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Total Skin Nerds S1:E10


[Amy Risley] Total Skin Nerds is brought to you by Skinfix. We're clean, clinically active and on a mission to help heal your skin. Welcome to Total Skin Nerds. I'm Amy Risley, the CEO of Skinfix, and a first rate skin nerd myself. On this episode, my guest is Dr. Zenovia, a board certified dermatologist, a leading hormonal skincare expert, and the voice you want to hear from when it comes to what happens to your skin through different phases of your life. Dr. Zenovia has built an incredible practice, paying detailed groundbreaking attention to the relationship between your hormones and your skin. From preadolescents, through pregnancy through menopause, and everything in between.

Coming up, Dr. Zenovia talks about the relationship between hormonal balance and your appearance, the role hormones play in collagen production and inflammation, what estrogen has to do with pain, plus what you need to know about progesterone, testosterone, thyroid, cortisol, and so much more. Stick with me nerds, don't go away. Dr. Zenovia is an expert in hormonal dermatology. In fact, I dare to say you are the inventor or creator of this idea of hormonal dermatology.

[Dr. Zenovia] Kind of, yeah.

[Amy Risley] As a woman is particularly interesting to me and all women I'm sure, all men too but women seem to be more attuned to their hormones and their fluctuations. So tell us a little bit about how you became interested in this specific field of dermatology and the link between hormones and skin health.

[Dr. Zenovia] Great question, Amy. I'm super excited to be here. I so appreciate. This exciting season finale. So basically, I mean, like all dermatologists, you graduate residency knowing everything under the sun about the basic science of the epidermis. And our boards are extremely catered towards the [inaudible 00:02:08] erudite and the zebra diseases. And the joke is, if it's clinically relevant, it's not going to be on the board exam, okay. [inaudible 00:02:17] the expert at all the genodermatosis, and all the autoimmune bullous disorders. And when you come out, you're kind of learning acne for the first time and you learn Botox at a residency. And anyway, so as I was kind of becoming a real dermatologist in the real world, I started to notice that there was a lot of transition in women's lives, and it was really affecting their skin. And a lot of these transitions were happening in my own life.

When I got pregnant with my first baby, I got a ton of melasma, my mom started complaining to me how dehydrated her skin was, and she was being irritable and had insomnia. And I'm like, "God, I wonder if this has to do with perimenopause." And anyway, it basically was a journey of treating thousands of people, including many, many women through all the stages of life. One of the key things that's different about dermatology versus other fields of medicine is that you treat kind of the human spectrum. You treat kids, adolescents, mothers and fathers and grandparents because we do skin cancer in old people, we do acne in teenagers, warts in little kids, and you run the whole gamut of the human spectrum, both male and female. And so I just began to kind of connect that there's like significant hormonal changes, particularly in women that we are kind of unraveling. We're now talking more about the menstrual cycle and people are tracking their period on all sorts of apps.

I noticed a ton of women were looking for bioidentical hormones because that kind of was taboo subject in the '90s and women didn't want to go through menopause feeling crappy and hot flashes and ugly, and whatever it was that they were feeling. They wanted to fix their hormones, but nobody was really kind of linking the impact that hormones have on the skin. So I just at a personal interest out of kind of the whitespace in my patients, I just started to link it and think about it and study it. And I went to conferences, and I started to look into bioidentical hormones and what hormones did for a woman both internally and externally. And I started to see that there was a real strong link between our hormone balance and how our skin looked.

[Amy Risley] Amazing. Well, I'm glad you did because it's a lot of interest to all of us women who are going through these stages.

[Dr. Zenovia] Of course.

[Amy Risley] And even just looking back as I was reading through some of your literature and understanding a bit about you before this interview, I realized just in retrospect what was going on with me that I hadn't understood until I read what you had written. So thank you. Let's talk a little bit about the main hormones that are affecting our skin and sort of what each one is responsible for good and bad.

[Dr. Zenovia] Really good question. I think that obviously we all hear about estrogen, progesterone and testosterone, but there's a whole nother slew of hormones as well. There's thyroid and cortisol, and there's a hormone called melanin stimulating hormone that is produced out of our anterior pituitary gland, which is our brain. And there's a whole milieu of hormones that affect the skin, primarily, estrogen, progesterone, and testosterone are kind of the sex hormones. They all are basically, they have an androgen profile, which hormone has more of an androgen bias and we know testosterone is the male dominated hormone, and testosterone does have a proclivity for the sebaceous gland. And we know that there are testosterone receptors in the skin, on our oil lamp, as there are many estrogen receptors on the skin, in our hair follicles, as well as our brain.

