Decoding Skincare with Dr. Elizabeth Hale

00:00:17
Speaker 1: Pushkin. On every episode of Decoding Women's Health, we talk about the science behind women's bodies and share stories from leading researchers and clinicians. But now I want to hear your stories and your questions. No question is too complex, awkward, or small. So tell me what kindacologic questions have been on your mind lately. We'll get into everything from entimetriosis to fibroids, pms, pcos, and more. We really want to hear from you, so please send your questions to us at Decoding Women's Health at Pushkin dot fm. That's Decoding Women's Health at Pushkin dot fm, or feel free to leave us a voicemail at four FI five two oh one, three three eight five.
00:01:18
Speaker 2: This show is not a substitute for professional medical advice, diagnosis, or treatment. It is for informational purposes. Please consult your healthcare professional with any medical questions. Also in this show, we use women as shorthand for people with XX chromosomes. We understand sex and gender are more complex and acknowledge the experiences we describe reach beyond that word.
00:01:49
Speaker 1: For far too long, we've been misled. We've heard over and over that aging skin is a problem that's impossible to fix. But that's simply not true. Skincare has undergone a radical transformation from advanced research and dermatologic science to regenitive therapies, retinoids, and exisomes. There are just so many options out there to promote healthier skin, in addition to, of course, the non negotiables like nutrition and exercise.
00:02:20
Speaker 3: You know, when people say I want to look X years younger, it's like, really not about the number, It's about looking like the best and healthiest version of ourselves. And the skin really is a window into one's health, one's well being, how one feels about themselves. You can look at someone and without even asking questions, we can tell does this person take care of their skin? Are they a smoker? Have they spent a lot of time in tanning beds or getting sunburns when they're younger? But our skin is aging, and it's often the first thing people see when they look at us.
00:02:51
Speaker 1: That's doctor Elizabeth Hale. She's a leading dermatologist and clinical Associate professor at the NYU Grossman School of Medicine. I really wanted to have doctor Hale on the show to give us all some advice on how we should be taking care of our skin today, tomorrow, and well into the future. So a lot of patients come to see you. What are their main issues.
00:03:14
Speaker 3: My typical patient may come in for the first time to have a check of all their moles, so we'll do a full body skin exam. Of course, they'll also have questions about skincare, maybe about sun protection and perhaps they maybe want to get rid of some sunspots that they have, or they're noticing creepiness of their skin, or wrinkles developing or uneven texture. And so it's sort of a conglomerate of medical, surgical, and then more cosmetic treatment of the skin. And my patients are, you know, range in age from about eighteen to ninety plus. But I'd say that the sweet spot that we're going to talk about is the bread and butter of my practice. I'm seeing women thirties, forties, fifties, sixties and beyond who are coming in for skin health because you know, the skin is really a reflection of overall health and well being, whether it's something relatively insignificant like a rash or acne, or rather it's a wrinkle or a sunspot, or importantly, whether you're teaching patients how to find a mold that's changing, or maybe help detect skin cancer. The patients are very invested in their care and they want their skin to look good. They're motivated to listen to what you have to say, and they're also first line because the skin is so visible, so they might be the first person to notice something going on with their skin. I also love that I develop long term relationships with my patients. In some fields, you want to fix a problem and say goodbye to the patient, but in my field, patients become really lifetime patients.
00:04:43
Speaker 1: How do you recommend people use sunscreen every day only when you're outside. How do you advise your patients.
00:04:51
Speaker 3: A favorite topic. You know, people think it's crazy when I say, I really do wear it three hundred and sixty five days a year. But it's important for people to understand. There are two main types of ultraviolet light that reach the Earth's surface and that we are exposed to. The ultraviolet B rays UV B. Those are the rays that cause sunburn, so it's easy to UVB burn. Those are the ones that when you go to the beach or pool, you're putting on sunscreen because you're trying to block those UVB rays from developing a sunburn, and that's of course very important to prevent melanoma. But most of the rays that reach the earth surface or UVA ultraviolet A UVA rays are longer wavelength than UVB, which means they penetrate year round. So you're not going to get a sunburn walking around New York City and you know the winter or where now you know, early spring, you're not going to get a sunburn walking around. But those ultraviolet A rays penetrate through clouds, through windows, so your office window, your car window, and they penetrate even on like a very cloudy or even rainy day. The ultraviolet A rays, you're not going to get a sunburn, but those penetrate deeper into your skin, into your dermis. They break down collagen and elastin, so they lead to wrinkle development and that uneven texture. There's a picture of a truck driver that went around for you know, in the media several years ago, and the side of his face that was exposed to the window aged dramatically faster than the right side of his face, which was relatively protected. It's those UVA rays coming through the window year round, breaking down collagen and elastin, leading to hyper pigmentation. So people get sunspots and melasma and pigment from UVA rays, and importantly, they also lead to the development of skin cancer. So you're not getting the UVB burning rays that lead to melanoma. But the chronic UVA exposure is year round, regardless of your climate, and that's what again penetrates through clouds and windows, and that's why you need to wear a broad spectrum sunscreen every single day on your exposed areas. You know, I'm not spraying myself down every day, but I do put a good broad spectrum sunscreen which includes zinc oxide, every single day, regardless of the weather outside, regardless of how much time I'm spending outdoors. It's just a good habit, just like brushing your teeth.
00:07:07
Speaker 1: And do you reapply during the day or do you just apply once and go about your day.
00:07:11
Speaker 3: So when you're outside or when you're in a sunny climate, you're supposed to reapply sunscreen every two hours, which I know sounds daunting, but that's what one is supposed to do. I do that when I'm outdoors on the weekends or on vacation, but on a regular day, I will put a broad spectrum sunscreen and after my shower in the morning on my face, neck, backs of my hands, and then at the end of the day, if it's still light out, depending which time I leave my office, I will usually just brush on a sunscreen. And there's so many different formulations for sunscreens, but I'll use a brush on powder, which makes it really easy to reapply because patient's dread hearing this two hours. I'm not going to take off my makeup reapply, of course not. But if you find a formulation, like I keep brush on powders in all my bags, I keep it at work in the drawer, and when I'm leaving work at the end of the day on a day that's non summer not too sunny outside, I'll brush it on. If it's sunny out and it's the summertime, I will actually reapply like a full coat of sunscreen. But I'd say more likely I'm doing just the coat in the morning and then I'm like brushing it on before the office.
