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Dr. Diane Berson: Expertise in cosmeceuticals · The Science of Skin

0:09
SPEAKER_00: Hi, I'm Dr.
0:10
SPEAKER_00: Patty Ferris, and I'm your host for this episode of Skin Care Confidential.
0:14
SPEAKER_00: Just as a reminder, Skin Care Confidential is an outreach of our medical meeting, the Science of Skin Care Summit, which was designed to teach healthcare professionals about the science behind topical skincare products and how to utilize them in your practice.
0:28
SPEAKER_00: Hopefully, you've been enjoying the content of Skin Care Confidential.
0:31
SPEAKER_00: If you have, we would love it if you could subscribe.
0:34
SPEAKER_00: And today I am so excited to have my dear friend and colleague, Dr.
0:40
SPEAKER_00: Diane Burson.
0:42
SPEAKER_00: I'm going to talk about Diane for just a second.
0:44
SPEAKER_00: And as usual, her bio is so lengthy that I can't read the whole thing, but I'm going to read a lot of it.
0:50
SPEAKER_00: So Diane is an associate professor of dermatology at Weill Medical College of Cornell and an assistant attending dermatologist at New York Presbyterian Hospital.
1:01
SPEAKER_00: She's in private practice with her lovely daughter, who's also a dermatologist, Emily, in New York City in Manhattan.
1:08
SPEAKER_00: And she also teaches in the Department of Dermatology at NY Presbyterian Hospital, where she primarily teaches both medical students and residents.
1:18
SPEAKER_00: Diane is a past board member of the board of directors of the American Academy of Dermatology.
1:23
SPEAKER_00: We shared that experience together, which was lots of fun.
1:26
SPEAKER_00: She's also a past president of the Women's Derm Society and served on the board of directors of the Legacy, the Awards, and the Fundraising Committees.
1:33
SPEAKER_00: She's got tons of accolades, but it would take probably as long as I have for this podcast to go through all them.
1:39
SPEAKER_00: So I am going to welcome Diane and thank her for joining me.
1:44
SPEAKER_00: Thank you, Patty, for having me.
1:46
SPEAKER_00: So, Diane, for those of you who don't know her, and I can't imagine anyone in dermatology who doesn't, but she is a well-known KOL, key opinion leader in the field of all things dermatology, but specifically topical skincare.
2:00
SPEAKER_00: Diane's been on the podium for years talking about skin care, how to integrate it with your medical patients as well as with your cosmetic patients.
2:08
SPEAKER_00: So she has a really unique, let's say, expertise to share with us today.
2:14
SPEAKER_00: And I want to start, Diane, with just you telling me, because I don't really know the answer to this, and I should, because we're such good friends.
2:21
SPEAKER_00: How did you become interested in topical skin care?
2:25
SPEAKER_01: Well, it's a great question, and I'm glad that you mentioned the medical because I actually suffered from acne, but then I had the benefit of training with Dr.
2:34
SPEAKER_01: Alan Shalita, who was a very giant in the world of acne.
2:41
SPEAKER_01: And so while I was in my residency, we did a lot of acne clinical trials, and I became interested in the treatment of acne.
2:49
SPEAKER_01: And obviously, if you're treating patients with acne, you have to be interested in skin care because, as we know now, it is such an integral part of the treatment of patients with acne.
3:01
SPEAKER_01: But my interest in acne segued into rosacea and then rosacea, obviously, some of these patients have sensitive skin, so we had to learn about skin care, certainly about barrier repair.
3:12
SPEAKER_01: And the reality is that barrier repair and subsequent skin care play a big role for our patients with acne, but also sebriac dermatitis, rosacea, psoriasis, eczema, and even anti-aging.
3:25
SPEAKER_01: Understanding the way ingredients work in terms of report restoring the barrier and skincare in general became an integral part.
3:33
SPEAKER_01: So my interest in acne and rosacea sort of segued into skincare.
3:38
SPEAKER_01: And then, of course, skincare has blossomed for all of us.
3:43
SPEAKER_00: Huge, a huge part of our practice.
3:45
SPEAKER_00: So that's so interesting.
3:47
SPEAKER_00: Let's talk for just a second.
3:50
SPEAKER_00: I kind of want to segment it into the different age groups.
3:53
SPEAKER_00: And with your area, I mean your expertise in acne, let's start with maybe our 20-year-old patients.
4:00
SPEAKER_00: Now, obviously, not all of them have acne, but sort of what kind of products might you recommend to a 20-year-old?
4:07
SPEAKER_00: And maybe we can talk for a minute about the 20-year-old with acne because that's such a big part of our practice.
4:12
SPEAKER_00: And then maybe the 20-year-olds who don't have acne.
4:16
SPEAKER_01: So for the 20-year-olds with acne, obviously we want them, we want just a sort of basic skeletal regimen.
