From Bleach Baths to Breakthrough Cleansers with Dr. Azam Anwar of CLn SkinCare

0:02Hey guys, welcome back to Skin Anarchy. This is Ekta and I have such a wonderful guest with me today. I'm really excited because I think when it comes to skincare we have so many different terminologies out there but a lot of them are not really rooted in medicine and science and there's so much to know especially when it comes to things like cleansing your skin and understanding different types of pathologies of that manifest with skin and how to take care of them so with us today is Dr. Anwar who is a renowned cardiologist an inventor a passionate entrepreneur and he's also the CEO and founder of Clean Skin Care.

0:40So welcome, Dr. Anwar. I'm so excited to chat with you today and to learn from you. Thank you, Dr. Akta. I'm so happy to be on with you and share whatever I can. Yeah, I would love to get started because I know that you have a very personal aspect to the story behind Clean. I would love to learn more about yourself and what got you into medicine and then led you to integrating your field with dermatology and getting into the skincare space, if you could kind of walk us down memory lane. Yes, absolutely. So I'm a cardiologist, interventional cardiologist, and was very busy taking care of any patients doing angioplasties and putting stents in coronary arteries.

1:23And then I became a dermatologic patient about 15, 16 years ago and developed a very small little rash on my shin, scratched it, And then this turned out to become a cellulitis or tissue level skin infection that was moving pretty rapidly. A very tiny little scratch to a size of a silver dollar in a matter of literally a week. I went to my dermatologist and he cultured it and said I had methicillin resistant staph aureus growing there. and he placed me on antibiotics orally and topically and recommended cleansers. And then I couldn't tolerate the chlorhexidine cleanser, you know, hebaclens. And then he said, well, why don't you do bleach baths?

2:17Bleach baths were pretty cumbersome to make. You put a quarter cup of Clorox in half a tub of water, which is 13 gallons of water. So you dilute your Clorox bottle or bleach a thousand fold and you sit in it for about 10 minutes and then take a shower to rinse off. And the whole process is cumbersome. It takes 30 minutes. But I did it for two or three months and I went back to him and I said, well, you know, this is pretty cumbersome, but the science is pretty good. I think we should be able to simplify this because, well, this has been around for many decades and we do this all the time. And I'm telling you, as a patient, it's really cumbersome and really bathtubs are dangerous.

2:56and so on and so forth. From there, we partnered and hired chemists. It took us four years, four to five years, to develop the product. And what we wanted was sodium hypochlorite, the main component of bleach, in a really low concentrations in there, and add some lactants and so on to make it safe. So that's how CLEAN got started. Wow, that's really interesting to me because I think about a lot of the different skin conditions, right? Like psoriasis and eczema. And there are so many different things. Cellulitis is a very unfortunate and extreme situation that happens. But even for the daily consumer, I mean, there are so many different conditions that require a very specific protocol when it comes to cleansing.

3:45And that's where I feel like I would love to learn a little bit about what you've discovered over the years of being behind clean about these kind of different needs that consumers might have, you know, if they have conditions like that in terms of, you know, how they should be cleansing and if you could share a little bit. Sure. So I'm a plumber, an interventional cardiologist, and we have developed coronary stints and I was in the middle of that many years ago. So for me, developing products was really pretty simple and straightforward. What was very interesting in dermatology is the skin, although so simple, is so important, you know, such an important shield and has so many different structures.

4:34And what I found was a common thread with a lot of the common of the common skin diseases, probably two thirds of the conditions of dermatology. with eczema, psoriasis, folliculitis, dermatitis. When the shield breaks down, the skin barrier breaks down, the microbes or allergens get involved there and create an inflammatory reaction down to the cellular level. So actually the various conditions have a simple common reason, but the inflammatory agent or the thing that causes problem, the redness and itching and breakdown of the skin could be different microbes. It could be a virus, it could be a fungus, it could be different bacteria, it could be Staph aureus, it could be strep.