00:08:12
Speaker 1: That's cool. I like that the sunscreen powder. I get confused, and you know, I like have an MDPHD, right, and I look at all of the different sunscreens out there. Do you have like a great recommendation of what we should look for, is that a chemical and mineral sunscreen? Do they have to have zinc oxide? Like the powder is such a great idea, but beyond that, anything else that we should look for to determine which one we pull off the shelf.
00:08:35
Speaker 3: You're absolutely right. It can be very overwhelming for the consumer because there are so many options, so many formulations. How high SPF do you need? It's very confusing, So I'd say basic sunscreen one oh one. There are two main types of sunscreen. There are physical and chemical sunscreens. The most common physical blocker is zinc oxide. It also includes titanium dioxide, but zinc is like the hero ingredient. Zinc protects very broad spectrum across that UVA and UVB range that we were talking about. But it really is the best UVA block So that's what I look for, you know, for my daily sunscreen. Chemicals of or come under scrutiny because some people just hate the word chemical, even though most of the chemicals used in products, including sunscreens, have been determined to be safe and effective. But there was some issues recently in the past couple of years with oxybenzone because of potential damage to coral reefs, and they've been banned in certain states in certain parts of the country. But that was more of an environmental risk. But the sunscreen ingredients that are available now, if they're not physical, they are chemical sunscreen ingredients, and they have some benefit also, they're not bad. They increase the water resistance and sweat resistance of a product, so you know, on a day to day, like I was talking about wearing sunscreen when I walk to the office, I'll use the mostly physical sunscreen like a zinc oxide. But if I'm going exercising outside, if I'm going to a beach, er pool, if I'm going on vacation, those chemicals are some combination of chemical and physical can actually make the product last longer if you're sweating or if you're swimming, so I think sometimes the combination is best. I will add, and we mentioned earlier some protective clothes. I am a huge fan of sun protective clothing because you don't have to worry as much about sweating it off, or if you're swimming, you don't have to worry that you're going to get a burn. Even though you put sunscreen on, you don't have to reapply as much. You know, a white T shirt has like an SPF of seven, and if you get it wet, it goes down to like an SPF of three, which is pretty much nothing. So I think like the UPF which are specially treated fabrics that provide SPF or sun protection are very helpful. But the SPF number itself can be confusing for people because the numbers just seem to get higher and higher. So typically we as dermatologists recommend daily SPF thirty or higher. Thirty blocks about ninety seven to ninety eight percent of the UVB rays, and people should know two. SPF or sun protection factor refers to the ability for a product to block just those UVB burning rays, so that's what SPF refers to. Ideally, you find a product that says broad spectrum ze and that it has either zinc oxide or another broad spectrum ingredient like AVO benzone, because you do want to make sure you're also blocking UVA. But when you're looking at the number that refers to the ability to prevent burning of the skin. For a while, it was like a war between the companies like this one's SPF eighty this is that's P one hundred. Do you need the higher that? So really I find that those higher numbers compensate for under application. You know, you're supposed to use two milligrams per square centimeter of sunscreen to get full coverage. So basically like a shot glass of lotion if you're covering your whole body, or like a quarter sized dollop we say to do like your face, neck and chest, but no one uses enough. Sometimes people put a little squirt of their like you know, tinted moisturize ron and they think they're covered. People tend to underapply sunscreen, so there may be a role for higher numbers to compensate for that. But otherwise I say SPF thirty or higher, and if you are in the sun, to try to remember to reapply every couple of hours.
00:12:10
Speaker 1: So yeah, I grew up in the days of like sitting in the sun with the baby oil on your skin right to get that deep dark tan.
00:12:17
Speaker 3: One thing about the baby oil, it's really interesting because some sunscreen brands now are trying to recognize you know, people don't like to wear sunscreen. But there are some brands that are developing now, like baby oils. But with SPF thirty or fifty, we want people to find a sunscreen they will actually use, and that is the best sunscreen, of course, staying in the shade when possible, and wearing hats and sunglasses. I actually have discovered long sleeve bathing suits and it's like once you do that, you never go back. It's like I used to try to keep up and spray my chest every hour, and now it's like I'm never outside without long sleeve sun protection. And they're actually quite fashionable now, so you don't have to look funny, right right.
00:12:58
Speaker 1: Those have been brought back actually in some of the tops too, some of the rash guard things Tooeah right, yeah, they're not good protection. Yeah, not bad. So let's get into some more cosmetic yet has some medical locations in terms of aging skin and wrinkles.
00:13:15
Speaker 3: Talk to us a.
00:13:15
Speaker 1: Little bit about what happens to the skin as we grow older and as we enter through midlife and beyond. What's going on with our collagen elastin. What are the mechanisms of skin aging.
00:13:27
Speaker 3: So starting at a young age is early is about thirty, you know. The collagen and elastin are two very important building blocks of our skin, and they in young, youthful, healthy skin, they are abundant. And as we start to age, as early as about our early thirties, we start to see a real depletion in pollagen and elastin. And this occurs kind of regardless of environmental influences. And we talk about intrinsic and extrinsic aging. So even without sun exposure, even without other risk factors, our skin naturally starts to lose collagen and elastin, It starts to get more dehydrated, it doesn't hold onto water as well. You start to see changes in the skin that get worse with each passing year. But there's also extrinsic aging. And if someone does not use sunscreen wheat, as we just talked about, ultraviolet rates breakdown collagen and elastin, and they also lead to pigmentation and skin atrophy, which is thinning of the skin and clumping. It's something called solar elastosis where you see clumping of the elastin fibrils under the skin. So unprotected sun exposure but also smoking pollution, all of the toxins that we're exposed to in the environment, these things can accelerate aging. And we've seen studies of identical twins that you know, one of them smokes and spends a lot of time in the sun, and they can look twenty years older than their identical twin. So we're all aging, and our collagen and elastin is breaking down, our skin is thinning. A lot of this gets accelerated with estrogen depletion in the perimenopausal years. So that's happening irrespective of your specific risk factors, and you can't control that. But when you can control is most importantly you're bosure to sun and how much you protect your skin. Also basic things like keeping your skin clean, hydrating your skin, moisturizing overnight. There are things we can do to try to slow down this process. But our skin is aging and it's often the first thing people see when they look at us. So when people determine how old, but also just how healthy someone looks, the skin is a real indicator. So we really like to get people to take care of their skin.
