Derm-it Trotter! Don't Swear About Skincare.
Feeling frustrated or overwhelmed with everything skin? Does the skinformation overload make you want to swear about skincare? Join Dr. Shannon C. Trotter, board certified dermatologist, as she talks with fellow dermatologists and colleagues in skincare to help separate fact from fiction and simplify the world of skin. After listening, you won’t swear about skincare anymore!
Derm-it Trotter! Don't Swear About Skincare.
Hidden Damage: Why Rough Skin Deserves Attention
A rough, sandpaper patch on your temple or ear isn’t just “dry skin”—it’s your skin whispering about years of sun you barely noticed. Board-certified dermatologist Dr. Neal Bhatia joins us to unpack actinic keratoses (AKs): how to spot them, why they appear earlier than expected, and what truly reduces their risk of progressing to skin cancer.
From freezing visible spots to treating hidden sun damage, Dr. Bhatia explains what really works—field therapy, photodynamic therapy, and daily prevention that fits real life. Learn how to protect smarter with sunscreen, supplements, and simple habits that keep your skin healthier for years to come.
Again, just feels like a pimple that doesn't heal, starts off as a red spot, that starts off as dry skin.
SPEAKER_02:What is really the likelihood that they're gonna turn into skin cancer and what type or types of skin cancer do they tend to turn into?
SPEAKER_01:Targets that whole zone of sun damaged skin and again gets at the precursors in the early stages and tell them, look, take this half an hour before you go out, and you'll be protected for about two hours to about 80% of the the need you have uh for reducing your sunburn risk.
SPEAKER_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_02:Welcome to the Dermot Trotter, Don't Swear About Skin Care podcast. I've got Dr. Neil Batia on with me here today, a board-certified dermatologist in San Diego, California. He serves as director of clinical dermatology at Therapeutics Clinical Research and as chief medical editor for practical dermatology. He's widely published, has a background in immunology, as well as interests and mechanisms of therapy, skin cancer, and medical dermatology. So it's a joy and a pleasure to have him here on the podcast. So welcome to you, Dr. Bhatia.
SPEAKER_01:Oh, Jenny, you're too kind and thank you. Thank you. Thanks for having me. It's a fun time to actually be part of it instead of just listening to it.
SPEAKER_02:So Yeah, and sometime hopefully one day we'll be able to get it together in person. But you're enjoying California. I'm stuck here in Ohio, of course. But one day, maybe. But I'm excited to have you with us because we're going to talk a bit about actinic keratoses. This is something that patients ask a lot of questions about. And even as physicians, we're treating these on a regular basis or people are coming through the door. And I think people just don't even know what they are. And you know, we're obviously doing audio, so we don't really have a picture to describe them. But I was hoping you get an idea of just, you know, what do these look like? What are these on the skin? So maybe somebody out there listening might get to their dermatologist to have these evaluated.
SPEAKER_01:Yeah. Well, actinogeratoses are as early as a reflection of sun damage as you could probably get that could be of concern that should bring it to the attention of the dermatologists. These are spots that we feel more that we can see. They usually start off as vague, dry spots. These aren't healing. They look a little red, uh, usually in photo exposed areas, uh, but often you know in areas like on the chest and shoulders, backs of the hands, areas that don't often see enough sunscreen, for example. Um, these are spots again, you know, in the dermatology world, we often refer to them as precancerous, but they're actually part of a spectrum. I I like to refer to them as the termites of the skin. You know, you see one and ten more are coming, and a hundred more are doing some damage. Uh so you really don't want to just treat one. You want to treat the process that makes all of them as well. That being said, again, patients should be aware of anything that, again, just feels like a pimple that doesn't heal, starts off as a red spot, that starts off as dry skin. These are the most commonly mistaken, if you will, uh patient perceptions of what actinokeratosis really are. What's also important is that these are not just for old people anymore. It's not a Medicare disease uh like it used to be. We're seeing actinokeratosis in 30-year-olds and 40-year-olds. And again, it's all a function of cumulative solar exposure from age 18 and up, if you will. Uh, what's also important is again, I always get a kick, even in San Diego and Wisconsin, where I'm from, Ohio, where you are, patients are always saying, Well, I don't go out in the sun. I didn't get this uh when I got out in the sun. And I remind them, this is kind of like smoking, right? You smoke two packs a day until you're 20 and you're coughing when you're 50. So this is old sun exposure catching up to you. Uh the other part of the equation, again, is it's never too late to use sunscreen. And just because you have one AK now doesn't mean you shouldn't start thinking about 10 years from now. So these are patients that we should be seeing regularly for screening, and they should be aware of anything that, again, not only doesn't heal, but also, you know, should be coming to attention of something a little suspicious.