4:24
SPEAKER_01: Obviously, we want them to use their sun protection in the morning.
4:27
SPEAKER_01: But for my patients with acne, I usually have them use a hydrating product at night.
4:31
SPEAKER_01: And when I say hydrating product, I'm not saying moisturizer.
4:35
SPEAKER_01: Because for patients who might be very oily or have large pores, they might prefer a serum.
4:40
SPEAKER_01: So I call it their hydrating agent, and often it is a moisturizer, but usually they're using their hydrating product or moisturizer at night with their acne medications layered on top of it.
4:52
SPEAKER_01: And usually it's going to be obviously a topical retinoid.
4:55
SPEAKER_01: That's our main ingredient for patients with acne.
4:59
SPEAKER_01: And obviously, for those patients who have acne who were using a topical retinoid, I encourage them to continue it essentially for life, even when their acne is clear.
5:08
SPEAKER_01: So most of my patients with acne will use a mild cleanser.
5:12
SPEAKER_01: If they're oily, I might have them use a cleanser that contains salicylic acid.
5:17
SPEAKER_01: And they're going to use their sun protection in the morning and their active acne agents at night.
5:21
SPEAKER_01: I usually have them alternate their topical retinoid with their benzol peroxide or benzo peroxide antibiotic combination to the acne on the other nights.
5:31
SPEAKER_01: But for our patients without acne in their 20s, they are so lucky and they don't know it, but their skin, their skin is so supple and smooth and healthy.
5:43
SPEAKER_01: And I think my approach for these patients is what my mother always said, which is less is more.
5:50
SPEAKER_01: And not to go crazy with what they see or hear with all these ingredients, because you know what we we both know what polypharmacy will do.
5:59
SPEAKER_01: They'll use all these products and get irritated skin.
6:02
SPEAKER_01: So I basically want them to use the basics: sun protection in the morning, moisturizer, and of course their topical retinoid, which they're continuing.
6:13
SPEAKER_01: And again, if they if they have any acne breakouts, they're going to have their spot treatment.
6:18
SPEAKER_01: But you know, some of these patients in their 20s still do have large pores.
6:23
SPEAKER_01: They might have oily skin, but they also are starting to get a little bit of dry skin.
6:28
SPEAKER_01: So the ingredients I want them to look for in their hydrating products usually are hyaluronic acid, glycerin, uh, niacinamide, some of the ingredients that will help keep their barrier intact and that are going to especially be compatible with their topical retinoid.
6:44
SPEAKER_00: All those nice hydrating humectins.
6:46
SPEAKER_00: Exactly.
6:46
SPEAKER_00: I love niacinamide too.
6:48
SPEAKER_00: You and I have talked about that so many times.
6:50
SPEAKER_00: Such a great ingredient.
6:50
SPEAKER_00: You mean everything, just pepper a little of that, and everything.
6:53
SPEAKER_01: It's a power block ingredient, right?
6:55
SPEAKER_00: It really is, you know, and it downregulates semen production.
6:58
SPEAKER_00: And I mean, you know, you wrote the chapter on it for my textbook on niacinamide, if you remember like forever ago.
7:05
SPEAKER_00: But it's such a great ingredient.
7:06
SPEAKER_00: And I think it's a really good go-to for that younger group, too, because they're going to get some really nice benefits from it, but it's not irritating.
7:14
SPEAKER_01: Right.
7:14
SPEAKER_01: Well, it's an antioxidant, so it'll help prevent sun damage.
7:17
SPEAKER_01: It's an anti-inflammatory, so if they have any redness from their acne or post-inflammatory erythema or any even little rosacea overlap or redness from their acne, it's going to help with that.
7:28
SPEAKER_01: And certainly it's a barrier repair ingredient.
7:30
SPEAKER_01: And it's also a pigment fading ingredient if they have any post-inflammatory hyperpigmentation or even early freckling.
7:37
SPEAKER_01: So it is, it is one of our favorite ingredients.
7:40
SPEAKER_01: And I find that it's it's present in a lot of moisturizers that are used for patients with acne, but it's also in a lot of the products that are labeled as early anti-aging for young patients.
7:51
SPEAKER_01: Uh, you know, there's a there's a moisturizer that I love that's really more of a serum that has niacinamide and glycerin.
7:57
SPEAKER_01: And although I love it for my acne patients, it's also referred to as an early anti-aging product.
8:03
SPEAKER_01: So, you know, that's that's the ingredient that I think's the best.
8:06
SPEAKER_01: And hyaluronic acid, of course.
8:08
SPEAKER_00: Those are those are two go-to's.
8:10
SPEAKER_00: It's kind of interesting because some of the over-the-counter products have as much as 10% niacinamide.
8:16
SPEAKER_00: Right.
8:16
SPEAKER_00: You know, traditionally, 5% is what people use.
8:19
SPEAKER_00: And I think at 10% it can be a little bit irritating.