00:15:35
Speaker 1: For women in midlife, what are those interventions in terms of protecting collagen, elastin skin thinning? What can we do? I would imagine there's some topical some dingustibles, maybe exercise, healthy nutrition. Can you just outline that.
00:15:51
Speaker 3: Yes, yes, yes, and yes to everything you just said. Okay, So, first of all, kind of regardless of skin type, I think there are some very basic skin care practices that everyone should get in the habit of, and I like to keep it simple for my patients. You know, I made skincare. It's like next level. There's a new product. Seemingly every week, there's a celebrity endorsed product. Now we're into you know, Korean skin and TikTok and the influencers. It's like endless as you can imagine. I get one hundred questions every day. But there are some basic things that really help. So first of all, every single morning, regardless of what season it is, I recommend that people apply an antioxidant serum underneath their broad spectrum sunscreen. So antioxidants are important. You know, Vitamin C is one of the most common ones, superoxide dismutase, vitamin E. There are so many great antioxints, green tea. But it's important because those neutralized free radicals in the environment, so UV exposure but also smoking pollution. These things all generate toxins in our environment, and free radicals get into the skin and break down pollogen and elastin at an accelerated pace. So an antioxidant helps to neutralize free radicals. So antioxidant serum underneath the sunscreen, so that's like a thirty second thing every single day, even if it's raining. Other than sunscreen, the other ingredient that has really well borne out data about helping prevent aging of the skin is tretonoing. You know, there is a lot of data over thirty forty years that the use of a retinol. So people have heard of retine. That's a very common medication used to treat acne, but it also helps with sell turnover. It helps to prevent aging of the skin by diminishing the appearance of lines and wrinkles because it can make the skin dermis thicker, it can improve collagen, it can help even out pigmentation. It also is an acne medicine, so it helps to prevent acne, but also it helps to prevent open pores and millia, which are these little annoying cysts that we get as our skin ages. So I typically recommend if your skin can tolerate it, you should talk to your dermatologists about using a retinol and hopefully a prescription retinol every evening underneath a moisturizer. So I tell patients you don't need complicated every morning, an antioxidant and sunscreen every evening a retinol under a moisturizer, because the side effect Sometimes patients here, oh great, so this tretonoan will help with pigmentation and wrinkles and make my skin even and prevent milia. But then they use a lot of it, and then they get dry and irritated, and it's like one step forward, two steps back. So like less is more with retinol, you want to use like a tiny tiny dot at nighttime, spread that dot throughout your whole face. I do my neck in decolotage as well, and then moisturize on top of it so that you don't get too dry and irritated. A lot of people can't tolerate tretonoan if they have roseatia or if their skin sensitive. So there are some other alternatives, like with bakugaya, which is derived from bacci seeds that has retinol like properties. There are a lot of other products, but I'd say sunscreen and the retinols are really the two things that have been borne out to slow down aging of the skin time and time again, this has been proven. Other than those things, there are countless ingredients that are amazing, but they are more personal preference. Some people like to use peptides, some people like to use you know, AHA BHA, which are alphydroxy beta hydroxy acids. You know, there are exosomes. There are just endless topical ingredients that people like. But I'd say again the antioxidant sunscreen, cleansing your face at night, and then applying the retinol and moisturizer. You've got most of that covered. As far as supplements which you asked about, you know, the data is mixed, and it's like it comes up all the time. I think eating a healthy diet is probably more important than supplementation because although in theory, eating and drinking collagen can help strengthen our collagen in our skin, but there's not yet great data that what we're eating is actually getting then metabolized by our GI system excreted to the skin in a meaningful way. But you know, there's no harm to it. So I tell people, you know, I don't have any problem with you taking collagen. I just don't know how much of a difference it will make. Eating a colorful diet I think is very helpful for skin health because you know, antioxidants. Again, we're trying to protect our skin but also our body from all of these insults we get from the environment and from the sun and from pollution every day. And the more colorful of food is typically the more antioxidants that it has. And then keeping our skin hydrated I should have mentioned, in addition to sunscreen and retinol, hyaluronic acid, which is an ingredient that our skin and our joints make anyway, as a lubricant, is a great ingredient, and it's a humeectin. It pulls water into the skin, it plumps our skin, it hydrates our skin, and it makes it look healthy because as we age, our skin also dehydrates, and as dehydrated skin looks more creepy, more wrinkly, and more sallow. And then we can talk about estrogen, my favorite topic.
00:20:45
Speaker 1: So a lot of women are using vaginal estrogen on their face. We actually compound some estriolo topical estriol with some peptides for our patients that we take care of. What are your views on using topical estrogen and systemic estrogen also, but let's start with topical estrogen.
00:21:01
Speaker 3: I'm so glad to hear that you recommend it, because the truth is, I used to think of it how I thought of collagen. You know, there's probably no downside, it might not do much, and then more and more there are some like anecdotal and some reports coming out and some data that it actually can be helpful topically from a skin perspective. So I do prescribe topical estrogen. I use it myself. I sort of feel like in thin skinned areas it's more likely to have benefits, so I'll put it on a little bit under my eyes or maybe on my neck. I'm curious what you think, because I feel in other areas where the skin is thicker, again, are we getting meaningful absorption of it to really make a difference. I think again, I'm excited to see that it is starting to have some good support and some data behind it. But I do absolutely think that a decline in estrogen is largely what's causing, you know, accelerated aging in women's skin perimenopause and beyond. So I'm thrilled that there's been a revolution and that people are taking HRT seriously because I think one of the many, many, many benefits of estrogen, and you know, HRT when people need it and when it's appropriate, it really can help the skin because we know that as we age and we're losing estrogen progesterone, a lot of things happen to our skin and also our hair. But our skin is drying out, it's not holding onto water, it's not as firm, the collagens breaking down, even more, the elastins breaking down, and also we start to have more androgen excess. So you know, women have balances of female hormones and males, and when we're declining our female hormones, the androgen, which are the male hormones can take over, which can result in annoying things like hair sinning and hair loss. So I'm thrilled that this field that you're in has evolved so much and that people are really advocating and asking about hormones because it was like taboo for so long.