SPEAKER_02:One of the more important things I think you mentioned is that kind of that feel test, like that textural change you mentioned where it feels kind of rough or scaly. Because I know when people come in, I always tell them, you know, I'm gonna kind of pet your face a little bit or the rims of your ears, because you often can feel them before you see them. I had a patient even today, he said, yeah, I've got this like sandpaper spot on my skin. I thought that's like the perfect way to describe it because it can be confusing, right? People think it's just dry skin, or maybe it's a rash, not realizing that this is something potentially serious that could turn into skin cancer. So I think that's probably the big question for you. People always ask, okay, so you say I've got this sun damage, I did it years ago, I'm gonna be good with my sunscreen, but clearly some of these precancero spots or actinic keratoses are popping out now. What is really the likelihood that they're gonna turn into skin cancer? And what type or types of skin cancer do they tend to turn into? Do I have to worry about melanoma? You know, that's a question.
SPEAKER_01:Yeah, those are very important because there's a lot of misconceptions out there. And you know, you're in the same boat as me. You know, patients are on Google before they come to see me, and they're all looking at the spots. And when you tell them what it is by feeling them, they they're the first to say, Well, are you sure? And I remind them that you know their two-hour Google search isn't as effective as my 28 years of doing this for a living. So that being said, we remind them also that these are spots that we feel because there's early precancerous change to them that leads to the texture change, and that's what gives a precursor to squamous cell carcinoma. So actinic keratoses are basically linked to squamous cell carcinoma under the microscope as well as clinically. But the good news is it's anywhere from 0.5% to 16% in the literature articles that are out there can show progression to actinokeratosis. There's also a subset that may regress on their own. So we definitely want to make sure we treat them aggressively and make sure those aren't the ones that get by the goalie and turn into cancer. That being said, there's fortunately no link to melanoma with an actinokeratosis, but again, in a heavily sun-damaged area, there could be a you know something else brewing, which is why we do the regular skin checks. Uh, the other more common uh cancer, basal cell carcinoma, there's a very rare linkage of actinokeratosis to basal cell carcinoma, but the vast majority of AKs will have a precursor relationship with squamous cell carcinoma. So that's really uh what we want to talk about. And again, with patients, you know, we have to remind them these are spots that you don't just see, they're spots that you feel. It's just like going to the dentist, you know, they take that little probe and we're wherever they feel it catch in your teeth, they say, Well, that's a cavity on the way. We do the same, like you just mentioned. We rub our fingers over their forehead, their ears, their nose, and say, Ah, we can feel that catch. That's an early sign of where actino keratosis may be starting from.
SPEAKER_02:Now, I just had a patient we mentioned, kind of feeling nice, touching them and you know, mentioning there were several spots there. And they said, Oh, aren't you gonna biopsy? You know, to confirm that's what it is. And it is important to highlight, you know, we know how to diagnose these from a clinical perspective. It wouldn't be fun to biopsy, nor is it really necessary when we can go after them. But an interesting question they asked, and and I know you know the answer to this, but I want to highlight it for our listeners out there, is that, okay, well, well, which ones will turn into something? You know, so they're trying to pick and choose maybe what we treat. How do you respond to that when people kind of judge maybe which one would do something kind of mischievous?
SPEAKER_01:Well, I and that's a real important caveat to the discussion of treating the whole zone. Because I remind them about uh hockey, for example, I tell them, you know, one gets by the goalie, but you never know which uh player is going to shoot the puck. And from that same example, I say, well, you don't know which one of these is actually already in motion of turning into a skin cancer. So we need to treat the whole process that makes the actino keratosis, not just treat what we see in front of us. And that kind of gives into the discussion of, okay, we may freeze these today, but we want to think about what are we going to do topically to maybe make your immune system survey for these spots more or add to the destruction of the earlier spots in motion. We also think about photodynamic therapy, which is the blue light or red light treatment, depending on which device is in the office, that targets that whole zone of sun damaged skin and again gets at the precursors and the early stages, not just the ones that are already clinically visible. So we tend to use the word subclinical quite a bit with these patients. We say, well, these are the ones we see today in the office. There are 10 more that are on their way that we're not seeing yet, and that's all in this zone of sun damage, whether it be the backs of their hands, their forehead, the H zone, or anything else on their trunk. So from that standpoint, too, we remind them again, this isn't from the sun you got from walking from your car to the office. This is from decades of unprotected sun exposure or cumulative sun damage. And even more so, and I'm sure you'll you'll say the same thing to your patients, anywhere where you got a sunburn, it's like having a big cigarette burn in your in your carpet, right? It never goes away, and it's always going to be a precursor of higher potential that we have to pay a little bit more appearance to.
