11:23
  SPEAKER_00: Um, even with cuticles, they can become swollen or painful.
• 11:26
  SPEAKER_00: There can be infection around the nail.
• 11:28
  SPEAKER_00: You know, gentle nail nail care is important, but can you describe some tips maybe that you know people can use?
• 11:34
  SPEAKER_01: Absolutely.
• 11:34
  SPEAKER_01: So the most obvious one is avoiding aggressive manicures or artificial nails that can cause trauma or biting them or cutting your cuticles.
• 11:43
  SPEAKER_01: Gloves can help if you're doing, you know, wet household work, like, you know, washing dishes.
• 11:48
  SPEAKER_01: But again, persistent pain, swelling, drainage, or warmth should be reported.
• 11:52
  SPEAKER_00: So I know that this is where it gets, you know, interesting because I know we like we talk about nails, but then again, hair loss is also one of the most visible treatment effects in most cancer patients.
• 12:03
  SPEAKER_00: And is that also a barrier issue?
• 12:06
  SPEAKER_01: Absolutely, because that skin barrier on your scalp is where your hair follicles are, and the hair follicles are is what your hair comes out of.
• 12:13
  SPEAKER_01: So scalp comfort and hair loss are totally connected to barrier care.
• 12:17
  SPEAKER_01: So when you know your hair becomes thinning or absent, then you know, that barrier, the skin barrier on your scalp is now exposed to sunlight or cold or friction, or it can become dry.
• 12:27
  SPEAKER_01: And so, again, gentle cleansing, moisturization, and physical sun protection can all help.
• 12:32
  SPEAKER_01: So treating your head, especially if you lose your hair during the treatment, is really important as well.
• 12:39
  SPEAKER_00: Now, you also mentioned pigmentation changes, and I know this is a big, big concern for a lot of people, you know, in in this space, uh, regardless of, you know, if you're going through cancer treatment, and I just want to understand, you know, with the skin, the nails, tongue, or any other areas like around your joints, they can become darker with certain therapies.
• 12:57
  SPEAKER_00: Other people may develop lighter patches.
• 13:00
  SPEAKER_00: How do you deal with those like pigmentation changes?
• 13:03
  SPEAKER_01: So the first question is are the changes temporary or persistent?
• 13:07
  SPEAKER_01: And so there's a time factor there that people need to understand.
• 13:10
  SPEAKER_01: But again, anything rapidly changing, like whether it's a growth or a bleeding spot or a lesion or really unusual pigmentation, again, should be assessed really quickly by the cancer treatment team because that may be more than just pigmentation and melanization of the skin.
• 13:27
  SPEAKER_01: You know, once you're done with the treatment, then you probably do need to go see a dermatologist.
• 13:32
  SPEAKER_01: And depending again on the type of cancer you had or the type of treatment you had, they may or may not be able to do something or you might need more time in between.
• 13:40
  SPEAKER_01: So it's um it's a really complicated question, Ecta.
• 13:42
  SPEAKER_01: I wish I had it the answer.
• 13:44
  SPEAKER_00: No, I mean, honestly, though, that's a that's a really important thing to understand too, though, is that because a lot of us think pigment is just, you know, it's normal, like, you know, but if you're going through cancer treatment, like it's something to watch out for.
• 13:55
  SPEAKER_00: So definitely.
• 13:56
  SPEAKER_01: Especially if you've had skin cancer, right?
• 13:58
  SPEAKER_00: Yeah, exactly.
• 13:59
  SPEAKER_00: I mean, if you have a history, but also like it's things like this, like you don't notice because we're so used to like hyperpigmentation or something, you know, normally as consumers.
• 14:06
  SPEAKER_00: So yeah, a lot of people should be aware.
• 14:08
  SPEAKER_00: But um, what symptoms require urgent attention, in your opinion?
• 14:12
  SPEAKER_00: Like, what are some really, really big red flags?
• 14:14
  SPEAKER_01: Oh my god, this is like a long list, but I would say if you have a rash and it's spreading really quickly, or you're blistering, um, or your skin's peeling like extensively, pain, like any kind of severe pain, any open wounds or wounds that start draining, like pus or yellow or honey colored crusts, anything like red streaks, anything.
