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Dermatology Trends 2025: Skin Microbiome, Immune Health, and the Future of Skincare

• Jeanne Collins • Season 2 • Episode 72

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Precision dermatology is rewriting the skin health playbook—and we dig into what that means for you. We sit down with Dr. Elle de Moll, a board-certified dermatologist and entrepreneur, to unpack why the skin is best understood as an immune organ, how biologics target disease without blanket suppression, and where wellness fits as research on the skin and gut microbiome accelerates. The conversation blends rigorous science with real life: female pattern hair loss in perimenopause, evidence-based treatments like spironolactone and low-dose oral minoxidil, and the emotional weight hair carries for identity and confidence.

We go deep on sun safety and expect straight forward answers on SPF 30, UV index, mineral vs chemical filters, UPF clothing, vitamin D supplementation, and why prevention beats a future Mohs scar on your lip or nose. For parents, you’ll hear practical hacks to make sunscreen kid-friendly—think brush applicators, texture choices for eczema-prone skin, and knowing when low UV days let you relax the rules. We also clarify medical dermatology versus aesthetics, why access matters, and how to find a board-certified dermatologist through the American Academy of Dermatology or your insurance network.

Finally, we talk entrepreneurship and motherhood: deciding to build a medical practice that prioritizes access and continuity, choosing what “glass balls” never drop, and letting the rubber ones bounce. The thread through it all is agency—choosing precision over perfection, asking for help, and making small, consistent choices that compound into healthier skin and a saner life.

If this conversation helped you rethink your routine or your care plan, subscribe, leave a review, and share it with a friend. Your support helps us empower more women to live all in—and it takes less than a minute to make a big difference.

Elle's Book Recommendation: Wild by Cheryl Strayed

More about Dr. de Moll:

A Castle Connolly Top Doctor, Dr. de Moll brings a wealth of experience and expertise to her practice, Elite Dermatology Physicians. Dr. de Moll is a board-certified dermatologist and dermatopathologist who completed her training at Mount Sinai, in New York City. Dr. de Moll has a passion for solving complex medical dermatology cases. She thrives on helping patients overcome challenging skin conditions that haven't responded to previous treatments. Dr. de Moll takes pride in her collaborative approach and her commitment to finding lasting solutions for her patients.

Elitedermct.com

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SPEAKER_00:

In your field, what is the latest and greatest that you're kind of like reading about? What are people talking about in dermatology?

SPEAKER_01:

That idea of the skin as an immune organ is like really panned out. All of our newest medicines are called biologics. They're very precise medicines, most of which are given as injections because they're so precise that if you took them as a pill, your stomach acid would degrade them. They're very clean molecules. We're changing the lives of patients with psoriasis, with eczema, paragonodularis, chronic erbicaria, hydra adenitis. We're taking these people's immune system, which is really what's causing their skin issues, and we're tweaking it, not suppressing it. We're not crushing it like we did with the old-day medicines. We're not using chemo drugs, which we used to have to use off-label for derived things. We have very precise clean medicines that fix their disease from the inside.

SPEAKER_00:

Welcome to the House of Germar podcast, where wellness starts within. The House of Germar is a lifestyle brand empowering women to live all in through material design and personal wellness. We are a destination for women ready to reimagine what is possible in their homes and lives and then create it. We are honored to have you join us on our mission to empower one million women to live all in. I am your host, Gene Collins, and I invite you to become inspired by this week's guest. Hello, everybody. Welcome. I am Gene Collins, and today, get ready. We are talking about entrepreneurship and dermatology. I am so excited. I have Dr. Elle DeMaul on the podcast, and she is a personal friend of mine. She is also my doctor. And I love this woman in so many ways. First of all, her background, her experience, her jumping 100% two feet in into being a dermatologist is so great. And she is so qualified. And she really specializes on complex problems. I'm going to put her whole bio in the show notes. So I'm not going to read it for everybody. But Elle, welcome to the show. Thank you so much for having me. I am so excited. So we're going to talk all things dermatology, all things skin. But before we do, I really like to specialize and tell people about your story and your journey. And I want to focus on that specifically for you because I did not realize until I went and had coffee with you how difficult it is to become a dermatologist.

SPEAKER_01:

Everybody wants to be a dermatologist these days. I don't know. It's the skincare trend.

SPEAKER_00:

And but like that's actually not easy to do. And folks, she has two young kids and a husband who's also a doctor. So if you wouldn't mind, like, how in the world did you even get into dermatology? And if you would share a little bit about that journey and that also that journey took you to become an entrepreneur and have your own practice at a very young age. And that is kind of scary. And so I would love to talk about that to start off. Yeah.