8:22
SPEAKER_00: So that always puzzles me.
8:24
SPEAKER_00: But, you know, these are mass-marketed products that I think have a younger demographics.
8:30
SPEAKER_00: And sometimes I think the whole notion that more is better is a problem because more isn't always better.
8:35
SPEAKER_01: No, that's why I said less is more.
8:37
SPEAKER_01: I think 4% to 8% is nice.
8:39
SPEAKER_01: Um, and obviously everyone has to try their products and see what they like.
8:43
SPEAKER_01: Um when these patients start getting into their 30s, they might notice that their skin could be a little bit more dry.
8:54
SPEAKER_01: They might not have the same situation as the oiliness and the pouriness.
8:59
SPEAKER_01: But they're also going to start noticing that they may have a little dull tone or texture.
9:04
SPEAKER_01: Uh basically, that's because there's a little reduction of cell turnover, so the skin may just have a dull, uh, dull look to it.
9:13
SPEAKER_01: Um, and patients who are in their 30s are also gonna start noticing little fine lines and wrinkles, mostly around the eyes and the crow's foot area or around the mouth.
9:23
SPEAKER_01: And that's because we do start losing our collagen and elastin around that age.
9:28
SPEAKER_01: So obviously we have to tend to that.
9:31
SPEAKER_01: But another thing I see in this age group uh regarding pigmentation is not only the development of freckles, but this is the age group where you're gonna start seeing melasma because, especially for women patients in their 30s, very often they've been on the birth control pill, and a lot of them have had pregnancies or starting to have pregnancies.
9:51
SPEAKER_01: And so using ingredients to target the hyperpigmentation, whether it's from freckling or melasma, um, might come into play.
9:59
SPEAKER_01: So this is when I would usually add in an antioxidant, and I usually have patients use their topical antioxidant in the morning under their sun protection.
10:09
SPEAKER_00: And what do you like for over-the-counter uh treatments for things like melasma?
10:16
SPEAKER_00: So many choices.
10:17
SPEAKER_01: Oh, well, I mean, we I could do a whole one-hour presentation, which I have, on uh new agents for hyperpigmentation, but uh obviously what we're seeing is uh the development of options that are hydroquinone free uh for hyperpigmentation.
10:33
SPEAKER_01: So we're seeing uh topicals that have tranexamic acid.
10:38
SPEAKER_01: Um we're seeing uh various uh botanical ingredients for hyperpigmentation.
10:44
SPEAKER_01: We're seeing uh see there's a product for cyst uh that has cystamine, which is used about 20 minutes a day for hyperpigmentation.
10:53
SPEAKER_01: Uh certainly vitamin C in your antioxidant in the morning is is going to be great for hyperpigment.
10:59
SPEAKER_01: Vitamin C is also another powerhouse ingredient.
11:01
SPEAKER_01: It's an anti-inflammatory, it's an antioxidant.
11:04
SPEAKER_01: Uh, it actually helps stimulate a little collagen, but it actually can help fade pigmentation because it inhibits tyrosinase.
11:12
SPEAKER_01: So using these antioxidants or these pigment-lightening ingredients in the morning under sun protection is what I usually recommend for this age group.
11:23
SPEAKER_01: And of course, continuing that topical retinoid or retinol at night in the 30s.
11:30
SPEAKER_01: And this is the age where you might want to add in some of the other ingredients into the nighttime moisturizer layered with the retinoid.
11:39
SPEAKER_01: They could be growth factors, they could be peptides, something that's going to help stimulate some of the collagen, which is starting to be lost.
11:47
SPEAKER_00: So you you said that one of the buzzwords that I wanted to ask you about.
11:50
SPEAKER_00: We'll hit that right now, and then we'll go on to older patients.
11:55
SPEAKER_00: Layering products.
11:56
SPEAKER_00: Yeah.
11:57
SPEAKER_00: I know you are an expert at that, and that's something that we get asked as dermatologists a lot.
12:02
SPEAKER_00: What do I put on?
12:02
SPEAKER_00: Do I put my moisturizer on?
12:04
SPEAKER_00: Do I put my sunscreen?
12:05
SPEAKER_00: Well, how how what's the order for the products to be layered?
12:08
SPEAKER_01: And you know, maybe everyone has their opinion.
12:11
SPEAKER_01: And I actually write out my my regimen very detailed for every single patient on a pad.
12:17
SPEAKER_01: Morning, what goes first?
12:19
SPEAKER_01: Afternoon, night, and I number them one, two, three, what goes on top, what goes where, or if it's all over.
12:25
SPEAKER_01: And so usually in the morning I will have them use their antioxidant first and their pigment lightning ingredient if it's different in that area.
12:35
SPEAKER_01: And then I will have them use their sun protection.
12:38
SPEAKER_01: That's pretty straightforward.
