Vitamin A Magic: The Retinoid Effect

Join us for an enlightening conversation with Dr. Todd Schlesinger, a board certified dermatologist, as we explore the transformative power of topical retinoids. Discover how these vitamin A derivatives work at the cellular level to address skin issues such as acne and wrinkles. We promise to simplify the complexities surrounding retinoid formulations and discuss the variety of available options, both over-the-counter and prescription-based.

Topics discussed:
• Overview of what retinoids are and how they function
• Discussion of the various types of retinoids available
• Differences between prescription and over-the-counter options
• Explanation of the advantages of modern retinoid formulations
• Addressing misconceptions about side effects
• Emphasis on the importance of individualized skincare regimens
• Exploration of natural alternatives versus scientifically-backed retinoids
• Information for integrating retinoids into a daily routine

Visit our website, www.dermittrotter.com, for more valuable information and skincare tips.

Transcript

Understanding Topical Retinoids in Skincare

Speaker 1 0:00

Welcome to Dermot Trotter Don't Swear About Skin Care where host Dr Shannon C Trotter, a board-certified dermatologist, sits down with fellow dermatologists and skincare experts to separate fact from fiction and simplify skincare. Let's get started.

Speaker 2 0:19

Welcome again to the Dermot Trotter Don't Swear About Skin Care podcast. Today I have Dr Todd Schlesinger on the podcast. He's a board certified dermatologist practicing in Charleston, south Carolina. He's a clinical assistant professor of dermatology at the George Washington University School of Medicine and Health Sciences, as well as has faculty appointments at the Medical University of South Carolina. He practices at Epiphany Dermatology, who recently acquired his practice. He also maintains an independent clinical trials practice at Clinical Research Center of the Carolinas, also in Charleston, south Carolina. He is a current member of the AD Board of Directors and he's also scientific director at FACE Conference in London. So, dr Schlesinger, welcome to the podcast. It's great to have you on today.

Speaker 3 1:04

Thank you so much for having me. I'm excited to be here with you and be in the podcast.

Speaker 2 1:08

Yeah, it's one of those things that you know. I love doing our podcast together, especially having an expert like yourself, because these questions, these topics we get are really motivated by what patients ask every day, and one of the things we're going to talk more about is kind of the you know, thefamous world of vitamin A and topical retinoids, and a lot of people know about this, or they're told to use a topical retinoid, but people don't even know what this means and what are the different types that exist. So we're going to start at the very basics and have you just explain what is a topical retinoid? When a patient comes in and you want to recommend it, how do you explain that to them?

Speaker 3 1:41

Well, I think, if you start with a strict definition of a retinoid, you know it's a molecule that binds and activates the retinoic acid receptors to influence differentiation and proliferation of cells. So, basically, what's happening is it's working inside the cell and through a direct ligand receptor binding, which means that the retinoid, of whatever kind it is, is binding inside the cell and then it has an effect inside the nucleus and that's what the effect comes from. Now, what is being influenced is the retinoic acid-responsive gene. So, ultimately, what's happening is you're influencing what's going on in the nucleus of your cell. And so, that being said, you know the function of a retinoid is to normalize abnormal desquamation, which is a skin cell turnover in conditions like acne. It also helps the hair follicle cells turnover our epithelial cells and increase the shedding of skin cells or keratinocytes. And so what happens here is you have comodones, you know, which are whiteheads and blackheads that are exposed, and then you have the reduction of small, or what we call microcomodone formation. So all these things are helping keep our skin smoother.

Speaker 3 2:46

And now, lately, there's been a lot of evolution in topical retinoids over the years, which have led to a proliferation of products being used in multiple skin conditions. So you'll see out there. When you go online and internet and search around, you'll see just hundreds or thousands of different products. So you'll also see. You know retinoids, you know, are a class of molecules that come from vitamin A, and you'll see the word retinol being thrown around as well. And we'll get into a little bit more in talking about the different types of topical retinoids that are out there.