SPEAKER_01:

I think that's great. I think, you know, while a lot of times people don't realize what dermatology is, there's a lot of aesthetics now and lots of people interested in taking care of skin. But dermatology really is a, you know, a field of medicine. I went to Haberford College in Philadelphia. I wasn't always sure I wanted to be a doctor. And um, it was kind of a second later in college decision for me. And so I was scrambling, fitting in all my prerequisites during the summer months and taking extra courses and trying to get it done because my interest was in anthropology. I was an anthropology major. I wrote my senior thesis on tattooing. I worked at a tattoo shop, went to tattoo conventions, loved everything about self-expression and display, and particularly the role of women in tattooing, which was traditionally a male field. So I have read almost every book that exists on tattooing in the skin written in the last 50 years. And then I decided to go to medical school to make sure I could have a career because I wasn't sure where tattooing would take me because I'm not an artist myself. Don't get me wrong. I could not actually do the artwork. And I decided to be a doctor. I went to the University of Connecticut School of Medicine, which was great. I tried everything. I loved everything. I delivered babies in Guatemala. I loved emergency medicine. I was in the interest group. I'd been in EMT in college. And I just was looking for a field where I felt like I could make a big difference in people's lives, where I could know my patients for a long time. And I decided to take a year off in medical school to be sure about that, and did some work in mouse model research for melanoma, which is, you know, one of the leading causes of death in skin cancer. And I really thought that this was an exciting time to study the skin because it's one of our largest immune organs, meaning, you know, our immune cells are there and play a big role. And that hasn't been traditionally how we thought about skin, but it is where the greatest research is growing in medicine in general. And so after a year of working on little baby mice models and giving them metastatic melanoma, I was pretty sure that I'd found my calling in taking care of patients with skin concerns and melanoma. And so I did a lot of research and met a lot of people and shook a lot of hands and tried to know everything I could about being in dermatology and was lucky to match at the Icon School of Medicine for Residency and Dermatology, which I did for four years. And then I liked it so much I stayed for an additional year as a Durham Path Fellow. So reading the slides we all make as dermatologists. And I just, I couldn't get enough. I stayed for a long time.

SPEAKER_00:

When you told me how many years you were in school and how many years you worked before you were actually able to do this on your own and start out and have your own practice, I was like, I had no idea.

SPEAKER_01:

Yeah, it's a long road. It's not for the faint of heart, but if you like it, it doesn't feel like a road to somewhere. You know, it that's all part of it.

SPEAKER_00:

Yes. Yes. But I really personally had no idea. And I think a lot of people don't know and don't really understand that dermatology is just like medical school and the amount of education and knowledge that's required and the amount of ongoing education. So in your field right now, we're going to stick to this for a second. In your field, what is the latest and greatest that you're kind of like reading about? What are people talking about in dermatology?

SPEAKER_01:

That idea of the skin as an immune organ is like really panned out. All of our newest medicines are called biologics. They're very precise medicines, most of which are given as injections because they're so precise that if you took them as a pill, your stomach acid would degrade them. They're very clean molecules. We're changing the lives of patients with psoriasis, with eczema, parigonodularis, chronic erticaria, hydroadenitis. We're taking these people's immune system, which is really what's causing their skin issues, and we're tweaking it, not suppressing it. We're not crushing it like we did with the old day medicines. We're not using chemo drugs, which we used to have to use off label for der things. We have very precise clean medicines that fix their disease from the inside. Wow.

SPEAKER_00:

Okay. I have no idea. So, as part of that though, does like overall wellness of your clients come into play?

SPEAKER_01:

I think wellness is the next frontier in dermatology. I think we're starting to look at the skin microbiome the way we're looking at the gut microbiome, and they're actually very closely linked. And I think in the next 10 years, we're going to see more studies linking gut and skin, like, you know, flora health with eczema and other, you know, conditions, even things like mycosis fungoides, you know, skin lymphomas, because I think that connection has been underrepresented. That being said, I think there's a lot of people who want that data to be here now, and it's just not. Like I would love to recommend prebiotics, probiotics, more wellness-based things for the skin. But I think that's where we're going.

SPEAKER_00:

Okay. And I love that because I think like holistic wellness is actually so important. And I feel like it comes up in everything else that we do. It comes up. It's no longer just go have like your annual physical and do your basic blood work. It's like it goes so much deeper, especially as a woman with hormones. And I mean, it's just everything.

SPEAKER_01:

Yeah.

SPEAKER_00:

It's everything, holistic wellness.

SPEAKER_01:

Totally. I think everything holistic wellness. And I think hormones play a big role. I've I've done a really big effort to educate myself as a doctor as we've really shifted our thinking in hormone replacement therapy for women. And it's getting, you know, totally rethought by the FDA and attending several lectures by Yale experts in perimenopause and menopause HRT. I think that's part of it. I don't prescribe it. I think it's outside my lane, but we're definitely looking at it. We're looking at estrogen on the skin, directly on the face. Is that helpful? I think the data is still coming. And I don't like to recommend things because they're trendy. I really want to see the science behind them so that when we make a recommendation, I know where it's coming from. But I love that that's where we're going.

SPEAKER_00:

I do too, personally. Yes. And we have to personally talk about something because since you are my doctor, we're going to talk about two things. We're going to talk about skin cancer and the sun and all that good stuff. And we're going to dig into that. But before we do, we are going to talk about hair growth for women. So these are my extensions. I've had them for three years. This is actually the last podcast I'm going to record with my extensions because I am going to take them out. Not because my hair is fully grown yet or that I even like my hair. So this is a whole emotional growth, learning to love yourself the way you are, loving how you look at yourself, which also plays into the sun as well. And we'll talk about that. But can you talk to me a little bit about some of the trends on things that people might not think to go to a dermatologist for, such as hair growth?