SPEAKER_02:I like what you talk about, you know, the cumulative exposure. You know, we we miss that sometimes, I think, for just highlighting for patients how important it is because they always talk about, oh, I went and I had this many burns, which obviously we know the role there, but just how things add up, right? Just day-to-day, running errands, being in the car, driving to work, you know, and the immediate there and now, right? They're not seeing the sunburn and thinking damage, but you know, just how that adds up over time, what that can do to your skin when it's not protected, that that's something I think that is sort of misunderstood or not really appreciated, how important it can be for development of actinic keratoses and potentially even skin cancer as well. You've you've highlighted again and talked about more about the ultraviolet light. What other risk factors, are there other things people have to think about besides their sun exposure, sunburns, if they've used a tanning bat? Is there other things that they need to think about that might put them at risk for development of actinic keratosis?
SPEAKER_01:I mean, genetic tendency and a little bit more fair skin types, of course, are really the keys to observation. I mean, there obviously there's a setup for patients who are going to have more, probably at an early age. Um, but the photoprotection, you know, behaviors that they probably learned early on, you know, not just sunscreen on their face, but again, I mentioned the back of their hands, like when they're driving, for example, or back of their neck, or even like tops of their feet, you know, when they're wearing sandals. I mean, these are areas that are all getting the same ultraviolet exposure. But then you think about someone who may have had a transplant, for example, or who is definitely at higher risk because their immune system is not able to survey, or if they've had exposures to ionizing radiation, or if they've had any exposures to arsenic or some other chemicals, these are things that can actually create another level of exposure that uh will again help have these actinokeratoses roll downhill. The other part of the equation, too, is again, we we may see more patients of darker skin types, and they may not develop as many actinokeratoses, but they're still at risk for skin cancer and as well as pigmentation change and all the other reasons to have them wear sunscreen. So, you know, the phobias of sunscreen and you know the risks of you know not complying with photoprotective clothing, we have to put together the risk of skin cancer in that same context. And you know, unfortunately, you know, I I have patients who come in, they say, Well, I just want I just want to be natural. I don't want to wear sunscreen. I said, Well, you know, skin cancer is natural. I I hope you're prepared for that.
SPEAKER_02:Well, that's a good segue into okay, how do we go after these, you know, with treatment? You mentioned also, you know, freezing or cryotherapy, and then talking a little bit about light and creams. Can you kind of an overview of like the different options that are there and sort of when you might choose one option over the other for a patient? Yeah.
SPEAKER_01:Well, the main key to the equation, I I often use it like dating. The pain, the first thing you're gonna do is you're gonna get to know somebody, you're gonna examine them, and you're gonna talk to them about not only what they have, but also their risks. The easiest thing to do on the first date, which is often the most uncomfortable, is freezing the spots initially. And I hate to uh think about it in many ways like a patient would, but it it actually gives them the fang the sense that something was done when they leave the office, even though it's uncomfortable. But within that same algorithm, we have to remind them that freezing only gets the treat, it only treats the spot that we're seeing. There may be five other actinogatosis in development around it, and more so it's not undoing the damage that the sun had caused over the years. So I tell them this is what we're gonna do as a bandage, but then we need something that's a little bit better remedy, which is more treating topically with different uh agents that'll either turn over the skin or create an immune response against the pre the the precast spots, or some combination of protecting against sundam. So drugs like retinoids, for example, are very important for photodamage and correcting their defect. There are some uh old school treatments like topical five or uracil, which turns over the skin and creates a very aggressive sloughing response, which can be a bit uncomfortable and a little bit uh difficult to manage sometimes. Humiclamide is another treatment that makes your immune response kind of work harder against surveying for those precanterous spots, which is again going to create a little bit of redness. And then there's a few others that have been taken off the market. Uh, and then one newer agent, which is called turbinivulin, which comes in an ointment form, which I think is now the standard of treatments on the market. Um, it's five days of treatment, very little local skin reactions that could be limiting, and yet is still very effective. So I think we've we've reached an era where that's going to be very important for us. Um, the other part of that equation, again, goes with compatible sunscreen and moisturizer, things that are gonna feel good on the skin, get rid of some of the sloughing and the dead skin. And then more importantly, is uh taking some supplements that'll have some antioxidant effects, uh, ingredients like polypodium leucotomas, for example, uh nicotinamide. These are all important supplements that are available on the market that actually can help over time reduce some of that impact of photodamage