• 14:32
  SPEAKER_01: And then obviously if you're getting fever or chills with a skin problem, any kind of swelling, especially facial swelling or lip and tongue swelling, and then more general things like difficulty breathing, rashes after you start a new medication, and dehydration.
• 14:47
  SPEAKER_01: Like if you can't drink water or you have nausea and you're vomiting, obviously immediately go to emergency care.
• 14:53
  SPEAKER_01: That goes way beyond the skin.
• 14:55
  SPEAKER_00: Absolutely.
• 14:56
  SPEAKER_00: No, absolutely.
• 14:57
  SPEAKER_00: Um, so I mean, I I'm curious because for someone who's just beginning their cancer treatment and this journey, what does a skin like a basic barrier supportive routine look like?
• 15:08
  SPEAKER_01: So it's actually super, super simple.
• 15:10
  SPEAKER_01: And the simpler the better, unless there's more here again.
• 15:13
  SPEAKER_01: Very gentle cleansing and moisturization.
• 15:16
  SPEAKER_01: And then depending on, you know, if you're going outside protection with SPF and the keyword is monitor, monitor, monitor.
• 15:23
  SPEAKER_01: So I would say the simpler and the smaller routines are best, like the fewest unnecessary variables there.
• 15:30
  SPEAKER_01: Put it this way when you start cancer treatment, that is usually not the ideal time to experiment with multiple potent active ingredients and beauty products.
• 15:39
  SPEAKER_00: Right.
• 15:39
  SPEAKER_00: No, I mean it's it's actually, you know, this is very subjective because for a lot of people, you know, gentle, like you said, gentle cleanse, it can be confusing.
• 15:48
  SPEAKER_00: Like, what does that really mean?
• 15:50
  SPEAKER_00: You know, at the end of the day, like gently cleansing your skin in this kind of situation.
• 15:54
  SPEAKER_01: So it's kind of similar to eczema that we talk about a lot.
• 15:56
  SPEAKER_01: So it's really using lukewarm rather than very hot water, um, keeping your baths and showers reasonably brief in that lukewarm water, going definitely for fragrance-free, having a cleanser that doesn't leave your skin feeling tight or squeaky because that is usually a sign of dehydration or stripping the skin oil in the microbiome, not using, you know, aggressive loofahs, rough washcloths, or exfoliating brushes, so not any kind of aggressive scrubbing.
• 16:23
  SPEAKER_01: And then I would say after you finish washing, patting the skin dry rather than taking that towel and just rubbing it to death.
• 16:30
  SPEAKER_00: Makes sense.
• 16:30
  SPEAKER_00: So in in this whole routine, like where does the moisturizer fit in?
• 16:34
  SPEAKER_00: Like, where should it, when it should it be applied?
• 16:36
  SPEAKER_01: So there's what's called kind of the three-minute rule um that you want to apply the moisturizer within three minutes of getting out of the shower, out of the bath.
• 16:43
  SPEAKER_01: And usually you want to leave the skin slightly damp so that that dampness can be put into your skin with the moisturizer.
• 16:50
  SPEAKER_01: So the moisturizer basically helps trap that water in that outer layer.
• 16:54
  SPEAKER_01: And definitely you may need to reapply during the day, especially on your hands if you're doing a lot of, you know, hand washing.
• 17:00
  SPEAKER_01: I would go for a lighter lotion and during the day, and then more of a heavier maybe cream or ointment during the night, because that's where you lose most of your hydration or you have very, very dry skin.
• 17:10
  SPEAKER_01: But again, the product texture, the suitability will depend on where on your body you're getting the treatment and the clinical situation, like specifically the type of cancer.
• 17:19
  SPEAKER_01: And definitely if you have an open wound or radiation reaction, you need to see your care team.
• 17:24
  SPEAKER_00: That makes sense though.
• 17:25
  SPEAKER_00: I I want to ask because, you know, we want to obviously, like from what I'm gathering, you know, what you're saying, we want to protect the skin in all of this.
• 17:32
  SPEAKER_00: That's the goal.