12:39
SPEAKER_01: If they're dry, they can put a little layer of moisturizer between the active and the sun protection.
12:44
SPEAKER_01: And by the way, we've just had such great advances in sun protection now with the mineral sunbrox, with micronized formulations, certainly with the addition of iron oxides for patients who suffer uh from melasma because we want to get that visible light.
12:59
SPEAKER_01: Uh but we have some, you and I have some favorites, and that'll be, again, another discussion.
13:04
SPEAKER_01: But there's some great uh sun protection products, and a lot of them have a little tint, so patients can use that as their makeup.
13:11
SPEAKER_00: Um, but that's usually nice, aren't they?
13:13
SPEAKER_00: They're so cosmetically elegant compared to years ago when we first started recommending them.
13:18
SPEAKER_00: One thing you haven't mentioned is eye creams.
13:22
SPEAKER_00: Do you start those in patients in their 30s?
13:24
SPEAKER_00: I was gonna get to that.
13:26
SPEAKER_00: Okay.
13:26
SPEAKER_01: That is something that you want to start using in your 30s if you're interested in using an eye product.
13:32
SPEAKER_01: And the ingredients are gonna be similar to what we're using on the rest of the face: retinol, um, antioxidants, anti-inflammatories, maybe some of the lightning ingredients, uh, licorice, some of those over the counter.
13:44
SPEAKER_01: But one thing that's added is caffeine because that might help reduce some of the the uh swelling.
13:50
SPEAKER_01: Um, but it's usually in the 30s that patients are interested in eye cream.
13:54
SPEAKER_01: And so if they are interested, I will have them use the product that I recommend twice a day.
13:59
SPEAKER_01: So that's added just to their morning regimen and their nighttime regimen.
14:03
SPEAKER_00: And dark circles, do you have any favorite things for dark circles?
14:09
SPEAKER_00: Cogic acid.
14:10
SPEAKER_00: Yeah.
14:11
SPEAKER_01: I mean, listen, retinol is still our our go-to.
14:16
SPEAKER_00: A good one.
14:16
SPEAKER_00: But sometimes they can be total and eye around the eyes, you know.
14:19
SPEAKER_00: It can be irritating to some patients, although there's some lovely retinol containing eye creams with low concentrations of retinol.
14:26
SPEAKER_01: Right.
14:26
SPEAKER_01: And now, tran, as I said, tranexamic acid is being added to them and some of the botanical ingredients, which are soothing and calming.
14:33
SPEAKER_01: Um, and then at night I will usually have my patient, and this goes for patients of every age group, my acne patients, my postmenopausal patients, using the hydrating product first and then the prescription retinoid on top.
14:48
SPEAKER_01: And that I'll do that for sure when I'm starting the retinoid.
14:52
SPEAKER_00: Um you'd be using that sandwich technique as they call it.
14:56
SPEAKER_00: So you have retinoid.
14:58
SPEAKER_01: You have retinoid in the middle of whatever moisturizer and I'm yeah, I'm doing the moisturizer first and then the retinoid, and then they could do another one.
15:05
SPEAKER_01: So let's say I'm using um a growth factor.
15:09
SPEAKER_01: Uh I'll have them use that growth factor product first, the retinoid on top, and then if they need a little bit more hydration, especially if that growth factor is a serum, then I'll have them use the moisturizer on top.
15:21
SPEAKER_01: Moisturizer, right?
15:21
SPEAKER_01: I mean, layering is great.
15:22
SPEAKER_01: Patients look great with layering.
15:24
SPEAKER_01: They just have that dewy look, and they they love having a regimen.
15:27
SPEAKER_01: Let's face it, we all like having a routine.
15:30
SPEAKER_01: Uh, routines are great.
15:31
SPEAKER_01: But I think really what's what's happened with skincare has been the evolution of newer formulations.
15:39
SPEAKER_01: So when I was a patient with acne myself, I would use these products on my face and I would go to school with peely red inflamed skin.
15:47
SPEAKER_01: I wanted to hide the treatments, were worse than the condition.
15:50
SPEAKER_01: And I think what I've seen, certainly with acne, but in terms of skincare in general, is the development of newer vehicles and formulations, new delivery systems.
16:00
SPEAKER_01: We have nanoparticles, we have encapsulated ingredients, we have extended release ingredients.
16:06
SPEAKER_01: But the key thing is that we are still having products that have efficacy, but that have improved tolerability.
16:13
SPEAKER_01: And when you're dealing with a 30-year-old, a 20-year-old, you want products that are cosmetically acceptable, that are going to be compatible with makeup.
16:22
SPEAKER_01: A lot of these products are going to be used in the morning under makeup.
16:25
SPEAKER_01: And I think that has been, you know, we've had niche groups that have evolved in dermatology.
16:31
SPEAKER_01: So, you know, cosmetic dermatology when you and I started, other than collagen, was acne.
