3108: How the Dermatology Industry is Failing People of Color

Episode Transcript
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Speaker 1 (00:00):
I listened to The Black Guy Who Tips Podcast because
Rod and Karen are hot.

Speaker 2 (00:05):
Hi, Welcome to another episode of The Black Guy Who
Tills Podcast.

Speaker 3 (00:09):
I'm your host, Rod joined is always on my co
host Karen, and we are live on.

Speaker 2 (00:15):
A Wednesday, ready to talk to you about the world
and podcasting and life and all that good stuff. Very
special Wednesday because the switch to comes out, Yes it does,
and even though our economy is terrible, apparently everyone can
afford one because they were ran out and I don't
know if I'm gonna get one, and I'm afraid to go.

Speaker 3 (00:36):
Wait at midnight, yeah me for the game stop, So
I think I might not be getting one, guys.

Speaker 2 (00:43):
And of course the other reason this special day is
because I found out right before we went on the
air that they're making a sequel to the movie ma
I don't know if you remember this movie. Yes I
do not, really, I don't think it's considered a classic,
but I liked it a lot. I did too, and
so we got that greenlit. So it's just great.

Speaker 3 (01:03):
News is happening all over the place, and we're not alone.

Speaker 2 (01:06):
We have a guest, as you can probably tell from
either like the way we titled this episode later with
some cool, catchy pun or just from the show notes.
Today's guest is skin Expert driving evidence based education, advocacy
and enterprise in diverse skin tones, and she's here today

(01:27):
to discuss how the dermatology industry is failing people of color.

Speaker 3 (01:31):
Doctor Tia Paul. Hi, nice to meet you.

Speaker 1 (01:35):
Hi, very nice to meet you, and thanks for having.

Speaker 3 (01:36):
Me, No no problem, thank you.

Speaker 2 (01:39):
How long do you have to go to school to
become a dermatologist?

Speaker 1 (01:44):
So it is four years of undergrads, then four years
of medical school, and then four years of residency. That's
the beer minimum. But dermatology is one of the most
competitive specialties to get into. You know, it's very similar
to plastic surgery. So most people do another edition one
year or two years of research. So I had done
two years of additional research at Mass General. So in total,

(02:05):
it took me fourteen years to become a board certified dermatologist.

Speaker 2 (02:09):
Wow, oh my god, I had no idea. And what
exactly does a dermatologist do?

Speaker 1 (02:17):
So a dermatologist is a physician who specializes in treating
the skin, the hair as well as the nails. So
we specialize in both medical aspects of treating the skin, hair,
and nails, but also we treat cosmetic stuff. We do
a lot of cosmetic stuff as well. And in terms
of ages our patients, kids can be as young as

(02:39):
one day old to as old as, you know, more
than one hundred years old, because most of us we
specialize both in pediatric as well as adult dermatology.

Speaker 2 (02:49):
And then like when you're going to school for all
of that stuff, like, is it you knew the whole
time I want to be a dermatologist or is it
like generally I just want to do something with medicine,
and then it just kept going until you arrived at dermatology.

Speaker 1 (03:05):
Yeah. So my story is very unique because I'm also
an immigrant. So I moved to the States when I
was eighteen for college, and it's very very hard to
get into US medical school, especially if you're on a visa.
So but I always had this vision. I always knew
I wanted to become a physician, and I also had
this crazy vision where I always wanted to go to
Harvard Medical School, even knowing that the chances of doing
that is very very low on a visa. But I

(03:26):
was always very hard working and all of that so
it was when I finished college. That's when I took
the two years to do research, and then I applied
for a medical school and I actually ended up getting
into Harvard and I did a joint program between Harvard
and MIT. But even during all of medical school, most
of it, I didn't know I wanted to go into Durhams.
So most of us get an idea of what they

(03:47):
want to do during our third and fourth year of
medical school because that's when we rotate through every specialty.
We spent a month in pediatrics, a month in OBTI
in I knew I did not want to go into
obqi in. It was very stressful for me. But when
I went through the dermatology rotation, I was like, Okay,
I see myself doing this. You know, it's a fun
mix of procedures as well as medicine on a day
to day basis. So that's when at the end of

(04:09):
third year of medical school is when I decided to
go into Durham And But dermatology is very, very, very competitive,
so you have to like, I think I applied to
eighty different programs or something like that, and then I
don't know, if you're familiar in the United States the way,
you know, we end up pick going to our residency program.
It's not based on what we pick, it's based on
if the program also picks you. There is a math system,

(04:31):
so we will submit the list of schools we are
interested in. Depending on that, you know, we will get
an interview, We go interview there, and then we submit
our rank liss So we will say, oh, I want
to go to this school. That's my number one priority,
number two, number three, blah blah blah, and the schools
will also do the same, I want this candidate that candidate,
and then the computer system generates a match, and based

(04:51):
on that we get to decide which part of the
country we're going to go to.

Speaker 3 (04:55):
Wow.

Speaker 2 (04:55):
Yeah, Wow, that's you had to you were deciding this
stuff all along the way, like eighteen and then when
you get out of college and then or was this
like not until the last couple of years that you.

Speaker 3 (05:06):
Have to make that decision.

Speaker 1 (05:08):
Yeah, dermatology was in the last couple of years of
medical school. But you know, in the medical field for
most of us, like all our twenties just goes into
training like we I have probably sacrificed so many like
you know, family events, weddings or this or that, because
we spend all the time in the library, just like studying.
You know, during residency, it was very normal to have
eighty hour work weeks, and even for going into dermatology,

(05:31):
which is now considered more of a lifestyle specialty because
once we are board certified and once we have our
own practices and stuff like that, a lot of us
don't work over the weekends in terms of taking calls.
We're still working. I have my own private practice, so
I'm still always on. But my point is I don't
have to see patients over the weekends. But because we
typically we don't have emergencies, right But during our training,

(05:52):
we still had very rigorous training. I still remember being
called in the middle of the night to go into
the hospital because of you know, severe rashes that happened
to people who are very sick and they're admitted in
the hospital. I trained at University of Miami, which is
in Jackson Memorial Hospital, where there was a lot of
high rates of HIV and patients would come in with

(06:14):
like very low CD four counts. They were very, very
sick and they had these rashes from head to toe,
and deritology would be called in the middle of the
night and I would have to like show up there.
I still remember so many times going in at two am,
three am with my little biopsy kid and we would
do a biopsy in the middle of the night, help
the team out by telling, you know, what the patient
should get started on in terms of treatment in the

(06:34):
middle of the night. So yeah, it was a lot
of hard work that you know. Sometimes we have like
PTSD from those days. But then eventually, wow.

Speaker 3 (06:44):
Man, that's that's intense.

Speaker 2 (06:46):
That's more intense than I would associated with in my mind.
I think also in our lifetime we've watched like with
the advent of social media, I think when people think
about dermatology, they mostly just think about good like just oh,
looking good, makeup, you know, that kind of thing. And
to be like, yeah, HIV patients need help from a

(07:08):
dermatologist in the emergency room, Like this is not just
a uh, it's not simply about you know, looking good
or the beauty industry.

Speaker 1 (07:17):
No, absolutely, And I actually have a quick story about that.
So so at Jackson Memorial Hospital, oftentimes we would have
very sick patients who flew in from different parts of
the world and they would literally come to Miami Airport
and they would be brought to Jackson. And there was
a case which was over the middle of the weekend
that I got called into because this guy was very
very sick, like his lung was not doing well, multiple

(07:39):
organs were feeling and I looked at him and I
remember very like, this was a rare condition, this rash
that I saw. I was like, I bet I've read
about it during my my textbook and stuff. So I
ended up doing a biopsy and it was a very
very rare type of you know, uh an infection, cryptocopal
you know, infection. But we basically diagnosed it because you know,

(08:02):
I was called in, I did the biopsy and that's
where you know, we were able to find the diagnosis.
And then you know, of course the team did more
tests after our initial tests. But yeah, the fact that
DERM comes in in the middle of the akin and
help out. I know, most of my colleagues wo be like,
what are you even doing here? You should be getting
your nails done or something, but we do stop and

(08:23):
even in clinic, right like, yes, I do a lot
of cosmetic stuff for my patients too, but I also
am the one that's diagnosing melanoma. I cut out skin cancers,
you know, and I specialized in treating folks with darker skin,
and so many time times I've actually picked skin cancer
in darker skin because people think, oh, darker skin, there's
no way I'm going to get skin cancer, and they
just like ignore it. So I was trained at the

(08:44):
University of Miami and they're actually Bob Marley, he was
at Miami where he was diagnosed with his melanoma. So
he actually had a melanoma on his toe and he
kind of ignored it because he was like, oh, you know,
there's no way I can get skin cancer. And the
other thing is it's on the foot, like the sun
on the foot. But there is a type of melanoma
called acral melanoma where it's way more aggressive, and unfortunately

(09:07):
that's how he actually passed away. But that goes to
show that you can actually get skin cancer on darker skin,
and not just that the type of skin cancer that
happens on darker skin sometimes tends to be more aggressive,
or oftentimes because it's not caught early, maybe because the
patients are ignoring it, or maybe they went to a
place where they didn't catch it. Early. Oftentimes you know

(09:29):
you're picking it up a little bit later then you
would pick it up on lighter skin.