Speaker 2 3:17

I think what a lot of our listeners may catch is how you mentioned that you know smooth skin and increases kind of that skin cell turnover to kind of help us. Because a lot of people are looking to topical retinoids, you know, searching over the counter, especially in terms of, you know, wrinkling. You know people hear how good they can be for wrinkles. You mentioned, obviously, that you use for acne and other skin conditions as well. If somebody is kind of looking, you know, over the counter and they see retinol or they see the word like adapalene, or they might even see retinoic acid, or maybe they've gone to a dermatologist and the dermatologist said, hey, no, I want to prescribe you something called tretinoin. How do you explain the differences between all these options that we have that are considered retinoids?

Speaker 3 3:56

Right, there's so many different ones and there's prescription retinoids and then there are non-prescription retinoids, there areino esters and retinaldehyde. So let me see if I can sort of tackle that for you and break it down as best I can. So you know retinol itself, as you mentioned, that's the natural form of vitamin A and it's the more potent metabolite. It's more potent metabolite is retinaldehyde, which you've probably seen as that, as an ingredient as well. So retinaldehyde is the natural precursor to retinoic acid. Tretinoin that retin-A tretinoin was the first retinoid to be approved, and that was in 1971 for acne, and it's the only retinoid with the official indication for photoaging and wrinkles, although I think there actually is another one now that's available. So it's not the only one now anymore available. So it's not the only one now anymore.

Speaker 3 4:43

Retinoic acid, which is a biologically active form, is formed in the cell when retinaldehyde, which I just mentioned, is oxidized irreversibly by the body. So that's a process inside your body. And then there's these receptors and we call those retinoic acid receptors or RARs, and that's where the binding occurs inside your cell for the two main natural retinoic acids, which are called all-trans retinoic acid and then 9-cis retinoic acid, in order for that retinoic acid to get into the nucleus or the center of the cell, it's got to bind a receptor in the cytosol of the cell, which is the part that's just outside the nucleus of your cell, and that's called the systolic retinoic acid binding protein. We also affectionately known as the CrabP protein or CrabApple Some people say CrabApple it's C-R-A-B-P and that actually transports into the nucleus where it can then bind those retinoic acid receptors. And then there's another receptor in the nucleus called the retinoid X receptor different from X, the social media site and that's called RXR. There's a medication called bexarotene. That's another retinoid, that's more of a drug that's selected for that receptor and we actually use that to treat a type of skin cancer called cutaneous T-cell lymphoma.

Speaker 3 6:00

So it's really interesting how many different retinoids there are and what they can be used for. And then, when you dig into it a little bit more, there's three subtypes of that RAR receptor. There's RAR, which is in the epidermis. There's RAR beta, which is in the dermis of the skin, which is the layer below the top, and then there are other body tissue and that's also found in other body tissues. And then there's RAR alpha which is found in all skin layers and you'll see kind of why that gets important to at least know that. You know there's different kinds of receptors, you know in our skin and then on top of that there's what's called a retinoester.

Speaker 3 6:35

So esters are actually what you might find in many topical products that you'll see over the counter on the shelf when you're looking at these online, and these are those precursors to that retinoic acid and those can be found in the skin what we call endogenously, which is naturally, but they can also be made in the lab or synthesized and those are pretty popular in the cosmetic sort of world. The ingredients they're very popular. In commercial anti-aging products you may have seen ingredients like retinol palmitate, retinol propionate Propionate is just like a fatty chain that's added to the retinoid and there's reasons why they do that and they each have their own benefits. So, for example, retinol retinoid, which is in products it's a synthetic, which means it's made in the lab, derivative from retinol and retinoic acid. They combine those two and the whole point is make it more stable when it gets exposed to sun. And there's a reason for that too, which I think we'll cover a little bit later, is why people get sensitive to the sunlight when they apply these and why they have to worry about that. It has to do with old retin-A and that retin-A was very unstable in the sun.