So estrogen is kind of the predominant female hormone we think of that. We know that testosterone is the male hormone, and progesterone is in there for kind of childbirth, and some of the menstrual cycle. So they're all like this soup, playing a role in your skin and your oil production in the inflammatory markers, in the dehydration of your skin. And so they're playing a part at the epidermis and influencing basically how your body processes collagen, produces sea bottom, develops inflammation. So there's a lot of hormonal stimulation at the epidermis level.

[Amy Risley] It's so fascinating. I loved how you sort of break down at least a woman's journey. I guess it's a man's journey too, but let's focus on women. A woman's journey through life into sort of six phases. And I'd love to do a little bit of a deeper dive into each phase and understand sort of what's happening, because that's when I really understood a lot more about what was going on in skin. I think, starting with puberty, which I have a 15 and a 16 year old, so I'm in the thick of it, it really helped me to understand why acne flares in puberty. But let's talk a little bit about what happens in each stage starting with puberty.

[Dr. Zenovia] Excellent question, Amy. Basically, the stages of life are not a digital system, they're not on and off. It's not like one day you're not in puberty the next day you are. When you look at cell physiology, the cells have the same DNA in them from the minute you're born, actually, the minute you're conceived on up to till death. Our DNA imprint the amino acid structure is the same, from an every cell in our body, it kind of doesn't change. However, what changes in the cells is what genes get turned on, and when. And so the idea that our genes turn on at different stages of our life is where we begin to kind of unravel the secrets of the stages, the hormonal stages of our life. So for me, who also has a teenager, I know that like around 11 years old, young little girls start getting crabby, they start getting a little oily, they start getting a little kind of snotty.

[Amy Risley] Yes, they do.

[Dr. Zenovia] [crosstalk 00:08:53]. It is the way it is and her skin started to change. Basically what's happening is through the growth hormone, and the androgen receptor hormones and all the gonadotropin releasing hormone, gnrh, gonadotropin releasing hormones, those are genes that get turned on around early adolescence. They go to the gonads, the testicles and the ovaries, and they turn on genes that weren't turned on before. The gnrh, the gonadotropin releasing hormone goes through your ovary and says, "Turn on estrogen, turn on testosterone." And you start releasing these hormones in your bloodstream that you weren't releasing when you were seven. So those hormones trigger sebaceous stimulation, and they go up into the hair follicles. Every hair follicles has an oil gland and you produce oil. And so you say oilier skin, more sebum production, scaly scalp, and you get smelly you start having BO, these are all [crosstalk 00:09:56].

[Amy Risley] Yes they do.

[Dr. Zenovia] Yeah. [inaudible 00:10:00] as my son I'm like you're 11 and you have like the man smell where [inaudible 00:10:05]. Is starts to happen. That's basically the trigger and of course during pregnancy. So puberty, this is to go through some of the stages, we definitely see a surge in androgens and sex hormones. So you start seeing acne in oiliness. And then again as we move forward into adolescence, and into pregnancy and things like that, when women start becoming fertile, we start seeing higher levels of estrogen. So we'll begin to see melasma and pigmentary disorders, and you start seeing sunspots a lot sooner than... You could be in the sun all day long when you're 15. But when you're in the sun all day long and you're 28, you definitely see more sun damage, because there's more estrogen in the system.

So we start seeing pigmentary disorders, and then again, in pregnancy itself, we start to see a certain eczematous conditions, rosacea, kind of an auto immune imbalance during pregnancy. Because during pregnancy, we're kind of in an immune suppressant state and so we get more inflammatory conditions post and during pregnancy that have to do with that immune state of pregnancy and the fluctuation of hormones. Some people look gorgeous in pregnancy. Like, "Oh my god, you're glowing." A lot of that is your estrogen is high during pregnancy and you get a lot of tissue remodeling, a lot of fibroblasts stimulation, so you look glowing. Now, a lot of women have elevated progesterone, which can cause acne during pregnancy. So high progesterone can be an acne causing cocktail in people's bodies, not in everybody. So that's why low progestin oral contraceptives, are better at acne treatment. So when a doctor is giving you a birth control pill for acne, they're looking for the birth control pills that have lower progestins because progestins are known to cause acne.