Speaker 3 (09:33):
Wow.

Speaker 4 (09:34):
Wow, I have so many questions for you, because because
me and Roger have been talking about this, I said, Okay,
I'm excited, so I'm going to actually seriously now they
might see random because I was just typing them down
kind of as they came.

Speaker 5 (09:47):
As they came.

Speaker 4 (09:49):
What was something that once you got out in the field,
you was like, school did not prepare me for this.

Speaker 1 (09:57):
Oh yeah, So there are so many different things I
can tell you. But that first year out of residency,
you know, when you're on your own, it's it's kind
of scary because you know this whole time, Like even
during residency, we see hundreds of patients, right, but anytime
we have a difficult patient, we have our attendings that
we go discuss those cases with, right, Like a rash

(10:18):
that doesn't seem the usual thing that you see on textbook, right,
you go discuss it with other folks. And then when
you're on your own during that first year, you're like, well,
I don't really have anybody to go discuss this with.
You know, in reality, you can discuss it with your colleagues.
So even now, you know most of us have like
either a phone message system or like you know, on
social media, like on Facebook. We actually have a group

(10:40):
called the Dramatology the boardst of our Dramatlogy group, so
when we have difficult cases, we will discuss them because
not everything is black and white. There are so many different,
rare things that can be very great. And the other
thing which a lot of time I feel like people
in general don't understand, you know, in some of these
medical conditions too. A lot of these diseases aren't not curable.

(11:01):
Like even acne, you cannot cure acne, eczema, you cannot
cure exima. These are conditions where you can, with the
right balance of maybe medications or even lifestyle choices, you
can keep them under control, but you cannot cure them
per se. But it was almost shocking to me, like
my first year out where the number of times I

(11:21):
have to like tell people that and remind people that, hey,
you know, I know you're coming to see me, but
I don't think I can cure your acne. We can
talk about getting it under control, but you probably have
to see me in follow up because acne is gonna
come and go, It's gonna wax and wan and things
like that, you know what I mean. So a lot
of these practical things I feel like you pick up
only when you're on your own. You're seeing your same

(11:43):
patients in follow up multiple times because it's so important
for us to see patients in follow up. That's how
I'm truly gonna get to know you versus like if
I meet you one time, there is only so much.
You know, we listen to your story, but there's only
so much we can come up with in terms of
treatment plan. We can start you on the most common
treatment plan that we prescribe for most patients, but we

(12:03):
need to see you and follow up to see if
that treatment plan is working for you. If that's not,
we move on to plan B. You know. And same
thing goes with skincare too. Not everybody needs to be
on a vitamin C and retinal. It's probably going to
irritate some folks skin you know, it has to be
very case by case. So yeah to slowing down listening
to folks understanding you cannot solve everything in one goal.

(12:26):
You need to like get to learn the person, get
to learn them over time. These are things you just
like learn when you're on your own, and they just
like practical things.

Speaker 2 (12:34):
You know, when you talk about the industry failing people
of color, the dermatology industry, in what ways does that
show up? And how did you become like aware of
that and you know, make that part of like one
of the things you would like to you know, I
guess speak out about.

Speaker 1 (12:53):
Oh man a lot, you know, And this is something
that has kind of like evolved throughout my career. Right, Like,
as a medical student, I probably picked it up, Like
I could tell that there was a difference, right, I
could tell that all our textbooks had these photographs of
folks with lighter skin, So exzema psoriasis like looks very
different on lighter skin versus darker skin. It's a different presentation.

(13:16):
Now things are changing a little bit. Now we have
textbooks that are coming out with emphasis and skin of color.
But it's a slow gradual change. But then in residency,
I also realized, not just in terms of diagnosis, even
in terms of treatment, right, there are certain lasers you
just absolutely cannot do on darker skin, like IPL, Like
every medspot has an IPL, but you cannot do an

(13:39):
ipl on darker skin because that can lead to like
hyper pigmentation, burns and whatnot. And so now my own practice,
which is in Newport Leachi in California, is very heavily
in on skin of color. And even yesterday I actually
had a patient that I've been seeing. This was the
second time I saw her. The first time she came
to me is because she got laser down somewhere else
and she developed really bad dark spots all the way

(14:00):
over her face. And this was like a well reputable
US place that she went to, so she trusted that place.
But I'm guessing maybe they just didn't feel less comfortable
treating people with darker skin because your settings have to
be different, so many things have to be different, right,
So then she came to me and very carefully, we
are treating her now with a combination of creams and
other lasers that are more appropriate for darker skin. So

(14:23):
there's a lot of difference for sure. And it also,
you know, kind of depends on where you trained, where
you live, like when if you're living like in Miami,
it's got a lot of exposure with different skin of
different colors, right, Like it's a very multicultural place. But
if you are in part of a country where you're
not getting that exposure, you're not going to be good

(14:43):
at a diagnosing like picking up the skin conditions that
can look different on dark darker skin and big treatment
because treatment is also going to vary, like even for
creams like tread knowing cream. We talk about, oh, tread
noin for acne for everyone on darker skin. Often treadnoin
will irritate your skin and it can make your brown
spots even worse by irritating the skin. So it's different.

Speaker 5 (15:05):
Can you get dandriff in your eyebrows?

Speaker 4 (15:09):
I've always wondered that, I know you've a kind of
an off the wild question, but I know you didn't
get any scalp, but I went, I was like, can
you get this in your eyebrow?

Speaker 3 (15:17):
Yeah.

Speaker 1 (15:18):
So there's a condition called sebric dermatitis, which is basically
dandruff on the scalp, but it can also present on
the face, and the classic distribution is around the eyebrow area,
around the nose area the years, and even sometime in
the chest area, So that's called sebric dermatitis. It presents
as like flaky patches or red patches, It can be itchy,

(15:41):
it can be very scaly, So you can see scaliness
even on the eyebrow area, and treat and wise. You know,
Ketoconsole shampoo, nyserol, you can get started with that over
the counter and if not, then you can see a
dermatolgist and we can give prescription creams. But you're absolutely right.

Speaker 2 (15:54):
How long have you been practicing dermatolity, like, you know,
out on.

Speaker 1 (15:59):
Your own after residency, so six years after residency, so
fourteen years of training plus six years.

Speaker 2 (16:04):
So in that twenty years, I feel like social media
would have had to like come through and like really
rise the prominence. And I feel like also like even
during the pandemic, with what we're doing right now, we're
all on camera with each other, but we're also all
probably looking at our.

Speaker 3 (16:21):
Faces, you know what I mean, Like you can't escape it.

Speaker 2 (16:25):
So like has that changed how the industry vieused dermatology
or the kind of work that's been requested of you
when it comes to this because of just how much
it seems like we're always all of us famous not
famous on camera or you know, at least having to
think about how we look.

Speaker 1 (16:46):
Oh, absolutely and I saw that, and I was kind
of in a part of that too, because I don't know,
you sorry about that if my camera went bloody for
a second. I was part of the whole experience too,
because I kind of started being more present on social
med on TikTok and Instagram, I think around twenty twenty one,
and so that was like a couple of years that
I've been out of residency. So yes, I would say

(17:08):
with the whole pandemic, everybody was kind of like, you know,
we had more time, right, So everybody, all of us,
we went on these apps, and partly it was for
fun and then for us as professional we also saw
it as an opportunity to speak to a wider audience. Right,
even if I see like hundreds of patients in clinic,
I'm still limited to hundreds of patients, but because of
social media, now I can reach to a million, possibly billion, right, So,

(17:33):
so on social media, what happened is, first of all,
like you mentioned, dermatology kind of became all about skincare,
and everybody kind of became skincare expert too. Right, even
right now, there's so many influencers. They're sharing their stories,
which we appreciate because it's important to speak out and
share about your experience. But there are pros and cons
to that. Right, If one particular individual is talking about

(17:54):
their individual experience, maybe those skincare products worked for him
or her, But it doesn't mean you can generalize that
for everyone. Right, It's going to cause side effects and
other things like that. And there are all these different
trends that are always trending, right, So whether you put
face tape or all these different things, again, everything has
pros and cons. But for a dermatologists, this is literally

(18:15):
what we do for a living. This is what I
do five days a week where I'm staring at people's skin,
but not just staring at people's skin. I am seeing
these people back in follow up to understand that that
nia cinema that I recommended, or the asalic acid that
I recommend it truly is it helping or not? And
I'm doing this with hundreds of patients, right, So that's

(18:36):
where the difference comes that for us, this is our
day job, our main job now because of our expertise,
Like you mentioned, a lot of skincare brands are super
interested in working with dermatologists now, right, Like when I
was in residency and all that it was not such
a big thing. And even for me, I have worked
with a lot of the leading brands, and not just

(18:57):
like in terms of talking about the products, but also
skincare startups. They want us to be part of their
advisory board because they are seeing the importance of having
us on it because from the practical things that we
have to offer, right. But I respect everybody's opinion, and
I think it's important to have a chemist on board
to dramatologists because we all bring our unique set of expertise.