16:36
SPEAKER_01: I mean, that was cosmetic dermatology.
16:39
SPEAKER_01: And it's sort of morphed since then.
16:42
SPEAKER_01: But, you know, for instance, with acne, everyone always thought it was just a condition of adolescence.
16:46
SPEAKER_01: And then it was understood that adult women get acne.
16:50
SPEAKER_01: And so we needed vehicles and formulations that were friendly and cosmetically acceptable for our adult female patients.
16:58
SPEAKER_00: Those patients aren't generally as oily as the younger subset of acne patients as.
17:03
SPEAKER_01: And so not only incorporating the skin care, but the act, but but the vehicles used for the medications themselves, such as retinoids, we've seen an evolution in retinoids that we now have creams and loachers.
17:14
SPEAKER_01: Amazing retinoids that contain emollients in them that are fabulous.
17:18
SPEAKER_01: But we've gone from niches and then and and then from adult female, the three hot uh groups that I call the three M's were males, millennials, and mature patients or menopausal women.
17:29
SPEAKER_01: And so um, you know, I think that as our niche groups have evolved in dermatology, so have our vehicles and formulations.
17:37
SPEAKER_01: So for the guys, for instance, who have more of an oilier sebaceous skin or thicker skin, I tend to go more with the gels and solutions, and they don't like using a rich cream.
17:47
SPEAKER_00: No.
17:48
SPEAKER_01: Uh so but anyway, yes, so in the 30s, I I do like to have them use an antioxidant, their lightening agent, their sun protection in the morning, their collagen-stimulating ingredient at night, whether I choose a growth factor or peptide, and that's layered under their retinol, and then they can use their eye cream twice a day.
18:07
SPEAKER_00: So let's let's delve into the 40-year-olds, because I know you have an office full of them, as we all do.
18:13
SPEAKER_00: And if you talk to them, you'd think the wheels were falling off, right?
18:16
SPEAKER_00: I mean, if they're sitting where I'm sitting, they would wish they were 40.
18:21
SPEAKER_00: But when they get to be 40, this is when they really, I think, like start to be super concerned about skin care and treating the signs of aging, because obviously, even some women are perimenopausal at this point.
18:33
SPEAKER_01: Well, I was gonna say, ironically, in their 40s, when they're starting to think of skin care, that's when things start of sort of going south.
18:40
SPEAKER_01: But you know, basically you start, you start that's the age where perimenopause can occur.
18:45
SPEAKER_01: And with perimenopause, you get all these changes for skin and hair for that matter.
18:50
SPEAKER_01: Um, but basically, you know, at perimenopause, your skin can start getting a little bit more dry.
18:57
SPEAKER_01: Uh, certainly you're developing wrinkles, you're developing a rough tone and texture, a dull complexion because of the decreased turnover.
19:05
SPEAKER_01: You're also uh developing discoloration along with the dullness, but you also might have an increased size of your pores, which occurs postmenopausally, and you might start getting acne again because you know, perimenopause is considered a hormonal change.
19:21
SPEAKER_01: And any hormonal change can cause little uh acne breakouts, especially on the lower part of the face.
19:26
SPEAKER_01: So it's sort of a pseudo-adolescence again.
19:29
SPEAKER_01: So there's so many because you're going through so much.
19:34
SPEAKER_00: And then you're dealing with all of this.
19:36
SPEAKER_01: Yeah, so there's so many potential things you're dealing with: uneven texture, wrinkles, fine lines, uh treatment.
19:43
SPEAKER_00: Explain why the pores start to enlarge, because that's a really important.
19:47
SPEAKER_01: Well, there's a couple of things that are going on.
19:50
SPEAKER_01: First of all, as you start losing collagen and elastin, and and basically when when your estrogen levels start to decrease, uh you're definitely going to get a reduction of collagen because um the fibroblasts in your dermis have uh estrogen receptors.
20:05
SPEAKER_01: And so when you're premenopausal, your your estrogen is stimulating these receptors on the fibroblasts to produce collagen and elastin, and for that matter, uh ground substance and glycose aminoglycans, which keeps the skin hydrated.
20:19
SPEAKER_01: So as the estrogen levels decrease, the amount of collagen that uh one is making decreases.
20:25
SPEAKER_01: But the collagen that you have is also getting destroyed by ultraviolet light, by environment, the collagen becomes more frayed.
20:33
SPEAKER_01: So you have destruction of the collagen from external factors such as sunlight and environment, and then you have less collagen being produced.
20:41
SPEAKER_01: So that's going to give you wrinkles, but it's also the ground substance in the dermis and the collagen that supports those pores or sebaceous pylosabaceous units, so the pores can dilate.
20:55
SPEAKER_01: And then what's also happening is when your ovaries are no longer making estrogen, your uh adrenal glands are still making androgens, so you're getting androgen production that's unopposed by estrogen, so you're making more oil again, so your pores are getting clogged, which also can help make them look larger.