00:22:47
Speaker 1: Right, Yeah, I think we are like we finally have moved through the Women's Health Initiative study and realized that our newer preparations are safer and effective and can really help women physiologically not only just feel better, but also be better in terms of their physiology. Coming up, we'll learn about the various regenerative treatments that are high in demand and dermatology offices all over the country, from exosomes and red light therapy, to micro needling, and to other mainstays like botox and fillers. Back in a minute. I read this paper about a year ago it came out. I thought it was so fascinating that wrinkles in our skin actually release inflammatory components that impact the rest of our body. So for me, that was a great argument about why should get botox right, Fewer wrinkles, less inflammation, health activity, any credence to that very interesting.
00:23:50
Speaker 3: I personally am not aware of the wrinkles themselves causing inflammation, but the things that cause wrinkles again like unprotected sun exposure that causes a lot of inflammation in the skin. So I think there is a correlation. But I haven't read your specific paper, but I will tell you you remind me of two other interesting things about justification for getting botox. It is well published also in this psychiatry literature, that it doesn't just make you look better, but you actually feel less stressed, you know, because we used to think it was just the fact that you're not frowning anymore. So maybe people don't think that you're unhappy, so maybe they're nicer to you because they think you're a nicer person. But it's actually there's data that there are neurotransmitters that make people happier that also can be increased when you're getting batcheltem toxins.
00:24:40
Speaker 1: Let's go into botox. Is it safe? I get that question all the time. Is it okay to use botox? Is it safe? Is there any downside to using it?
00:24:48
Speaker 3: Thank goodness, it is safe.
00:24:51
Speaker 1: I'm happy about that. Personally.
00:24:53
Speaker 3: It's really funny because I actually think it's one of the safest and most reproducible things that we do. And when you think about it, that like batchulinum toxin can be used as you know, biologic warfare or in like huge doses it can cause botulism, And it's like, how are we doing this every day to so many patients and ourselves. But it's because the amount of bochu lineum talks and that we inject. When we're injecting botox or javot or disport or zeum. There's there's so many botchulum talks and a's that we use, but we use such a minute amount. It's specifically targeting facial muscles. There is very good data on its safety and efficacy. We're not giving it systemically. We are injecting it very local into the muscle where it can affect the neuromuscular junction and try to minimize muscle contraction, very selectively to ease the appearance of wrinkles. And the amount that we give is so teeny teeny tiny and it is completely safe.
00:25:53
Speaker 1: Crapy skin. Talk to us about crapy skin, because that's a big complaint that I that I hear on a regular basis. You know, the skin around my arms is creepy, the skin around my knees is creepy. What is that and what can we do about it?
00:26:07
Speaker 3: I mean, this is probably the most common complaint I hear. That's the hardest thing to treat. We know, creepiness is very common as women age, particularly people who have a lot of sun damage, and particularly people that have less estrogen. I think it's a combination of the loss of estrogen and that starts to happen quite precipitously with perimenopause and beyond. We know that the estrogen deprived skin gets creepy and is not reflective of the shape you're in. Sometimes people think, but I work out and I have really great arms, and I still have crapy skin. So I think some of it's genetic, some is hormonal. A lot of it is sun exposure. So I think starting at a young age and really trying to protect your skin from the sun is something very helpful you can do. Considering HRT and hormone replacement is very helpful. So you want to keep your skin hydrated, You want to keep your body hydrated by drinking lots of water as well, but also using a product like hyaluronic acid or moisturizers with something like seramide. These are things that hydrate the skin. But also retinol that gets into the skin and helps to support collagen and elastin. That's helpful as well. I use tretonoen at night on my face, but we'll try to use a body retinol cream, you know, on the arms and try to prevent some of that breakdown of collagen and elastin. And then there are devices we use lasers, not a blade of fraction oversurfacing like fraxil. We do CO two ORBM like the Ultra Clear. We do a lot of microneedling plus radio frequency like there are a lot of devices that can tighten skin. But I find that that creepy arm thing. If someone can solve that, they'd be very successful.
00:27:36
Speaker 1: You know, sometimes I think filling out with muscle, like as you strength train and build muscle, may help. Do you think or doesn't help?
00:27:44
Speaker 3: I mean, I think muscles so important for so many things. I really think muscle is like the key to longevity for so many reasons. But I will tell you that I see so many women who have great arms, and they love how their arms look in clothing, and they have definition, and they still can get crapiness and some of that is genetic. But yes, keep lifting weights for sure.
00:28:03
Speaker 1: Yeah, yeah, I totally believe muscles is the organ of longevity. Let's talk about some other treatments. Red light therapy pro con useful, not useful.
00:28:14
Speaker 3: I think there's some data on it, for sure. I get asked about it all the time. Now, you know, there's a lot of great marketing and a lot of great tiktoking going on because it's like very you know, fun to look at. But red light there are data that it decreases inflammation in the skin. It can help contribute to strengthening your collagen. There's some data for red light with hair regrowth. It's hard to quantify, but when patients ask about it, I'm definitely a proponent if they want to do it.
00:28:40
Speaker 1: How often do you recommend? Some I do red light therapy.
00:28:44
Speaker 3: Weekly, Some people do it every night. I know I do it like once a month. If that.
00:28:51
Speaker 1: So, let's talk about some other more novel treatments. Can you tell us what exosomes are and how they apply into your field of dermatology.