(19:19):
But at the end of the day, you're gotta put
everything together right, not rely on one person.

Speaker 5 (19:25):
Right.

Speaker 4 (19:25):
What are trends that have happened, like you say, on
TikTok and YouTube and all these different places where you've
seen like people come in and you hear people you
have like a for you know, you have four, five, six, seven,
eight people all doing the same trend and you're like, oh,
there might be something wrong with this trend that you're
doing because it's obviously tanning up your face, messing up

(19:46):
your skin and all this stuff. Have you seen like
trends that people are doing like and then the consequences
of it. They're coming to you to kind of help
repair something that they've seen as a trend.

Speaker 1 (19:57):
Yes, so number one, I think the the biggest thing
we see literally every day is using too many products
on their face or like combining the wrong combination, right,
Like people want instant gratification, people want instant results, right,
and they think the way to get to it is
you add on, slap on ten different products on your face.

(20:19):
Most commonly, that causes your skin to get super irritated.
Your skin barrier gets compromised, so then your acne gets worse,
your exzma gets worse, and you know. And that's why
I appreciate when some content creators share their journeys of
things going wrong right from using some of the information
they see online. So that's just like not even like

(20:42):
a trend thing, but just like a very common thing
on social media that I feel like, especially young kiddos, right,
Like they don't need red nool at the age of ten,
but it's fun to fancy. And I almost feel like
some brands take advantage of that, like they want to
target that population, so their products are very colorful, very pretty.
I have a seven year old daughter. She loves you know,

(21:04):
looking at all these skin care products that I keep getting,
and she wants to try them because it's a bright
yellow bottle or like a purple bottle, you know what
I mean. But this is all marketing at the end
of the day, if you think about it, everybody just
wants you to buy stuff, right, how much of it
is truly in your best interest of getting you the
best skin I don't know, it's hard to tell, right.

(21:25):
But then there are also particular trends, like there's like
this one thing about not washing your hair often on
social media where recently I was said that you shouldn't
even if you have dander, if you shouldn't wash your
hair often. Again, might have worked for one or two people,
but for a majority of people, that's going to cause
overgrowth of east, going to make things worse. So it's

(21:47):
important to get some advice from social media, but maybe
diversify the content creators that you're listening to. Maybe listen
to some germs, listen to some you know, non germs too,
like people who specializes in different things.

Speaker 2 (22:01):
Is it a lot of pressure on you as well
to like maintain a certain like aesthetic because as a
dermatologist and in such like you said, yeah, you're on TikTok.
Is it a thing where people are like, I don't
want to go to her she had a pimple this morning?

Speaker 3 (22:16):
Or is it you know, or is like is.

Speaker 2 (22:19):
There a pressure to that or is it like you said,
where it's like a transparency or like behind the scenes
are like, hey, I get them to guys, that's all
calmed down.

Speaker 1 (22:28):
Oh my god. No, there's a lot of pressure. That's
just me being honest. Even like in clinic, especially if
I'm doing like cosmetic stuff and lasers and stuff, I
feel this kind of pressure to have clear skin because
I'm also my biggest advertisement. So even I'm talking about
I forget about social media. Even like folks that are
coming to see me in clinic, they could be coming
in for a skin check for molds or something that's

(22:50):
completely different from cosmetic stuff, but they end up seeing
my skin and they're like, Wow, your skin seems so smooth.
What have you done? And that, you know, leads to
like a whole different converse, right, So from a clinic standpoint, like,
there's that, but then also I work with a lot
of skincare brands, including brands like reputable brands like Sara
vi Laroche pose where they don't want to when they're

(23:11):
taking our photos and stuff like that. They don't want
to alter the images. They don't want to photoshop it.
They want to have real skin, right, and they never
force us in any way to like maintain clear skin.
They just want it to be natural but internal. For
me and myself, I want to make sure that my
skin looks good, especially if it's going to be like
not photoshopped. And I appreciate that. That's why I like

(23:33):
working with Sarahvio large perse because I know that things
are clean and authentic, right, and that's how it should be.

Speaker 2 (23:40):
No, that's cool, That's that's I just like something to
think about in this day and age of the internet.

Speaker 4 (23:45):
It is what are the most common skin conditions conditions
that you see in adults in all different.

Speaker 5 (23:53):
Skin tones, just in all different skin tones.

Speaker 1 (23:57):
So in adults, I think the number one thing it
comes down to its effects of sun damage, So chronic
sun exposure. I think we forget like when we're in
our teens and twenties, pretty much all of us have
pretty good skin. That's why sometimes when I see, you know,
a content creator or beauty content creator or influencer talking
about really good skin, and they're like in their early twenties.

(24:18):
I'm like, I have a lot of respect for you,
but you're in your twenties, right, You're meant to have
very good skin. Later on is when the signs of
aging starts showing. So it can be as simple as
getting a lot of brown spots in all different skin tones.
So brown spots, I would say, it's inevitable. It's not
a question of if. It's a question of when we
are all going to develop that our skin is looking

(24:39):
more dull and coarse and fine lines. These are just
like normal parts of aging. I always say, it's actually
a privilege that we get to experience that. Yes, but
you can take care of it. At the same time,
you should be proud of it, you know what I mean. So,
but I would say those are just common concerns I
see in clinic pretty much every day. But in terms

(24:59):
of skin conditions, common conditions are like eggzima because our
skin also gets drier as we get older, so we
can get like very non specific like dry itchy patches,
which is like eggzema acnique and even happen in your
adult life. Even if you've not had it in your
twenties and thirties. So many times I have folks that
are in like their fifties and they're like, I've never

(25:19):
had happen in my whole life. Why am I getting
it now? And to be honest, there's no answer to that.
Because of hormonal changes and it just like happens skin cancer.
That's another thing that we see a lot in clinic.
But yeah, but it's fun, you know. I honestly like
I consider it a blessing to do what I do
because every day is so different. Like I'll come look

(25:41):
at my schedule. It could look like, oh, I have
like five different skin checks in a row, and then
the next thing, you know, some of these patients also
start talking about cosmetic concerns. So it's like a nice
mix of things. I'm cutting out skin cancer in the morning,
in the afternoon, I'm doing complete lye It's completely different,
maybe like a laser or something like that. So every
day is very different.

Speaker 4 (26:00):
Are some things that actually I don't say specifically, but
have a tendency to affect darker skins more Because I
know you Your question was like, well, is there a separation?
And I was wanting to do the generalized one, but
then I was like, well, then what is something that
you see have a tendency sy more in darker colored skin?

Speaker 1 (26:18):
Man, the number one thing I would say is hyper pigmentation.
Are dark spots Like I'm sure you guys can relate
to this. If we get a pimple, I could care
less about that pimple. That pimple is going to go
in three or four days. That brown spot is going
to stay for four or five months. Yes, with a
bug bite, the bug bite, the itchiness and all that
is going to go away, but the dark spot is

(26:39):
going to be a reminder for many, many months. So
I would say that's like the number one thing we
see for whether because of the sun directly like sunspots
and stuff, or because of some underlying condition like acne, egxemma,
bug bites, they all resolved with what we called post
inflammatory hyper pagmentation, meaning that after all that initial inflammation

(27:00):
on the skin or the initial irritation on the skin,
that then heals with that discoloration. So you might hear
this word called p i H. P i H means
post inflammatory hyperpigmentation, which essentially means that after any sort
of an initial insult on the skin. Your skin is
healing with that discoloration, and again it's it's normal. That's
just we have done in and that's that's normal. But

(27:23):
it bugs people, you know.

Speaker 2 (27:26):
I noticed also you uh describe yourself as you know,
evidence based, having an evidence based education.

Speaker 3 (27:34):
Is that a big fight now?

Speaker 2 (27:36):
Because I feel like so much of what the world
is right now feels like evidence and education and stuff
is just under attack, Like expertise is under attack, and
it's like vibes, you know, we're just going by vibes,
especially in our country right now. It's like, you know, hey,
put somebody in charge of health services and they're just
kind of going on vibes and I'm like, I don't
know there expert professionals, you know, So like, is that

(28:00):
a thing you're experiencing in your line of work? Are
people coming into your office under the guy, you know,
with either misinformation or bad information that they're getting from
other sources.