21:11
SPEAKER_01: So it's like a double whammy.
21:13
SPEAKER_01: Yeah, so your pores are large, but your skin's also dry and sensitive and wrinkly and pigmented, so all these things are happening, and it only continues to occur starting in the 40s, into the 50s, and thereafter.
21:25
unknown: Yeah.
21:26
SPEAKER_00: So what do you do at this age group?
21:28
SPEAKER_00: Assuming they don't have a big acne problem.
21:32
SPEAKER_01: Right.
21:32
SPEAKER_01: Well, you know, it's basically the same ingredients.
21:35
SPEAKER_01: Uh you might char you might choose a different formulation.
21:38
SPEAKER_01: So someone who was using a serum might need more of a moisturizing cream.
21:43
SPEAKER_01: And a lot of the products that we recommend, that you and I recommend, come in a lotion form and a cream form.
21:49
SPEAKER_01: And, you know, sometimes you use the lotion in the fall and the summer, and you use the cream and the winter.
21:55
SPEAKER_01: But for the older patients who might have a drier skin, that's when I might use the cream.
21:59
SPEAKER_01: But I'm still Still going to be layering that retinoid or retinol on top of it.
22:04
SPEAKER_01: That's when I might use more of the growth factors, the peptides, and certainly some of the lightning agents if they're dealing with, you know, hyperpigmentation.
22:15
SPEAKER_01: Obviously, there are procedures we can perform in the office to help.
22:20
SPEAKER_01: But this is why every 40-year-old wants to tell their 20-year-old younger self, start maintenance now.
22:27
unknown: Right.
22:28
SPEAKER_01: Start prevention now.
22:29
SPEAKER_01: So you don't end up in that situation.
22:31
SPEAKER_01: Right.
22:32
SPEAKER_01: And the other things that we see in postmenopausal skin, not are just the wrinkles and pigmentation, but for some patients, their skin has more redness, more erythema.
22:40
SPEAKER_01: You know, redness is not just caused by rosacea, it's caused by chronic photo damage.
22:45
SPEAKER_01: You know, and and and then surface blood vessels, T langectas.
22:50
SPEAKER_01: And then on the non-facial skin areas, uh obviously we see a lot of changes post-menopausally.
22:57
SPEAKER_01: Not only is the skin drier and itchy, but the skin becomes thin and atrophic.
23:03
SPEAKER_01: Uh, it doesn't heal as well.
23:06
SPEAKER_01: There's poor wound healing.
23:07
SPEAKER_01: We see purpura.
23:08
SPEAKER_01: Uh so there's all these issues that occur on the skin, both on the face and on the body.
23:13
SPEAKER_01: You know, let's face it, Patty.
23:15
SPEAKER_01: A lot of a lot of the things that we see on the skin are influenced by so many factors genetics, hormones, stress, the amount of ultraviolet light or pollution, even lifestyle factors like sleep and diet.
23:27
SPEAKER_01: So, you know, that's why I think there's been so much more of a move toward overall wellness and dealing with all of these factors.
23:37
SPEAKER_01: But, you know, certainly we have all these great ingredients that we can recommend to our patients.
23:43
SPEAKER_00: So, really, what we now talk about is the exposome, all the environmental factors that your skin is exposed to, including things like nutrition, poor nutrition, having a factor, lack of sleep, stress, all of that.
23:54
SPEAKER_00: All of those things play in.
23:55
SPEAKER_00: And you're right, there's lots of confounding factors.
23:58
SPEAKER_01: Yes, it's the whole holistic approach to skincare.
24:01
SPEAKER_01: But in addition to the holistic approach, there's so much great science now that that we've had with our skincare products.
24:09
SPEAKER_01: And, you know, the bigger companies that we both are familiar with have just come out with such great products and such great ingredients.
24:17
SPEAKER_01: And I I think we really have to thank these bigger companies for investing so much money into RD to get the right ingredients out there, to get the right vehicles, the right delivery systems.
24:29
SPEAKER_01: Um, and look, there's so many trending things that are occurring in our field.
24:35
SPEAKER_01: I'm so excited for us, for my daughter, for her generation.
24:38
SPEAKER_01: Um I think we're gonna be seeing, I mean, basically, we talk about hormones.
24:42
SPEAKER_01: I think we're gonna be seeing more uh utilization of products for hormone receptors, both agonists and antagonists.
24:51
SPEAKER_01: You know, we have a topical hormonal antagonist now uh as a prescription for acne, and I think we'll be seeing the same type of thing for hair loss.
25:00
SPEAKER_01: Uh, and you know, certainly for aging, uh, you know, there's there's a topical product that has a synthetic non-hormonal uh estrogen receptor agonist.