• 17:33
  SPEAKER_00: But, you know, what does protect the skin really include?
• 17:36
  SPEAKER_00: Is it more than just skincare?
• 17:37
  SPEAKER_00: And, you know, what should we know?
• 17:39
  SPEAKER_01: Yeah, it's definitely more than skincare.
• 17:41
  SPEAKER_01: It's everything that your skin comes in contact with.
• 17:43
  SPEAKER_01: So minimizing friction, just like we talked about, don't rub it with that towel, avoiding extreme temperatures like super hot water or if it's super cold outside, right?
• 17:51
  SPEAKER_01: Like minus 40 in some parts of the US in the winter.
• 17:54
  SPEAKER_01: Um, wearing clothing that's soft, things like organic cotton, soft breathable clothing, using gloves when you're doing household tasks to minimize contact with household cleaners, and obviously sun protection.
• 18:05
  SPEAKER_01: A lot of cancer therapies can increase photosensitivity.
• 18:07
  SPEAKER_01: So, again, you should ask the care team about specific sunscreens, sun precautions, and those can be everything from shade to hats and protective clothing like SPF clothing, um, or just not going out during the midday sun.
• 18:21
  SPEAKER_00: So it's interesting because ingredient categories really come to mind here.
• 18:25
  SPEAKER_00: You know, are there certain categories that patients what they should avoid?
• 18:29
  SPEAKER_00: I mean, I know a lot of the common ingredients we hear about are things like avoiding fragrances or perfume, any kind of drying alcohol such as ethanol, AHAs, BHAs, aluminum.
• 18:38
  SPEAKER_00: I mean, are there any nuances here?
• 18:40
  SPEAKER_01: Yeah, so I would say not every ingredient within a broad category is automatically unsafe for every patient.
• 18:46
  SPEAKER_01: So again, it's a complex question and the formulation certainly matters.
• 18:50
  SPEAKER_01: So, for example, there may be fatty alcohols like acetyl or sterile alcohol that are totally different from volatile alcohols and that function as emolents.
• 18:59
  SPEAKER_01: So just because you see the word alcohol doesn't necessarily mean it's ethanol or isopropyl alcohol and is drying, right?
• 19:05
  SPEAKER_01: Similarly, preservatives and other cosmetic ingredients um should be evaluated, you know, based on concentration, formulation, sensitivity, exposure, like all those things.
• 19:15
  SPEAKER_01: But again, fragrance-free, I think, is key here.
• 19:18
  SPEAKER_01: Perfume and fragrance does no one any favors.
• 19:21
  SPEAKER_01: And getting the routine approved by the clinical team, like, and again, no harsh ingredients.
• 19:26
  SPEAKER_01: Like I wouldn't be recommending, you know, formaldehyde-releasing preservatives like DMDM or necessarily large quantities of parabens and phthalates if you can avoid them.
• 19:36
  SPEAKER_01: But again, going back to the clinical team and especially being careful on any broken, infected, or reactive skin.
• 19:42
  SPEAKER_00: No, the interesting, I'm really interested in this because is unscented the same thing as fragrance-free?
• 19:49
  SPEAKER_01: That's an excellent question.
• 19:51
  SPEAKER_01: And so the answer, I would say the short answer is not always.
• 19:54
  SPEAKER_01: So just because it says unscented, I mean, it the product may not have a noticeable smell, but that doesn't mean they didn't use masking ingredients.
• 20:02
  SPEAKER_01: Fragrance free generally indicates, you know, fragrance has not been added.
• 20:06
  SPEAKER_01: Although, again, you should look at the inky list and you should make absolutely sure that there's nothing in there that's buried in the inky list, especially if you have allergies.
• 20:15
  SPEAKER_00: Now, in terms of like patients like testing these products, you should patch test though, right?
• 20:20
  SPEAKER_00: Like for everything.
• 20:21
  SPEAKER_00: Always.
• 20:21
  SPEAKER_01: Always.
• 20:22
  SPEAKER_01: So you should use intact skin.
• 20:24
  SPEAKER_01: So again, don't patch test on a wound.