Speaker 1 (28:12):
Yeah? No, absolutely, you know, I feel like that's there
all the time. But like, no matter what you say,
you know, even I've seen some of my videos, no
matter what you say, you are gonna get hit with
people who disagree with you, right, And no matter what
the statement is, right, Like it could be like the
sky is blue and somebody could be like, no, the
sky is not blue blue, it's light blue or something

(28:33):
something like that. Right, And now what happens with evidence?
And I understand in skincare the tricky part is some
of the stuff there is no strong evidence, right, but
we make our recommendation at least based on maybe studying
a larger sample size, right, versus a lot of the

(28:53):
recommendations you see on social media. Again, could be a
personal sample size of one personal experience only, and then
that video goes viral like billion views or something, and
all of a sudden that seems like a more real
thing then the other stuff. That's like, you know, truly
at least backed up by evidence, but it's a very
like a gray area. It's very hard to like say
what's right, what's wrong? But at least from us, you know,

(29:16):
that's what when I'm talking to my patients, the way
I describe it is like I can only tell you
based on what's been studied, but there's so much that
has not been studied, Yes, and that those are the
gray areas, right, Like you know, the analogy I give
is also like a lot of like skin care and
procedure in pregnant patients, right has just not been studied,

(29:38):
so by default we say it's better to avoid those, right,
same thing in real life, you know, if something has
not been tested enough, it's hard for us to safely
recommend that online.

Speaker 3 (29:51):
Yeah, I think.

Speaker 2 (29:52):
I think also like with it being such a like
a seller this market, like if there's an economy behind
a lot of stuff, so like to me, you almost
have to be a little skeptical of where you get
your information because you may have people that are like, oh,
this lotion works for everybody one hundred percent of the time,

(30:15):
all skins, no matter what the condition is.

Speaker 3 (30:16):
It cured me of cancer.

Speaker 2 (30:18):
I got to And they may just be trying to
sell it. And I'm thinking hopeful, you know, as a
person that watches them, like, oh no, this is their
experience and this is just life. But you don't really know.
So like maybe I think, you know, being able to
go see a doctor in real life or whatever feels
like a more pertinent thing, even if it is something
that just is individually anecdotally affecting me. At least a

(30:40):
doctor that I'm going to see on a regular basis
or whatnot so on with some expertise, like we can
figure this out together, as opposed to a person on
the internet who, as you said, could just be talking
a singular experience or literally just be selling me something.

Speaker 1 (30:54):
True. Yeah, it can be very very tricky, you know,
and even ipholl for that stuff out I said skincare right,
when I go on TikTok, I end up buying all
this other crap in thirty days. I'm like, this was
purely you know I should.

Speaker 3 (31:08):
That's how they get you too. Yes, that's how they
get me too.

Speaker 2 (31:11):
I have so much stuff in my house where I'm
just like, man, these are whatever it is in these
cookies that I keep accepting on these internet.

Speaker 3 (31:19):
Websites, it is following me very accurate.

Speaker 1 (31:22):
They're like listening to everything you're talking, right, I feel
like I'm talking to my husband about something and next thing,
you know, the product like pops up on your Yeah.

Speaker 3 (31:30):
Oh yeah, I'm for sure getting some.

Speaker 2 (31:33):
I'm gonna get some skincare ads soon as we get
off this podcast.

Speaker 3 (31:36):
Oh yeah, you got act.

Speaker 1 (31:40):
Exactly exactly.

Speaker 4 (31:43):
What are some of the most common I guess I
would want to say, aeroso mistakes that you see parents
make with children, because I know you say you've seen children,
but you know when they first born, you know, and
things like that, like what are some things that you'd
be like you, I don't think you should do this,
or maybe they need to do more of this, like
because you know, children's skin when it wornt are very sensitive.

Speaker 1 (32:05):
Right, right, So the number one thing is against still
like the whole sunscreen thing, you know, because because I
see this every single day. There is so many things
that people complain about later on in their life, whether
it's brown spots or if these pre cancer things you know,
like rough, crusty things, or it's wrinkles, or it's like

(32:29):
so many things they can easily be if not prevented
one hundred percent, but you could see less of that
if we are good about sun protection. But from a
very early on stage in your life. Right, I'm guilty too.
I grew up in India. I did not wear sunscreen
the first eighteen years of my life because it wasn't
a thing there, you know what I mean. But now

(32:50):
I would say that at least for my kids, I'm
pretty good about making sure they're truly wearing sunscreen, but
no sunscreen is one hundred percent effective. You still have
to be mindful when you're out in the sun during
the peak hours of ten am to four pm, even
if you're putting on sunscreen every single hour. But they
are in the crazy sun, they're getting toasted, you know.

(33:14):
So it's a balance. I'm not saying, you know, restrict
your kids from having fun, but it's a balance. And
if you're truly seeing them getting bad sunburns, then that's
a clear sign that you gotta slow down. Your sunscreen
is not being as effective or you're just spending way
too time in the sun, because that damage might not
be showing at the age of ten, but it will

(33:35):
force sure show up on your skin at the age
of forty or fifty or whatnot.

Speaker 2 (33:39):
Yeah, I definitely remember the first time I found out
black people could have.

Speaker 5 (33:43):
Some burn me too.

Speaker 3 (33:44):
I was shot. Yeah, it was because it happened to me.

Speaker 2 (33:47):
I feel like I feel like every black person finds
out the same way.

Speaker 3 (33:51):
It's just you look up one day and go, what
is this? I just got really dark?

Speaker 5 (33:57):
Right for me? I don't think I got.

Speaker 3 (33:58):
Some burn, but I got I definitely got I got
what's dark.

Speaker 5 (34:01):
I was like, oh my gosh, I am really baking
out here.

Speaker 2 (34:04):
I got sunburned and I peeled and everything. Oh no,
yeah it was sore, Yeah it was I was. I
honestly got I would have if I would have failed
every lot of tech to test that, they would have said,
can black people get summer? I feel like, of course not.

Speaker 4 (34:17):
I know.

Speaker 2 (34:18):
So are there myths or misinformation or things like that
that you see out there that affect people like that,
because I know I definitely fell victim to black people
can't get sunburned?

Speaker 1 (34:30):
Yeah, no, one hundred percent. Like the whole concept of like,
oh we have melon in our skin, we are protected.
I mean, there is a little bit of protection, but
it doesn't mean, you know, we can go take full
advantage of being in the sun, because yes, you're still
going to get the same consequences of too much sun exposure,
which is whether skin cancer or even you know, early

(34:50):
signs of aging somehow. You know in clinic, it's funny
if I tell people or wear sunscreen to prevent skin cancer,
I feel like that doesn't work as well as if
I tell people, Hey, where your sun screen? You're going
to be spending less on cosmetic procedure later on in
your life. But you're going to get dark spots later on.
That works way better. Wow, It's a long term investment
into your skin if you want to be spending less

(35:11):
money on other stuff later on in your life.

Speaker 3 (35:13):
We are a vain society, so that does make sense.

Speaker 2 (35:17):
It's also funny too because I feel like as a
black person is it works both ways for us, where
like there's a pressure to be like black.

Speaker 3 (35:25):
Don't crack, Black don't crack.

Speaker 2 (35:27):
So like you, you know, you're like, I don't want
to fail everybody by my skin falling apart when I'm
or whatever.

Speaker 1 (35:32):
So yeah, and then it becomes an emergency once you
start seeing those signs. Then you're like, okay, don't fix it.
What can we do? Fix it now? And you have
to be also careful. You know, you can't just fix
everything all at once. If you're going to do all
these procedures, be careful, go slow. So it's like anything
in life, there is a fine balance, and prevention is
so much better than like trying to treat.

Speaker 5 (35:54):
Stuff, right, is it hard?

Speaker 4 (35:58):
Because I know you treat all types of skin canitions
and some of them probably I'm just assuming can be
amplified with like makeups and creams. Have you ever had
to tell a patient, ay, you might have to go
up period of time without putting anything on your face
in order for whatever I'm you know, me telling you
to do to clear up. And you got somebody who

(36:18):
wears makeup all the time kind of fighting you, and
you're like, well, it's gonna take twice as long and
might not clear up.

Speaker 5 (36:24):
Like I'm telling you this because I actually want your skin.

Speaker 4 (36:26):
I'm concerned about your skin, not concerned about not trying
to find of how the world views you type of thing.
Like I'm for the bitterment of the patient, and like
I got to know they has to be difficult to
kind of fight against somebody when you know, because particularly
as women, we're taught we'll make up, you know, cover
it up and all that stuff.