SPEAKER_01:

Yes, hair is well under our purview as dermatologists. We also do nails. And I think there's this feeling that women shouldn't lose hair or don't lose hair because that's more of a men's thing. And I think it's much easier if we call it patterned loss. You know, a lot of people talk about male patterned loss. And yes, that is what men often get, but women get female patterned loss and they tend to have a slightly different pattern. They lose more prominently in the temples often. And we describe a widening of the part or Christmas tree pattern. But it's very common slash normal, I dare to say, that some of your hair thins. For some women, that starts unfortunately as young as their 20s. But almost everybody around perimenopause starts to see a change because our hormones are shifting. And that directly affects hair growth, how long the cycles are, the size of the hair follicle itself. And I think women feel like their options are kind of more to get extensions or to get powders or to cover it up. And they don't really think that there might be something that could help them keep the hair they have.

SPEAKER_00:

And I've been working with you. And so, as part of my journey, I'm going to share publicly on social media part of my journey of doing this because I think there are so many women that struggle and perimenopause, menopause, like it's just really hard. You know, your body's changing and you don't like what's happening and you feel like you don't have any control. And it's when you go and you look in the mirror, there are all these changes happening. And then on top of that, you have hair loss and it's sort of like compounding. And it's and it's really tough. It's really hard. And so I am going to take my extensions out because I am taking medication thanks to you. My hair hasn't really started to grow yet, but you know, we're gonna find out what happens, and it's also part of the journey, I think for me, of wellness for women and learning to like what you see when you look in the mirror, which is not always that easy.

SPEAKER_01:

It's not easy, and I I wish it was. I talk about hair a lot from alopecia areriada and my young patients, and you know, all their hair falling out all of a sudden in six weeks, which we don't have a good story for to, you know, to pattern glass. And I I said to somebody, you know, losing your hair, if we lived in a totally visually blind society, you would be fine, you know, just trying to drive home the point that this was just hair without saying the phrase this is just hair, because it isn't. We don't live in a visually blind society. Hair means a lot, it means a lot about gender and self-expression and identity. So I never try, you know what I mean? But it's important when people think that their hair loss is a sign of something bigger, because oftentimes we do talk about that too. Like, are you healthy? Is it your iron? We think about unfortunately cancer patients losing their hair. Although, as a side note to that, there are a lot of increasing movements, cold caps, and things that people are doing during chemo to keep their hair. But, you know, we tend to associate hair loss with illness and and just so many negative things that it's just as an anthropologist, right? It's just such an interesting topic that ties in a lot of feelings and social norms. And so I think it's really interesting to use the medicines we have. And if right now there's nothing FDA approved for female hair loss, but there's a lot of medicines that have been used for a long time, including sporonal lactone and oral monoxidone and even finasteride that off-label have a lot of benefits for hair and that have been studied in there's case series and evidence that this can be something that really helps women hold on to the hair they have, in addition to HRT, which is always something that's worth discussing and making part of the conversation because that is one of the benefits of HRT.

SPEAKER_00:

Yep. I'm on that too.

SPEAKER_01:

Yeah, I'm trying it all, girl. I think women, you know, this idea that menopause happens and then that somehow we lose femininity or our identity or our vitality. I I think we have to rewrite the story on menopause. And there's so many very interesting people doing that. And so I'm really honored when I can help women, you know, claim some parts of their identity back by get growing their hair.

SPEAKER_00:

Yeah. Yeah. Well, and so much of what you do, like you're helping my daughter, right? My daughter's working with you for her skin and she has eczema and all kinds of things. And I feel like one of the things I love about your practice is that you help people at all ages, and you bring modern science, just the latest in what's out there, to all different ages. How do you remember all of this?

SPEAKER_01:

I love dermatology. I'm a big nerd. I keep telling people I don't really have hobbies. So, like collecting cool rashes or like seeing that great case and cunning for me is like the win. And I'm a bit of a competitor as well. I was a college athlete. And so I love when somebody comes in and said, I've seen another doctor and nobody can get rid of this. Can you? I'm like, well, great. Like now there's a challenge component to it too. You know, this is what I like to do. You know, I think AI is growing. There's an a wonderful app for all physicians called Open Evidence, which is uses AI for to, you know, kind of simplify medical data because there's always going to be new medicines in other fields and things, you know, like the GLP ones coming, they're causing hair loss and acne. So I didn't train in a generation with GLP ones. I'm also not prescribing GLP ones, but I need to know a lot about them. And so attending lectures, having access on a day-to-day basis to even AI and textbooks and community, uh, I'll help make sure that I'm not missing something when I see patients come in on the new latest and greatest drug.

SPEAKER_00:

So much to learn, so much to know. Oh, I have so much to ask you. Let's stick to this. Let's stick to appearance. Let's stick to the sun. Our friend the sun. Everyone, you need to go follow Elle on social media because we all try in our own individual businesses, especially as entrepreneurs, to walk the walk, talk the talk. Like we got to do it. And you, girl, do it. You are outside, you've got your hat, you've got your sunscreen, you've got your glasses, like you are living it with protection against UV. But this subject is another one where it's like people are used to, and I would say everyone I know would say they feel like they look better with a tan. Yet the sun is terrible for us. So, what do you tell your clients who are like, but I look dead, I look better with a tan, and you know that the sun is bad for them. How do you deal with that with your clients?

