Regenerative Derm: Baloney or Breakthrough?

Welcome to season three of Dermson Drugs and video podcast brought to you by Scholars and Medicine, the best education platform in dermatology and provided to no cost to medical providers. Dermson Drugs is where cutting edge dirt meets the hitter miscomedy. Dr. Matt Zyres from Dr. Dermotology and each week from Dr. Mevres and C. Buddy, Dr. Laura Ferris from the University of North Carolina, and Dr. Tim Patton from the University of Pittsburgh and we use our 60 years of combined dirt experience to discuss debate and dissect the hottest topics dermatology. It is everything you need to know to be in the cutting edge of dirt and you actually have some fun listening. New episode of Dr. Bufrowde on Scholars and Medicine, Apple Podcasts, Spotify, and other major podcast platforms. And I highly recommend downloading the Scholars and Medicine app to access the full podcast video archive and explore the best educational content out there, not that far-mated AI-generated slop, but actual real nitty-gritty coverage of all of dermatology, the latest stuff, the stuff you learned in residency, the whole sherman, and it's supported by an amazing AI clinical consultant called Ask Simon. So this week we have an unusual episode for Dermson Drugs. We are thrilled to be joined by Dr. Amanda Hill, who is also part of Dr. Dermotology to talk about regenerative medicine and regenerative dermatology. Dr. Hill, welcome on the show. I just want to start off by just telling us where to go to med school, where to do Derm residency, how should we believe that you regenerative medicine immediately sets off the word crap in my head of like that's baloney, why should we believe you? Exactly, yes. Well, first thanks for this opportunity. I've listened to you guys all the time. So it feels pretty surreal to be on the podcast. So thank you and thanks for all that you can contribute to dermatology. I've got a big feat to attend here. Try to get the correctliness out of regenerative dermatology. So I went to undergrad at Michigan State. I was a nutritional scientist major. So I've always kind of been interested in nutrition and health. I taught exercise classes on campus. And then I went to Georgetown from school medicine for medical school. I and was at University of Chicago for a transitional intern year. I did the Air Force Scholarship for medical school. So did a stint as a flight doc, which is primary care for the pilots and their families. A bit be a little air force base in a Northern California where the U2 is. So you did some like high altitude medicine there. And I did my biology residency at Stanford in the Bay Area, you know, tech that I think it shaped a lot of like my interest in tech and AI and just a little more forward thinking and design thinking model they have there. I then practiced, I did my payback time for the Air Force at Nellis Air Force Base in Las Vegas. And then I moved back home to Michigan where my family is and joined docs from aology group. You know, for me, the biggest thing that one of the things that I was seeing as a kind of a merge from on my training, my Air Force time, you know, seeing patients, particularly a lot of Perryment of Paws, Menopause patients. Was, you know, these profound changes they were seeing in their skin and a lot, you know, itching, acne, hair loss, you know, aging signs and they're coming to me for, you know, this wrinkle that they don't like and their skin's not the same and they're wanting me to inject filler or Botox and just part of me just felt like this isn't, I mean, this is just treating us. This is masking a symptom when there's a deeper problem going on. So I kind of dove down into this is a more training. I think hormones were a big role for me. You sounded a little too much like a medical student interviewing for Durham right now. Well, the skin is really what fascinates me is it's a window to systemic disease and it's really, I'm never going to do anything. All I'm going to do is treat Pemphicus and psoriasis. I promise. I promise. We can go ahead. Go ahead. You're good. You're good. So then I started the A4M Long Jevvy Medicine Fellowship, which is through the American Academy for Anti-Aging Medicine. They have spent a year long. I just finished it this weekend or about to I took my oral board exam. But I mean, the main focus of that fellowship was really looking at what's going on the home arcs of aging, which there are about 12 defined home arcs of aging and how we can, you know, potentially intervene earlier to slow the aging process down. It's really trying to optimize our health span, not like live as long as possible. I think people think longevity and they think Brian Johnson, which is fine in some people may want to be in that biohacker. But really, you know, so many Americans have metabolic dysfunction, which worsens their psoriasis and hydrodonitis, right? So if we can be a little more preventative and identify some of those symptoms earlier, I mean, a lot of it's more lifestyle things too than we're going to improve everything. So I did some training. I did finish the A4M class. I took several hormone classes with like Heather Hirsch, Rachel Rubin. I took all their courses because there isn't really a great standard for like what you're supposed to do. Everyone, because of the Women's Health Initiative. So I needed to really educate myself from a lot of different angles so that I could feel comfortable. One of the big reasons I did the training myself was I was trying to find people to refer my patients to coming from California where I think there were more options that I just didn't find. There were more regenerative medicine in California than I did. I don't believe it. I couldn't find anybody who was doing, it was either doing lots of pellets or still seeing that hormones cause cancer, right? So I think the truth often is in the middle. And then with the Dr. Mataji group over the last six months or so, we've launched a longevity and regenerative aesthetics clinic. We're really the longevity scientist just trying to optimize the hormones for the information insulin resistance. I mean, let's start kind of right there. So whenever I think of like, I think there's being like the three specialties of baloney and then being aesthetic medicine, aesthetic dermatology, longevity medicine, regenerative and obviously I'm being like facetious. If I really thought this was baloney, we wouldn't be talking about it. It's real. Like this is real and useful. We're all going to be hearing a lot more about it and probably at the end of this episode, we're all going to become your patient. So what is the difference? So like how specifically what is regenerative medicine as opposed to aesthetics and longevity? Yeah. So regenerative medicine is you're trying to regenerate like real human tissue in the