Speaker 1 (36:47):
Yeah, I know every day. Again, So my goal when
I'm taking care of my patients, whether if they're coming
in for acne or egg amount on their face, or
if they're coming in because of you know, cousebody concerns
and they want to look you know, good for their age. Right,
the number one goal I tell people is I want
you to get to the point where you don't feel
the need to wear makeup. I want you to get

(37:08):
to the point where you're just wearing tinted sunscreen, because
right now all I'm wearing is tinted sunscreen. I can't
want that. I just came straight to the gym. I
didn't realize this was a live thing, so I was like,
you know what, I'll just so I came from the gym,
I changed my top, and I'm like, literally here with you.
But that's the whole goal, right to wear minimum makeup
because it's been known that if you're struggling with things

(37:28):
like acne, makeup can clog up your pores and it
can make your acne way worse if you have eggzima,
same thing, some products, some preservatives, and your makeup can
cause the skin to get more irritated and it can
make things worse if you have roseatiha, another indicator of
very sensitive skin. Same thing. Too much makeup can can,
you know, make things get worse. Makeup to me is

(37:49):
like in a way suffocating your skin, you know. And
that's why even for me, when I do put on
any makeup, I can't wait to take that makeup off
at night before I go to bed, and maybe back
in the day I used to go to bed with
makeup on, but now I'm like, oh my god, it's
like going to bed without brushing my teeth right, Like,
it just doesn't feel right. It just feels very dirty
and it just does not feel right. But yes, makeup

(38:12):
can definitely make things worse. The goal is to wear
less makeup and be proud of your skin, be proud
of you are.

Speaker 2 (38:20):
Should people wash their legs in the shower? Because that
was a big debate on Tiptop. That was a trend
last year, and I'm I'm team wash your legs in
the shower. I'm just more of a like, if you're
in there, you might as well try to wash it all.
But I did see some people try to make some
arguments that we maybe just the water would just trickle
down to the legs and they clean themselves. Well, is

(38:41):
there like any dermatological opinion on this.

Speaker 1 (38:46):
On washing your legs?

Speaker 3 (38:48):
Yes, should people wash their legs in the shower when
they go take a shower.

Speaker 5 (38:51):
That was a trend and people actually arguing about that.

Speaker 1 (38:54):
Oh I would safe wash it, you know, maybe I
like it did not pay attention to this trend. But
like for we see so many like problems such as
like ingrown hair in between your legs or you know,
there are certain conditions that can happen because of overgrowth
of bacteria. And because it's important to note, we all
have healthy bacteria that lives on our skin. We have

(39:15):
healthy easts that live on our skin. But the problem
happens when there is an overgrowth of stuff right where
that balance is screwed up. So and you want to
maintain that with good hygiene. That goes down to like kindergarten, right,
So you want to keep things nice and clean. Yeah,
you never want to overdo it, like you don't have
to keep scrubbing your skin three times a day and

(39:36):
take multiple showers and dry out your skin. No, it's
about a balance. But at the same time, you get
to clean it when it needs to be cleaned.

Speaker 3 (39:43):
That's what I thought me too.

Speaker 4 (39:46):
For somebody that has eczema, what is a good soap
for them? You know, because I know that's kind of
a sensitive thing and I know for some people they
have a hard time because it's so much done.

Speaker 3 (39:57):
Is it just one soap? Is it a thing?

Speaker 4 (39:58):
Like?

Speaker 2 (39:59):
Oh yeah, because a matter of fact, can let me,
I mean to change your question, go ahead, but when
should people see a dermatologist versus just like, oh, let
me just ask someone what self should I use?

Speaker 3 (40:11):
True?

Speaker 1 (40:12):
Sure, I mean you can always look. Not everybody have
access to dermatologists, and not everybody has intury pay for it,
so I'm very mindful of that. I would say that
it starts with simple things like what we call sensitive skincare,
so sensitive skincare meaning it means pretend your skin is
like a baby's skin.

Speaker 3 (40:31):
Right.

Speaker 1 (40:32):
You want to avoid things like too much perfume or
too much fragrance in your skincare products because that's been
shown to make your skin flare up or get worse
if you have sensitive skin. So finding a body cleanser
or a soap that's meant for sensitive skin that's free
of fragrance, that's an important step. Personally, I like brands
like there's a brand called Vanny Cream VA and I

(40:55):
Cream and Cream that most dermatologists recommend for folks with
exima or sensitive skin. I do like Sarah v Cedaphil.
These are just, you know, good. It doesn't have to
be a fancy brand, but these are good over the
counter brands that does a great job in terms of
taking good care of your skin, but it's concepts like

(41:16):
moisturize your skin. The number one cause of itching or
rash or redness or irritation is when your skin is
super dry, no matter how much water you drink. You know,
this is another misconception. People think, Oh, if you don't
drink enough water, that's what causes dehydration of the skin.
While there's a correlation like if you don't drink enough water,
you could be dehydrated, yes, and that could manifest on

(41:38):
the skin. He's drinking his water now. But no matter
how much water you drink, you still have to moisturize
your skin because that's like food and drink for your skin.
So not moisturizing your skin enough, using the wrong moisturizers
or something that has fragrance in it. And then the
third thing that can make eggzema worse or sensitive skin

(41:58):
worse is taking hot showers. I am guilty of.

Speaker 5 (42:02):
That me too.

Speaker 4 (42:03):
I'm like, oh, I want to take a loopwarmwer y'all
you come in there.

Speaker 5 (42:07):
You think the building all fine? I mean, like the
hot a the better. What is we doing here?

Speaker 1 (42:12):
That is where I feel like sometimes I am personally like, oh,
I told five different people this morning in clinic not
to take hot showers, but you know, my steam is up.
But I know right after that at night, when I
take a hot shower, I go crazy scratching my skin
because my skin gets dry, right, And not just me,
I see my husband with that. I see patients. They're like,

(42:33):
you know, doctor Paul, my skin is the worst at
night when I'm trying to go to bed, And I'm like,
do you take hot showers before going to bed? Oh? Yeah,
how do you know. I'm like, that's exactly why it's itchy,
because you're taking the hot shower. Your skin is getting dry,
you're not moisturizing. And then at the end of the day,
you know, we are relaxed during the day, we're busy, distracted,
not busy scratching our skin. At the end of the day,

(42:53):
you know, finally our mind is a little calm. And
once you start scratching your skin in one area, your
body sends out all these signs and its wanting to
scratch all over and then you go crazy scratching your skin.

Speaker 2 (43:04):
Yeah, hot showers Karen does. She likes lava setting you know,
like one maybe one degree below lava like whatever won't
set you on fire.

Speaker 3 (43:14):
One degree below that, So I hear you. Uh, But
I also like when you.

Speaker 2 (43:20):
Say like moisturize, are we talking like you get out
the shower.

Speaker 3 (43:23):
And I know when I was a when I was
a kid, there's no way this was right.

Speaker 2 (43:28):
But whatever, maybe I'm wrong, Maybe I'm wrong. I didn't know,
but they there's people that just put vasoline on your
like face, And is that a good good thing to do?

Speaker 1 (43:40):
Oh yeah, that's that's a that's a thing that was
trending on social media for a while. So it's called slugging.
I actually like that one, Okay slugging. Slugging basically means
you're putting like a layer of vasoline or something greasy
to kind of help lock in the moisture. And you know,
you can put on some moisturizer and then put a
thick layer of vascline. The whole idea is, you know,

(44:01):
you're absorbing all that moisture into the skin. Yeah, and
some people swear by that, you know, like aqua ward
to another thing. You know, you could put that all
over you just have to be careful. Two things. One
is if you're prone to our clogged pores or sometimes
you know it's called milia that is like little white
bumps that can happen around your eyes. If you're prone
to that stuff, you don't want to put an occlusive
such as vacline because that's going to clog up your pores.

(44:23):
So that's number one. And number two is if you're
using active ingredients like retinol and all that stuff, you
don't want to slug after that. You don't want to
put vacline after that because that's going to like make
your retinol go inside your skin and irritate your skin more.

Speaker 3 (44:37):
That makes sense.

Speaker 4 (44:38):
What do you think about the Korean skincare trend? Everybody go,
I won't glassy skin out thought it looks pretty, but
I mean, I don't think in real life my skin
is supposed to blind everybody.

Speaker 1 (44:52):
Yeah, So while I love Korean products, and I feel
like Korea has done a great job with skincare products
and also proceed all of the you know, they're all
like tested out there, are very popular there because I
think Koreans are just very into skincare and good skin health, right,
so I definitely value that, and you know, I work
with skincare startups that will literally go spend some time

(45:13):
in Koreer just to learn about the whole skin held there.
But this glass skin, don't even get me started. Because
and you guys can vouch that it depends on your lighting.
It depends on what type of light you have in
front of your skin. It depends on how much oil
based moisturizer you're using and the right reflection of light. Right,

(45:34):
that's it. When I'm seeing people in clinic, even the
folks with the best skin, nobody is coming in with
glass skins.

Speaker 4 (45:41):
Right because I'm like, I don't see people in the
street with this skin.

Speaker 5 (45:44):
Like, I'm like, I only see it online. I was like,
this doesn't make sense.

Speaker 1 (45:50):
It's ridiculous. Have you ever seen babies with glass skin
and they have the best skin on earth?

Speaker 3 (45:55):
Right? Right?

Speaker 4 (45:56):
Right?

Speaker 1 (45:56):
We don't they have good skin. There is a concept
of clear or like, there is no such thing as
perfect skin. There's healthy skin, but there is no such
thing as you know, pure glass skin, you know. But
you know, I think we loosely use that terminology to
talk about, you know, smooth skin, and there are care
products skin that can help achieve that. But you do

(46:20):
want your skin to be like glass? You want your
skin to be like skin?