• 20:26
  SPEAKER_01: Cautious test, small area.
• 20:28
  SPEAKER_01: Again, it won't guarantee that it'll be safe everywhere or throughout the entire treatment.
• 20:32
  SPEAKER_01: And you should never ever like pass up evaluating a serious reaction if you have one.
• 20:38
  SPEAKER_01: But yes, patients with um cancer treatment or highly compromised skin should absolutely patch test everything.
• 20:44
  SPEAKER_00: Now I know that itching, like this is a big one because I know itching can be a very, very common symptom, but I mean, can it really be managed at home?
• 20:52
  SPEAKER_01: Yes and no.
• 20:53
  SPEAKER_01: So definitely like mild dryness and that relates to itching can be improved with the gentle moisturization, uh the soft clothing, avoiding heat, you know, having a cool compress if you need it, that oftentimes calms down those itch nerves that are embedded in the skin.
• 21:09
  SPEAKER_01: Keeping your fingernails short can reduce scratching because sometimes we scratch without even realizing we're scratching.
• 21:15
  SPEAKER_01: But I would say if it's persistent or intense, that can also be a reaction to medication, or it could be anything from inflammation to liver or kidney issues or other systemic therapy effects.
• 21:27
  SPEAKER_01: So that needs medical evaluation.
• 21:29
  SPEAKER_01: So it's back to the oncology team.
• 21:31
  SPEAKER_00: Makes sense.
• 21:32
  SPEAKER_00: Yeah, so basically it's like every single symptom, like you really do need to check like what it's going on.
• 21:37
  SPEAKER_00: Like you can't assume like this is normal for me.
• 21:39
  SPEAKER_00: Yeah.
• 21:39
  SPEAKER_01: You do.
• 21:40
  SPEAKER_00: Yeah.
• 21:40
  SPEAKER_01: And and kind of Googling it or asking Chat GPT and then thinking, oh, I'll deal with it myself.
• 21:46
  SPEAKER_01: Um, no, it's always good.
• 21:48
  SPEAKER_01: The team is there for you.
• 21:49
  SPEAKER_01: So use them because they're there for you.
• 21:51
  SPEAKER_00: Absolutely.
• 21:52
  SPEAKER_00: No, I want to talk about some of the Codex Labs products.
• 21:55
  SPEAKER_00: I mean, I personally love the products in the line, and I know that um, you know, a lot of them.
• 22:00
  SPEAKER_00: It can be very beneficial if you're using them correctly.
• 22:02
  SPEAKER_00: And so let's talk about them.
• 22:03
  SPEAKER_00: And before discussing them, I I would you I want our listeners to interpret this part of the conversation correctly, you know.
• 22:09
  SPEAKER_00: So um, you know, is there anything like you want to say before we dive in?
• 22:13
  SPEAKER_00: Because I want to talk about a few of them.
• 22:14
  SPEAKER_01: Yeah.
• 22:15
  SPEAKER_01: So I just want to say that they're supportive care products.
• 22:18
  SPEAKER_01: They are absolutely not replacements for anything, you know, prescribed medical treatment.
• 22:22
  SPEAKER_01: And a cosmetic or an over-the-counter skin protectant can't treat every form of, you know, radiation dermatitis or drug rash.
• 22:30
  SPEAKER_01: And you absolutely have to again check with your team, your oncology team for guidance.
• 22:35
  SPEAKER_01: But we think they can be useful.
• 22:37
  SPEAKER_01: And we do have people who are, you know, doing various types of cancer therapy, whether that's chemotherapy or radiation therapy, um, using them.
• 22:45
  SPEAKER_01: But again, run everything by your team.
• 22:47
  SPEAKER_00: Makes sense.
• 22:48
  SPEAKER_00: So let's let's start with the cleansing step.
• 22:50
  SPEAKER_00: And I know the the Bia unscented soap is a wonderful product.
• 22:54
  SPEAKER_00: Um, what is it intended to do?
• 22:56
  SPEAKER_01: So it's allergen-free.
• 22:58
  SPEAKER_01: It's obviously um by unscented, that means it's fragrance-free.
• 23:01
  SPEAKER_01: Um, but it's mostly the glycerin-rich.