same form that it was. And we really like, that's kind of where stem cells come in. You know, like there's a wound and we're trying to regenerate the wound to be like exactly how it was before or even with the aging process, we're trying to make your skin exactly how it was before. So like true regenerative medicine is more hard, is more difficult than trying to like slow the aging process or improve the quality of the skin. So does laser resurfacing count as regenerative medicine? And we put it in that in that regenerative, like we're trying to regenerate tissue. I think if you, you know, looked at the dad article that I think you have that one, right? It was like getting it back to the true form. And that's more difficult to do, but I do think, I mean, this is where the lines are a little bit blurred, but we are regenerating tissue. It's not going to be exactly how it was before, but we want to try to make it better than it was. Yeah. So is it really reversing aging? Is that really what you'd say regenerative medicine is? I mean, yeah, I mean, I'm trying to think like, it's like we just asked you to define artificial general intelligence, which is the way you can get all AI experts to immediately, but you can also use it in disease states too. So I mean, aging is like this normal process. I don't necessarily mean as it considered disease. I guess that's up for debate, right? I mean, it leads to a lot of diseases. But so we're going back to the optimal state of health as maybe. Yes. Yeah. That's it. I would say yes. Yep. Okay. And then I'm like, Rachel Rubin and Heather Hirsch and I'm like, I know who they are. And I'm like, do either of you two have either of you two ever heard those names? Nope. I know Rick Rubin. That's, I don't know who that is, but I'm sure. So those are right. These are like two women who have really brought back hormone replacement therapy and like really kind of tried to bring this back into general medicine, tried to dispel a lot of the myths, tried to like, you know, sort of point out what the issues are with like the women's health initiative. So like if you're my age, they, they show up on every social media feed you have. You're like, I feel like, you know, I'm friends with them because I see them all the time, you know, Mary Claire Haver, like all these people, but they are like women who are really trying to bring back like physicians should know how to prescribe hormone replacement therapy and that they're, we have like done women a disservice by making estrogen seemed like something that's unsafe. Yeah. Well, let's start with the hormonal stuff because that's like I feel like when I was a, I remember as a kid, like my mom going on estrogen for menopause and then like when I was in medical school, like, mom, you get off of that stuff. You're going to get breast cancer. And then a few years later, I was like, mom, you're going to get back on that stuff. You're going to get a heart attack. And like now I have no idea like what is, is, is estrogen good? Is progesterone good? Jesus, the more of the bit like what's the fair issue had to do with it. article on this, what did you have any take on it or should we just go straight to Dr. Hill telling us what the answer is? Yeah, I mean, I can kind of go over the article that I looked at. So the article that was called skin hair and beyond the impact of menopause. And I felt like very called out that I was given this article to review, but that's okay. Listen, you're going to be going through menopause in like 30 or 40 years and we want you to be really. Thank you. Yeah, that's right. Because the median age of menopause actually is 51. So, that's forever. Forever away. Yeah. So yeah, I mean, just like a couple of the things and I'll kind of focus a little bit on the skin stuff, but like, you know, within four to five years of menopause, 80% of women will have like mild symptoms like within, but you know, four to five years before they hit it, but up to 20% may start up symptoms up to 10 years before, you know, you hear phasomotor symptoms like hot flashes are the most common thing. But, you know, also about two-thirds of women will have skin issues. Some of the big things are dry skin, I guess is the main one. But then there's also, you know, wrinkles, sagging, all of that stuff. And then there's also things like itching. That go along with that. So yeah. So that is like, you know, we talk a lot about like itching and people's met on our podcast and like, oh, think about your old patients and the fact that they're on, you know, diuretics or statins, but we should also think with women like maybe it's because you basically don't have any itching. And then there's also like the genital urinal, you know, the urinary and genital symptoms. So like vaginal dryness and you know, that causes like a lot of pain, dysprunia. And you know, one of the things as, you know, somebody who now thinks more about metapause and hormones at the stage of my life is like, what I have come to appreciate what was a little bit in this article is profoundly like the impact on the risk of urinary tract infections, right? So we can say like, oh, you're complaining about dry skin and wrinkles, but like, UTIs are a huge issue, right? So and a lot of that is like the reason I just thought old women get, old ladies get UTIs because that's just like what happens when you're older, you're just, you know, you got more incontinence and you get UTIs, but there's actually some decent data that this is related to estrogens, you know, this is very much related to estrogen deficiency, you know, some things like hair, like you know, women complaining about their hair not being growing and there's a reduction in the antigen phase that is associated with metapause as well. So like those are some of the things that I thought were really, you know, interesting here. So what is your most should, should women be thinking about what's the right term here, optimizing their hormonal state when they're going through, you know, metapause symptoms are getting significant. Is it something that a 40-year-old should be like, I can't hurt to get it checked or is it like, what's the age range of this stuff? It's a great question. I'd say number one, earlier the better. So let me just step back a little bit, I mean, with the hormones, right? So the big issue I think you talked about was with the Women's Health Initiative that came out in the early 2000s, stating, you know, the press release came out before the publication came out and essentially it was like hormones cause cancer, heart disease, everyone needs to stop. When you actually go back and look at the data, there's a couple of things. Number one, they were synthetic hormones that were used. It was synthetic estrogen or like pregnant mayor urine and then it was a synthetic progesterone, a proxy progesterone