Speaker 2 (46:23):
Yeah, do you ever see like Well, two questions first
is is there like a difference in the number of
like men that come in versus women that come in
for skin care, because I think, especially with it being
attached to like a lot in people's minds, a lot
of people is attached to like beauty, and I think

(46:44):
a lot of men don't necessarily want to like be
upfront about like I'm very concerned with how beautiful people
perceive me as you know, as opposed you know, at
least not in public.

Speaker 3 (46:54):
But I don't know what they do with that doctor.

Speaker 2 (46:55):
Maybe everyone's going to the doctor, they're just not talking
about it.

Speaker 1 (46:59):
I've definitely seen a pretty big trend where men are
actually secretly very much into this stuff. In fact, in
my clinic, I have a lot of men that are
in pretty executive positions and stuff like that who come
in for all these lasers and micronailing and all these
procedures pretty regularly, probably even more than women. And in fact,

(47:21):
I was actually having a conversation with my husband the
other day, I was like, maybe I feel like women,
we are more conscious about the budget, and we think
more about the price stack because these things can be expensive. Yes,
they can look like guys are like it seems like
some of them don't care. Well, then I have this
hypothesis is maybe because you know, for women, we also
spend so much on our nails, our hair, like yeah,

(47:42):
down things, different things, right, But my point is no,
a lot of guys are into this stuff, but they
are the ones who are not going to talk about it.
If I ever asked them if I can share that
before an actor on social media, the answer typically it's okay,
which is fine, you know, I'm okay, But then it's
totally fine. And my husband too, well, my husband, he

(48:03):
doesn't have a choice. I will share his wayfore and after,
but I can't tell secretly he loves it because he
my husband has a lot of acne scars and he
has darker skin. So it's very very tricky when you're
treating acne scar for darker skin because a lot of
the lasers, a lot of the devices can easily cause
what we call hyper pigmentation or dark spots and stuff

(48:23):
like that. So we have made a lot of progress
and now his skin is starting to look very good
and I can see secretly he like loves it. He's
not going to talk about that and tell his friends
and family and all that it's me talking about it.
I'm like, look at his skin, how much does improved?

Speaker 3 (48:37):
Or like other people?

Speaker 5 (48:38):
I think.

Speaker 2 (48:38):
I think also part of that is just how men
are friends. Like I was thinking of a joke the
other day I did I just didn't say on the shelf.
But it's like, uh, men tell each other stuff that's
very revelatory, but it's too late and they act like
you already knew, so it'll just be like, yeah, you know,
I was at my kids graduation. It's like you gotta

(49:00):
we haven't talked talked about ten years. So I wonder
if that is, you know, because like something like a
self care routine is more of an almost every day
thing as.

Speaker 3 (49:14):
Opposed to like just I got a kid thing or whatever.
But I feel like men don't do a good job.
We don't.

Speaker 2 (49:20):
We don't do a good job in our friendships are
talking about stuff like that.

Speaker 3 (49:23):
I have a friend Justin.

Speaker 2 (49:24):
Who always like it sticks out to me because he
is the one who's like, man, we need to go
get our feet done, dude.

Speaker 5 (49:30):
We got been asking you about that right right right?

Speaker 1 (49:33):
Yeah, I can't imagine you know, bunch of girls getting together.
We're like, your skin is looking great right now, like
what are you doing? Yeah, I can't imagine guys being
like your man, right.

Speaker 5 (49:43):
What products you.

Speaker 1 (49:48):
Didn't notice or not or maybe like you know this,
you just don't like talk about it out loud.

Speaker 2 (49:52):
Yeah, yeah, No, it sticks out to me the times
that it does happen, because just because it's rare and
it does happen.

Speaker 3 (49:59):
You know, depending on your of friendships.

Speaker 2 (50:00):
I had friends that'll be like, oh you are what
do you use a face You never use a face
mask or something like that, and I'm like, oh, yeah,
now we're talking about it. But yeah, it's just it
is not an often thing. And and like you said,
I've heard that conversation many a time with women where
it could be two stranger women like they don't even
they don't even know what the default is for each

(50:22):
other's skin, like for them to be like, girl, what
you do?

Speaker 3 (50:25):
Okay, I'll see you face.

Speaker 1 (50:29):
Your story right, Like I'll go up to the grocery store,
I'll go up to random places and I'll have folks
that will come up to me like Wow, your skin
looks so good, Like, what do you do?

Speaker 4 (50:36):
You know?

Speaker 1 (50:37):
I don't think I can ever even if a guy
has like the best perfect skin, I can't imagine people
like going up to them and be.

Speaker 2 (50:43):
Like, what you're doing?

Speaker 3 (50:44):
I'm gonna start it. I'm gonna start Your skin is gorgeous?

Speaker 4 (50:51):
Yes, yes, what is uh the simplest skincare routine for
most people?

Speaker 5 (50:58):
I know?

Speaker 4 (50:58):
Like that moisturize, exfoliate, like cleans, like I don't some
of the basic stuff, but what is it?

Speaker 1 (51:06):
You go?

Speaker 4 (51:07):
These are like the things that are like you need
for most the foundation of most like just basic skin
care needs.

Speaker 1 (51:15):
Yeah, so I just say the three essential steps are
number one cleanse, number two moisturized. Number three, uh, soundscreen,
which is protection.

Speaker 5 (51:24):
Such.

Speaker 1 (51:24):
Okay, if you really want to like add stuff, give
me one second. I'm gonna pull up something. Okay, Okay,
I'm actually at my clinic. So I just saw this.
I don't know if you can see this or read this,
but this is basically when I'm recommending stuff. So number
one step is always cleansed. Number two can be treatment.
So treatment is going to be very targeted based on

(51:44):
your individual problem. So if you have acne, you want
to use a treatment serum like a silicilic acid serum
that's gonna be meant for acne. If your issue is
not acne, if you're trying to target uneven skin tone,
then maybe you want to go with something like vitamin C.
So that treatment, that serum should be very, very targeted
with what we call active ingredients. That means ingredients that

(52:06):
are specifically targeting a skin concern. And then again number
three is moisturized. Number four is the sunscreen. Same thing
at night. All you gotta do is cleanse. If you
want to add the treatment step, make it the next step,
but again make it targeted, not just what you're hearing
on social media. And number three is moisturized. And then
a couple of times in a week you can end

(52:27):
up exfoliating your skin. So exfoliation can be okay, can
be good. I mean I do exfoliate my skin, but
not every day, because if you overexfoliate your skin, especially
in skin of color, you can cause too much dryness
and too much irritation of your skin to the point
where overexfoliation can compromise your skin barrier. Because our skin
is like you know, we have these bricks and motor

(52:49):
that is protecting our skin from the outside environment. If
you're using too much exfoliation, that border, that skin barrier
is no longer protected. Its compromise the gaps in it,
and so now you can easily get irritated from like
another skincare product, like a retinol or something that you're
using on your skin. Right, So this is also why

(53:10):
less is better. If you're exfoliating, exfoliate couple times in
a week, not every single day, and you just listen
to your skin. You know, every every month, your skin
might be acting different. So your skincare routine might need
to change every month every depending on you know, the
place you're traveling to. You know, my skin acts differently
inside of California where I live versus when I go

(53:31):
to Florida. It's it's a different temperature. Your skin is
going to be different.

Speaker 2 (53:34):
Does skin bleaching affect people's skin and like does it
do or have you ever had to even work with
someone that had like either damage from skin bleaching or
their goal was it like bleach your skin.

Speaker 3 (53:46):
A lot a lot?

Speaker 1 (53:47):
You know, I actually get these dms on my social
media Instagram all the time because I have a lot
of folks that follow me there from India, And in
India there's this whole concept of like, you know, people
want lighter skin, right, not necessarily brighter skin. You know,
my emphasis as a dermatologist when I'm talking about treating
dark spot is merely to even out the skin and

(54:08):
make it brighter, but not lighter.

Speaker 3 (54:10):
Right.

Speaker 1 (54:10):
You should be proud of our skin color, but we
shouldn't later. But in India, for example, there's this big
thing where people get this injection or not just injection
iv intravenous injection of a product called gluta thion. So
that's a medication or that's something where not just India, Philippines,
a lot of other countries people get that ivy injection

(54:31):
of gluta thion to lighten their skin overall. Now that
stuff is not safe in the United States. Dermatologists are
completely against it. Some metspas will have that stuff, but
there have been reports of death in the Philippines, and
in fact, I think the Philippines is banned. But you know,
there can be libor damage, kidney damage and whatnot. But

(54:51):
my point is you're right, a lot of people are
trying to lighten their overall skin but that's not because
they're trying to fix any problem. They're just trying to like.

Speaker 2 (55:00):
Right, yeah, internalized stuff. Yeah, and because you have like
cast systems you have obviously in colorism. I know in
the United States, that's a big thing in our community
for a long period of time. So like, yeah, it's
it's definitely it feels more like insecurity than than an
actual medical issue to be like, hey, I need to

(55:21):
brighten my skin.