00:29:00
Speaker 3: So exosomes are basically little packages of messengers, like they're telling the skin what to do, and it seems almost like too good to be true, like you're you can tell a skin cell to reprogram and be healthier, to have less inflammation, or it has some antioxidant capability as well. But exosomes, there are some data that they can be very powerful and helping to rejuvenate and kind of reprogram your skin to a younger stage. Now it's controversial, not everyone believes in exosomes, but I do think there are some good data and enough that I do I do recommend using them topically. Sometimes things are being injected now, so I personally don't inject exosomes, but I know some people do. Similarly, there are some products very popular in Korea that are derived from salmon'sperm that, similarly, like exosomes, are thought to like reprogram the skin, rejuvenate, bring it back to it a younger, more capable stage. But injecting things gets me nervous. And I inject a lot of things every day, but I the exosomes in the salmon's ferm. There have been reports now of granulomas and things happening, so I steer clear of that.
00:30:15
Speaker 1: So talk to us about micro needling. What what is it attempt to do and is it beneficial?
00:30:24
Speaker 3: So micro needling, there's a spectrum of micro needling. There are some devices that people can do at home. There are some devices that maybe your esthetician will do when you go get a facial and then there are more complex devices which couple micro needling with something like radio frequency. So those are devices that as a dermatologist we perform in the office. But basically the concept is that you're delivering tiny, tiny microscopic holes through tiny, tiny needles into the skin, and they can serve two purposes. First and foremost, the thought is that this controlled micro injury to the skin is causing a wound healing response, so that in response to these little micro needling insertions, your skin is healing and you're maybe hopefully producing more collagen as part of that wound healing process. You're trying to cause collagen to remodel and to get stronger and more resilient and therefore translate into less regold skin. So there's an exciting whole area of dermatology which is applying products immediately after procedures in the office, but also maybe coupling them with micro needling when it's done at home. Maybe you're getting better penetration and therefore more meaningful results.
00:31:33
Speaker 1: Can we talk about fillers? Are they losing popularity? Are people moving away from them?
00:31:38
Speaker 3: I have always thought that less is more with filler. I think that a few years back, people in my field, you know, got a little over excited about fillers, and people were walking into their dermatologists and getting way too much filler. I will never put more than one or two syringes procession and my sister and I laugh because we consider ourselves like undercorrected. You know, while you go to the dorm meetings and people have these beautiful but often overfilled faces, And I think a little bit of filler can still be really a good thing. I think if you're seeing a board certified dermatologist or a board certified plastic surgeon, or someone who's familiar with the anatomy of the face and all the different options for fillers, I think they can still be used very tastefully and do a great job. But I think really less is.
00:32:25
Speaker 1: More tell to us about PRP benefits.
00:32:29
Speaker 3: Carp In theory is like my favorite thing. I think it's very variable how people respond to it. So PRP is platelet rich plasma, and the patient will come into the office, we will draw their blood, spin it down, will centrifuge it, and separate out the plasma that is rich in platelets. And as people may remember or may know, platelets are the cells that you know when you cut yourself shaving or you have a minor injury. The platelets are the cells that help to clot and prevent that bleeding. But then they initiate a whole cascade whereby many growth factors are released, and there are many things that platelets release that stimulate collagen productions, stimulate wound healing, help with healing processes, and people will this concept. It's like instead of getting foreign filler or other things injected, you're using your own blood. And I love it and I use it for in some cases hair thinning, we use it for rejuvenation, we use it for healing after certain procedures. But it's very variable. I mean, I have some patients that swear by it. It's all they want. They don't want to do filler, they don't want to do botox, but they love PRP. I think it works best in areas like crows feed are under the eyes, where the skin's very thin and you can see a meaningful difference. You know. PRP is not a filler, so it's not going to do much for like a deeper liner fold, but I think for superficial fine lines, creepiness, I think it has a role.
00:33:50
Speaker 1: I want to talk a little bit about hair and nails. What's the relationship between hair, skin, and nails. Why do they travel together.
00:33:57
Speaker 3: They travel together because they contain keratin, which is something that makes up the outer layer of the skin as well as the hair and the nails, and all of these things are can that ectoderm. There are internal organs and then there are what you see on the outside. And this is part of what I loved about dermatology, that patients can see what's going on with their skin, with their hair, nails. I get less excited about it, but they all do go together. So as we age and with declining estrogen, you know a lot, this takes its toll on our skin, but also our hair and also our nails because our nails become more brittle and they're they're not sticking together as well, and starts to develop ridges in them, and you know, we call them longitudinal ridging, or maybe they they chip and they break and they peel and there's a breakdown of keratin. We do know that our skin dehydrates, and so the skin around the nails dehydrates, and so it's important to protect your skin. You're supposed to apply moisturizer around your nails, and if you're doing a lot of housework or you know, cleaning dishes, you should wear gloves because all of these chemicals and cleansers can irritate the skin and therefore break down the skin and the nails. So you know, it's all again about prevention. Same way that we're doing sunscreen and moisturizers for our skin, we ideally are moisturizing like our cuticles and taking care of our nails as well. Very few things get better with age, and the skin, hair, and nails all tend to go in the wrong direction.
00:35:25
Speaker 1: Keep eating right and keep exercising, and manage dress and sleep. So I just about hair loss, that's another big issue. Like I think the statistic and correct me if I'm wrong, is like fifty percent of women will experience hair loss in their lifetime.