Speaker 3 7:44

So how do we make it better? These are the different ways to make it better. And then you know there's another one out there which I think you mentioned, called adapalene. Now adapalene is over-the-counter now it used to be a prescription only and now it's over-the-counter in a different concentration which is lower, and it's selective for just certain RARs or receptors. So if you remember that old tretinoin we talked about, tretinoin binds all the receptors, all three of them. So it's not very selective, right? So when you're more selective for certain ones, such as the RAR, you're going to get an advantage, and that advantage comes from feeding acne and also helping your skin cells differentiate more, what we call terminal differentiation. It helps them be more stable in the skin.

Speaker 3 8:28

So I think in the bottom line for people is how to decide what's right for you or an individual. How do we as a clinician make that decision? It really depends on the intended use. So, for example, a dapaline, which is also known as Differin, was developed to be less irritating and least prone to be degraded by the sun, which allows for that daytime application. It's got a great safety record so it allows it to become over-the-counter in that lower concentration of 0.1, and also be formulated with benzoyl peroxide, because it won't break down like tretinoin would.

Speaker 3 9:00

And benzoyl peroxide, we know, is irritating and drying. We know about that because it's over-the-counter and everybody uses it. And there's been some concern, you know, in the marketplace about benzoyl peroxide and benzene and all that which has still remained to be determined. But the ultimate decision, I think, of which one a clinician might use in a patient depends on the condition being treated and then that clinician's particular comfort level with those retinoids. So your doctor may, you know, be more comfortable using certain ones and others, based on experience. So that kind of helps us to determine, sort of with our patient which one's the best one to use.

Speaker 2 9:33

And do you think too kind of the decision-making process. Do you ever feel like the tolerability factor comes into play, like something like do you consider, like a retinol, to be somewhat weaker since it's less potent and more tolerable from a side effect profile? Is that also part of the decision-making process if you're talking with a patient?

Speaker 3 9:50

Absolutely.

Speaker 3 9:50

I mean, I think that adverse event management is key. We want to make these medications tolerable for our patients. As you move up and down the line from different ones, you actually can have different tolerability levels, even within one retinol to another retinol, and that can depend on how that retinol is not only made, but how it's formulated. So if it's encapsulated, for example, in a right formulation, if there's these new nanoparticle formulations that are out now that are being looked at, if you've heard of some, there's some newer brand names of you know.

Speaker 3 10:23

First, you know, tretinoin is a first generation retinoid. There's four generations we only really see first, third and fourth. The second generation kind of was really a no man's land. We didn't really have anything in there. But over the generations we've been able to create. You know, the science has been able to create retinoids that are less irritating by adjusting which receptors they sort of bind to and then putting them in the right vehicle. And on top of that you got to do good skin care. So we've learned and this is one thing we're kind of behind our European colleagues of how important it is to have an excellent skin care regimen when someone is using a retinoid to balance out some of those issues that we see.

Speaker 2 10:58

Yeah, because I think it's you know, just with you going through the details, it's a more complex you know, I think question than even what you know. Patients come in and which one do we use? I think you're right, it really relies on the clinician's experience, their comfort and then probably the tolerability factor. But I think another question that comes into play that patients are asking too, about if a certain retinoid is right for them is, you know, there really is this trend of looking for something that's more natural or maybe a natural alternative. Do you mind commenting on, you know, what's considered more natural versus? I know you briefly talked about synthetic and for some of these more natural alternatives, if there's something that you know, there's data behind it to show that they could be beneficial.