SPEAKER_01:

So, you know, one in five Americans gets skin cancer. That's just the statistics. So, you know, I don't have to try to convince anybody I'm gonna be really busy no matter what, because this is unfortunately a problem that affects a lot of people. And our love of a tan is very like transient in the grand scheme of human culture, right? And many other cultures being very, very fair and showing that you haven't been outside and it comes with all sorts of class and privilege, you know, connotations to not be tan. So feeling that tan is like a good thing is very American and very of the last, I don't know, 60 years. And I would tell them that the ways to have a fake tan, whether that's a mousse or an at-home lotion or a spray tan, all of these things are so much better than they used to be. I have tons of patients who look tan fabulously without frying their sun, their skin in the sun, pardon. And UV causes damage, you know, whether you're somebody who thinks they tan easily, so it's like less for you or not. What UV B particularly does is penetrate the dermis, attack your DNA in your skin cells, and cause mismatch repairs. And so your skin is getting these little disconnects in the ladder of DNA. And your body's really good at fixing that. And for a while it will. It will catch a lot of these mistakes and you're fine. So you're going out tanning, you're 30, 40, 50, nothing bad has happened yet. See, I'm fine. But over time, that DNA mismatch correction that we're supposed to be doing is gonna miss one. It's not perfect, right? And that's just hard because a lot of these skin cancers come up on places where you've had the most sad eyelids, edges of the nose, ears, lips, places you don't really have a lot of skin that you want to be losing in the most surgeries that I send people for. And so I think a little, you know, ounce of prevention is worth a pound of cure. I don't think people need to be perfect. I don't think people need to not go outside. I want people to go hiking and fishing and do all their life adventures. But pretending that you sunscreen's not going to help you or protect you from some of that damage is is kind of foolish for no reason. SPF 30 blocks 97% of UVV rays, so you don't need the hundred. You can track the UV index on your weather app. So if it's a UV index of one or two, sure. Go out that day with less sunscreen or without your hat. You know, let's be realistic here. Not, it's not all the same. You know, I'm totally willing to meet people where they are in terms of the data, which is yes, there are nuances to this question. And so when the UV index was zero and we were at the pool and I told my husband he didn't need to reapply sunscreen on my three and five-year-old, he was like, What? And I was like, Look at look, science, science, the UV index is zero. Like we do not need to. So I I, you know, I'm not one of those crazy, you know, sunscreen, uh like, you know, absolute fanatics. I don't have any of the weird masks or hoods or things that my husband wouldn't walk out in public with me. But I think it's important to prioritize that health. And there's a lot of good data about vitamin D and the role that that plays. And don't we need to be getting a little bit? I promise everybody, especially with lighter skin tones, skin colors graded one through six, so one, two, and three on the lighter side, is getting enough sun from May till October if they're outside 15 minutes a week with their face and arms exposed. But we don't store vitamin D, so no one's getting it in Connecticut in the winter. Yeah. If you have a darker skin tone, you might not be getting enough. I think vitamin D comes in a capsule form, and that's a perfectly lovely way to get it.

SPEAKER_00:

And I do take vitamin D, and I've been doing that for years. I did not know that I needed to, but I did. And I wish I could get more of it naturally, but that just doesn't happen. As you said, in Connecticut, we don't see the sun enough.

SPEAKER_01:

No, and it's not worth a trade-off for me. I tell people if you could get vitamin C from sucking on a cigarette, is that trade worth it to you? Because somehow it feels a lot more natural to get it from the sun, but it doesn't necessarily make it better.

SPEAKER_00:

Right. And you did say something that I don't want to miss. You talked about because the UV index was zero, you didn't have your husband reapply sunscreen, but yet he still has sunscreen on.

SPEAKER_01:

Yes. Yeah. Sunscreen is good for about two hours, is what we know. And then it's not like it turns off. It's not a yes-no question, but it does wear off. And so we recommend if you're going to be somewhere where the UV index is five or six, then at the two-hour mark you reapply.

SPEAKER_00:

Okay. Two-hour mark. All right. What is, and this is a little in the in the weeds of sunscreen, but I think it's important because not all sunscreen is created equal. And I think sunscreen has different products in it, some of which, you know, definitely are not considered as good as others. Because of the hair extensions, I actually can't use sunscreen with a lot of those products, a lot of the sprays and stuff. So I'm using sunscreens that have a lot of zinc. So my stuff comes out white and it is impossible to get it off in the shower. But if I don't, my extensions will turn pink. So there we go. I go with like a zinc-based sunscreen. Is there a difference in sunscreen? Or you're just like, any sunscreen is better than no sunscreen, so I don't care. Or is there really some sunscreens that are actually better for our skin?

SPEAKER_01:

That's an interesting question. And I'm very pragmatic, clearly. So any sunscreen is better than no sunscreen, period. Full stop. SPF 30 that is FDA regulated, I'm happy. There are concerns in a growing portion of people who are looking at the data. And again, I still use all sunscreens, but they're looking at the fact that if you look at blood levels of sunscreen when you are covered head to toe, chemical sunscreen particles are small enough to cross the skin barrier and you can find them in the blood. That's the whole story that we know. The concern is is it doing anything when it gets there? There's concern for endocrine disruption and some other things. No studies show that yet. Again, the amount of sunscreen you need to put on your whole body to see those blood levels that they did in these studies is more than I'm sure anybody's using. But it's something to look for. And I I, you know, I believe a lot in UPF protective clothing and other mechanisms of protecting yourself from the sun. I think too much of anything is bad in life. That's just kind of something I think we've learned from mistake and mistake again, where we always think we've found the silver bullet to aging. And then, you know, surprise, too much of a good thing's bad again. Zinc is super interesting. It is a physical barrier, zinc and titanium. Sunscreens physically block the light. They do not absorb it and turn it to heat, which is what chemical sunscreens do. And non-nano particles of zinc and titanium are too big to cross the skin barrier, so they cannot be absorbed. So if people have these concerns, I think it's perfectly reasonable to use a physical sunscreen like zinc or titanium. Again, the non-nano ones. The nano ones are really nice because they're a lot more invisible, but then they're small enough to cross, and you're left with the same question. But I'll take what I could get.