[Amy Risley] Okay, well, you talked a little too about how this increase in melasma and melanin production triggered by an increase in estrogen say during pregnancy can also cause that sort of, those typical signs you see of darkness around the nipples or darkening of the skin and on the vulva and different areas of the body. But talk a little bit about the link, as you alluded to between estrogen and the building of collagen and elastin and the increase in sort of the skin barrier integrity that gives you that glow during pregnancy.

[Dr. Zenovia] I love it. Perfect transition. One of the things just a small little add on, Amy too, the darkness of the vulva and the nipples in pregnancy is a real increase spike in melanin stimulating hormone during pregnancy. So a lot of that comes from the melanin stimulating hormone as well as the higher estrogen, but the anterior pituitary gland in our brain produces a tremendous amount of MSH and that causes our moles to get darker, our nipples to get darker. So definitely pregnancy is an amazing hormone kind of process. But as far as estrogen and the link with collagen, it's a really interesting model. But if you look at estrogen levels and collagen levels and females, it's almost a one to one correlation. As your estrogen levels go up, your collagen levels are kind of one to one, as your estrogen levels go down, your collagen goes down.

And part of the reason why is we know that estrogen is a very proliferative hormone, it causes tissue growth, it causes proliferation, and it does cause stimulation of fibroblasts, those are the elastin and collagen producing cells of the skin. So we know that during high estrogen phases, your breasts get tender, you look blotty and pouchy, because estrogen is kind of stimulating all your cells to swell. So I do think that there's a tight correlation mainly between estrogen levels at the skin level and collagen production.

[Amy Risley] Let's talk a little bit about perimenopause, menopause, because that's when the estrogen starts to really decline and that's when everything starts to really kind of come [inaudible 00:14:34].

[Dr. Zenovia] Yeah, and it's a really slow process. I have to say that the perimenopausal period is really kind of a psychologically trying time for people because you've got your babies, they're growing up and now all of a sudden you're feeling not yourself. You might be a little more depressed, not interested in the things you used to be interested from a sexual standpoint, libido for example. And skin wise, we begin to see things, we begin to basically experience more dehydration and dryness. When you decrease your estrogen levels during that kind of perimenopausal period, we do see trans epidermal water loss is what we call a TIWL, trans epidermal water loss. You decrease your ability to retain water. So you do need more moisturizer, things like that, that becomes more accentuated when you're in [inaudible 00:15:31] menopause. But you start to see early signs of it. Women are complaining, "I used to be so oily, I'm not willing anymore. I have to put moisturizer on my face. My cuticles are cracked. Sex hurts because I'm drier down there." So there isn't definite correlation between epidermal hydration and estrogen deficiency.

[Amy Risley] So estrogen deficiency in effect is causing a leaky skin barrier.

[Dr. Zenovia] Basically, it does and it's not so much that the cholesterol barrier is compromised, but you're just not holding it in as much because the spongy cells aren't there to hold it down, and so you're just dehydrating them more. It's like your sponge is thinner.

[Amy Risley] One of the things you also talked about was that estrogen has to do with our pain reflex or our pain senses, and that when estrogen declines, you're more sensitive. And so we're not imagining things, our skin is actually more sensitive and potentially more reactive as our estrogen declines.

[Dr. Zenovia] It is. So I see, when we do procedures for example on women, lasers that are invasive, or even surgical procedures, I always tell women, "How are you with your menstrual cycle? Do you feel more pain, like if you have a pimple for example, before your period? Does it hurt extra?" And they're like, "Yeah." That's because for whatever reason, I'm not sure if there has not ever been an established link between the neurons, the actual neurons of the tissue, and what estrogen does to them. Or if it's just like a psychological weakness, we're just intolerant a little bit more, more irritable when we have a little bit less estrogen. And so that makes us feel more pain. So I definitely sense without a doubt, people experience more tenderness. When I'm injecting lighter cane for a procedure, they're more tense, or when I'm doing acne extractions, and completely relevant to their hormone state.