Natural vs Synthetic Retinoids Debate

Speaker 3 11:37

Yeah, no, it's a great question. I think we're all looking for something, you know, that can benefit our body. And you know, stay away from what we call, you know, synthetic things, but sometimes it can be actually good. So retinol itself can be found in nature. So you know that can come from animal or plant sources, but most actually, products that you see out there are actually made in the lab. So there's very few of them that are actually natural that you can get your hands on. To name a few adapalene, tazeratine, trifarotene, all those ones that you see. Those are well, adapalene is over-the-counter and prescription, tazeratine is a prescription, trifarotene is a prescription and those are all synthetic. Those can interact with the same cellular process as those products that we would consider natural.

Speaker 3 12:19

There's another synthetic retinoid that's well. We mentioned trifarotene. That's actually a fourth-generation retinoid, so the newest that we have and that also offers selectivity to the RAR receptor, like adapalene does, and I mentioned. That's found in the epidermis, top layer of the skin. So that's very helpful to help reduce irritation. So that one's approved for acne of the face and trunk and comes as a cream. And one of the reasons it got approved for the face and the trunk for acne is because it's less likely to be absorbed, and so they felt it was more safe to apply it over a wider area of the body because of lower systemic absorption. And then also there's another one called Tazaritin, as I mentioned. That one's approved for facial fine wrinkling and pigmentation, in addition to acne and psoriasis. Quite earlier, I just mentioned that Tretinoin is the only one, but it's not the only one. That's for facial fine line or anti-aging. Tazaritin is also approved as well.

Speaker 3 13:16

So, as far as you know, is natural better? Yes, not always. Really, some of these synthetic retinoids, even though they're synthetic and that work kind of sounds bad, it actually means that these are tuned, fine-tuned for the body and actually can be less irritating. They can be less likely to break down with sunlight because, you know, when break down, um, certain retinoids like tretinoin you know the old school tretinoin if you break that, the sunlight breaks that down, but byproducts of that breakdown can actually be irritating. So, um, it isn't always necessarily the sort of thinning of the skin everybody thinks that retinoids thin skin. Really they make the skin healthier and thicker and more collagen. So it's some of those breakdown byproducts which are creating that sensitivity toward the sun. So, you know, natural is a nice word, but it's not always better when it comes to retinoids.

Speaker 2 14:03

I think that's a really good point and I don't know if you've ever had patients come in and ask you know about like Bacuchiol or rosehip oil. You know some of these natural alternatives I know. Probably Bacuchiol is probably the most. Maybe potential data behind it on it might be beneficial. Probably the Cuccio is probably the most. Maybe potential data behind it on it might be beneficial. Are those things you sometimes recommend?

Speaker 3 14:21

as well if people are looking for a more natural alternative. Well, you know, we're about to publish a paper. A group of colleagues of mine I was gonna mention it later, but we're going to publish a paper that talks about all that stuff especially relates to acne, and it's going to be talking about all those ingredients. You know there's so many ingredients. Mainly what it's about is putting drugs in a formulation, but also adding in that topical skincare, and those ingredients you mentioned are great Shea butter, there's avocado oil, there's, you know, colloidal oatmeal. You know there's all kinds of different things that we use to help improve the barrier function of the skin. You know, reduce water loss, reduce irritation, make everything more tolerable. So that's absolutely 100% what we should be doing and recommending that to our patients. So yes to all of the above. Try to find the ingredients.

Speaker 3 15:08

I mean, unfortunately, all those you had mentioned the data right. We dermatologists live and thrive on data, so some of them don't have that much data behind them. Dermatologists live and thrive on data, so some of them don't have that much data behind them. So you know, even a lot of the retinoids that you see out there they're in cosmeceuticals. Those don't have the type of studies that the FDA would require of us to do a you know drug to have a drug approved. So just remember, it's always going to be based on lesser quality data than you would see for unapproved you know medications. Just be that's something to be aware of as well.

Speaker 2 15:38

Yeah, really important to highlight that. As we've been talking about, you know the variety of, you know topical retinoids and obviously you and I really you know recommend them for patients for various benefits. How do you tell a patient you know, obviously, if you're treating acne, you know you go over the benefits for their acne On the cosmetic side too. How do you describe what the benefits may be for a patient as well to use a topical retinoid?