Speaker 3 (55:22):
It's like, I don't think I don't think that's acting me.

Speaker 2 (55:24):
I don't think that there's no diagnosis for just your
skin is the color that your skin is.

Speaker 3 (55:29):
You know.

Speaker 2 (55:29):
I have questions from the audience too, careen, but go ahead,
you can go, and then I'll bring up the questions
for the audience as well.

Speaker 4 (55:36):
Okay, oh yeah, because I like when I said I
had tons of beause I have tons of questions.

Speaker 5 (55:41):
I have something called I think that called HS. It's
like really really long. I don't know all.

Speaker 4 (55:46):
The words for it, like like like the like the
the scientific way for it. And I just recently, as
an adult, found out that this is something that I've
had since I was a kid, and it produces balls,
like and they can go like underneath your arms are
you're growing and around like your breast area.

Speaker 5 (56:07):
And I remember when I was.

Speaker 4 (56:08):
A kid when I would shave my arms or if
I would use like a too strong of a dealdrent
because I don't sweat eat, it takes like for me
to put to perspirate. And so I mean one time
I tried a degree, and so when I tried it,
I got like these bumps up beneath my arms and
then after a while they faded away. And so I
am very thankful for a dumbertolisist. This kind of specialize

(56:30):
in black skin. Because they told me they was like
this happens often in black people, and it was like
a lot of.

Speaker 5 (56:36):
People grow their gold their whole life.

Speaker 4 (56:38):
And they kind of random to get these balls and
they because they come and they go and they don't
and they don't pay it no attention. And a lot
of times she said, people come to me when they
get bad, and I'm talking about like real bad where
you have to get like injections and things like that,
like in it and for them, because I had to
get like injections, and that's when she told me what
I had, and I kind of I don't want to
say I felt stupid.

Speaker 5 (56:57):
I was like, I wish somebody would have.

Speaker 3 (56:59):
Told me to.

Speaker 4 (57:00):
It's like like earlier in life that this was something
that I was dealing with or fighting with. So particularly
with that, have you had people come and they're kind
of shocked, the surprised by some of the diagnoses that
you give them. You and when you tell them like
more black people have a tendency to get this, they're
more shocked by that than anything else because they might
have family or friends that might be dealing with it.

Speaker 1 (57:21):
Yes, so what you're talking about is called hydratonitis. So
for a TIVA, it's a very long word. I don't
know why they they named it like that, but you're right,
it's people. Well sometimes even in our during our training,
we used to think that, oh, it's relatively rare, But
to be honest, it's not that rare. I think it's
rare because oftentimes it's being underdiagnosed, you know, Like I

(57:43):
think primary care doctors a lot of times won't even
pick it up. They might just be like, oh, you
have acne in your armbits or you have folliculitis, you know,
and it's often type misdiagnosed and it's also because sometimes
it can be tricky because technically there are three different
stages stage one, stage two, stage three. Stage one is

(58:04):
very early on where it just literally presents as like
little pimples, like little boils that come and go, come
and go, and like you describe the classic areas of
the armpits below the breast in the growing area. Stage three.
Stage two is when it's a little bit more uh,
you know, you see deeper boils like puss coming out
like angry. And stage three is when you have even

(58:26):
intense scarring because these boils are interconnected, they have like
little sinus tracks and whatnot, right, and it it's like
very severe painful. I mean, I have had a lot
of patients actually throughout my career where I've seen it's
gotten so painful that they couldn't move their armpits, you know.
So oftentimes, you know, it's kind of like diagnosed by
the time it's stage two or stage three, because yes,

(58:48):
that's when it starts to look like classic textbook. But
that stage one HS is often uh, you know, either
misdiagnosed or and sometimes I unders even as germs. You know,
it might not be as classic because a lot of time.
By the time patients come to even see us, they
might not even have the boil. But it's based on

(59:09):
the story. If you tell me the story that it
comes and goes, especially if you're shaving it's getting a
lot worse. You're just won't be disposed to it. That's
that's when for me, I'm like, yes, this could be
early HS versus folliculitis, and we treat them very similarly.
But it's it's a condition where the main problem is
not even so much bacterial overgrowth. It's actually inflammation, like

(59:30):
these hair follicles are getting clogged up, and then your
body is trying to like treat it almost like a
foreign body, and there's a lot of inflammation that goes on. So, yeah,
you can start off with cleansers called hippocleans that can
help keep it clean, and then you know there's different
treatment protocols. Yeah, anti persponents can help sometimes because it

(59:51):
helps with if somebody is sweating too much, it can
help with that and and that can also keep HS
under control. But you're right, it's more preval in darker
skin and black skin. It's more prevalent in certain age
groups too. I mean not age groups. But in groups
like there is a correlation between obesity, there is a
correlation between smoking. So those are also important factors which

(01:00:14):
we need to ask found patients mainly not to be judgmental,
but mainly to let them know that, hey, if you
lose weight it might help, or if you're reducing these things,
that's another motivation to like try to quit smoking.

Speaker 2 (01:00:27):
You know, I have a question from the chat what's
the best over the counter treatment for ezema on darker skin?

Speaker 1 (01:00:36):
So it would always be like good moisturizing creams that
have seramides in it, So Sarah be moisturizing cream is good,
brands like userine Cedar fil but look for the moisturizing
cream rather than the lotion because creams are a little
bit thicker, so they are they do a better job

(01:00:56):
in terms of helping dry skin.

Speaker 2 (01:00:58):
There you go, Let's see how much how much facial
exfoliation is too much? Once a week twice? Is it
the same for the body? Says think pretty smart.

Speaker 1 (01:01:09):
Very very good question, because yeah, body usually can tolerate
more because the skin and the body is different from
the face. The face is very delicate, so face, I
would say, yeah, once or twice a week, but that
number is going to get very from person to person.
But you will know if you're overexfoliating, if your skin
feels starts to feel very tight, if it starts to
feel dry, if anytime you're putting on a skincare product

(01:01:30):
and you feel like it's burning the skin, that those
are just signs of your skin barrier saying hey, you're
irritating me, back off.

Speaker 3 (01:01:38):
So yes, is it okay?

Speaker 2 (01:01:41):
I'm guessing this is baby or but maybe maybe it's
body all and okay, yes, body all?

Speaker 3 (01:01:46):
Is it okay?

Speaker 2 (01:01:47):
To make saying body all into Vanny cream? I find
it a little too thick by itself, said Debbie.

Speaker 1 (01:01:54):
You know, personally, I would recommend try the Vanny Cream
lotion if you're not a huge fan of the cream,
because the formulation is different, the texture is different. But
I'm not huge into mixing things up, and especially body
oil again not knowing how much it's going to clog
up your pores and stuff, So I would just say
try the lotion, which is more water based compared to

(01:02:15):
the cream.

Speaker 3 (01:02:16):
All right, let's see how about Mary.

Speaker 2 (01:02:21):
Is laser treatment worth it or is it ultimately bad
for the skin? Because it makes it thinner and more
susceptible to sun damage.

Speaker 1 (01:02:29):
I'm so glad, thank you Mary for asking this question.
So this is a myth. You know, it's not that laser. Again,
when you say laser, there are thousands of different lasers
out there. The hair removal laser is not the same
as laser for skin rejuvenation. There's a lot of different
types of laser. That's number one. Concept Number two. If

(01:02:50):
you're trying to use the laser to again for skin
rejuvenation purpose where you're treating your pores, fine lines and
all that, do your research, find a doctor or find
a place where you can really trust them. And if
they have like the most latest laser technologies, almost all
of them, they don't thin out the skin. They can.
In fact, it's the opposite. Some of them will help
collagen production, so it's the opposite where they like strengthen

(01:03:13):
your skin. But this is where you're got to do
your research and go to place, especially if you're a
darker skin. You absolutely have to go to places where
this is something they do on a regular basis, right right.

Speaker 4 (01:03:23):
Right, I've heard go to the places where you can
see true before and after pictures like like like they
have like the pictures of their patients and things like that.

Speaker 1 (01:03:31):
Yeah, and you know, and this is something I wish
more and more people were transparent about. Like for me,
I don't do fillers on my patients or on myself, right,
So if somebody comes to me and they want filler,
I mean I could probably do it because I've been
trained to do that, but that is not something I
do every day, So I am not gonna that's not
in the best interest of the patient, you know what

(01:03:52):
I mean. But I'm treating darker skin with lasers ten
times a day. That stuff I'm comfortable with. Actually I
made a post about this today because I have a
patient who came to me with a complication somewhere else
and we've been helping her improve her skin. But the
point is, even with my own hands, complications can happen.
That's just like it's like there's always pros and cons

(01:04:14):
to everything. But what I know is how I know
how to manage those complications. If something happens, I know
what exactly to do to you know, undo them, right.
And of course, none of the complications I've ever had
has been permanent, And that's the whole goal. You want
to like use technology, use things where you know it's
not going to be permanent, right, but temporary hypo hyperfragmentation
post procedure can happen, but at least I take every

(01:04:36):
step possible to avoid those, and god forbid if it
does happen, which is rare but can happen. In fact,
anybody tells you that they have never had complication, run
that means they have not done enough procedures.