acetate. So there was synthetic oral hormones and we don't use those anymore. But even so, if you look at the estrogen only arm, so this would be in the women without a uterus, they didn't have a uterus, so they didn't need the progesterone for uterine protection. The incidence of breast cancer actually went down. Yes. That was like never, that was so misreported. Like I remember learning this in medical school. Yeah. So the more you know about the more angry you get, right? And then the in the arm with the synthetic estrogen and the it's a conjugated equine estrogen and the progesterone acetate, the incidence of breast cancer went from four in one thousand to five in one thousand with no change in mortality, right? And then with the cardiovascular risk, this was typically seen in the older women who had been not on hormones. They've had cardiovascular disease kind of brewing without their hormones on board. And it was with when they reintroduced oral estrogen, which oral estrogen goes through first past metabolism in the liver and can increase your risk for clots. So number one, a lot of these risks were completely overstated. And number two, we don't use those hormones anymore. Now we use bioidentical hormones, which are exactly the same structure as the your body makes. And we typically use estrogen in a transdermal like patches or creams or sprays, so it's absorbed through the skin. And it's not increasing risk for clots. So or the transdermal estrogen does not increase your risk for blood clot from baseline. And then I get I have to interrupt you there because the word bioidentical always that sets off some things for me is that sounds like that sounds made up sounds made up like what just bioidentic where do you get a bioidentical hormone? It's not it's not hard. Think about what was you know estrogen was was equine estrogen. It was purified from horse urine. So we were giving women oral horse estrogen versus making human estrogen, right? It is it's derived from a Yamura potato, but it's chemically it's structurally the same as what our bodies make, which is where the bioidentical comes from. So okay. But it's FDA approved. So these you you can get this through your normal pharmacy. This is FDA approved medication. And so is the oral micronized progesterone, which is the bioidentical progesterone, just meaning it's the same structure that your body makes. So that's okay. And so I think I had thought of bioidentical is like we're going to mix up this in that and the other and now I'm going to charge you 37 times more than the actual ingredients costed themselves. But that's the unfortunate truth is that for so many years there weren't options for women and they couldn't go to their regular doctor. And so they were going to these places where unfortunately I do think they were taken advantage of with these compounding pharmacies and spending a lot of money when it's not necessary. It's really not necessary. So what is your so do you so a woman who what should trigger like a 40 45 50 year old woman to like want to get tested want to get or should it just be everybody like and should they get tested or is it symptoms right? So I think a lot of the dogma now is you don't go in and say like let's check all your hormones like you are you when you have symptoms then you address symptoms or do you advocate testing? So I do I do a combination of both that would be to be honest with you. So I when woman when usually it's one of women feels off like something's not right like I am not how I was before. And this can this is typically like this early perimenopause which can be 10 15 sometimes even 20 years before menopause but they sent something is off. Unfortunately there's not pathology at that moment. So a lot of times these people are dismissed when they go to their regular doctor in a traditional care where it's like in and out like you don't have a disease state and I think we can all agree our system is great for a acute care you have a disease we're going to treat it but for preventative care or for these earlier symptoms like you know it's not necessarily set up for that. So for me it's when somebody feels like something is off and that's when we come in. And I do I do some testing I usually do start with blood testing but there's limitations right so it's looking at everything in conjunction with each other but I will spot check their estradiol their progesterone their testosterone levels that's a whole another topic to get in with women in testosterone because we don't currently have an FDA approved testosterone for women but testosterone is important in all human bodies. So and I also check micronutrient levels in insulin sensitivity you know insulin resistance starts 10 15 20 years before diabetes and that fasting insulin starts rising before the glucose does. So if we can you know identify that insulin resistance and intervene with oftentimes lifestyle exercise strength training dietary adjustments you know we can delay the onset of disease and so to me that's like what longevity medicine is it's really good preventative medicine trying to optimize our optimizer internal health with hormones metabolic inflammation so that we can you know have the longest health span. I don't like sound of that I would rather just have some peptides that I can inject once a week and not have to exercise not have to die it just get some melanetane I get some terseptide. I think that's what patent does. From a I do all that stuff. From a skin standpoint I mean if a female came in and said I want my skin to look healthy and I know that means sunscreen and I want to retinoid prescription and vitamin C and all that stuff but I also have heard that hormones can prevent that and so I want to be thrown on one of those too. Like there's no way I'm doing that as a dermatologist. Are you doing that as a derm or are you going to say, well, I need some other symptoms beyond just, I don't want to get wrinkles. How do you approach that? So you're you're creaming correct there. I mean, there's no FDA-approved indication for estrogen for skin. I am not just, if you come in and say I want hormones because my skin has wrinkles, like, no, I'm not prescribing that. I do, as part of like our practice, I do a full assessment. So I am looking at a comprehensive picture. So if I see some, they're having symptoms of low estrogen, right? And they, that's typically you're having symptoms of low estrogen. Maybe your FSH is rising a little bit. I will start some, an estrogen path. I will start hormone therapy. And often you are going to have a secondary improvement or at least slowing up that aging process in your skin. And also bones are a big one, are with the aging process just in general. But if you're looking at for facial aesthetics, the, the bony structure, that's our support. We're women, I mean, all humans, our