5:27And then it also could be allergens, right? Like poison ivy or even products. So when you mix that all together, you get a variety of symptoms and then the doctor goes, well it's this condition or you know condition a b c or d you know you guys deal with hundreds and hundreds of conditions so mechanistically it's pretty common and the main thing for skin problems is to get the canvas cleaned properly without damaging the surface So it turns out that you need something that's not going to damage the skin. It's going to have some anti-inflammatory properties. And the anti-inflammatory properties of sodium hypochlorite or even hypochlorous acid are really interesting because it reduces NF-kappa B, which is the final signaling protein in cells that cause all the manifestation of the symptoms.

6:34So diluted bleach baths reduces that by 50 % in the rat model, aviation rat model. And also diluted bleach is anti-aging, reduces the protein P16. And then we've known from the past that low levels of sodium hypochlorite is also antimicrobial without the microbes becoming resistant. So it has, you know, a couple of theoretical advantages. And then on top of that, we added surfactants because you need to loosen up the debris and oils and bacteria and so on from the skin. And so I think the act of using surfactants that are not too harsh, but also getting them in the shower. So the act of washing.

7:22So you add a combination of something anti-inflammatory, antimicrobial, lathering, and using lukewarm water. All of that leads to a very clean platform. So that was our core product was the clean body wash. and then if someone has really kind of dry skin we've added hypochlorite and glycerin so to make it more humectant and more hydrating and if somebody needs a more deeper cleansing with follicle issues you know hair follicles etc or acne salicylic is a acid is a really wonderful product. So sodium hypochlorite and salicylic acid combines there and it gives you a deeper cleansing. So I look at skin, whether it's normal or mixed or oily or dry, and then you can kind of use the various products that we have, but the core ingredient being sodium hypochlorite and surfactants.

8:27That's very interesting. And, you know, especially this makes me think of also like athletes because when you're you know when you're an athlete or you're in the gym a lot and you're sweating a lot and you're then waiting right to like go and take a shower or whatnot i mean all of that that's happening is creating this like crazy environment you know and people end up breaking out and they're always like why am i breaking out so much but it's because your sweat is literally sitting on your skin you know for like whatever amount of time after you work out to when you get to the point where you can take a bath or whatnot.

9:01And I'm curious, you know, at that point, I think sometimes I've also heard that people can overdo it, you know, with the cleansing because they feel like they need more. So I would love to like understand, I mean, you had mentioned surfactants. What is that balance that you found with the use of surfactants? Because there's a lot of literature and, you know, hype around this idea of why surfactants can be damaging to the skin barrier. And I just want to learn a little bit more about that in terms of this context, you know, where does that play in with, you know, how you've crafted clean and, you know, what we usually see in conventional products?

9:41Yes. As far as athletes and sweaty skin, an important concept that people need to realize is wet skin tears easily. So these little micro tears that you can't even really see or more prominent so you're for instance a piece of paper tears more easily when it's wet so the first thing athletes should do or people that are active you know sweat anywhere just you know dry get dry get out of wet clothes get out of wet shoes get just wear flip-flops just having the skin dry with air is going to be protecting so the other issue with athletes is that anytime we come in contact with towels equipment or other human beings like such as mma and wrestling and so on the microbes transfer over from the thing or people to the other person very very quickly so the key is to get in the shower right away so i think the key is get in the shower within 30 to 60 minutes get into dry clothes those are the most important things and then remember that the skin barrier is what you're trying not to break and that's the most important defense that you have it's better to just rinse off without even really any soap and not hurt your skin you know and do it quickly it's almost like washing your dishes, you know, with ketchup on it, right?

11:08You, if you truss it off right away, it's going to, you know, everything's going to slide off easily. So I think the, the product should be non damaging or the barrier shouldn't be broken down. So if you're scrubbing really hard or you're really using really harsh products, then that's actually going to do more damage. And then I wouldn't, I wouldn't use, you know, heavy duty scrubbers or bristles or so on. So you want to gently and quickly clean the skin afterwards. And, you know, for us, we've just made the clean sport wash, which is the same as the body wash. I mean, the ingredients are, you know, really gentle and non-drying and, but it still has enough muscle to do some other things, but not too much.