SPEAKER_00:

Okay. Yeah. And I will say to people, like, I have to tell you, because I've had to do this and I've had Moe's surgery, I've had it on my lip. That was so not fun, folks. I they didn't even tell me when I did it that I could only drink things with a straw for a week. I couldn't eat real food. They didn't even tell me until after it was over. And I had no idea. I was so ill prepared. And I also had one like right on my chest. And I was like, once again, terrible spot to have a scar. Really terrible spot to have a scar. So I personally have had to, you know, because of all of these things, pay a lot more attention to the sun and to the sunscreen that I use. And I very often will put on like baby-based sunscreen, which has zinc in it. And it's really like it's white. It's so hard to get it off. I'll, you know, I'll go to Mexico and it's like all white. I'm like at the beach and I'm all white. You know, it's like I'm trying. I'm really trying. So I have one more question about sun, too, actually. A first question is the mindset of the skin damage that I am getting now. So when I have something pop up that we have to remove, is that from something I've done recently? Could that have been for what I did when I was 12? Like, where does the damage happen? Or, like you said, is it just that it compounds? So it doesn't really matter what I did when I was younger, if that question makes sense.

SPEAKER_01:

Absolutely. A lot of the sun damage is sun from when we were younger. And I try to tell people that so they don't lose hope that like what they're doing now still matters. Your exposure of UB over your life is cumulative. So whatever age you are, if now is the age you decide to get careful, there's benefit. It's never too late. Maybe 90 plus. Maybe at that point it's too late. But anything below 90 plus or if you decide to be careful, you know, that is a good thing. The damage can take a really long time to develop. And so I, you know, even if you find, you know, are a reformed son lover like I am, who was in the tanning beds in the 90s. I was not a dermatologist. I wanted to be tanned from my high school prom. I looked so great, you know, that's scary. And the reality is burns and tanning bed use as a child are worse for you than they are in adulthood. They have a bigger impact in your cancer risk. So being careful with our kids is really important.

SPEAKER_00:

Yeah, that's me. Yep. Mm-hmm. In college in Arizona, a sun and tanning beds. Oh my goodness, when I think back about it and I think back to when I was younger and we used to go lie out on the blacktop with trays, aluminum foil trays, and put baby oil with iodine on them and just like reflect the sun onto our face is so terrible. So terrible. Yeah. Okay, so let's talk about kids for a second. What suggestions can you make to people about how to get their kids to embrace the concept of sunscreen? Because I am sure my daughter is no different when she was little to the children now, even though she's 19 now. Putting on sunscreen ain't so fun when you're a kid, and that's not cool. So, how do you help kids embrace the concept of sunscreen, just like wearing a helmet when you ride a bike?

SPEAKER_01:

Because it is like wearing a helmet when you ride a bike. And in my house, if you're not wearing a helmet, you're not riding that bike. And when you give kids wiggle room, I think they, you know, you know, capitalize on that. You give them an inch, they take a mile. I've got a three-year-old who's really committed to seeing how far she can get away with everything. And I think they also, you have to meet kids where they are. You're not gonna buy them an uncomfortable helmet. You're not gonna buy them a helmet for like hockey when they're doing bike riding. I think giving them the right tools. So we have a little applicator with a makeup brush that my kids can do independently, that's important for one of my daughters. Uh, another daughter has bad eczema and like thicker sunscreens really flare her. So we do use more sprays because that's what makes her skin more comfortable and she's still getting the sun protection. So who am I to complain? And, you know, also having like a little, you know, hacks and that and and recognize when the UV index is zero so that I'm not always the hovery mom that's like making them afraid of the sun or being outdoors, because I think that's really good for kids to grow up outside.

unknown:

Yeah.

SPEAKER_00:

And you don't want your kids to be like, oh yeah, my mom doesn't let us do anything because she's a dermatologist and the sun is bad. And, you know, yeah. Especially because you have a business locally in town and you are very well known locally in town. So let's talk about being an entrepreneur and starting a business. What made you decide you wanted to do that?

SPEAKER_01:

I decided that I wanted to be the master of my own destiny. And I think, you know, I kept thinking there are ways that I was gonna do that, working for other people. And at the end of the day, you know, if you have the opportunity to really take control of your life and and work for yourself, that that's the best opportunity to do that, to really say how every day is gonna look, what the small and medium and long-term, you know, uh horizons are gonna look like. And especially when I feel like as a physician, patients at the end of the day look to me and they say, Well, the buck stops with you. Like, you know, you're my doctor, you take care of me. When you're a cog in a wheel of a big thing, that's not always true, but you feel like it should be. So I, you know, now it really stops with me.