bone is getting smaller. And so when that scaffolding is small, as when the skin starts to fall, then you have the changes and the fat pad to the skin quality. So estrogen is approved for the treatment, like for osteopenia, for the prevention of osteoprocess, that is an FDA approved indication. So I think of it, it is going to help the bone structure. And so many women have osteopenia. We just don't check Dexas until 65, because that's what the guidelines say. But I do look at all of that. So do you think it's, it's very important. And if one and two women are going to have an osteoproducture in their lifetime, like that's, that's significant. And if estrogen, you know, in the appropriately selected candidate in a well informed patient, you know, besides it's a good option for them, I feel like that actually may have less risks and potential benefits over some of these. So, like, thinking in the dermatology world, so you could say, all right, I'm not going to say skin quality. There's no evidence. But, you know, like, I'm in a place where we have a special vulvar disease clinic. And we have, you know, a lot of, I mean, when I see who comes in, I'm like, it's obviously all women. They're all, they're the vast majority of them are kind of in like the perimenopause, demenopause, depostmenopause age. I mean, I would have to imagine at least some of the dermatitis that we see in, you know, and women is because they are estrogen deficient. So given that, if you are somebody who treats women with vulvar disease, do you think it makes sense to say, yes, it is within our purview to be doing this? I'm calling a timeout on this because we've got a, in a few weeks here, we have a double board certified OBGYN dermatologist who was one of my residents coming on to talk about nothing but vulvar problems. So we're taking the vulva out of today's taking the vulva off. No vulva today. Forget it. Forget it. Fine. Okay. And okay. So we're not, we're going to take is like, do you want to move beyond estrogen? Because I guess the one question I still have, I mean, do you think it's normal germs could, could reasonably prescribe hormones? Like is it great? You did a year long, you did a year long fellowship. So like, I've taken one of the courses. Yeah. Yeah. So Dr. Rachel Rubin, she's the neurologist. She said on the FDA panel to help take the black box warning off estrogen. She says yes. I mean, hormones affect every single organ. I think nobody is owning hormones, but hormones impact all of our patients, regardless of your specialty. So that, I mean, she advocates for yes. I think, I think if you have an interest in it, you should learn it because if you're not, I mean, patients don't have access. So the FDA approval, the warning is off. It's easy. The black box warning label is off. We're getting, where are patients getting their hormones from, right? There's whole generations of physicians that haven't been trained. There's not a novo BGYNs or primary care. So, I mean, it don't, but it's not something you're interested in. Sure. Like, don't do it. But I think we're, there's a lot of patients that have a great need. The skin is greatly impacted by the hormones and just like the overall health. And so this is where I am more longevity dermatologist, right? So I took that extra training. I don't think you need to, but you need to be aware of it. And there is an impact with the hormones. I mean, think about all the things that start postmenopausal, right? So I think hormones are playing a role there. But if the thing is no FDA approved indication for the skin, then now I like, I would be like, look, I think they could help the skin. But if you want to take it because of your bone health, there are doctors who have spent their careers studying bone health. And there's more things than just estrogen, right? There's the bisphosphonates, although nobody uses those anymore because of jaw fractures. But there's other IV therapies. Like, I don't know anything about that. And I'm not going to start learning now. And to say, well, I know a little bit about estrogen. That's just what we just, that's just the right attitude for a doctor, Patent. I think it's just the learning. You don't have to, but I mean, you're, osteophenial leads to osteoprocess, right? So, yeah, but I know a lot about a doctor. I'm not saying that that's not true. But what do you do when you put patients on a bunch of prednisone? Because you always tell us when you do is prednisone for BP? Are you like a lot of bone doctor? Go talk to somebody else about it. I don't find somebody who gives the damn. Not me. Much more about osteoporosis, management, and prevention than what a dermatologist knows. You know, I, I, there used to be like, Oh, put them all on Phosphamax. But then there are these rare fractures in osteoenocrosis of the jaw that I didn't know anything about. And there are things like, well, did you check your naory calcium and check PTH? And I'm like, you know what? I should not be addressing the bone. The osteoporosis at all, because that is a whole other field of medicine that people have gone through residency. And then, you know, subsequent training to do, I am not qualified to do that. I tell them, you know, well, it's like a scan. Let's do all that stuff. But I'm not going to manage the osteoporosis. That's not appropriate. It's just not appropriate. And I'm not managing the osteoporosis, either. I'm not, I'm not managing the osteoporosis. They're seen in a chronologist. I'm seeing more on this earlier side of things. And most of my patients meet FDA approval criteria. They're having, you know, severe vaso motor symptoms. They have genneteria, urinary syndrome, and menopause, or they have osteopenia, right? So I am prescribing it on FDA label. But there, my point, I guess, is that is there is a lot of other potential impacts. And I mean, even just on overall health. And my point, I guess, in optimizing the hormones is that if we're going to do regenerative therapy, we're trying to regenerate tissue, but we have suboptimal hormones. You've got insulin resistance. You have inflammation, even if we're doing things like sculpture, you know, or hyperdilute radiasis, or stimuli, or laser treatments, you know, it only makes sense to me that if your internal health is, you know, in a good state of homeostasis, which most Americans are not, you're not going to get as good of a response. Fair. All right. Before we move on to, I know Patent is dying to talk about the skin spam. Before, before, before, before we get to that, I occasionally come across an article that talks about topical estrogen. And like for your face, for wrinkles and anti-aging and that kind of stuff, does anybody do that or is that like, nobody does that? People do it. A lot of the compounding pharmacies, you know, online are doing it. I think it's, it's not