00:35:39
Speaker 3: I thought it was even higher. So hair loss is one of these things I now just know to expect it. It's so common, and especially as women are going through perimenopause, menopause and beyond. But basically hair fitting has so many factors. It can be genetic, of course, you know, if someone's like my grandmother had exactly the same thing. It can start in some people at a younger age. But I'd say most women over certain age, I think more than fifty, not one hundred, but more than fifty definitely experience hair fitting. And I think a lot of that is hormonal, as we talked about earlier, As we have less estrogens and an overabundance of androgens, we start to develop more of like a male pattern thinning of our hair, where we start to have hair thinning in our frontal you know, in our upper lateral, the sides of our foreheads, the crown of our head, or maybe the part starts to widen. These are all things that I see every single day in my practice. And you know, until the past maybe four or five years, we put everyone on biotinvite it and then we started realizing bias. It really doesn't do that much unless you're biot in deficient, which is very rare. But there are so many great treatments for hair thinning and hair loss. They range from over the counter products like rogain, certain vitamins, and hair supplements like neutrophil extress, viviscale. These are things that do have some data. And then monoxidil, which is what rogain is topically, has really had a huge surge in popularity. I actually take it myself. Monoxidyl is the oral form of rogain, and it's called low dose oral monoxidyl. But it has been shown to really improve hair thinning and women. And the mechanism for that is by increasing blood flow to the scalp, and so it's basically a medication that increases circulation. And so there's a thought that increasing circulation to the scalp nourishes the hair follicles, makes them healthier. And I have countless patients on it. Just over the past two or three years, there's been a real surge because there is a lot of data on it.
00:37:43
Speaker 1: What are the side effects of monoxidal? I think you can get some hair growth in other parts of your body with the monoxidal.
00:37:49
Speaker 3: Is that correct?
00:37:49
Speaker 1: Or Am I right?
00:37:50
Speaker 3: Yes? You know, you're absolutely right. So you can get that with topical and oral monoxidal. So the side effect is it may increase hair on your scalp, and it also can increase hair growth in your temples, your jawline, even like your arms. For a while I told people to sort of accept that as a side effect and then they can do laser hair moval or waxing, or they can use is derma flash and remove hairs. But the truth is, and I learned from my patients, I'm sure you do too. It's like the longer I've been doing this. It's like the patients teach me so much. Usually when we initiate a course of oral monoxidal, we have patients split the pill in half and take just one point twenty five milligrams for the first few weeks and then go up to the two point five milligrams and men sometimes you go up higher. But I have these savvy patients, and randomly patients would say, oh, I decided just to stay on the one point twenty five because I didn't like the increased hair growth I was getting, And now I have the great results still on my scalp that I'm not getting the increased hair growth on my on my face or on my arm. So I personally, now I just get a pill splitter. I did one point twenty five, which is habitab. It's a very low dose, but it seems to be efficacious and minimize that the increased hair hypertrichosis on the rest of the body.
00:39:00
Speaker 1: Next up, doctor Hall will break down the abcs of melanoma detection back in a minute. So can you give us a little bit like a skin cancer one oh one? What do we need to know about skin cancer? What are the common types of skin cancer.
00:39:31
Speaker 3: Skin cancer is the most common cancer diagnosed in the United States, and it's more common than even lung cancer and colon cancer and breast cancer all combined. It's also increasing not just in light skin individuals, but we're seeing skin cancers and people of all skin types. So really everybody needs to get checked. But what's most notable to me about skin cancer is the fact that we know in most cases what causes it. Okay, we know unprotected sun exposure causes about ninety percent of skin cancer, so it makes it also one of the most prevengable types of cancer because the skin is so visible. There's a real role for early detection. The skin cancer, like melanoma, when it's caught early, it's almost completely curable all the time. When it's caught and it's confined to the skin, and we treat that locally in our office under local anesthesia. Once the skin cancer invades deeper into the skin and develops potential to spread throughout the body, that's when the prognosis really changes. So the key is really educating the public wearing good sun protection and coming in to get checked, because early detection is really critical as far as the types of skin cancer. We usually break them down into melanoma and then non melanoma skin cancers. Eighty percent of skin cancers are actually basal cell carsonoma, which is a non melanoma skin cancer. Luckily, basal cells are generally not life threatening. They tend to be local growths. They might start to crust and bleed and grow on the skin, but they have a very very rare chance of spreading through the body. So mis cell carcinoma is the second most common, and that's also considered non melanoma skin cancer. Squay mis cell is the one most correlated with chronic sun exposure. So the more time people spend outside, as we live longer, as the ozone layer depletes, we're getting more sun exposure. So squay mis cell carcinoma occurs on sun exposed areas mostly, and squay mis cell carcinoma is usually curable too, but it does have potential to spread to lymph nodes, and so the key is really treating basil and squay mis cell when they're caught early, and that's done by a dermatologist and often with mose surgery, which is what my fellowship was in melanoma is the one that has potential to be extremely dangerous and why we really like people to come in to have that opportunity to detect it early while it's still completely curable. Unlike basil and squay mis cell, which occur more in people as they get older and they have more cumulative lifetime sun exposure. Melanoma is really interesting because there's a peak in young women so due to tanning habits and the fact that a lot of young women still continue to use tanning beds, and unfortunately the FDA is now making that more possible again after a big fight to try to legislate that people you know, going to the prom or people in college. Young women are still getting sunburned on vacations going to tanning beds. That directly increases your chance for melanoma. So it's different from the mutations we get from cumulative sun exposure, where you're getting the non melanoma skin cancers. It's the sunburns, it's the intense UV rays of a tanning bed. Those predisposed people to melanoma, which is potentially very serious, especially when it's not caught early. And interestingly, melanomas tend to occur on areas that are usually covered. There's obviously exceptions. Melanomas often occur on areas like the buttock or the trunk or the chest and back, areas that are usually covered with clothing, and then people fry themselves. They go to the Caribbean one week year and get a sunburn that is very damaging mutations in the skin, and that's where people get melanomas. So I'd say we can skip the more rare types of skin cancers. It's usually the non melanoma basal and squamous and melanoma, and that's the bulk of what we see as dermatologists.
00:43:25
Speaker 1: So you said that melanoma is usually they can't occur where the skin is covered up. So why is that? Why is it an inflammation? Is it a systemic thing that happens with the sunburn.