and reduce the risk of sunburns and eventually reduce the risk of skin cancer, hopefully. And then the other part of that equation is again scheduling photodynamic therapy at a time when they can be available for the skin reactions that follow. Because photodynamic therapy is based on sensitizing the skin, exposing it to a light device that is going to create a reaction to destroy those spots and destroy the spots that are coming. The downside for many patients is that they're gonna be a little bit red and they have to stay indoors for a day or two. So it is a little bit of investment in time. So that takes a little bit of scheduling. It's probably not something we would do on the first day because they have to stay in the office for about two hours to incubate their uh sensitizer, they have to stay in the light for about 16 minutes, 40 seconds, or 10 minutes, depending on if it's red light or blue light. And then for the next two days, they really need to plan to be indoors away from light. And I one thing I think you mentioned too about UV light, we're we're learning a lot about blue light from devices, blue light from the computer screen. We're learning a lot about visible light. All of these now are creating some of the same interactions with the skin that UV light has been. And the newer sunscreen agents, uh, whether they be mineral or chemical, whether they have shield, whether they have tint, they're they're actually meant to help us focus on you know the blue light and visible light. So, you know, many of us have patients who work from home. You know, we learned a lot during the pandemic about you know how much time people are spending in front of the screens. And they they have to be wearing sunscreen actually indoors, which for many of them is counterintuitive. It's an extra step. But we know that if they do that, it's gonna help reduce their risk of uh developing a lot of these spots as well. So that's kind of the algorithm of incorporating those three devices. Now, many will turn to other treatments such as chemical peels, uh laser resurfacing with a CO2 laser or a fractional laser. Those are typically out-of-pocket treatments that are not covered by insurance, although, again, there are others who can use similar devices that might have some insurance coverage, but typically those are considered a off-label or out-of-pocket treatment. That being said, they do help it to resurface and give a new layer to the skin, but they're not really doing anything to the process. They're more just treating what we see in front of us and improving the texture of skin as well as the photo damage. Uh, but you know, patients are still at a setup for actinokeratosis, even with those treatments.
SPEAKER_02:So someone came into you and had, you know, maybe this was, you know, because this is what you said we're seeing a lot more of, and I agree with you, a woman who's 40 years old, maybe has one or two spots you've noticed on her face, maybe a history of using a tanning bed or has had a lot of sun exposure early on in life. You know, would you approach her with maybe the option of freezing, or would you address kind of the zone or field therapy that people call it where you'd be a little bit more proactive versus reactive, just maybe based on age? Because I think a lot of people think, oh, you got to be covered, right, to do these light treatments or creams that you have to have multiple precancers. But do you feel like there's you know validity and like a room for it, you know, to actually have purpose where we could go after this a lot you know more aggressively than what we do? Because a lot of people do.
SPEAKER_01:Oh, absolutely. I mean, someone like that who may be you know public facing, you know, they may be on TV, for example, they may be in sales, they may have a reason to be out in public, they may not be ready to have the treatment on that same day. So we probably would have to schedule it and say, all right, look, we'll freeze you on a Friday afternoon when you can take the weekend off, you can recover a little bit. But we talk to them a lot about photodynamic therapy because of the benefits that it's doing to reverse some of the elements of photoaging. And there's there's very good data in research as well as clinical practice on what blue light and red light can do to help resurface and improve the texture of the skin, improve the sallow color, improve some of the uh wrinkling and some of the dyschromia from from uh old sun damage. And a lot of patients like that who are in with one or two spots, you know, we have to remind them that you might have 10 uh in a year from now if we don't do something more aggressive. So they're a little bit more in tune to saying, yeah, maybe let's do something like that now, and they'll get the benefits of the impact of photoaging as well. So a lot of different conversation topics to have. And you just have to really put things into every individual's context. You know, a 70-year-old man who you know doesn't spend a lot of time in front of people may not feel the need to worry as much about appearance as, again, a 40-year-old female who's out in the public. So definitely want to take, you know, take your audience and talk to them about those options. And then the other part of that equation is incorporating a timeline of you know, letting the skin rest before you do the next treatment, whether it be you know liquid nitrogen, then two weeks later, incorporate a topical, do the topical for a month, you know, give another two-week holiday, then do the photodynamic therapy, and just kind of rinsing and repeating that cycle so that you're staying on top of those patients who are not only high risk, but also the ones who come in with early spots and then you know try to mitigate those and prevent those from turning into skin cancer too.