[Amy Risley] Okay, so that happens in perimenopause, menopause, post menopause, it also fluctuates throughout the menstrual cycle as well, which is why right before your period, you're sensitive, during your period you're sensitive because your estrogen is taking a bit of a dip.

[Dr. Zenovia] You got it.

[Amy Risley] Amazing. I mean, it makes so much sense. So given how critical estrogen is to the whole equation, and I have heard about people using topical estrogen to treat vaginal dryness and to treat other issues. Is there any value in putting an estrogen or an estrogen like substance in a facial skin cream.

[Dr. Zenovia] There is. I remember very early in my career, the vaginal creams that were estrogen based  [inaudible 00:18:16] and things like that dermatologists were playing with them on the eyelids, [inaudible 00:18:20] significant results with just doing vaginal estrogen creams on the eyelids for that early, laxity in the lower lids. And that fell off the radar for a long time, Amy primarily because when the Women's Health Initiative came out, which was this huge cohort study by the FDA, that basically reviewed hormone replacement therapy, and its relationship to all things female. It came out that there might be a link between estrogen and breast cancer. And breast cancer, as we know, has a ton of research and media attention behind it. And since that Women's Health Initiative came out, that was I don't know, 15 years ago now, people have unraveled kind of the links that were postulated in that study, which essentially scared the heck out of all of the providers that were supplementing women with estrogen, and it had like estrogen, cause links to breast cancer, and that kind of blind correlation has been dismantled.

And we know that estrogen doesn't cause breast cancer. So like I said, those early findings of estrogen having a trophic effect on the tissue, a building up of the tissue on the face fell off the radar when those studies came out, and now the pendulum has swung back. So for example, one of the things that I found is, there's a lot of plant-based mimickers of estrogen, such as soy based particles and things that are already used, kind of in different lines, but nobody has really kind of isolated an estrogen mimicker to see if it does have an effect. And that's kind of the work that I have been doing to develop my line, Dr. Zenovia.

[Amy Risley] You talked a lot. I listened to your podcast on Gloss Angeles with Kirbie Johnson, who I love. I love her podcast and you talked a lot about desquamation which Kirbie fell in love with the term. Tell us a little bit about, I mean desquamation is basically the skin's natural ability to exfoliate, shed it sells, but talk a little bit about the connection between hormones and the slowing down of desquamation.

[Dr. Zenovia] I love it. I like for example, one of the things that it's kind of like paradigms, right? When I look at the skin as a physician, and as a dermatologist, I feel like I'm part immunologist, part pathologist because I still look at the microscope every day, when I do a biopsy of someone's skin. So I see what it looks like on the human tissue, and then I look at the microscope, and I can do this micro macro correlation. So when you look at the cells under a microscope, the skin is a very rejuvenative organ, kind of like a lizard. You can cut up a lizard tail, it'll grow another one. Not all cells in our body have rejuvenation capacity. So the cells in the skin have eight basic layers. It starts at the stratum basil osom, which is the basil layer on up to the stratum corneum, which is the dead layer.

And that process of a cell going from the base of the epidermis, differentiating through the keratinocyte and squamous layers on up to the top and then flaking off is a very beautifully regulated, elegant kind of process. It's essentially the differentiation of ourselves from their basic stem cell component, which is the basal cell on up to a dead level of the stratum corneum. And that process is very regulated by our genetic profile and it's impacted by our immunology. If you for example have an inflammatory disorder of the skin like psoriasis, psoriasis accelerates desquamation so you end up keeping up dead layers or estrogen. When you're a baby, that process of desquamation happens really fast. So your skin sheds every seven days and you're like smooth and silky.

[Amy Risley] New as a baby.

[Dr. Zenovia] And then when you're 80 that desquamation process is really basically truncated and really slow down, so you [inaudible 00:22:48] desquamating slower so you think of like the old crusty guy. So the idea and then retinae and retinols kind of regulate that shedding process. This is what we get that beautiful dewy skin with retinol. So as far as the hormone link with desquamation, I don't think that's been established Amy, but I can tell you that because estrogen and estrogen like molecules do have an effect on fiberglass production, and you use the collagen production in the skin which is basically in the dermis, you end up getting kind of a smooth, even kind of sponge across the dermis. So your epidermis which sits on top of the dermis looks tighter and smoother. So it's not really impacting the desquamation process, that's where I incorporated retinols and glycolic acid in my line because I still think those are paramount and kind of the dewiness of the skin.