00:43:36
Speaker 3: It's interesting, it's because that skin is usually covered. So someone who may live in a temperate climate like New York and most of the year they're wearing clothing, and then that one week a year they go on Christmas break or spring break and they wear a bikini and they're in the sun and they're frying their skin and they're getting sunburns. You know, so it's like this intense sun burst we call it like it's like a burst of sun exposure, so that skin has no tolerance for that because it's been covered. People like farmers and sailors, people that work outside, they have so much sun damage and they get a lot of pre cancers, a tinic keratosis, they get a lot of squamous cell cancers. They don't tend to get as much melanoma. And it's really interesting. So it's thought that if your skin is exposed over the course of time, it sort of hardens and develops a sort of tolerance to sun exposure, so they get the less risky types. But it's the people that don't usually spend time outside and then fry their skin those mutations are a lot more dangerous, and those mutations on this otherwise protected skin lead to melanoma.
00:44:37
Speaker 1: At what age do melanoma's peak and women?
00:44:40
Speaker 3: So there are two peaks for melanoma. But the first peak is young women and it's usually women in their twenties and early thirties, so there's a significant peak there, and then after that, after about age fifty or sixty is when the rate of melanoma tends to increase as well as the rate of the non melanoma skin cancers, but the mortality rate is still higher in older males, so it's more common in young women. But maybe because women are more likely to notice the changing mole, you know, in new black spot on their skin, they may come in for early detection, whereas older men have the highest mortality for melanoma and likely because they're not getting their skin checked and maybe not noticing things as much.
00:45:23
Speaker 1: What do our listeners need to know about early detection and melanoma that can save their lives.
00:45:28
Speaker 3: So melanoma can occur in two different ways. One type is denovo, which is like a new spot on the skin that seemingly appears overnight. That is less common, but it can be quite notable when you see like a new black nodule on your skin or a black black lesion or a mole. But more commonly moles can evolve in a pre existing mole or a dysplastic nevis, which is a word for a typical mole. Those moles start to exhibit some signs that we call the abcdes of melanoma. A is for a symmetry. Usually a benign mole is symmetric, whereas a melanoma or a mole that's evolving towards melanoma, half of it may start to grow unlike the other half. B is for border irregularity, so instead of having a nice smooth border, it may have jagged or scalloped or uneven edges. C is color variability. A benign mole is usually light tan, light brown, dark brown, but pretty uniform and pigment, Whereas if you're seeing areas within a mole that are darker or even black or even white, which can signify regression, red blue. These are changes that are unusual, but you can see those in a mole too, So if there's variability in color, that can be concerning. D is diameter, although recently there's been a change because we've gotten much better at diagnosing early melanomas with a role of dermascovy special tools that we use. So it used to stand for diameter anything enlarging greater than about six millimeters, which is the size of a pencil eraser. But I'm part of a group that's trying to get that to change. D for darkness, because sometimes you're looking at an entire back and there's one mole that's just dark and jumps out of you, or like the ugly duckling the dark mole. So D is diameter or darkness. And then E, which is probably the most important, is evolving. So if you've had a mole a long time it starts to grow in size or change in color, change in border, that is a sign that it should be checked. If you notice something, and at the Skin Cancer Foundation we say new changing or unusual, So any of those things you should go see your dermatologists. Because early detection really does save lives.
00:47:39
Speaker 1: So should everybody get an annual skin check with a dermatologist or just people who are at elevated risk.
00:47:44
Speaker 3: So we tell people to get checked anyway once a year, and if you've had skin cancer, at least twice a year. But my personal opinion is everybody should do it after the age of eighteen. I recommend it for everybody, regardless of your risk factors or your skin type, should have a skin check because it is painless, it is the best screening test. It is very high yield. Because skin cancer is so common and there is such a role for early detection, as you alluded to, if you have certain risk factors, primarily if you yourself have had skin cancer twice a year at least. If you have a first degree relative so a parents, a sibling, a child who's had melanoma, you also should be checked twice a year. And if you have a significant tanning history, if you have two or more blistering sunburns or five sunburns at any point in your life, you should get checked twice a year. And you should definitely be open about the fact if you have used tanning beds, because it's thought that exposure to tanning beds as a youth increases your chance for melanoma by seventy five percent, and youth is defined as underage thirty five. So if you've used a tanning bed at all, you absolutely should get checked and your dermatologists won't shame you, but you should tell them that you had did use to use standing beds, because we know we needs to check you more frequently.
00:49:02
Speaker 1: You did say that the rates of skin cancer are actually rising right now, But yet I think are congnzant of using in sunscreen. Right We don't sit in this on and use oil, or at least most of us don't. Why are the rates rising? And is that melanoma that's rising are non melanoma skin cancers. Is this climate change? Why why are we seeing these rates go up.
00:49:24
Speaker 3: It's a great question and it does really puzzle as dermatologists because people now know what causes skin cancer. It's over an unprotected sun exposure. There's some thought that people are not really taking the message seriously, like you're right, like a lot of us are much better. You know, growing up, I too, and I hate to say it, but I too used baby oil and they used to seek a tan. And you know, many people have gotten a lot smarter, and we protect ourselves. But unfortunately, despite the fact that people know it causes skin cancer. And I should add ninety percent of the signs of premature skin aging are also caused by overexposure to the sun. So sometimes my patients who didn't care and they for some reason about the skin cancer, once they realize their wrinkles and brown spots are from the sun, then they take it seriously. But unfortunately a lot of people are still seeking a tan. We try to educate them. It's much safer to get a sunless tan for people who like to look tan. There are all these trends like at last year's sunburned art. We're trending like on TikTok where you put sunscreen just in a shape and you get like a tattoo with a sunburn. I mean, just like all these crazy things. And now that they aim to remove the ban on tanning beds in youths, you know, our current administration is passing legislation to get rid of those bands for youths using tanning beds. And probably to some degree, just to be fair, we're much better at diagnosing skin cancer and we're doing that a lot more.
00:50:49
Speaker 1: So for people who have more melanin or who have darker skin. Do they have different presentations of skin cancers? Is it more difficult to find them? Do they have higher rates lower rates? And just in particular in terms of cancers, what conditions are somebody who has darker skin more predisposed to.