SPEAKER_00:

Which is amazing. So I don't want to neglect the fact that you have two little children and you also have a husband who's a doctor. Yes. How in the world do you juggle this? Because you're not just like running a business, you're running a family, you're running a household, you've got little people, and you have you. How do you juggle it all? Just as like a woman to woman. How are you doing this?

SPEAKER_01:

I think juggling is an interesting idea. And somebody once told me that, you know, there are glass balls and rubber balls that you're juggling, and it's okay if the rubber ones hit. And I think when you're really busy, you have to decide what the glass balls are. Time with your kids, you know, put downs, reading stories, making sure, you know, my husband and I have some grown-up time, you know, being here for my patients on time, ready, like thoughtful for that. Those are glass balls. Those are things that are not gonna ever be negotiable for me. But things that are, you know, having the right backpack for my kids or the latest and greatest toy, you know, or having signed them up for the right extracurricular when those signups go up so fast, that's a rubber ball. My kids are gonna learn maybe a little bit of disappointment and resilience and move on. And everything can't be so precious that I'm frozen by the ability that some things are gonna get missed.

SPEAKER_00:

You're not striving for perfection.

SPEAKER_01:

No, perfection is the enemy of the good. And I think being a mom, every every mother knows that. And when you just keep adding on to that mother title, which as we all know is like the most important one, well, every time we add on to that title, it's more and more clear. You have to be more and more stringent about what the glass balls are gonna be in your life.

SPEAKER_00:

Yeah. So I have a business question for you. When do you decide like expansion? How do you decide that as an entrepreneur? Like, I'm going to expand the business, I'm going to hire another doctor, I'm going to just make the business bigger, just as a business person. How do you make that decision?

SPEAKER_01:

It's a good question. I I've been really lucky to open in New Canaan and be very busy. I think we have a little bit of an underserved medical market in town. People want to stay in town for things that merits a mess. 106 has been under construction for years. Like it's hard to leave town. You have to leave 25 minutes to go basically anywhere. So I feel like, you know, we're meeting an unmet need. And the other reality is that a lot of dermatology has shifted to cosmetics. So even just within the county, by being a practice that focuses exclusively on medical dermatology, we just have more ability to take care of the poison ivy, the shingles, the skin check than somebody whose time is being pulled in many directions. And so I want to keep growing this vision until we've met everybody's needs and until people can call and the wait list is, you know, the wait list isn't three months. And you know what I mean? That I can only do that by recruiting other people. I've got the same, you know, 80 hours in a week to try to get stuff done at work that everybody else does. And, you know, I've got to start borrowing other people's hours to kind of make this dream come true where busy medical practice that you know you can get the care you need.

SPEAKER_00:

Like word of mouth for your practice is incredible, and the number of people that comment on how great your practice is. Because I think your practice has a vibe of small town doctor, which is not a part, but yet you're affiliated with a big hospital. Like so you've accessed all the big things and you are not in small town in terms of your skill set and your knowledge and what you're bringing to the table. But yet you walk into your office or you call on the phone, you get to talk to a human being. And it feels like everybody knows everybody and you run into people that you know in town. So I just have to say that's very cool because that does not happen in most practices anymore, because most practices are just such a part of a larger conglomerate. So you have created an energy of wellness in your practice. And part of that wellness is just knowing your patients and knowing who they are.

SPEAKER_01:

Yeah, I think it's a shame the way medicine has evolved in the last 50 years with a number of middle managers and administration folks outnumbering doctors, you know, 10 to one. I don't think that helps people feel taken care of. I don't think that helps people be seen or be well or get the kind of attention they need. And, you know, the system when it's big and clunky doesn't make allowances for, oh, well, you know, so-and-so is pregnant and having a baby tomorrow. Like, let's get them in. Like, let's really help them out, or so-and-so's kids leaving away for the semester, you know, abroad, and like this is their last chance to get in. Like, let's really do everything we can to like help them. These might not be life or deaf deaf decisions every day. This is dermatology. I recognize that, but they are like quality of life decisions. They are impactful to how we carry out our everyday, even more so now that we're on screens all the time and and and how your skin looks is just cast about all over all over.

SPEAKER_00:

Mm-hmm. And especially for the younger generation. I will say, you were so accommodating to put my daughter on the wait list, you know, instead of having to wait three months to see her. You managed to like squeeze her in one day and it was great. It was so fantastic. And uh, she is so indebted to the help that you were giving to her. So thank you for that. So I want to talk about one thing that you talked about, and I don't want to skim over this medical dermatology versus, and correct me getting the term wrong, medical dermatology versus like, is it called cosmetic dermatology?

SPEAKER_01:

Yeah, or even aesthetics, because a lot of it's being done by non-dermatology folk.

SPEAKER_00:

What is the difference? Like, how does someone know?

SPEAKER_01:

Totally. I think everyone should be really transparent in their advertising. And I think a lot of places are that they're focused on skincare and injectables and cosmetics. And I try to make it very clear on my, you know, practice website and all of my material that I am not. I have never been a makeup person or a skincare girl. I don't have a complicated skin regimen myself. I do do cosmetics and I try to be very honest about that. I was just seeing my good friend Dr. Butler this weekend, IPLing off some of the sun damage from when I was, you know, 19 in a tanning bed. You know, I think that feeling good and looking good to your point is a part of being happy and successful and, you know, living my best life. But I do zero of that in my office. I don't like it. I don't enjoy attending the meetings on it. I couldn't tell you what's the latest and greatest in cosmetics because I don't go to those meetings. And they're separate meetings, and there's a whole scientific community who's very interested in answering those anti-aging questions. But I am here for you for diagnosing all the melanomas and treating complex hydranitis and scraping molluscum off kids and doing the things we need to do that make life better medically. Okay.