SPEAKER_02:And for some of the tobaccos, I know we talked a little bit about five flower your cell. Have you been using it in combination with calcipitrine or a vitamin D cream where they combine it? Do you feel like that's been useful as a treatment option as well?
SPEAKER_01:I inherit a lot of those patients from the VA, from Kaiser, uh, and they they have some very uh uh they have some very vigorous skin reactions. They're they're they can burn and stain, they they're not sure of what the protocol is that they should do, which when. Uh so a lot of patients come in a little bit confused. Uh they also get irritated quite a bit and they may not have the adjuncts to controlling that irritation, whether it be emollients or anything else. Uh the one thing that you want to tell patients not to use are topical steroids because that undoes the inflammation that we're actually trying to recruit to treat the process. Um, so I I more often am using terbenibulin ointment just because, again, I I think the reaction patterns are are more effective and more manageable. But you know, patients on 5 FU and calcifitriine, they they tend to do very well. It's just the burning and stinging can be a little bit of an issue for them.
SPEAKER_02:Yeah, I think that's obviously the downside with the the creams, the the tolerability is really the driving force, I feel like, for a lot of patients, you know. Yeah.
SPEAKER_01:If they're not on something they can stick with, they're not gonna they're not gonna get the outcomes.
SPEAKER_02:Yeah, we used to we used to teach, you know, when you had you know Tom Cruise, you know, you can you remember back in the day the movie said, Can you handle the truth? It was like, can you handle the irritation? We used to all about that because boy is it real. And you do have to pick, I think, like you said, personality, lifestyle, temperament of the patient. Definitely sometimes with topicals, there is uh, and sometimes obviously with PDT too or photodynamic therapy that no pain, no gain can happen. It's just variable in how much everyone experiences.
SPEAKER_01:And and to that same point, you have to time it. You know, I've I've had patients come in and say, Well, I'm I'm I have uh my sister, you know, I have my daughter's wedding the next day. Can we do it then? I'm like, no, we're not doing that. You know, I have to get out of right, I to I have to play around to golf that afternoon. It's like, well, then we're definitely not doing anything today. So, you know, again, a lot of it goes with that.
SPEAKER_02:Yeah, exactly. And and the trends is you've seen, I think, across healthcare too, and and you alluded to this earlier, is looking for supplements, natural ways to kind of go after sun damage. And you talked a little bit about polypodium and also nicotinamide. Do you mind just explaining a little bit like what we kind of know about those and how they might actually be helpful for correcting sun damage?
SPEAKER_01:Yeah, I I know that um there's a lot of misconception about when to use sunscreen and when to take these pills. And I remind everyone that you know, sunscreens are like toothpaste to the skin. You know, you're not really treating anything, you're preventing problems. And we do things, you know, again, twice a day to actually keep a level of maintenance against the process that's gonna harm us. Just like we brush our teeth twice a day. If they use sunscreen at breakfast and lunch, they're prevented, they're helping to prevent the exposure from getting to the skin at the most uh sunny day times of the day. So I put it into context like that so they understand how sunscreen is actually helping them by preventing problems, not treating problems. What polypotamine leucotomas does is it reduces the interaction of the skin with ultraviolet light by antioxidant effects. But it takes a little bit of time to kick in. So, like if you have someone who's going to the beach or want to play golf or going on a hike, I tell them, look, take this half an hour before you go out, and you'll be protected for about two hours to about 80% of the need you have for reducing your sunburn risk. And then I tell them take it again two hours later. You know, for golf, I tell them take it at the turn. For a hike, I tell them take it again on your way back. You know, just put it into context of what their activities are, and they'll understand that's like, okay, I'm doing this to reduce my risk of sunburn because sunburn is no fun. And that also, again, put increases their risk. So it'll help kind of put into context for them a prevention strategy as well as a treatment strategy with what we're seeing in front of us. So some of that is really very helpful. I mean, you can't expect patients to put themselves in bubble wrap and you know wear gloves all day long or wear a hat all day long. It's just unrealistic, even though those who do are are helping themselves out. But the fact of the matter is if they if they can get into some routine of, okay, this is what I'm gonna do every day, and I'm gonna change my outcomes, they'll help reduce their skin cancer risk for the long run.