So in general I think desquamation is kind of where it's at. And I hear that you kind of have your own line with barrier function, I think barrier is kind of the hallmark of beautiful skin, repairing that barrier, managing that barrier and basically supporting it with ceramides and peptides. It's all part of it. There's no one hit wonder. The skin is too complicated of an organ to think one thing is going to make it look amazing. This is why the comprehensive lines I think are really where beautiful skin comes from.

[Amy Risley] Yeah, so given that you are all about sort of supporting the barrier and the barrier function and then desquamation is important, exfoliation is important. What would be you've said retinol, you said glycolic acid, what would be sort of your top five ingredients that you feel we should be looking for in our skincare products?

[Dr. Zenovia] Amy, I love you, you're such... you're pulling the questions that I want you to ask me, like coming out of you.

[Amy Risley] Okay. Good.

[Dr. Zenovia] Girl, I could tell yourself, you need to be a dermatologist I swear.

[Amy Risley] I would have loved to, I just wasn't good at math and science so unfortunately.

[Dr. Zenovia] I hear you baby, you're so good. I tell people all the time, it's not so much the product, it's the ingredient girls. Read the back of your labels. So okay. I mean, first and foremost, I'm a sunscreen worshiper, but I know it's not sexy, but got to have it. I do believe in an act of retinols. The problem just a little comment on retinols. The problem with retinols is retinoic acid, or Tretinoin has a very complicated chemical degradation process in the cells. And what people don't know is that the retinoic receptor is actually in the nucleus. That's crazy. You have to bypass the cell membrane, bypass the nuclear membrane to get inside the nucleus, it's not. So a lot of the retinols on the market are really just named retinols, but they're not actually being delivered in the tissue. So I spent a lot of time kind of formulating my retinol to make sure that actually got delivered in a stable form, pass those two membranes to get into the nucleus.

Because retinols are really amazing at multiple things, but I love retinols as you know. Glycolic and exfoliation is key, because you're really trying to strip down that barrier and reveal that healthy live epidermal tissue. I do think barrier function is important, so ceramides which are cholesterol agent, that is the mortar of the brick and mortar, the tissue really helps seal that barrier and protect the skin from inflammation and the environment. I also believe in antioxidants. We talk about antioxidants all the time. I know that everybody has their favorites of pomegranate, green tea, polyphenols, vitamin C. I'm a fan of active vitamin C, and I am...

[Amy Risley] By active, what do you consider a sort of an active level? Because I know there are lots of vitamin Cs out there, some state their levels, some don't. I just got asked this question yesterday by my brother, but what do you think is the best vitamin C.

[Dr. Zenovia] Vitamin C is a really tricky substance because it oxidizes in our earth's atmosphere kind of on contact. So some of like the esterified version of vitamin C is an ester form, it's got a little esterification on its tail, and that makes the molecule more stable. And if you produce your vitamin C substance in an oxygenated hood, a lot of the vitamin C that you're pouring in your bottle, in your manufacturing plant destabilizes and basically oxidizes and reduces and it becomes unstable. Manufacturing is huge with vitamin C. So we produce our vitamin C moisturizer in an argon gas chamber, so that it doesn't oxidize.

It's kind of like a really, it was very mindful chemistry when we were coming up with our line. But in addition, it's not so much the percentage because again, Amy, you can have a high percentage, but if it's in its unstable form, it will oxidize. So I really like ester forms of vitamin C, I really like concentrations at 5% or more. And the key thing is, vitamin C can be very irritating because it's ascorbic acid, and it can inflame skin. So I like vitamin Cs that are delivered in a lipid soluble substance. That's how it gets into the cell and it's stable form and it doesn't become acidic and irritating.

[Amy Risley] That's so interesting. Our barrier line is built around a lipid complex and we use a lot of other actives as well including peptides and hyaluronic acid. But our chemist has said to us often, "I use a lot of these other actives and other lines, but I've never seen them work as effectively." And his hunch is that the lipids are helping to deliver them deeper into the skin potentially make them less irritating. So it's fascinating to hear that.