something I'm putting all of my patients on. The data like isn't super clear. You know, we don't have great data on it. It probably won't because it's generic and cheap. And who's going to do the studies, unfortunately, if my patient like wants to try it, I think at a low strength, this is the make-observes in the slow. And if there's, if I'm seeing them, I am checking their levels to make sure we're not getting super physiologic. So I'll do it if somebody wants to, but we don't have like great data saying that like this is, you know, or when this initiated or who to select for. Okay. All right. Let's move on, Patent. What was your, to, is here my ears? My deep dive paper, November 2025 edition of Mayo Clinic Proceedings and is titled "Skin Span," a healthy longevity framework for skin aging by Wiles at Al. It's a review paper that talks about skin aging in general. And what therapies we can encourage our patients to pay a thousands of dollars to inflict upon them. The first section is on epidemiology. Society's getting older with age, skin complaints are common. Figure one summarizes all the things that happen, different layers of skin and the effects that those changes have. Figure two, histologic changes. Most of this is, is kind of review, but I mean, it's a, it's a very good review. Figure three, kind of like a review of figure one, just things that happen to skin as we age. Skin aging is the result of the expo zone, which I, if I encounter that word, that is pronounced expo zone. Expo zone. Intrensic and ex-trainedic processes that age the skin. Genetics is felt to contribute to less than 25% of skin aging. The rest coming mostly from external factors. They mentioned two specific mechanisms, damaged by reactive oxygen species and telomere shortening. Maybe starting to focus on, you know, some targets for therapy. It discusses the detrimental effects of UV radiation, smoking air pollution, all things I think we're aware of. The top paper talks about SASP. This was another thing. I had no idea that this existed. Sinescence associated secretary phenotype. I don't ever remember coming across that. It all, so SASP allows Sinescent cells, which are bad, to continue to exist. It goes into assessment of skin aging, and I don't really care about any of that. There's like 18 things that they go over. I vaguely remember rotating with obaji and scoring people with a glow cow scale. and remembering not to chew gum or lean on the walls and listening to an endless loop of Anya songs. The paper talks about the confocal score for the assessment of extrinsic skin aging, the CISA score, and you have to have a confocal microscope to do it. So this will totally be marketed as a necessary tool for any germs that want to have a high-end skin spa. Like the CISA score is an essential part of your management plan. It costs $350. Are you implementing the CISA? Do you have a confocal? I don't have a confocal. No credibility of Dr. Hill is rising significantly. Our table one was the bunch of strategies to maintain skin barrier. It's stuff that we tell all the patients, general cleansers, fragrance free, this and that moisturization. My favorite recommendation, keep the skin covered in the winter. Like I remember going outside in January, nothing but my underwear and people were like, "That's so bad for your skin." That was like, "What?" Second favorite recommendation, don't wear wet clothes. It's in there. Table two gets more into the, how do we make money part of skin care? Top part is the more reasonable things. Sunscreens, retinoids, vitamin C, nicinamide, hydroxy acids. Middle categories, all the cosmetic nonsense, like peels and lasers and PRP, which I think is crap. Curgical lifts are in there, but I'm sorry. A surgical lift is not in any way physiologically reversing skin aging. Maybe I'm wrong about that. Then the bottom section is where all this snake oil stuff really kicks into high gear. Ceno-theraputics and exosomes and peptides and growth factors. If there are any patients that listen to our show, if your dermatologist starts talking to you about any of these therapies, grab your wallet and get the hell out of your office. No, actually, the Ceno-theraputics stuff is, that's interesting. So these senescent cells, sometimes referred to as zombie cells, they're like hanging out with skin. That's why I like it. No, I'm not. I'm like, "I like it." And the zombie are the only ones who are made. They're hanging around in the skin. They're making a mess of everything via the sasps and we want to get rid of them or at least be able to block the effects they have. And that's what Ceno-theraputics comes in. And this is like the crit. It's interesting. It's crazy. There's this regimen of desatinib and what was it? Choirsative. And so I'm like, "What's desatinib?" Desatinib is like a chemotheraputic agent. It is a cancer drug. It's like, what was the first one that I've been using? Is it like a GTFR or something? Yeah, it's like a matknib or something. Yeah, a matknib. It's basically that. It's like the second generation of a matknib. It is a cancer drug and chryrocytid. I'm like, "Okay, yeah, you put that on your face." And it is like, "No, you take an oral version of this cancer drug mixed with chryrocytid. You don't do it every day. It's like three days a month, right, Dr. Hill? I mean, I am not doing that type of thing, but there was. And they continue to rise. There was a recent article suggesting that, "Actually, this may be not be so good." And so, to me, I'm like, there's so much low-hanging fruit before that type of thing. You're still eating fast food four times a week. That's not going to be helpful for you. So I have not. I'm with you there. I thought it was interesting that they got into kind of along the same lines because desatinib is a tyrosine kinase inhibitor. And so they said, "Jack's that inhibition. Maybe that has anti-sasp activity." So that is a study that is totally right for all these patients on jacks. And then you take the people maybe on non-jacks and do some sort of assessment of skin aging, right? Well, if he versus jack inhibitors, who ages faster? So I'm almost done. Second, the last paragraph talks about the Yamannaka factors. And Yamannaka was like one the Nobel Prize in 2012, shared a Nobel Prize with another guy. These are these factors that they studied where you give them to differentiated cells to like reverse engineer them so that they all have this, what they call them, ISPCs, which stands for. They're pluripotent stem cells. Yeah, induced pluripotent stem cells. So that stuff was interesting, but right, I mean, it sounds like that's kind of even maybe some of the things that, you know, like you said, just the stuff that makes more sense, the retinoids, the vitamin C, the UV, I may fund other cosmetic things because I just don't do it. And so I disparage it