SPEAKER_02:And that's what patients want. They want options, right? I mean, they're used to sunscreen. I feel like people are kind of tired on sunscreen. And for another podcast, obviously there's kind of this uh attack on sunscreen era that we've been, you know, dealing with, I feel like, on social media and this podcast that we'll address. But so I think just giving people these other options, it's a whole, you know, skin cancer, actinic keratosis prevention, if you will, sort of uh, you know, toolkit that they have lots of options to go after it. And the one thing I think I forgot that I wanted to kind of bring up is just the chronicity of actinic keratosis. I'm gonna have you kind of end with like speaking to that because I think that's very well misunderstood, sometimes even by uh, you know, providers out there that are treating it, or obviously even the patient, because I've had patients come in like, you just treated these, you know, a year ago, six months ago. What's going on? You know, once you treated something recurred, I've got new ones. Do you mind kind of explaining it? Because I think that is kind of another misconception that leads to a lot of patient frustration.
SPEAKER_01:Yeah, it's it's kind of how I go back to that dating example. I tell them, I say, all right, well, look, you're you just met me today, but we're gonna stick together for a while because I'm gonna be seeing you back at least every six months, if not every year, to make sure that these don't come back. I remind them, you know, and again, at the risk of offending your listeners, I say, look, this is a lot like losing your virginity. Once once it's happening, you're not going back. So now that you have these, you're gonna keep getting them if we don't be careful to screen you adequately. Uh the other part, again, is that we have to stay on top of regular screenings, not just for your risk of these, but for melanoma and anything else that could be related to the amount of sun exposure you have. So the chronicity for them is I'll be seeing you routinely to prevent problems and stay ahead of this, so that we don't have to get into more aggressive treatments like the topicals or you know, photodynamic therapy if we can if we can keep them at bay and try to freeze what we see. But more importantly, also is you know, again, establishing a routine for them so they have a map of what to look for and they know that the consequence of them not being screened could actually lead to surgeries and and things that we might have more risk with. The other part, again, is in dermatology, you know, we do our best to cure problems, but there are many things that we end up maintaining, whether it be eczema, rhizus, severic dermatitis, actinokeratosis fits right into that. You know, once you're in that club, we're gonna be following you for probably for the rest of your life. So we just have to put that into a context. But I we also try to do it without blame. We say, well, remember all those years we were at the beach? Well, you did this to yourself, so you know, suck it up, right? I mean, we can't really do that either.
SPEAKER_02:No, no. Our job is not to judge, but to treat and help people, you know, that's what that's what comes first. Well, well, thank you so much for coming on and going through that. I think that gives a clearer picture. We've got to understand, you know, a lot of people even heard what's an actinic keratosis or what's an AK or pre-cancerous lesion. So that was a great overview of everything. And we'll we'll be sure to stick with you too, just like your patients stick with you and maybe get you back on here.
SPEAKER_01:Dr. Trotty, you point out.
SPEAKER_02:Oh, of course, of course. Well, I do want to let our listeners know if they want to track you down, do you mind sharing with them how they can find you online or if you have social media?
SPEAKER_01:Oh, sure. Well, I mean, our our place is called Therapeutics Clinical Research. We're in San Diego, California. Uh, I'm not much of an influencer on social media. I speak at a lot of conferences, but uh our place is found on uh social media and we can uh we usually keep a presence there. I I tend to keep a little bit lower profile on online just because of uh some confidentiality things that we deal with with with clinical research trials. So that's that's the only reason.
SPEAKER_02:Makes sense. Well, I'm sure people still want to track you down and they can listen to you. I'm sure they can find you if they Google you, they'll find some of your presentations or more information. So you know, you can't hide too much from them. That's pretty good.
SPEAKER_01:Well, thank you for having me. This was fun.
SPEAKER_02:Of course, yes. We'll have to do it again. And I want to let everyone know if you like what you hear, please click like and subscribe. And stay tuned for the next episode of Dermotrotter. Don't swear about skincare.
SPEAKER_00:Thanks for listening to Dermot Trotter. For more about skincare, visit dermittrotter.com. 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.