[Dr. Zenovia] That's it. And the way to think about it is, it's kind of just playing chemistry and the cell membrane is a bio layer so it's two layers and it's made up of lipids. And the only thing, it's like putting a drop of water on oil, what happens? It doesn't go in. But if you put oil on oil, it goes right through. So lipid goes into another lipid so that was brilliant that you guys did that and I use a lot of lipids in my delivery systems as well because it's just a superior in tissue absorption.

[Amy Risley] You talk a lot about inflammation as well which we've heard over the years Dr. Paragon I think was sort of the first start talking about inflammation and how it affects the skin. But talk a little bit about that and how that might increase with age. And then in particular, I'd love to hear more about your nighttime treatment because it sounds fascinating, but talk a little bit about inflammation and what that means for the skin.

[Dr. Zenovia] I love this topic because it's kind of like being a doctor. I think, as physicians you get educated with a certain amount of literature in your training medical literature, and then you see that literature kind of evolve over time with your career. And one of the things that I've noticed in my career is just this concept of inflammation. Gut health, this is like kind of all the rage now, and even heart attacks, which we thought were just like, oh, a blood clot when your coronary artery you got a heart attack. Oh, no, there's a ton of inflammation in heart attacks. So it's a very fascinating field and I love immunology, that's probably my second favorite subject because the immune system basically governs what our body develops, right?

Your immune system allows you to get... when your immune system is not functioning perfectly, you get autoimmune disease. When your immune system is out of whack, you get inflammatory acne. When your immune system is basically affected, it's not surveillancing your cancer cells, you develop cancer. So the immune system is a massive surveillance system in your entire body. And inflammation is a very natural process that the body has developed through evolution that essentially protects us from all sorts of diseases. But inflammation is also not good, too much inflammation. So imagine if I cut you with a knife, a dirty knife, your body has to see the bacteria go up into that wound, basically phagocytize the bacteria, but then also plant down new epidermal cells and heal your skin. So you're not like a caveman walking around with a cut all day.

So essentially, inflammation is totally important but too much inflammation can cause disease, autoimmunity, cancer, heart attacks, acne, multiple sclerosis. So all the diseases that we hear about have some inflammatory component. And aging, just the mere concept of collagen degradation, volume loss, epidermal dehydration, there is an inflammatory component there, and it starts Amy with oxidative damage. So we know that the ultraviolet radiation causes oxygen free radicals and we wear sunscreen. We know that we use antioxidants to absorb these free radicals. And once those free radicals and the oxidative stress, kind of surmounts the ability for our skin to repair itself, we get inflamed. And so inflammation is the endpoint of oxidation, oxidative stress, and now how do we clean up inflammation? So you can't be putting cortisone on your face every day.

Cortisone or prednisone is like a grenade on inflammation, we don't want to be that promiscuous, we only want to slow down inflammation just a little bit. So one of my favorite things was developing the Inflam-aging Night Repair, because I do think there's room and there's space for putting a little anti-inflammatory product on your face every night to basically absorb what you couldn't get with your sunscreen and your vitamin C or antioxidant. And then at night, you're repairing your skin, and it involves a really powerful green tea polyphenols which are really an antioxidant. There's some research that the ECGs in green tea can shrink cancer, and that's in the oncology literature. So green tea polyphenols are very anti-inflammatory, resveratrol, caffeine, and it's kind of a trifecta cocktail that I put in my Inflam-aging Night Repair. And I just think everybody should be on it.

[Amy Risley] I love it. I love this idea. I mean, the thing about those ingredients too is that to your point, they're safe to use every single night. There's that downside, they're really good for you. They're good for your skin, they can clean up all that stuff, as you say that you didn't catch with your preventative measures or that your body's own defense mechanisms weren't able to overcome. So interesting. One of the things you talked about too is that the aging process and this process of going through the six stages of life is not linear. And that this was really fascinating to me that it happens almost like a growth spurt that it can happen in spurts. I've definitely noticed that where you go to bed one night you wake up the next night and you're like, "Where did this come from?" What's going on? Why is the skin under my arm, so all of a sudden hanging?" And it just seems to happen overnight. So talk a little bit about how that process happens, or why that process happens.