• 23:04
  SPEAKER_01: And so it was designed to clean um, especially like skin with atopic dermatitis without stripping moisture or disturbing the skin microbiome.
• 23:12
  SPEAKER_01: So it's microbiome certified and clinically evaluated for that.
• 23:16
  SPEAKER_01: It has, you know, great ingredients like shea butter, cocoa butter, calendula, and carrot.
• 23:21
  SPEAKER_01: So it's great for itchy, dry, irritated skin, including contact dermatitis and atopic dermatitis, but it can also be used if approved by the clinical team for dermatitis associated with um cancer treatment.
• 23:32
  SPEAKER_00: You mentioned it um it's glycerin rich.
• 23:35
  SPEAKER_00: Why is that relevant during cancer treatment?
• 23:38
  SPEAKER_01: So a lot of soaps can be highly alkaline, like in high pH or highly degreasing.
• 23:43
  SPEAKER_01: And so that leaves skin vulnerable to feeling, you know, that tight feeling that we talked about earlier.
• 23:48
  SPEAKER_01: And so this soap doesn't have that strip feeling.
• 23:51
  SPEAKER_01: But again, individual responses can differ.
• 23:53
  SPEAKER_01: And so the glycerin is important because it doesn't strip moisture and it doesn't strip the skin oil.
• 23:58
  SPEAKER_01: And again, because you know, people undergoing oncology treatments can develop allergies they didn't have before.
• 24:05
  SPEAKER_01: Gentle doesn't necessarily mean appropriate for things again, like open or infected or irradiated skin, but it's about as gentle as we have, and the pH is as close to seven as we can make a soap.
• 24:16
  SPEAKER_00: That's that's really good to know.
• 24:18
  SPEAKER_00: And you know, I I personally love glycerin in cleansers, so I know that it can be very, very gentle for the skin.
• 24:23
  SPEAKER_00: That's good, that's really good.
• 24:24
  SPEAKER_00: Um and as far as the um moisturizing part, the Bia eczema relief lotion is a wonderful product as well.
• 24:30
  SPEAKER_00: Can you tell us more about that and how does it help like exposed skin kind of heal?
• 24:36
  SPEAKER_01: So it was originally designed for atopic dermatitis or contact dermatitis and other things, you know, relieving itchiness from hives.
• 24:44
  SPEAKER_01: So it's very soothing, it's very anti-itch, very deeply hydrating.
• 24:48
  SPEAKER_01: We know that it helps rebuild the barriers and it basically helps with skin cell turnover, kind of that natural shedding.
• 24:54
  SPEAKER_01: So a lot of the, I would say, skin issues associated with the inflammation on the skin barrier from chemo or radiation therapy are very similar to eczema.
• 25:05
  SPEAKER_01: And so things like the BA complex, the hyaluron acid, the ceramides, and the 1% colloidal oatmeal are all helpful in terms of reducing that itch and helping rebuild the skin barrier, which has been compromised because of the treatment, not necessarily because you have dermatitis, but because the treatment induced that dermatitis.
• 25:23
  SPEAKER_01: So it can function in a very similar way for oncology patients as it does for people with eczema.
• 25:29
  SPEAKER_00: You mentioned um, you know, some very, very interesting ingredients.
• 25:32
  SPEAKER_00: And I know that, for example, ceramides, colloidal oatmeal, they're commonly discussed in barrier care.
• 25:38
  SPEAKER_00: Why is that?
• 25:38
  SPEAKER_01: So ceramides are lipids that are naturally found in your skin barrier, and so they're just supplementing your natural lipid environment, which is really important because, again, you know, as your skin barrier gets damaged, those lipids get stripped, or if you have a harsh cleanser, they get stripped.
• 25:52
  SPEAKER_01: And then colloidal oatmeal has been used for a long time in skin protectance.
• 25:56
  SPEAKER_01: It's great for, you know, the usual soothing, itchy skin.
• 26:00
  SPEAKER_01: And I would say I never thought I'd come to see patients or customers with oatmeal allergies, but they do exist.