25:11
SPEAKER_01: It's not a hormone, it doesn't behave like a hormone, it's broken down to an inactive ingredient, um, but it stimulates the estrogen receptors on keratinocytes to make the skin feel thicker, uh, on fibroblasts to increase the ground substance and elastin and collagen, and even in theory on hair follicles and you know, for hair thinning for postmenopausal women, which is such an issue.
25:35
SPEAKER_01: Huge problem.
25:37
SPEAKER_01: A lot of uh nutraceuticals, that's that's your specialty that really do help.
25:42
SPEAKER_01: And I'm actually coming around on the collagen front.
25:44
SPEAKER_01: I was a naysayer.
25:46
SPEAKER_00: Yay! There's a couple of really good meta-analysis I'm gonna send you because there is enough data at this point, I think, to suggest that there are benefits to taking collagen hydrolysates.
25:58
SPEAKER_00: So you you touched on, but I want to go a little bit more into the postmenopausal female.
26:03
SPEAKER_00: You talked about the unique ingredients, but also, so we know postmenopausal, you you lose 1% of your collagen a year.
26:11
SPEAKER_00: And that is brightening.
26:12
SPEAKER_00: That's a brightening statistics because as many years postmenopausal as I am, that's scary.
26:17
SPEAKER_00: Now, what are the kinds of things I know you start to gear it up at that point?
26:22
SPEAKER_01: Yeah, I mean, so basically you you're losing, you you might lose a big chunk at the beginning.
26:28
SPEAKER_01: You know, you could lose a lot.
26:30
SPEAKER_01: And then after that, thereafter, it's one to two percent per year.
26:33
SPEAKER_01: And look, let's face it, women are living longer and longer.
26:37
SPEAKER_01: They're living productive lives, they're active, they're working.
26:40
SPEAKER_01: As I said, 80 is like the new 50.
26:43
SPEAKER_01: But the age at which menopause occurs has stayed relatively stable.
26:48
SPEAKER_01: So what you're seeing is that women are going to be living a larger and larger percentage of their life as post-menopausal women, some of them half their life.
26:58
SPEAKER_01: And so we definitely have to pay attention to this age group and address the issues.
27:02
SPEAKER_01: And so, you know, we're basically utilizing the same ingredients.
27:06
SPEAKER_01: We may be switching our formulation or vehicle, but there are products now.
27:10
SPEAKER_01: Uh, you and I both looked at one the other day.
27:13
SPEAKER_01: That's another buzzword.
27:15
SPEAKER_01: We're seeing more and more products being geared toward postmenopausal women.
27:19
SPEAKER_01: And they basically contain the same idea.
27:21
SPEAKER_01: They're stimulating collagen, they're anti-inflammatory, they're antioxidant.
27:26
SPEAKER_01: Um, some of the things that are a problem, as I mentioned, were purporaus.
27:30
SPEAKER_01: So we might see products with vitamin K.
27:32
SPEAKER_01: Um, we might see, of course, products with retinol because that strengthens the barrier and stimulates the epidermis, uh, and of course, stimulates collagen.
27:42
SPEAKER_01: Uh, there was this uh non-hormonal agent I mentioned.
27:46
SPEAKER_01: Um the ingredient is is methyl estradiol propanoate, which is in a product that uh stimulates estrogen receptors, but it just it's a product that uh resembles estrogen, but it's a non-hormone ingredient that gets degraded.
28:04
SPEAKER_00: And then that's the biopel product.
28:06
SPEAKER_00: Yes, just so people know what it is, MIPL, yeah.
28:09
SPEAKER_01: It's MIPL, and they have, you know, they have a serum that could be used in the morning and a cream that could be used at night.
28:14
SPEAKER_01: Right.
28:14
SPEAKER_01: And basically, uh basically, you know, again, you're stimulating estrogen receptors on fibroblasts, on keratinocytes, and therefore it acts like an estrogen.
28:25
SPEAKER_01: And I think that the whole hormone receptor field is going to grow.
28:28
SPEAKER_01: Look, we have so many things that are coming in skincare uh that are trending now, um, even for this age group, uh, dealing with the microbiome, uh, exosomes, regenerative medicine, stem cells, uh, newer peptides.
28:44
SPEAKER_01: I mean, even discussions about an anti-aging vaccine, and then the whole issue of um using things like metformin uh for increased health and what effect that has on the skin because of um end products in the skin.
28:59
SPEAKER_01: So I think that skin care and skin health and anti-aging is just at its infancy in some ways.
29:07
SPEAKER_00: I d I agree with you 100%.
29:09
SPEAKER_00: We're we're light years ahead of where you and I started following the skincare industry.
29:15
SPEAKER_00: And I love hearing you say that the cosmetic companies have done so much great work because they really have, and I say that often, they have really advanced our understanding of the science behind skin aging and also how to address skin aging.
29:29
SPEAKER_00: And that, you know, it's the major consumer companies are putting the money into these really great studies.