SPEAKER_00:

Which is important. At what age should someone start to do sun screening of your skin?

SPEAKER_01:

The United States Protective Task Force, which is the governing body that decides based on all the data and the risks and the cost of cancer when screenings are appropriate, that just lowered the guidelines from 50 to 45 for colonospedes, does not recommend skin cancer screenings across the board. Like they do not recommend them at all because cost-wise, whether your basal cell is this big or the size of a half dollar doesn't really matter and doesn't change the cost that much. And very often basal cells and squames, once they're big and obvious and bleeding and everyone would pick them up, they can still be treated and managed. And they're not routinely recommended and they're not covered under preventative screening, like reimbursement, which is hard to explain to people because I also think that skin cancer screenings are a good idea, but I can't convince the government of that. Um so I generally tell people if you have a first degree relative with melanoma, that means parents, siblings, uh, or kids, then you need a screening every year because melanoma is fairly heritable. If you have fair skin, a history of blistering sunburns or tanning beds, like you should be start getting a skin check probably by 30, 35. And if you have any medical conditions that predispose you, which your specialist should be telling you about immune suppressance, radiation, anything like that, CLL, all of which decrease your body's ability to fight skin cancer. Like side note, our body's really good at fighting skin cancer. And when we immune suppress people for any reason, their skin cancers go crazy. So those are the populations that really need it. And then, you know, I can't say that there's a universal age of everybody needs to see me every year. Okay, that was so not the answer I expected. It's always data for me. I want to say, like, I want to see everybody always.

SPEAKER_00:

But I know, but I love that. But I'm actually shocked that it's not considered part of a regular protocol that the government recommends, a regular protocol, just like a physical. Like I'm shocked at that. That is that's why I expected that there was actually an age answer to that question. There is not. Okay, well, I've been going. I I'm now on every six-month plan, folks. So, you know. Prevention is a good thing. All right. So, like I said, you are a super busy mama. Two little ones, you are running your own business, your husband is a doctor. How in the world do you make time for you?

SPEAKER_01:

I think that's an interesting question. I think the moms who juggle and do all the things that were really good at getting every all the glass balls not to drop, but the one that you have to kind of create out of thin air would be like your own kind of like wellness. And I think that's a lot harder to do. I've done a really interesting job meeting a lot of cool entrepreneurs and women business owners in town, you're starting with yourself last summer when I was in the very early days of opening my doors. And, you know, I think it's fascinating. I love meeting these other women. I love meeting these other colleagues who are doing similar things, and we talk about it a lot. And I don't think there's an easy answer. And there are weeks where there's no self-care wellness and it would be, you know, misleading or kind of paint a rosy picture of what my life is to say that there is. And then there's weeks where, you know, I take like a good chunk of time, a whole Saturday, and I go to the library and I go for a run, and my husband or my nanny, you know, like not for nothing. My husband works every other weekend. And and learning that I was allowed to get care, child care for myself without an explicit agenda was very eye-opening. As a working mom, I felt like I should be working or with my kids. And since I work a lot, that meant there was really no time for me in that schedule, especially because I became a mom in the pandemic. There was nowhere to go. Um, but I think that, you know, creating space for myself and not me feeling that childcare is like a luxury or something that needs to be saved for if I'm working has been really, really helpful because sometimes you just need six hours to not get smeared like peanut butter on.

SPEAKER_00:

And that is so perfect that you said that. And I'm so glad you shared that because it's about you making yourself a priority. And that is just as much of a priority as everything else. And so often women feel guilty about doing that and about taking that time where they're not at work. I'm feeling like, okay, if I'm not at work, then I need to be a mom and taking some of that mom time or some of that work time and saying, no, I'm gonna carve a little piece out for myself, and that does mean I need child care because I'm gonna shave off a little on either side. But if you don't take care of you, and you know that's being in the medical profession, if you don't take care of you, it impacts everything in life. You have to. It's so important and mind, body, spirit, all of it. Just making time you've made time to come and meet me for coffee. That's hard to do as an entrepreneur.

SPEAKER_01:

It's busy. But I think as since I'm raising two daughters, you have a daughter. I think the importance of doing it is I now see kind of mom guilt in in raising them that my focus on wellness will teach them focus on wellness. And if I don't do it, how will they ever? Yes.

SPEAKER_00:

Yes. All right. So I have a couple more questions, and then I'm taking so much of your time. I know you have to get back to your patients. So, first question is someone who is watching this or listening to this and they've never been to a dermatologist before and they're trying to find one, but they don't live in New Canaan, Connecticut, or in our surrounding areas. How do you suggest they go about finding appropriate good quality care?