Maximizing Benefits of Topical Retinoids

Speaker 3 16:00

Yeah. So I tell them that retinoids improve the differentiation of cells and I make that in terms that can be understood pretty easily. But they help to improve the way the cells function in the skin. They also have a nice effect on skin aging. For example, tretinoin before sun exposure even the basic tretinoin first generation blocks proteins in the skin that activate collagen degrading enzymes. We call those MMPs or matrix metalloproteases, which inhibits collagen breakdown. Some of these can also induce synthesis of new collagen by increasing what we call type 1 pro-collagen expression. So we're balancing toward synthesis of collagen and lessening breakdowns. That's one of the biggest things I tell them.

Speaker 3 16:40

There's also evidence that retinoids improve the barrier of our skin and reduce what we call transepidermal water loss, which is a measure of how fast your skin loses water. Those are some of the biggest things that retinoids do. They have many functions within the cell. They work on the receptors within the nucleus to even pigmentation, fine lines or wrinkles and then collagen. So those are the three main things I would say Pigmentation improvement, fine lines or wrinkles, which is differentiation of the cells, and then balancing of collagen as well, all for an anti-aging effect. That's why people have a nicer. You know if you can see someone's using retinoid. They typically, you know it improves the quality of their skin.

Speaker 2 17:21

I think a lot of people will be sold on that. Just what you told them the benefits. It's not a hard sell for patients, but what can be the hard sell is really sometimes the side effects. You know, you probably see this too, where compliance can be difficult because of you know the reputation retinoids have for causing, you know, dryness or irritation or you know some sort of flakiness for patients. How do you really talk through potential side effects for a patient, and especially when they have this concern? I get this all the time. Well, I can't use that because if I use a topical retinoid then I can't be out in the sun. How do you answer those concerns for patients?

Speaker 3 17:53

Yeah, I mean, I think it's a very important question. I think retinoids are associated with irritation and dryness in some cases. Some of them break down with sunlight more than others. They've worked really hard to make new formulations that have been created to help reduce these side effects, including I'd mentioned earlier the microspheres, various what we call excipients or inactive ingredients in the products. There's newer nanoformulations that are being looked at now that help improve stability, reduce irritation and then improve penetration in the skin.

Speaker 3 18:21

But regarding sensitivity toward the sun specifically, the theory is that the early generation retinoids are subject to breakdown, so that leads not only to loss of activity but generation of these potentially harmful photo products and or the development of other adverse events.

Speaker 3 18:38

So I think that with modern products, sensitivity is not really as much of an issue anymore and I don't really tell my patients, if they're using a modern retinoid, to be hyper concerned about sun exposure. But I do continue to preach safety with the sun and effective sunscreen use, like it would anyone. I think if someone says that you know that the retinoid they're using is causing them to be overly sensitive toward the sun, that I might switch them to a different one. But I think that if a patient's continuing and I have a lot of patients who just swear by. You know generic retin-A that they can get. You know generic tretinoin that you know from the pharmacy those patients using that first generation retinoid then they would be. You know the patients that have to stay out of the sun more, but I think with the newer ones they should. You know they should do better. So we don't think it's as big of an issue as it used to be.

Speaker 2 19:23

And then if you have somebody you're going to prescribe you know a topical retinoid, for what do you go through with them Like the process of you know how do you use it appropriately. Because I think that's one thing I always tease, you know you don't think you can overdose on a cream, but I always tease on a topical retinoid. You can overdose so you can use too much and too fast and really have an outcome you don't want, usually overly, excessively dry and the redness and irritation. So how do you walk a patient through the appropriate use for one and how do they avoid or sort of combat that dryness irritation factor as well?