29:36
SPEAKER_00: Talk a minute about the microbiome because it's such a buzzword.
29:39
SPEAKER_00: And you know, we weren't talking about the microbiome 10 years ago, not like we are now, and barrier repair, quite frankly, but the microbiome we know is part of the barrier.
29:47
SPEAKER_00: The very sort barrier is not bricks and mortar.
29:50
SPEAKER_00: We don't look about it that way anymore.
29:51
SPEAKER_00: It's complex, it's got microbes.
29:53
SPEAKER_00: So, as we well know, coming out with products directly going after the microbiome.
30:00
SPEAKER_01: Look, the brick and mortar is still important.
30:02
SPEAKER_01: Ceramides and moisturizers hydrate the skin.
30:05
SPEAKER_01: But you know, we have a very diverse microbiome.
30:09
SPEAKER_01: Uh, and interestingly, some of the earlier treatments that we use for various conditions might have disrupted that microbiome because they were so irritating and drying, and we do need those good bacteria to keep everything in balance.
30:21
SPEAKER_01: We have antimicrobial peptides to help prevent disease.
30:25
SPEAKER_01: Um, but basically, you know, the microbiome includes not just bacteria, but but all the different organisms, yeasts, and uh basically uh you have probiotics, you have postbiotics made by certain bacteria, you have prebiotics that help support it.
30:44
SPEAKER_01: Um and you know, the microbiome helps, for instance, keep uh our skin at an acidic level, what we used to call the acetyl.
30:53
SPEAKER_01: And so if you destroy the microbiome and this that makes the skin alkaline, and that causes flaking and dryness and irritation and redness, so you want to keep it stable.
31:04
SPEAKER_01: There is a new product, there are a lot of new products now that use the product of P acnes, for instance, which is now C acnes, uh, and this uh propionic acid is anticebum and it's anti-inflammatory, it's anti-pigment.
31:21
SPEAKER_01: But using products that help restore the microbiome are being used for anti-aging, for eczema, for acne, for rosacea.
31:30
SPEAKER_01: But the idea is keeping that microbiome as diverse as possible will help reduce inflammation, will help reduce collagen loss, and will help restore the barrier.
31:41
SPEAKER_01: We're seeing products that use the thermal spring water and postbiotics from thermal spring water, which help hydrate the skin.
31:48
SPEAKER_01: So, again, I think this is a whole new avenue, also.
31:51
SPEAKER_01: And this is not just for the skin, it's for the entire body, it's for the mouth, everything.
31:56
SPEAKER_01: And you know, we know that oral care is important for body care, which is important for skin care.
32:02
SPEAKER_00: So fascinating.
32:03
SPEAKER_00: So we have have, of course, run out of time and have barely scratched the surface.
32:08
SPEAKER_00: So we may get you to come back.
32:10
SPEAKER_00: We're so excited and happy to have you.
32:12
SPEAKER_00: And you're as always, you're such a wealth of information.
32:15
SPEAKER_00: Nobody knows ingredients better than this girl right here.
32:17
SPEAKER_00: I've learned so much from you.
32:19
SPEAKER_00: So much.
32:20
SPEAKER_01: That's that that's that's that's very generous of you.
32:23
SPEAKER_01: But uh so much for from your ingredient junkies and what we call ourselves are skincare.
32:28
SPEAKER_01: I'm a terrible ingredient junkie, skincare nerds.
32:30
SPEAKER_00: Yeah, but it's just exciting right now because there's so many new things, and we have so much to offer to patients.
32:36
SPEAKER_00: So thank you for joining us.
32:39
SPEAKER_00: Uh, I hope I'll see you along the road.
32:41
SPEAKER_00: I know I'll see you at ASDS.
32:42
SPEAKER_00: Diane and I will be on a panel together at the ASDS meeting this year on Regimen Building.
32:48
SPEAKER_00: So that should be really fun with Ruth Gidaldi and Doris Day.
32:52
SPEAKER_00: So the girl, the girlfriend hour.
32:54
SPEAKER_00: We should call it the girlfriend hour that would be genius.
32:56
SPEAKER_01: Or skincare the the girl skincare nerd.
32:59
SPEAKER_00: Yeah, it's gonna, it's gonna be a lot of fun.
33:01
SPEAKER_00: I look forward to seeing you.
33:03
SPEAKER_01: Thank you, Patty.
33:04
SPEAKER_01: So it's always so wonderful being with you.
33:06
SPEAKER_01: You're just you're just a breath of fresh air, and you're so brilliant.
33:10
SPEAKER_01: So thank you, thank you so much for including me and inviting me.
33:14
SPEAKER_01: And um, have a wonderful fall.
33:16
SPEAKER_00: You too.
33:17
SPEAKER_00: Take care.
33:17
SPEAKER_00: Thanks again.