11:56So there was a really good balance. And we started everything with our company with doing studies in the most vulnerable. So although theoretically we developed the product and we thought it was going to be excellent, I wanted to be sure that clinically it would work in children with atopic dermatitis or eczema as young as six months. And as you know, they're very, very sensitive and irritated skin. And they all had moderate to severe eczema. And we found that our products were well tolerated by them. Wow. So when we showed that in a six-month-old with eczema and staph colonization, they did well with our product, we had really good confidence that that 14, 15 or 18-year-old wrestler or football player, you know, lacrosse, would tolerate the product well.

12:55That's really cool. That's really interesting that you were able to test it in a younger demographic. demographic. I think that's a lot of being talked about right now is that there are a lot of products out here in the OTC space for skin health, but that component about whether it's actually tolerable by younger skin types, that's a very big question mark. And so that's very interesting that you found that. Studies, one in Dallas, Dr. Ghali, and then we did another study in Chicago and Houston, and both were published in the PD Derm journals. And so we got our start with the most difficult group, I would say, children with skin conditions.

13:37We met the standards of the PD Derm community. So it's become a standard of care in that community. And then from there, it was a lot easier to go to adults. And we continue to do studies in very difficult skin conditions with our products. And we think, well, you know, that's a good way to contribute to the field, but also prove out the product, you know, for instance, with eczema or HS, you know, hit or not a supertiva, or also working other conditions like CTCL and staph colonization. So that's where I come from. I want to really prove the products in very difficult conditions and then give the doc really good confidence on the, you know, day-to-day care as well all right that that makes sense to me i think you know in terms of like you know skincare i i personally like as a consumer even i look at it and i'm like there it needs to be a more data driven approach rather than just you know this is a cool package and you know i'm gonna put it on my shelf it needs to actually serve a purpose so that's very exciting that you you know the you have done the the work and the research is there to back it now one thing i wanted to actually kind to circle back on, you'd briefly mentioned it was this, the NF-kappa B pathway.

14:52And I, just for our audience to further understand, you know, NF-kappa B is involved, obviously, I mean, it's a pretty big marker and, you know, it's involved in a lot of the inflammation that's seen across the board in skin conditions. So when we're talking about something like psoriasis or eczema or any of those, can you discuss with us a little bit about why it's important to down regulate NF-kappa B and actually impact this inflammatory cascade that happens? I mean, just so that, you know, we can understand the therapeutic benefits of that. Yes, great question. So the way I would think about NF-kappa B is start out at the skin level, and then when your skin either has an internal condition such as psoriasis or eczema or drug reaction or something external from the outside coming in and irritating it like you know radiation or a knife or microneedle or or in wrestling or jujitsu somebody's twisting your skin it creates an insult so when that insult is there and that insult gets activated the signals go into our cells and various interleukins are activated you know the you'll hear IL-23 IL-17 all of those interleukins are activated and then finally those proteins unsheath NF-kappa B.

16:27NF-kappa B sits out outside of the nucleus of the cell in the cytoplasm yeah so it's sitting in the goop so to speak and then and it's inert it's inactive but those interleukins activate and pretty much unsheath and activate nf kappa b which then moves into the cell into the brain of the cell and tells the brain hey we're under attack you know we better produce proteins to cause, you know, more blood flow or itching or whatever. And so you manifest the disease such as itching and irritation, redness that the patients see. So NF-kappa B is activated. And so when you down-regulate that, which, you know, various drugs do and so on, and so does bleach bath, you know, something really simple, it's a beautiful thing because that's the common pathway for various, you know, various diseases, right?

17:29And the various diseases, we give different drugs, right? Do we give Humira, you know, for TNF-alpha, which, you know, eventually stimulates NF-kappa B, or we, you know, given some IL-13 or 23 blockers or 17 blockers, those all activate NF-kappa B as a final signaling protein as well. So it's kind of a non-denominational protein which activates, you know, the things that you see. Interesting. Yeah, so it's basically like the end result of a lot of different, you know, inflammatory, you know, like I guess stimuli, you know, the different cytokines and the different interleukins you mentioned, they can all go and activate it.