because I don't understand it. That's a life philosophy. That's good. Literally somebody should have this as like an example of like whenever somebody's getting bullied. And they're like, that's just because they're jealous. Yeah, that's Pat. No, that's Pat over here talking about the aesthetic dermatologist. Absolutely. Absolutely. Absolutely dripping with jealousy. It's horrible. But all right. So any like, what did you take away? It's a good, it's a good article. And I'm reading it. I'm like, well, we know all this. But then I was like the sasp stuff, the senescent cells, the zombie cells. We take zombie cells and we want to turn them into vampire cells that live forever. That's what really grabbed me about this paper, the Yamannaka factors, all pretty neat stuff. And for any, I might be getting this wrong. So if I am, so the way that you think about the sasps cells, they are senescent, they're like an individual cells that are senescent, but they don't die. They hang out and make all the cells around them be crappy. Like that is the basic idea of them. They're like your downer friend who makes everybody else like blah. And if you don't want your kids to hang out with. Yeah. And if you can just get rid of them without getting rid of the other cells, then the other cells will perk back up. Is that basically that is that director Hill is that fairly yeah, okay? You target them since I didn't really like look at that paper all that much. Like is there something are you like, ah, I mean, is that where the quercetin comes in like quercetin targets them? Or is this like this idea of autophagy like we're or like yeah, you've got to shoot them in the head. That's the only way to get rid of the zombie cell. This is where we're trying to go with like skin aging though, rather than like you have a brown spot, you need a lightning cream, you got a red spot, you need something for red. It's really trying to target that aging process like from an earlier cellular level, which I do think could have like trans-h, translational application to potentially other organs of our body too. And if we think, you know, these home marks are aging are precursors to most of the disease states that we, you know, heart disease, diabetes, so forth. If we can slow that again, slow that process down a reverse set, then it can have, you know, potential like benefits for overall health as well. But I'm not using anything at this moment to target those. That's where a lot of the like research is going. And that's that's one of the things that I'm like paying close attention to because I think we're again, you got an NAD cream, a methylene blue, you've got your treadmill and you know, what what are these all doing and why are they doing it? How do we know they're getting into the skin? Like it's all like a lot of it is I agree like a money grab and patients don't know clinicians don't know. So it's really trying to make sure that to me like going upstream of the aging process. Can you talk a little bit about like exosomes because like that exosomes drives me crazy because it's like, well, they're like umbilical cell exosomes, but we stress them with heat and they're like, no, no, no, you need to stress them with hunger or I don't like don't feed them. And then it's like a dipacyte like literally there could be millions of different exosomes. Is there any science and sense to that whole process? Yeah, it depends on which company you talk to, right? And what they're they're there philosophy is. So I mean, I've done like a good amount of on the exosomes, you know, there are different exosomes, these extracellular vesicles, they're messengers between cells, they carry different signals, if you will, you can get them from adipocytes, masoncomole stem cells and then also the platelets. So I do think some of the platelet derives exosomes have some reasonable data, meaning they did skin biopsies before and after showing actual change in the collagen and the last son of the skin. And they're well tolerated, they're not irritating, right? The safety profile, their manufacturing processes are good. So I do like those ones, but some of the other ones, I mean, no, we don't have these like great data as placebo controlled and things like that. So I'm not like keep layering different things on for my patients. So do you even topically or how do you use exosomes? Like here's exosome lotion or are you like, I'm going to micro needle your face and give you exosomes. Yeah. So I typically will use that. So there are some formulations, again, their manufacturing processes quality control are pretty top notch and they've have studies like, like, like, skin biopsy data. So I feel more comfortable in that that are shelf stable. And so then this is something like they use at home. There have been some studies with like topical exosomes like exosomes, like, exosomes and PRP kind of split face showing equivalent. I don't, we have them, some I don't know if I'm with I'm kind of juries out if it's hugely different. Is it worth that extra expense or just micro needleing with good pre and post care and making sure to me and like that you're in a healthy state when you have that micro micro needleing done. Yeah. I have determined that Dr. Hill is going to be the poll. I'm a tourist, regenerative medicine dermatologist. She is like, I don't know if that works. I don't know if I would do that. Her office manager is like, what are you doing? - I would say I'm-- - For the public conditions, right? And they really appreciate it. - That's true. I would say I'm pro exosome because two different people who I think of as really smart guys, Dr. Ted Lane and Dr. Justin Harper, have both who I don't think would bullshit me. They might, but I don't think they would. They have both told me like, no, exosomes are like the real deal. Like they are, as a delivery, it's not the exosome itself. It actually gets growth factors and other baloney into your living epidermis. That's what I have been told. I just Dr. Hill is that vaguely how you think of exosomes as like? - Not. I agree. I do agree, but I think where you're getting from the company, their manufacturing process, their quality control, they all really is very, very important. And so right now everybody's got their spin on their exosome and you're like, is your exosome? One of the big problems is one of the companies actually took a whole bunch of other companies and looked at their products and there weren't even any exosomes in half of them. So this is where we're at. So to me, it's just making sure those sources from a good reputable place that has studies to prove some efficacy. - That's what I think. - Is there like a stamp of approval on a product where you could say, oh yeah, that was rated, their net error exosome. - National exosome foundation. - Well, that's what I said. - There's not an exosome. As