The Importance of Skincare Regimens

Speaker 3 19:55

Well, I think you know with dermatology we've said for many years a pea-sized amount cover your whole face. And it's still true. I mean, you don't want to over-apply retinoid, you want a thin film over the full face. If they're going to be using first generation retinoid, they need to use it only at night. If they're using a more modern one, like a Dapalene, you know they really could use it during the day. It doesn't really have that breakdown issue that we'd see, you know, with the older units. So I might mention you know we're going to have a lot of great information coming out about this.

Speaker 3 20:21

But you know, I think the word cosmeceutical is out there and everybody's asking about you know what's that? You know that's word. It's just been out there for quite a while now. Actually it's almost like in the modern lexicon, but it was coined. The cosmeceutical word has been coined. Was coined by.

Speaker 3 20:36

Kligman was one of our. You know if you're old enough to remember who Kligman was. In the 80s he described hybrid products. You know back then that were. You know formulations. But that term never got accepted by the FDA. It really has never been formally recognized. So we use that but it's not really a recognized term.

Speaker 3 20:52

But we're learning about how important skincare is as an adjunct to the prescription therapy we use. Good skincare can help make pharmaceuticals more tolerable. The key ingredients I might mention to a patient are something with hyaluronic acid. Alpha hydroxy acids are good, you know. They can help also improve collagen function of the skin and help slough off dead skin cells off the surface of the skin. Glycerin and penthenol are nice moisturizers. Niacinamide has gotten some play for anti-inflammatory purposes.

Speaker 3 21:24

I mentioned before Clodial Oatmeal. You mentioned a bunch of other products out. You know Pacuccio and other ones that are now out there. So I'll try to find, you know, a skincare regimen that I can combine with a retinoid for my patient to help them combat that. But the bottom line is they got to be on good skincare. So what I don't do is prescribe retinoids in isolation. They're always going to be part of a regimen and I tell my patients that really, if you're going to use these things, you should be using skincare and you should be using an excellent sunscreen and covering up. So it's part of the whole package.

Speaker 2 21:52

So to kind of conclude, because this has been, I think, a really fascinating conversation, you know a little higher level, you know we're just talking about there's a lot of you know basic chemistry and just understanding say, oh, I'm just using retinol and they're not even aware of the variety that's out there or that their clinician might recommend something that's better than another one, just based on what their needs are, tolerability or other factors. So for you, if you don't mind, like providing like a couple examples with your favorite retinoid products, like maybe a patient scenario example, what you would recommend and what that skincare regimen, maybe a mini version, would look like, just to kind of give our audience a little bit of tangible advice that they're kind of just thinking how would I, you know, sort of integrate this in whether it's over the counter, or talk with my dermatologist about a prescription version?

Speaker 3 22:38

Right, I think it's great. I think when I speak to a patient, I tell them my four pillars of skincare. You mean retinol, retinoid is one. I like growth factors or different kinds of peptides that are going to help stimulate new collagen as well. I like them on an antioxidant, you know, and then a sunscreen. Those are the kind of four main things that I tell patients. If you're going to be on a full skincare regimen, then those are the four things. Especially if you're into aging, you want to be on, of course, with acne. You're going to be combining with acne products. So you know, I think if I look at my you know shelf here in the office and what things I carry, I mean we try not to carry too many products. There's so many things you can carry, but in the office we carry a product called, product called Sente. I've used it for a number of years. Sente is a line that has a molecule called heparan sulfate in it, which is, I look, at it as kind of a pre-growth factor.

Speaker 3 23:25

But they've got a product called Sente Eventone and Eventone is a 0.5% encapsulated retinol. So I like it because it's retinol we like. Retinol gets converted into the body retinolic acid, right. It's combined with that hero ingredient or heparan sulfate, and it's encapsulated so they put it into a formulation that helps it be less irritating, because retinoids can be retinols in some formulations actually can make, and on my skin they're pretty hardy. But if I use some products, certain products can actually make it turn red and it doesn't happen that often with most things. So I also use a product called Aven Retrinol. It's R-A-T-R-I-N with a capital A, capital L. That one has. Retinaldehyde, which I mentioned as well mentioned as well, you know, in discussion is one of those. You know metabolites that end up becoming retinoid acid, which is the final, you know end product that we that actually affects the receptors in the body. That has vitamin E and peptides or proteins and those can also help the skin as well.