18:12I mean, it's interesting to me because everyone's talking about the inflammasome. You know, that's really why I brought up that and wanted to learn more because it's a big buzzword right now in the beauty and skincare space is this idea of there's a skin inflammasome, you know, and how can we manage that and how can we work with that, especially in the setting of something like these skin conditions that we were discussing earlier. and you know it's very fascinating to learn that there are I mean obviously from a pharmaceutical standpoint there are drugs but what can we do really topically so I mean what is your recommendation in terms of just general cleansing I mean do you think that everyone should incorporate products that are using ingredients such as hypochlorous acid and then do you mean are they safe for just general use and everyday use?

19:02I think if someone has really, you know, good skin and they're doing well, you know, I think just, you know, a gentle, you know, cleanser, things that are readily available will be good. I think the main thing is to realize that a lot of skincare products and makeup and so on have preservatives in them. The preservatives are there to kill microbes and so that the, you know, the jar of whatever product you're using does not grow, you know, aspergillus, you know, fungus or staph or whatever it is in it. And a lot of people may develop allergies and so on to those, to those products. So I think it's important to really wash those off at night, you know, in the shower and to go to bed with really, you know, clean, you know a clean canvas and you know let it naturally you know rest overnight and then if you have some issues then you might need to use something a little bit more intense now i would be careful with the hypochlorous you know products so we are putting out a hypochlorous product ourselves as well because the stability of those products are really difficult so you know It's not a very stable product, so it has to be manufactured well, and there are only probably a couple of manufacturers that do a really good job of that.

20:29So although theoretically hypochlorous and hypochloride can reduce inflammation, I think the manufacturing should be kept in mind. And hypochlorous, which comes out in a spray, our products are washes where you go in the shower, and I'm a big believer in showering, but sometimes it's not possible. So hypochlorous is just a spray that you spray on and theoretically it could reduce, you know, the inflammation, it could be anti-aging and so on. But, you know, is it really any better than just, you know, a good, good gentle cleanser that you would use at night? I don't know that I can really say that.

21:09Yeah, that makes sense. I mean, it's just interesting, you know, because it's everywhere right now. Hypochlorous acid is, I think it definitely had its big moment when we first saw it in the spray form like you mentioned you know a few companies came out with it and everyone was using it i literally saw it all over social media and you know it was like the big thing like this is the miracle product right now especially for people who are more acne prone you know they were very much gravitating towards um the sprays and whatnot and it just you know it was interesting to me to watch because it's like well do we all really need it you know and so consistently being used, you know, it just makes you wonder in the longterm, what are we really doing to the skin if we're using it so often?

21:52Yeah, I think it's, it's going to be fine in the longterm because, you know, the amount of microbial kill is very little. So it's, it's not going to affect your normal, you know, your normal flora. Yeah. I think especially after procedures, you know, microneedling, et cetera, anything, dermabrasion or if you have problems and it's helped it you know certainly continue it right you're going to be your own best doctor what's going to work for you so i'm not worried really about the overuse i'm worried about the over hype we have to be honest if something works or not or if there's evidence or there's not evidence you know for it i think the spray is very good for Let's say there's a child who doesn't really want to wash, but it cools down their eczema.

22:47I think it's going to be wonderful. Or if somebody has acne and it's really helped them, why not? Or if they're going under radiation therapy and they're irritated, why not? But for somebody with normal skin, I don't know. No, that makes sense. I think that it's the overhype. I like what you said. you know you're not worried about the overuse with overhype i think that's definitely something i can get behind as well i think right now the way that you know skincare products are kind of like recommended in this space it's really about hype and you have to really think as a consumer do i need this you know do i need this in my routine or do i already have 15 steps that i'm using and this is not really necessary so it's very interesting i wanted to actually you know ask you about this because I know that clean products are recommended by a lot of dermatologists, you know, and you guys are doing so great in this space.

23:44How did you build trust with the medical community, especially the dermatological community with your products? Well, I just love working with dermatologists because, you know, one, they have incredibly high intelligence. as you well know getting into dermatology is the hardest specialty now fun working with smart docs you know and they also have the time you know and it's a small enough community to create great relationships and they're also very very skeptical you know so they took us in and they did and said hey great it might work it might not let's just do some clinical studies you know so we we did studies we had anecdotal information that it's going to work on this and that but then we worked on you know the study in dallas that i mentioned then we went to chicago northwestern and university of texas and houston they studied it and we go hey great we spent you know for a consumer company we spent well over a million dollars in our studies and invested a lot and I had some administrative people in our company that were not happy that we were spending so much on clinical studies versus marketing.