• 26:07
  SPEAKER_01: And so now that we've sold, you know, over 10,000 products, we have seen that there is a small percentage of people with a colloidal oatmeal allergy and some people who start cancer treatment and they don't have an oatmeal allergy and they develop an oatmeal allergy.
• 26:22
  SPEAKER_01: So just want to make sure that everyone realizes that, you know, even familiar ingredients like oatmeal that you might take from granted can also cause sensitivities.
• 26:29
  SPEAKER_01: So again, patch testing and consulting the team if you see any kind of redness or reaction.
• 26:36
  SPEAKER_00: Because I know that Codex is very big on studies and like data, you know, and I think that's one of my favorite parts about the brand.
• 26:42
  SPEAKER_00: What study results do you have so far for the lotion or the mild and moderate eczema?
• 26:48
  SPEAKER_01: And as I was kind of saying, the skin barrier breakdown is similar after cancer treatment to eczema.
• 26:53
  SPEAKER_01: There's a lot of analogies.
• 26:54
  SPEAKER_01: So we have a a two-month or 56-day kind of efficacy studies that we conducted um between 2024 and 2026, about 105 adults and 80 children aged um one through 12.
• 27:06
  SPEAKER_01: And so we consistently saw significant increases over 100% in hydration, reductions in the water loss, reductions in the scaling, and significant, significant reductions, like over 90% in eczema scores and itching and burning.
• 27:21
  SPEAKER_01: So we know that for atopic dermatitis, it's a very effective supporting product.
• 27:26
  SPEAKER_01: And, you know, we can't automatically interpret them in oncology patients, but we basically have data that show the benefits of the lotion.
• 27:34
  SPEAKER_01: Again, ask your cancer team about it, but there's a lot of overlap in what happens to the skin barrier between atopic dermatitis and say chemo and radiation therapy.
• 27:44
  SPEAKER_00: That's very interesting.
• 27:44
  SPEAKER_00: I'm I'm so glad you have that data.
• 27:46
  SPEAKER_00: Honestly, that's a game changer for anyone going to be.
• 27:49
  SPEAKER_01: I do want to get the data on on call on actual oncology patients.
• 27:52
  SPEAKER_01: So we are working on that.
• 27:54
  SPEAKER_00: Oh, wow.
• 27:55
  SPEAKER_00: That's exciting.
• 27:56
  SPEAKER_00: That's really, really exciting to hear that.
• 27:58
  SPEAKER_00: I think that's like, I mean, honestly, at the end of the day, like I always wonder is like, you know, where how do you even start shopping for a product like this when you're going through something so life-changing, right?
• 28:07
  SPEAKER_00: And so for our audience, like I really encourage you guys, like, this is what you do.
• 28:11
  SPEAKER_00: You know, you look for data, you look for studies.
• 28:13
  SPEAKER_00: So that's very impressive that you guys have even, you know, the preliminary data right now.
• 28:16
  SPEAKER_00: For the the Kung Fu recovery gel, I want to talk about that product.
• 28:20
  SPEAKER_00: Um, can you tell us what it is and like what are the key actives?
• 28:23
  SPEAKER_01: So it's a hydrating gel that is designed to soothe redness and to actually maintain the skin barrier after disruption, like especially after UV radiation, because it supports antioxidant enzymes.
• 28:36
  SPEAKER_01: So it basically helps your skin fix itself.
• 28:39
  SPEAKER_01: So it's um rehydrate and maintain the skin barrier and not have it kind of just fall apart.
• 28:44
  SPEAKER_00: Are there any special warnings that belong with the phrase irradiated skin?
• 28:49
  SPEAKER_01: We we have a warning saying that, you know, consult with your medical team if you have severely damaged or, you know, irradiated skin because sun damage is very different.
• 28:59
  SPEAKER_01: Like UV radiation can be very different from radiation therapy used for cancer.
• 29:05
  SPEAKER_01: So again, is it a long-term, you know, chronic daily use product?
• 29:09
  SPEAKER_01: No, it's more of a short-term to be used during the treatment.
• 29:13
  SPEAKER_01: Like, I wouldn't recommend people using this for years, but it can be used during a specific treatment.