[Dr. Zenovia] It kind of blows my mind too because I mean, I'm going through the process myself, and I remember kind of when I hit 40, I'm like, "Oh, my God, my hair is just thinner." Hair loss is huge, with hormone changes, basically it's not like a child goes from one word, the next day two words, the next day three words. Children go from two words to 15 the next day, and then oh my god, 20. And they do these like spurts of growth. I do think aging happens that way. And it might be that when you think about cell physiology, because that's where it all starts, there's like a tipping point of when certain things get turned on or off. So let's say you need so many micrograms of estrogen to be in the soup of yourself to trigger this gene to turn on, well, you didn't get there, like you kind of got there like overnight, because it's like boom, and it's like tipping point that's the rate limiting step of the chemical reaction. And this happens in our genes. Let's say there's certain genes that get turned on.

I'm just going to make it up off the top of my head, but let's say your 11 year old little girl, and you're kind of going through life and you're gonadotropin releasing hormone started turning on and your ovaries are now making a little bit of follicle stimulating hormone, you're making a little bit more estrogen, but you don't quite have acne. And you're just like, your body's just sitting there kind of like making a little bit a little bit, but now mom and dad get a divorce and now you're super stressed. And now you're like not sleeping and crying all the time and you're stressed all the time. Now, cortisol surges. Well, now your ovaries are just seeing that little baby estrogen, that's normal, now you get like a cortisol rush, and boom, you start getting acne. It's like a cocktail. You don't know what the heck's happening in there. And your cells are being kind of bombarded by a soup of mediators. And you need a chemical reaction to kind of, like we call it the rate limiting step for the Michaelis kaplin [inaudible 00:37:31] curve which pushes the reaction forward.

And if you only had a certain amount of substrate, the reaction doesn't go, but if you put one more micromolar in there, boom, the reaction goes. So I think that's probably my theory on why we see kind of spikes of aging because I was good two days ago, but I just look weird over the last two weeks.

[Amy Risley] I don't recognize myself, it's very disheartening. So now knowing everything that you know, which is formidable amount of information, what would you recommend to a woman say in her late '20s, early '30s, who's sort of on that CUSP potentially, she's in that sort of golden phase, golden years of her skin health and to anticipate what's going to come next. So how do you talk women through the stages and how they should change what they're doing both internally and externally?

[Dr. Zenovia] Okay, great, God I love it. So first I think that again to say that you can never start early enough okay. And we're bombarded constantly Amy with media, advertisements, some snake oil level, some legit it's so hard to know what to do. So I'm kind of a stickler as an evidence based physician, evidence based is kind of the buzzword in medical science now, I kind of lean on where the research is, and kind of what's tried and true. We know right now and I don't know if this podcast is going to be listened to 20 years from now and they're going to be like, "Oh my god, those girls were so stupid, they didn't know what they were talking about." They're basing our information on what we know today. Okay. And it's like peptides were all the rage in the '80s. Then you have like stem cells, who knows what the heck is going to come out in 10 years, right?

[Amy Risley] Right, something they find on Mars, maybe you know.

[Dr. Zenovia] Yes, or some molecular something that we don't know. But as of today, you and I Amy speak the same language, and I would tell a young girl, no matter what, you need protection from the sun in the morning, you need an antioxidant in the morning, at night, you need a glycolic and retinol. And above all else, you need to sleep, have a low inflammatory diet and take care of your gut. I mean, like kind of basics, kind of like, and I think those are important right now. Gut health was not talked about 20 years ago. But I do think it's become increasingly important in the immune system of your body. And the immune system is so incredibly important. So those are the four kind of concepts that I do espouse very early for women, and they continue on, as far as eye creams and serums. And it's like, okay, squeeze all that in but don't forget sunscreen, antioxidation, glycolic and retinol, and everything else is kind of icing on the cake.

[Amy Risley] And then as she ages you just talk her through the stages and the various interventions that can help to supplement that.

[Dr. Zenovia] Correct, for example, when you develop melasma, do we add hydroquinone? Do we add Kojic acid? If you start getting like adult female acne, do we add a little Phytoestrogen on your skin to kind of minimize that balance? And that's kind of, that Phytoestrogen element is what I think is lacking in a lot of skincare. And that hormonal balance is key. So this was kind of the inspiration for the skin line to actually, not everybody's going to be on bioidentical hormones between the ages of 30 and 50. So what are you going to do? And so you add a little bit of that Phytoestrogen to balance out that skin element, it's not affecting the body internally, but it's giving you that little estrogen support that you need at the skin with the plant safe mimicker.