Speaker 3 24:20

Skinmedica, for example, a big company, they've got a retinol 0.5%. Complex SkinCeuticals is another one that we like a lot. Even over-the-counter Adapalene is helpful for patients that have acne complicated by hyperpigmentation. You've got Triferatine out there which has some great data on acne and pigmentation combined, you know, for those kinds of patients. So that's just a few products.

Speaker 3 24:41

I mean, you know I work with a lot of companies, so I may work with some of these companies as well, but those are the ones I actually carry in the office. But we're always evaluating new ones and I'm always obviously keeping up with literature and seeing what's out there. There's so many great products and then when you go to Europe, as you may know, when you go to some of the European meetings, you'll see another group of products out there that they've got, that we don't have yet out there, that they've got, that we don't have yet. So just be aware, I think, that most of the products you'll see out there, especially over-the-counter products, don't have the great data.

Speaker 3 25:13

The big companies have good data but there's so many ingredients out there and individually they aren't studied in their final formulation. They may be studied to some extent in the lab and then they extrapolate that data to the you know, the product itself and just you know, consumer has to be, you know, like anything else, caveat emptor. You know, buyer beware and just keep an eye on what you're doing and make sure you're getting something and really rely on your dermatologist I mean, a board certified dermatologist is no substitute for that kind of advice and interaction and you know deciding together what you know what would be most helpful, and then, of course, the feedback that you get from trying it. So that's kind of how I look at it. I think it's a very shared decision-making process between myself and my patients, and so we do the best we can.

Speaker 2 25:57

Yeah, I think that's a great way to kind of end. I can't believe our time's flown by, but this really should give everyone a taste that. I think it's a little bit more complex than people appreciate just the variety of topical retinoids, but I think we can both agree they're a necessity for a great skincare regimen. A piece like you mentioned, that pillar. I love that because I think people sort of dismay them sometimes and they also don't know what's out there and what the data is. So definitely going to see your board certified dermatologist to have that conversation would be extremely helpful. So thank you so much for coming on the podcast today. I do, extremely helpful. So thank you so much for coming on the podcast today. I did want to check in with you and see if you could let our audience that they want to find out more about you or find yourself on social media. Do you mind sharing that with us today as well?

Speaker 3 26:36

No, not at all. I mean, my Instagram is at Todd Schlesinger MD. You know, just all run together lowercase Instagram. That's probably the best way to get a hold of me. Epiphanydermatologycom that's our website for the practice. We also have a website called Clinical Research Carolina Clinical Research Center of the Carolinas. You can just look it up online and put Charleston. It should take you right to our research website where, if you happen to be in the Charleston area and you're interested in being in a study, or if you're a sponsor or skincare company or other company that's interested in doing studies, that's a place to find us on there. But if you start with Instagram or LinkedIn, I think I gave you the LinkedIn so you can always message me on any of those and I will get back to you. So, yeah, thank you for having me and I appreciate it. It was a really great conversation.

Speaker 2 27:20

Well, thank you for coming on. We really appreciate your insights and expertise. I know for our audience we've definitely, you know, kind of got their interest going on topical retinas. I think people think it's a lot simpler than what it is, but you show the complexity of it and the need for that shared decision making as well. So stay tuned for the next episode of Dermot Trotter. Don't swear about skincare.

Speaker 1 27:41

Thanks for listening to Dermot Trotter. For more about skincare, visit DermotTrottercom. Don't forget to subscribe, leave a review and share this podcast with anyone who needs a little skincare sanity. Until next time, stay skin smart.