SPEAKER_01:

There's two ways to do this. One is to start with the American Academy of Dermatology website, find a derm. You will find a board-certified dermatologist and not somebody kind of masquerading as somebody who's interested in skincare and you can work backwards that way. The other is to start with your insurance and filter by dermatology that way, because that'll be two words of one stone. You'll also find somebody who's in network for you, and that's really helpful as opposed to going to Google where I feel like there's a lot of advertising for kind of skin-related things, and it can be a little bit more confusing.

SPEAKER_00:

Perfect advice. And yes, it is covered by insurance. Like it doesn't necessarily cover all of it, depending on your insurance, but a lot of those things can be covered by insurance, which is really helpful. You're not always just an out-of-pocket, out-of-network type of service. So thank you for that as a patient. Thank you. Is there anything I didn't ask you that you think is really important to communicate, whether it be about dermatology, trends, yourself, your business, women, any subject? Did I miss something?

SPEAKER_01:

You didn't miss anything. I just really like being in town. I like connecting with you, connecting with other patients and women in particular, and kind of sharing the experience, sharing what I've learned, going out on your own, doing your own thing, you know, whether you're in medicine or not. I think some of the same themes uh are kind of shared. And I want to give every woman who's thinking about making that life shift, career or otherwise, like a hug and like it's so worth it. And future you're gonna be so happy you did it.

SPEAKER_00:

Perfect. And you're so correct. And there's so many people. And I think I found from meeting you and other women, like you said, you don't have to be a doctor. You could be going out trying to do your own thing on so many different levels and so many different things. And there's so many people that are out there to support you and to help you because some of the challenges that we have as entrepreneurs are similar no matter what business you're in, what field you're in, what town you're living in. It's a similar juggle with all of this. So don't be afraid to reach out to people. Yeah.

SPEAKER_01:

I think when you go in with, I'm doing this too, can you help me? I've had so many more yeses than no's. Yes. Yes, me too. Asking for help.

SPEAKER_00:

Yeah. Which is hard sometimes, asking for help. Yeah.

SPEAKER_01:

Oh, yeah. So if you're not ready to ask for help, you're not ready to take the leap. You have to be ready to ask for help.

SPEAKER_00:

You have to be ready to ask for help, right? And you have to be ready. I also found you really have to be ready to let go of some things. And you don't have to control every single part of your business or do every single part of your business. You need to learn where your specialties lie and how do you resource to provide things that you don't know. You don't have to know how to build a website. You don't have to know some of these things. It's okay. You have to outsource and find people that do to help build a tribe to help you.

SPEAKER_01:

Absolutely. I think that will bury you in the details if you think every single piece of your business is the thing you need to do. But at the same time, listening to my amazing friends and colleagues who have done things who have a great website. Like, hey, yours is great. People love to tell you. Like, I love my website too. Thank you. Let me give you my person.

SPEAKER_00:

Exactly. That is so true. All right. Before we go, I love to ask all of my guests to recommend a book that has impacted them personally or professionally. I'm a huge proponent of reading. I know you read a ton. You already announced you're a nerd. You read so much. What book would you like to recommend that you think people should check out?

SPEAKER_01:

My book's a throwback. Maybe a lot of people have read it already. It is called Wild by Cheryl Strade. She is a very powerful female author, and I think has had a lot of life experience. And the book details her coming of age and hiking the Pacific Crest Trail on the West Coast with really no preparation. And I read it every year, pretty much at least once. I go back and read it, and I find different pieces of it at different phases of my life really uh inspirational. And so I find that it's a powerful read. I'll I'll say that, but I a really good one.

SPEAKER_00:

Ooh, I like that. I've never read it. So I'm gonna have to go get that. I'll lend you my copy. It's always in my desk. Oh, I love it. That is so great. Thank you. And I have a book for you. Have you read 10X is easier than 2X?

SPEAKER_01:

No.

SPEAKER_00:

Gotta go read it. It's a business book, but it's a good one. It's a good one because I know you're really you're looking to expand your business and really do a lot more and like really make a difference in the world. Yeah. And that sometimes is hard to do when you have a list of things you want to do that are really long. And I found that helped me a lot as I was trying to like step into bigger and better and more. Really good one. 10X is easier than 2X. Love that. I love that. So thank you so much, Al, personally, for being my doctor. You are just so amazing. And you're also just an incredible woman. I am always so inspired by you. I love following you on Instagram. You give really practical, great advice about products and sun and what to do and the sponge thing that you use for your kids to put on sunscreen. Like you put that in. I was like, where was that 20 years ago for me? Like, where was that? So I really encourage people to follow you. You're very real, which I think is really important in a in an age where people are not so real. You show up as you are and you try to help people with their skin and with their challenges, but recognizing this is real life and perfection is not it, folks. Um so I thank you very much for coming on the show and sharing your brilliance. And I hope you have a beautiful day.

SPEAKER_01:

Thank you so much.

SPEAKER_00:

Thank you for joining us for another episode of the House of Germar podcast, where wellness starts within. We appreciate you being a part of our community and hope you felt inspired and motivated by our guest. If you enjoyed this episode, please write us a review and share it with friends. Building our reach on YouTube and Apple Podcasts will help us get closer to our mission to empower one million women to live all in. You can also follow us on Instagram at House of Germar and sign up to be a part of our monthly inspiration newsletter through our website, HouseofGermar.com. If you or someone you know would be a good guest on the show, please reach out to us at the podcast at houseofgermart.com. This has been House of Germar Production with your host, Gene Collins. Thank you for joining our house.