• 29:18
  SPEAKER_01: We've primarily been doing experiments with it on RF microneedling and lasers, like fraxal lasers and IPL lasers.
• 29:26
  SPEAKER_01: So that's definitely damaged skin.
• 29:27
  SPEAKER_01: Like the lasers definitely damage that skin barrier.
• 29:30
  SPEAKER_01: They make significant holes in it at some point.
• 29:33
  SPEAKER_01: But I would say again, oncology treatment is a whole different ballgame.
• 29:36
  SPEAKER_01: So always consult with your team.
• 29:38
  SPEAKER_00: That makes sense.
• 29:39
  SPEAKER_00: And you went, I mean, can you talk to us a little bit more about the testing?
• 29:42
  SPEAKER_00: Like what did it show?
• 29:44
  SPEAKER_01: So on normal skin, we have the short duration studies, you know, as I said, post-UV or, you know, are of microneedling exposure for redness, hydration, skin barrier, antioxidant, and also tested it on patients with topical steroid uh withdrawal because they have a very damaged skin barrier from um, you know, 20 years of steroid use.
• 30:03
  SPEAKER_01: And there we see very clearly that it provides relief because they get incredibly itchy and burny.
• 30:09
  SPEAKER_01: So we see how it works on those nerve endings in the skin and how it helps the skin recover.
• 30:14
  SPEAKER_01: So I would say it's great at kind of the lotion, the eczema lotion is great at itchiness.
• 30:19
  SPEAKER_01: This one is much better at burning sensation and really helping skin that's been compromised repair itself faster and rehydrating it really quickly.
• 30:29
  SPEAKER_00: That's really interesting.
• 30:30
  SPEAKER_00: And you know, I'm curious because I know a lot of us layer our products together.
• 30:33
  SPEAKER_00: So if someone is using more than one product, should they layer everything together or is there some sort of an order you recommend?
• 30:39
  SPEAKER_01: So I wish again I could say boom, boom, boom, and the answer is unfortunately not automatically.
• 30:45
  SPEAKER_01: And so the problem is that the more you layer on, the more opportunity you're creating for irritation or getting an allergic reaction.
• 30:52
  SPEAKER_01: Um, and then you don't know what it is that caused the reaction.
• 30:55
  SPEAKER_01: So I would say staging things and staging them slowly is good.
• 31:00
  SPEAKER_01: I would probably start with the recovery gel and then work my way up to the lotion.
• 31:05
  SPEAKER_01: And the order would probably be the recovery gel because it's more water-based.
• 31:10
  SPEAKER_01: So it'll sink and penetrate deeper faster than the lotion, which does have sunflower oil in it.
• 31:15
  SPEAKER_01: So that's some of it will stay on the surface.
• 31:17
  SPEAKER_01: And if you put that on first, it'll block the recovery gel from penetrating.
• 31:20
  SPEAKER_01: But again, before using the two together, I would A consult with the care team and B, I would try it out and maybe spend like a week or two with just the gel, maybe a week with just the lotion, see if one works better than the other.
• 31:34
  SPEAKER_01: And then then you can kind of combine them because your skin has been exposed to both and won't have a shock.
• 31:40
  SPEAKER_01: You know, the last thing you want to do is shock your skin.
• 31:43
  SPEAKER_00: Yeah, exactly.
• 31:44
  SPEAKER_00: Exactly.
• 31:44
  SPEAKER_00: No, that's honestly why I asked because I know that it's it's very different.
• 31:47
  SPEAKER_00: You know, if you're going through chemo or radiation, I mean, this is a very, very different skin environment you're dealing with.
• 31:52
  SPEAKER_00: So really checking to see how these products sit, you know, it's very important.
• 31:56
  SPEAKER_00: Um, so I would love to ask you, if you don't mind, you know, a few rapid fire questions because I think these can be very helpful for somebody who just really is, you know, starting off on this journey and doesn't know where to begin, or just common questions.
• 32:07
  SPEAKER_00: So should a patient wait until symptoms become severe before reporting them?
• 32:12
  SPEAKER_01: No.
• 32:12
  SPEAKER_01: Early reporting is always better.