Speaker 2 (01:04:49):
Let's see, Tony got a question from a man. Tony says,
for men who are entering their early forties, what type
of skin routine should they have?

Speaker 1 (01:05:00):
Again, assuming that you know you have overall healthy skin,
no specific concern like acne, I would emphasize on the basics,
which is every single day cleanser, moisturizer, sunscreen. That's like
your basic basic. And then if you're looking for, like
you know, healthy aging of this skin, you could possibly
look into retinol, but not everybody can tolerate retinal. If

(01:05:20):
that's the case, look for any serum or moisturizer that
have peptide in it, because peptides also help stimulate collagen,
because those are just natural things that over time, as
we get older. You know, the reason our skin starts
to sag or our skins start to look dull is
because we're losing collagen. Our fat pads are moving, and
those are some things you can do to kind of

(01:05:41):
keep up with that loss.

Speaker 2 (01:05:42):
All right, people still have more questions. I'll try to
go through them a little fast for you guys. I'll
get a couple more in and some are redundant. Some
of y'all ask like, good scared career care routine a
couple of times, so cool?

Speaker 3 (01:05:55):
What SPF should we be using? Says dB.

Speaker 1 (01:06:00):
The number one. The best sunscreen is the one you're
actually gonna use, and that depends on the texture of
the sunscreen, the color, the field, the smell and all
of that. Anything that's SPF thirty or higher is good
enough because you know, it's like a curve, right, Like,
the best protection is up to like SPF thirty. After that,

(01:06:20):
even if it's SPF hundred, the difference in terms of
actual sun protection is not that massive. The only thing
is sometimes if it's SPF hundred, people don't like the
texture of the sunscreen. So if you're not really gonna
be using that SPF hundred, there's no point buying that.
So by a sunscreen that's SPF thirty and higher, look
for both UVA and UVB protection. And the biggest thing

(01:06:44):
is using the right amount of sunscreen, which even I
didn't use it my whole life till I become a
dermatologist because it's the right amount. Is to use two
finger lengths of sunscreen for your entire face. Most of us,
you know, we only use a very little amount, but
that's not enough sun protection. So two finger lens for
your entire face. And if you're truly gonna be outside,
then you should be reapplying your sunscreen every two hours.

(01:07:05):
Do I reapply sunscreen every two hours every day?

Speaker 4 (01:07:07):
No?

Speaker 1 (01:07:07):
I don't because I'm mostly inside. But if you're gonna
be outside, you're gonna do it all.

Speaker 2 (01:07:12):
Right, And then Ridge says, are you shocked by how
popular those pimple popping videos have become?

Speaker 1 (01:07:20):
No? People love that stuff. People love love.

Speaker 3 (01:07:24):
Have you ever thought about doing that for your content?
You know?

Speaker 1 (01:07:29):
Actually, that was like one of the first videos that
I posted on TikTok, like three four years ago that
blew up my TikTok Like. I posted a very what
I thought, very mundane video of like me popping up
simple pimple. I posted it at like ten pm at night.
I went to bed. This is twenty twenty one. I
woke up with forty thousand followers overnight at some multimillion

(01:07:50):
views overnight. But then I don't post those videos because
you know, maybe the stuff I talk about is different
from just like popping pimple videos, you know. But I
know if I were to pop more of those videos,
I would probably gain more followers faster. But I just personally,

(01:08:11):
you know, because that's not a big part of who
I am or part of my practice, I don't necessarily
do that, but I know they're very popular. People love
that stuff.

Speaker 3 (01:08:19):
You got, You got integrity, doctor T.

Speaker 2 (01:08:21):
I would have been looking on the street for some
people with some with some problems, like hey, free pimple popping.

Speaker 1 (01:08:27):
Come on in, come to my clinic and spend a
couple of days with me. You will get so many
people popping videos.

Speaker 3 (01:08:38):
All right, this is the last question. Let me look through. See. Okay,
here's one.

Speaker 2 (01:08:41):
I think a lot of people probably want to know
what's the best way to deal with dark spots becoming
prominent due to the age or sun exposure.

Speaker 1 (01:08:50):
Number One sunscreen. Even if it's not going to treat
the existing dark spots you have, it's going to slow
down the rate at which you're getting new dark spots.
Number one sunscreen number too. There are a few ingredients
you can look for with respect to serums and stuff
like that. So ingredients such as nice Cinemai, Kojic acid
as a lake acid. I know these are fancy terms,

(01:09:13):
but these are ingredients that have been shown to be
effective in treating dark spots. But in reality, coming from
somebody who literally takes care of folks with dark spots
every single day, I can tell you this. Skincare products
can help to some extent. They're fantastic in preventing new spots,
but they are not going to completely erase your existing spots.

(01:09:36):
They can help absolutely. You know, if you look into
my skincare regimen, I use products that are helping me,
but that's not the way to one hundred percent get
rid of them one hundred percent. If you're trying to
get rid of them, you have to look into procedures
like laser or chemical peel blah blah blah. And even
with that, I have to constantly remind my patients it's
not a cure. It's not like a one time thing.

(01:09:57):
You then have to do maintenance because if you promise me,
I'm not going to get older. And if you promise
me or you know, you're never going to be out
in the sun, then I can tell you this is
a one time thing. But going to your trainer, going
to their gym is not like a one time thing.
Same thing comes with all these procedures and treatments.

Speaker 3 (01:10:15):
Well, doctor Taya, it was great meeting you.

Speaker 2 (01:10:18):
We really appreciate you coming through and answering all the
questions for us and our audience.

Speaker 5 (01:10:23):
This has been fun.

Speaker 4 (01:10:24):
Yeah, tell everybody where you're at and how to reach
you and how to fight your own line because we
might have fans in your area that might actually want
to come and see you.

Speaker 1 (01:10:33):
Yeah. So I am based out of Newport Beach in California.
Actually I'm very close to the John Wayne Airport, which
is the Orange County Airport, because I do have a
lot of folks that can't even fly from all parts
of the country to come see me. So we are
like five minutes from the airport. But for me, you know,
like I said, I know that even if people want
to come see me in clinic. Sometimes it's hard, right,

(01:10:54):
Like logistically it's hard. You might be a different parts
of the country. So I tried to communicate with people
through social media, which honestly is like a creative outlook
for an outlet for me. And so you can find
me on social media as doctor Ta Paul d R
t I A p A U L on both TikTok
and Instagram and thank you for having me. Like I

(01:11:16):
consider myself very very lucky even though I've done fourteen
years of training. But I absolutely love dermatology. I love
what I do every single day. I can't imagine like
not seeing patients in clinic, you know. I mean, I
do a lot of the social media stuff, I work
with a lot of companies, I work, you know, do
all these things, but at the end of the day,
it's very important for me to actually see people in clinic.
So that's why I have my own private practice where

(01:11:38):
it's actually me, not like other doctors, like just me
like seeing my patients too, and part of the day.
It's like, you know, you realize as you get older,
it's not just like money, fame and all that. It's
truly everything that you do on an every day basis
that brings you pure happiness, right, So, and my patients
are like, oh my god, doctor Paul, like my place,
you know, my face cleared up or these spots are gone.
It just it does bring me a lot of happiness

(01:12:00):
because I can see the confidence, you know, And that's
why I always tell people the ultimate goal is not
to have to wear a makeup. You should be proud
about who you are naturally.

Speaker 2 (01:12:08):
Well, thank you for coming on. This is so fun,
so informative. We definitely learned a lot. Our audience learned
a lot. And you know, I love your story too,
you know, coming here from India and like practice, like
going to school, practice of dermatology, all of that stuff
is really cool.

Speaker 3 (01:12:27):
And yeah, like just so glad you came on.

Speaker 2 (01:12:30):
Go find her, go follow her on the social media
is all all that stuff, guys. And we'll be back
on Saturday where you can, uh, you know, listen to
us feedback. You guys are gonna write comments about doctor
uh doctor Paul almost said, doctor t I'm from the South,
so we're like we're like doctor first name, miss the

(01:12:50):
first name, but.

Speaker 3 (01:12:51):
Doctor you can write in about doctor Paul.

Speaker 2 (01:12:53):
They're gonna tell us like what they thought about this
and all that stuff on Saturday, so we love all
that uh until then. Oh and then we have a
movie review coming Thursday, and we have our nerd Off podcast,
spen Off about nerd culture. That stuff is Friday. So
if you're premium, we'll see you guys Thursday and Friday.
Everybody else will see you Saturday. Until then.

Speaker 5 (01:13:16):
I love you, I love you too, Cla

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3108: How the Dermatology Industry is Failing People of Color

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