like the run of the mild dermatologist who, you know, where your patient comes in and is like, what about the exosomes? Is there like any advice you give to just the general dermatologist about, here's how you could tell if it's a good exosome product or not? Like, is there an exosome product you would recommend if like just as a general? - Yeah, we want an exosome product. - I mean, I really like plated. It's a platelet-drived exosomes. A lot of the studies, Dr. Wiles, who did the skin span. She's doing some, she's a dermatologist, MDPHG, doing a lot of really great research in regenerative dermatology and regenerative medicine at the Mayo Clinic. So I do, like I have read all their studies with their exosomes and their maybe factors. So I do. No, they did just ask me on their advice. So a little conflict with fresh chest there I haven't gone but gone yet, but I do like their product so that's the one that I feel most comfortable using. I know there are some other ones but you know fair it's all right. We're gonna we're gonna rap this up just with the paper that I did was a jet semi article that came out earlier this year. The first half of it which was trying to get back to the top top regenerative medicine for dermatology for skin for skin basically and what was interesting in here was it had a really it's a really useful tables. The talking about the different types of stem cells, the different types of cellular factors and so just the first thing because this was interesting to me. Some things that I didn't really understand so the two things with two first functional things with stem cells. There are self derived stem cells and then there are autologous stem cells where not autologous would be self rather whichever there's some from come from you and others you get from somebody else and the ones that come from somebody else. They have to be immune cloaked so that they don't because you can't just take like patents stem cells and give them to me and like my immune system would get rid of them. So the choices that you've got these pluripotent embryonic stem cells right the problem with those guys is that they are. There's ethical concerns with the idea of them and they conformed charatomas but then you've got pluripotent induced induced pluripotent stem cells where in theory you could harvest these from your from somebody and then like grow them up and have do stuff then you've got these now those are ones I think you like have to harvest them and send them away and like then they send you to stuff back. Then you've got the ones that you're harvesting more quickly in the office. So you've got mizinkable stem cells from bone marrow, which I don't see any germs doing bone marrow to the harvest, but you've got mizinkable stem cells from adipose tissue those ones you hear talked about a lot because I think that is something that there are some germs and plastic surgeons doing where you basically get lipo and then you somehow process the fat that got sucked out and get the mizinkable adipose adipose sites and then you've got the stem cells from umbilical cord blood those seem like good ones because there's no ethical problem and they are immune Nate cloaked so the immune system doesn't doesn't take them. There's actually been a few studies with those in a topic Derm that they might actually help You've got mizinkable cells from placental tissue. You've got epidermal stem cells where again you heart I think those are the ones I remember people were doing like biopsies behind the ear and then sending them off to get harvested and they would come back But I don't see stem cells to be some of the germs are using a whole lot of right now, but PRP falls into the same category of a cellular You know regenerative medicine thing. So first, Dr. Hill with all of these cellular ones I first assumption is that they have to be injected that like I suppose if you lays if you did resurfacing laser Maybe you could use them topically but with like most of them it seems like you're gonna have to inject them for them to do much But PRP like I remember a few years ago PRP was really hot like people were like I Micronetaling it in and vampire facials and you use it after laser and you don't kinds of stuff and you're injected into joints and Like is PRP still I feel like I don't hear as much about it as I used to but that just might be that I'm not listening as much like What's happened? So I feel like that's a hot topic in Durham or at least was what's going on with PRP? Yeah, so I think people are PRP is still used I think just the issue with PRP like it's very much a patient patient variable, right? It's the page depends on the patients PRP so it's not as standardized and even the methods of extracting the PRP Like which method you're using how many platelets there are there's a lot of different like options out there It's something that I will still use but it's not like a huge like it's not like to me It's it's safe. I'm not gonna do any harm I think it can help with the wound healing But is it gonna create this like huge massive change? I haven't necessarily seen that do thing for hair when you're looking at other factors involved in hair loss It could be an addition, but I I add that later once I get you more medically managed as well and then I do think it can be helpful, but I I do have not From the people will still like inject it too So if you're you know if you're doing with micro needle link then we can still inject some of that after I don't think to me I haven't seen these huge significant changes I think the issues you talked about yes with these other stem cells and the Zencomal stem cells whether they're at the Dipocyte derived You know from the umbilical cord or so forth It's like we can't to inject those right now right now like you that's not yeah I guess if you accidentally did it in your office, which I don't know I'm not doing that I don't know any germs that are made that you you harvested their bone marrow and then you injected it I know some like regenerative spine people are doing that But I haven't seen a germs doing that I'm not doing that either. Yeah, yeah I'm only I think you hear about it with a worth of people doing like oh for 10,000 seven e replacement You can get you know mizencomal stem cell harvest and then legit those into your knee and maybe you don't need a knee replacement Like that kind of stuff. I I hear about but it sounds very like just get the knee replacement Like it's ten thousand dollars like unless you know Right if you're you know if you're a regenerative doctor then sure you can afford to generate your own knee But otherwise that ten thousand dollars probably could go to better use Yeah, it also seems like a set up for infection right like you're I'm gonna trust somebody to pull out some stem cells grow them Right presumably got a grow or