[Amy Risley] I love it. I love how you've drawn the connection between all of these phases of our life and the things that are happening with our estrogen progesterone and testosterone and how they manifest on the skin because it just makes it so much clearer and easier to understand. And then there are things that you can do to your point to balance those hormones and help sort of ameliorate those skin concerns. I think it's genius. I am really, really excited to check out your line at Sephora on October 13. I hope it'll be in Canada.

[Dr. Zenovia] You can look me up now at DrZenovia.com and that's my Instagram handle too. So it's already selling online on our website, but Sephora officially launches it October 13 so I'm really excited. For me Amy honestly, it's like it's that same kind of like the way my medical practice runs in Newport Beach, I mean ZENA Medical is the name of my business it's like I kind of want it to be that like small town ice cream shop, where you go there for like real solid love advice and concern and honest medicine. And that's how I kind of want my skin line to come off. I want it to really help people who've been struggling with things that they haven't found answers for.

[Amy Risley] Yeah, I love how you talk about root cause and we're all about root cause at Skinfix as well. It's like we'll treat the symptom, we'll calm the eczema flare or we'll treat the keratosis Polaris but what's causing that? And how can we with a topical get at that? Obviously there are other things at play and supplements and diet and sleep and I'm a big sleep proponent as well, but how can we treat the root cause? And I love that about your line I think that's so important and understanding what's going on is just so critical. So I just really appreciate your time and I look forward to-

[Dr. Zenovia] Thank you, Amy. Me too.

[Amy Risley]... meeting you in person. If I get out to California to see my parents I'm going to come and see you at ZENA Medical.

[Dr. Zenovia] You come and see me for anything and look I'm sure that you're such an introspective person, very lofty in your thinking. I love it. You ever want to invite me again and we talk about anything, procedures, is Botox safe? What the heck are you guys doing out there in the dermatology world? I feel happy because in the same way that I kind of approach epidermal science and chemistry, I have all sorts of fun, interesting ways that I think about skin rejuvenation and fillers and kind of debunking a lot of the myths out there.

[Amy Risley] Amazing. You're such a straight talker and you make the science so easy for the rest of us to understand. So we will absolutely have you back and look forward to it. Thank you so much.

[Dr. Zenovia] Thank you, Amy.

[Amy Risley] To learn more about Dr. Zenovia's medical practice, visit www.zenamedical.com and to learn more about her products, check out www.drzenovia.com. I learned so much from talking with Dr. Zenovia, her breadth of knowledge about hormones and our skin made so much sense to me. It was like multiple aha moments throughout our discussion. Here are the three things I can't stop thinking about. One, understanding of hormones is truly a key component to understanding our skin, how it feels, what it looks like, why it changes. I'm excited to know Dr. Zenovia looks at dermatology through this lens and provide so much hormonal education for the rest of us. Two, when people refer to pregnant women as glowing Dr. Zenovia explain that the phenomenon has to do with hormone triggered tissue remodeling. It isn't magic, it's science. It's like the ultimate example of how our internal systems are directly connected to our skin.

And three, according to Dr. Zenovia, the kind of estrogen deficiencies that occur in menopause are directly correlated to a leaky skin barrier, which means it's even more important to restore and protect your skin barrier as you age. Thank you for listening to this episode of Total Skin Nerds. Please subscribe to our show on iTunes and Spotify. Total Skin Nerds is produced by Rob Corso, Casey Khan and Harley Khan for FreeTime Media. Our theme music is by John Palmer. Special thanks to Melissa Miller, Sherry Feldman, Kelsey Chapman, Jane Meriden, Carol Loop, and Megan Collins, and I'm your host Amy Risley. Till next time nerds.

[Amy Risley] Total Skin Nerds is brought to you by Skinfix. We're clean, clinically active and on a mission to help heal your skin.

Speaker 4: Total Skin Nerds is a podcast created to educate. It is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical advice. If you are looking for help with a skin concern, we would encourage you to seek the advice of a board certified dermatologist, functional medical practitioner, or other qualified health care provider. You can find a registry of board certified dermatologists in the US at find-a-derm.aad.org and in Canada at dermatology.ca. For a registry of qualified functional medical practitioners, you can visit ifm.org. Thank you so much for joining us on this episode. We hope that you enjoy listening to Total Skin Nerds as much as we enjoy making it.