00:51:09
Speaker 3: As far as skin cancers go, it's definitely more common to develop skin cancer if you have light skin, light hair, light eyes, easy freckling. You know that. We call it a Fitzpatrick skin type one that very fair skin. So there are six skin types as far as skin tone goes propensity to burn versus hands. So if you look at type six. You know African American very dark skin, unable to sunburn. You know those people. We also see skin cancer in as well, much lower rates in people with lighter skin. But what we do know is that because darker skin patients are not used to checking their moles or maybe not thinking about sun because they don't burn, they don't get checked as frequently or as regularly. And when melanomas are diagnosed in darker skin populations, they tend to be more aggressive and the prognosis is much worse. So we're really trying to educate everybody, regardless of your skin type, to get checked. I will point out a couple specific subvariants. There's a type of melanoma called acral melanoma or acraal lentigenous melanoma. Those occur on the souls of the feet and also less common but on the palms of the hands, and people with darker skin are at especially high risk for melanomas in these locations. Clearly, they're not just sun exposure, because the soles of the feet are not often exposed to the sun. There's some thought that, you know, the skin on the palms and souls of darker skinned individuals tends to be lighter and have less melanin so maybe those areas are at greater risk. But I often tell my patients that Bob Marley, you know, one of the greatest legend musicians of all times, he died of melanoma of his toe. He had a delay in diagnosis. The story is that he was a soccer player. It was written off as maybe a bruise. It was ignored until it was too late. But if it's not treated, you can die early. He was such a legend. Think of how much life he still had ahead of him. So that is when subtype in darker skinned individuals. We talked briefly before about sway to sell carsonoma and I mentioned sccs or squay mis cell carcinoma. They are definitely more common in light skin individuals that spend a lot of time outdoors, but we see them in people of all skin types with chronic sun exposure, and SCC in particular also can occur in other types of situations and scenarios, For example, a chronic wound. If someone has a non healing ulcer or a wound, that skin is prone to development of squay mis cell carcinoma. If someone has had radiation for another type of cancer. That area that was radiated is actually at a high risk for developing squay mis cell cancers down the road. And it's interesting because radiation can treat certain cancers very well, but there is a latency period and after about twenty years fifteen to twenty years, that field is prone to development of skin cancer, particularly squoay mis cell cancer. Lastly, and this is more in your line of work, but there is a type of squay mi cell carcinoma that's related to hp V virus, which is the virus that we screen for in perhaps mirrors of course cervical cancer. But HPV can also lead to squam a cell carcinoma. So that can occur in the external genitalia of women and men and also internally.
00:54:28
Speaker 1: So important too. I think to highlight maybe that when you're doing your own skin check, right, look between your toes, look at your fingernails and your toenails, right, because you can get melanomas in your nail beds. Also that may look like a little bruise, right, So something that's not resolving should always be evaluated correct.
00:54:47
Speaker 3: Absolutely, and you should check yourself and also get checked by someone who will look between the toes in the butt crack, you know, through your scalp and your scalp.
00:54:55
Speaker 1: Yeah right, yeah, right exactly. Looking forward to the future of your field, what are you most excited about?
00:55:03
Speaker 3: There are so many exciting innovations in our field, and so many that it's hard to keep up with. So I think instead of fearing AI, I'm trying to get excited about the improvement in the ability to diagnose skin cancers at an earlier stage and to really work like as an adjunct with AI, you know, so people worry or a they're going to take over. Now, I think that there is incredible advances in screening for skin cancers. And I think, you know, nothing right now is as good as like human eye holding a dermatoscope to help us look at lesions in conjunction with you know, devices and machines that help to map moles and they can tell if something's changing like before you may detect that with the human eye. So I think it's exciting that we're getting better. And then also molecularly, you know, there are there's a test now that's a tape test by dirm Tech where we actually can lift the RNA off the moles look for mutations that can be present in melanoma, and we're getting better at sort of like non invasive diagnostic technology. There's certain imaging devices that are getting better at looking at the skin. So I'd say I'm excited about the press of getting even better at diagnosing skin cancers. And of course there's so many amazing treatments for you know, immunotherapy has really completely changed the landscape of treatment of advanced melanomas. Dermatology is so exciting because the patient is so invested in their care. They want to come in, they want to talk about the changes they're noticing with declining estrogen levels with sun exposure, and there are so many great products and great devices that we can use to help patients look and feel better. So I would just encourage people to make that appointment with the dermatologists, get your skin checked, and don't forget the sun's free.
00:56:53
Speaker 1: What was the campaign protect the skin You're in That was like, yeah, ago, right, yep, And I really really really appreciate your time today.
00:57:01
Speaker 3: All the pleasures of mind that so much for having.
00:57:15
Speaker 1: If there's anything that we should take away from this episode, it's that our skin needs to be nourished and protected. The good news is that there's an endless number of options to do both of these things. Of course, sunblock is doctor Hale's top priority. Her recommendation is to apply every single day, and to make sure you're reapplying sunscreen every two hours when outdoors year round. Check the ingredients. Look for broad spectrum sunscreens with zinc oxide. Early detection of skin cancer is crucial. Consider scheduling your next appointment, especially if you have a personal or family history of skin cancer. We all want to look and feel our best as we age, and there are lots of treatment options out there that may help reduce fine lines and wrinkles. You might consider asking your dermatologist about adding a prescription and all to your skincare routine. It may help prevent aging of the skin and improve collagen production. I hope this episode left you feeling empowered about all the ways that you can take care of your skin. Whether you're just considering your first injection or deciding on a new moisturizer, just know that there are board certified dermatologists like doctor Hale who can help you determine the best products and treatments for your skin for years to come. Decoding Women's Health is a production of Pushkin Industries and the Atria Health and Research Institute. This episode was produced by Kalaliah. It was edited by Amy Gaines McQuaid, mastering by Sarah Bugaire. Our associate producer is Sonia Gerwit. Our executive producer is Alexander Garreton. Our theme song was composed by Hannas Brown. Concept and creative development by Shaban O'Connor. Special thanks to Vicky Merrick, Alan Tish, David Song, Boltzmann, doctor David Dodick, Sarah Nix, Jacob Goldstein, Leah Rose, Jordan McMillan, Morgan Ratner, Owen Miller, Eric Sandler, and Greta Cohne. I'm doctor Elizabeth Pointer. Thanks for listening and until next time.