separate them out and then inject them back in but so when you say inject in the skin Are you like it directing subcutaneously or you not you because I know you're saying you're not doing that but Like PRP or for these stem cells for the stem cells Oh, yeah, I'm not sure I have I don't and how about PRP do you ever do PRP injections? I'll just the scalp Mainly the scalp I will after my greenie to Ling, you know, it's like you know just the dermal and your dermal um I Don't know if it helps you know to it's not like this huge different right but again to me I'm like I think it's never just it to me. It's not just one thing It's just trying to get your body as healthy as possible to me making sure we're not doing like harm by adding all these things that probably don't work and And trying to get your to me. I want your skin to be as healthy as possible I'm not just chasing a wrinkle with some you know shoving some eat something in a wrinkle right like why is that wrinkle there? We're losing collagen elastin. What are some things that we can do to slow the aging process down looking at? I'm like a holistic view so before we go on to patents trivia We've had some debates on the show about collagen supplements oral collagen supplements. I I'm have Believe that the company sponsored studies patent course brought on something as well for college company study one Sure they work the non-sponsored one show that they don't. What's your take on that? - I have a whole, I have a bin of collagen powder in my kitchen to throw in my coffee every day. So that's where I'm on it. - So Ferris is in. Ferris is literally drinking the cool aid, the cool aid has collagen in it. The collagen in the cool aid. So what's your take on, do you do collagen supplements for your patients? - I do and I take collagen supplements as well. So I think getting it from a good source, I use one from like designs for health that does have some, because again, supplements are not regulated by the FDA. So are you getting what they're telling you you're getting, right? So you want to get it from somewhere that's reputable and the one from designs for health, the whole body collagen does have some kind of trademarked sources in there, if you will. So they've been there's been some studies on. I think it can help, you know, with the skin, hair, nails, also just joins an overall tissue. And I know it's not going to do any harm. - Yeah, that's the key. - We talked about estrogen and all the topical stuff. Would, would have we not talked about that you think is an important thing that you, that is an important aspect of regenerative care? - And with the kind of the focus on dermatology, I would say, that's a good point, it's a good question. So we didn't really talk about a lot of the bio-stimulatory injectables that I think could potentially be helpful. - People know about people know about all that. - What would you say? What's bio-stimulatory? So things like sculpture, like cut, how's the apatite? What else? Halleranica? - Renewva, I think is a pretty interesting one, the acyllular fat matrix saligraphed. Were you inject that and then it's stimulate your body to make fat? Because lots of fat pads and certain areas, that's definitely one that I really like as well. Yeah, those are the main ones. - Okay, all right. Let's move on, Patton. What do you got for trivia? What's our topic this week? - Category is getting old. Dr. Hill has no chance. No. All right. Actually, we may have all forgotten the answers. - Well, the oldest person here, I feel like this is my topic. - All right. So the plot, a man remains eternally youthful while a painting of him ages and bears the consequences of his transgressions, named the novel and author. - Is it like Benjamin Button something? - That's the curious case of Benjamin Button was a movie with Brad Pitt where he liked aged backwards, but that is not the, the, the novel of this classic plot. - This is a classic. - The glory and gray. - Yes. - Okay. - What the picture of Dorian Gray and who wrote that? - I can't remember. - This isn't related to 50 shades of gray, is it? - No, it is not. - It's a secret. It's a pre-punch once he's old. Once he's old. It was written by Oscar Wilde. - Okay. All right. - Okay. All right. Number two, on the Beatles album, Sergeant Pepper's Lonely Hearts Club band Paul McCartney wonders if his significant other will still love and care for him when he turns what age? - 80. - No. - 64. - Oh, my Ferris is bringing it today. Bringing it. Win I'm 64. No, that's not ringing a bell for anyone. - Nothing. - Will you sing it for us? - It was actually 64. That was the answer. - Yeah. - Win I'm 64. Will you still need me? Will you still feed me? - Win I'm 64. - Ferris was honestly just a mild guess. - No, I've heard the song. - Oh, okay. Okay. - Okay. I thought those were really easy. So the third one I made impossible. All right. The oldest Olympic gold medal winner was Oscar Swan, SWHN. I don't know if that'll help you or not. He was 64 years old when he won gold medal in a shooting event at the 1912 Olympics for what country? - What country? - Germany. - No, that's a good guess. It's in the area. - I'm thinking it would have been a bi-ad. I'm sure he was a bi-ad close. - You're all around. - You're all around. - Yes, Ferris. Finland. - You had named every country except this one in the area. - Sweden. - It is Sweden. - Well, it was going to be my first guess. - Yeah, this was great. So this was the event. It's called team running deer single shot shooting event. They would have like a little cardboard cut out of a deer and shoot it across the thing and you had one shot and had to hit it. And the team Sweden won the gold medal and he was on it. Crazier even still, he won a silver when he was 72 years old. Same event, but it was like obviously later. And it was a double shot. - Oh, you got two chances. - Yeah, so he was probably on that dissatant quersetan. - Probably before that. - He got a lot of work for them going on. - Yeah, before it was a thing. Yeah, lots of exosomes. - He was an early doctor. - Yeah. - All right. - That's an awesome sport. You know, now we have things like break dancing, but like I love a sport, like a paper deer that you always shoot. - Why would they ever get rid of it? - I just can't imagine. Like you're like kids if you go paper deer shooting someday, you two might be in on the end. - Well, I want to thank everybody for joining us this week. I hope in Dr. Hill, I really want to thank you. This has been a really fun episode. And I learned a substantial amount this episode. I want to thank everybody for joining us this week. I hope you'll have to watch it twice. We hope you've learned a few things, but mostly we hope you're planning to join us next week. Until then, I'm Matt Zyrus. I'm Tim Patton. - And I'm Laura Ferris and we are Derms on Drugs.