• 32:14
  SPEAKER_00: What about a burning sensation?
• 32:16
  SPEAKER_00: Is that proof that a skincare product is actually working?
• 32:19
  SPEAKER_01: Oh my God, no.
• 32:20
  SPEAKER_01: Burning usually indicates irritation.
• 32:22
  SPEAKER_01: So stop using the product, seek guidance, and especially if your skin's compromised.
• 32:26
  SPEAKER_00: Okay, now this one is is very close to my heart because I've I've seen a lot of misinformation.
• 32:31
  SPEAKER_00: But does quote unquote natural mean safe during cancer treatment?
• 32:35
  SPEAKER_01: No.
• 32:36
  SPEAKER_01: They can natural ingredients can irritate the skin, cause allergies, or interact with the treatment just as much as synthetic materials.
• 32:42
  SPEAKER_00: Now, can a moisturizer treat an infection?
• 32:46
  SPEAKER_01: No.
• 32:46
  SPEAKER_01: Infections need immediate medical inspection.
• 32:49
  SPEAKER_00: Should patients use topical products on a radiation field without asking?
• 32:54
  SPEAKER_01: No.
• 32:54
  SPEAKER_01: Always follow your radiation team's guidance.
• 32:57
  SPEAKER_00: I love that.
• 32:57
  SPEAKER_00: Now, what are the three most useful everyday principles for skincare?
• 33:02
  SPEAKER_01: So gentle cleansing, so not stripping, consistent moisturization when appropriate, and early reporting of any changes to your care team.
• 33:11
  SPEAKER_00: Now, if listeners remember only one idea from this episode, what should that be?
• 33:16
  SPEAKER_01: So the skin is a protective system, not a passive covering.
• 33:19
  SPEAKER_01: You want to support it to improve your comfort and quality of life, but you have to remain coordinated with the cancer treatment and your care team and you and worsening sick things, always assessed.
• 33:30
  SPEAKER_01: Not no self-treatment here.
• 33:32
  SPEAKER_00: Yeah, I love that.
• 33:32
  SPEAKER_00: Thank you for sharing that.
• 33:34
  SPEAKER_00: You know, I I really always enjoy our conversations because you bring so much knowledge um to the discussion.
• 33:39
  SPEAKER_00: And I I really want to ask you, Dr.
• 33:40
  SPEAKER_00: Paladis, if our listeners want to find out more about obviously Codex Labs or you, I mean, where can they find your work?
• 33:46
  SPEAKER_01: So we finally got codexlabs.com.
• 33:49
  SPEAKER_01: So it's no longer codexlabscorp.com, although that works too.
• 33:52
  SPEAKER_01: So codexlabs.com or at codex labs on Instagram and Facebook.
• 33:57
  SPEAKER_00: Love that.
• 33:57
  SPEAKER_00: Thank you so much.
• 33:58
  SPEAKER_00: This has been such an amazing, amazing conversation.
• 34:00
  SPEAKER_00: And I I really genuinely am just so excited that Codex is leading the way in this kind of, you know, this space.
• 34:06
  SPEAKER_00: Because I, like I said in the beginning of the episode, for everyone listening, this is something we never get to discuss.
• 34:11
  SPEAKER_00: We never hear anyone educating on true, you know, options for people who are going through something so extreme as cancer therapy.
• 34:17
  SPEAKER_00: So I can't thank you enough for your time and your knowledge.
• 34:19
  SPEAKER_00: It's been very helpful.
• 34:20
  SPEAKER_00: But I do want to say for everyone listening that this is not medical advice in any way.
• 34:24
  SPEAKER_00: So everything that we discussed here on this episode, you really do first and foremost, like Dr.
• 34:28
  SPEAKER_00: Paladins said, you need to talk to your oncology care team.
• 34:31
  SPEAKER_00: That is the number one fundamental thing.
• 34:33
  SPEAKER_00: But if you have any questions, feel free to reach out.
• 34:35
  SPEAKER_00: Thank you so much, Dr.
• 34:36
  SPEAKER_00: Paladus.
• 34:37
  SPEAKER_00: Wonderful.