24:58I go, listen, I don't want to put anything out that the derms don't like, you know, we're here for the dermatologist. They're going to make this for breakers. And then we are very confident of our products. So we provide over, gosh, almost a million bottles of samples per year now. The dermatologist and we service them the best we can. So we want them to try it. And then lastly, we're extremely confident of the products and we have a really good return policy. So I think over time, that has built a lot of goodwill and confidence. And we have the Derms come in to a lot of educational seminars with us and we provide a free product to use.

25:43So they've got it in their own shower. Their kids use it. We send it to their kids. so we built a company you know around dermatologists i added a very strong medical advisory board we've got you know over a dozen luminaries and you know they're big supporters of the product and they we just don't add people willy-nilly we add people that actually use their products and understand it and are really big believers in cleansing and then we continue to do more studies we just finished a survey study with hs you know 145 patients it was presented a hs foundation meeting a small community but very important to us to show that our products really worked well there it worked beautifully you know reduced itching pain odor you know drainage etc and the hs community itself has really adopted our products and promoting it so we go to the doc, we go to the derm, and we go to the people with conditions, you know, skin conditions.

26:47So we're strong on the, you know, medical support or endorsement, if you would call it, quote unquote. Yeah, no, I mean, that's really, really exciting to hear, actually, because I think you're absolutely right in what you said. I mean, dermatologists are very, they're very skeptical. And I think that especially when they're able to get behind a product. I mean, for me as a consumer, it definitely sparks my interest automatically because, you know, to be able to impress them is a big deal, you know, and right now there's a lot of products that I see where I'm like, well, there's not a single medical professional that I'm seeing talking about your product, you know, so it makes it more difficult for me as a consumer to then say, I'm going to go and buy this and put this in my daily routine.

27:31That's what something that I think a lot of times this industry kind of overlooks is the idea of like, well, we're using, these aren't just like beauty products, you know, like with something like makeup, right, you're using it maybe, you know, on and off, but with skincare, you're using it every day for maintenance, you know, it's actually part of healthcare. And so when you're, you know, for this for my, for our listeners, you know, if you're actually investing in products, you have to be able to say that there is a medical community backing it, and there is proof why they're backing it you know and i and i don't know why we've strayed away from this concept so much but i see it all the time you know on social media where people are recommending things that have they don't have dermatologist approval they don't have um doctors and you know uh scientists behind them saying yeah this makes sense you know why this works like it actually adds up so to the fact to see that you guys are actually creating that and you're really bridging a gap in my opinion.

28:26I mean, it's very, very exciting and fascinating to me as a consumer. Well, thank you. I want to talk a little bit about scalp health, if you don't mind, because I know that you have wonderful products in the range that are focused on, you know, also the hair care aspect and scalp health is a huge, huge topic right now. I think as a community, the consumer community, we've realized that the scalp is not just, it's not just, you know, about washing your hair, you know, to put it in layman terms. I mean, it's, it's really about taking care of your scalp, making sure it's healthy, making sure your hair growth is healthy.

29:01So why can you tell us like, why is the scalp such an important area to address for overall skin health and hair growth? I think people need to divide their head into really two, two, you know, two ways to manage One is the hair, right, which is luscious and conditioned and so on. And we focus more on the scalp, which we think is, you know, where the itching and redness and bumps and all those things really start. And we found that our product, the Healthy Scalp Shampoo, which has sodium hypochlorite, salacin, it has a little bit of glycerin as well. It was just a wonderful product that anytime there's itching in the scalp, you know, whether it's folliculitis, sap derm, it worked really beautifully.

29:56And even scalp psoriasis. So we found that the common denominator of the symptom is itching. And the itching can be caused from anything as simple as, you know, dandruff to those other conditions that I mentioned. and by cleaning the scalp one to three times per week was adequate. In order to really clean the scalp, you need a little bit of muscle. You need surfactants and salicylic acid and so on. While that's really good for the scalp, it might be drying for the skin. So I'm an advocate of cleaning the scalp, but not too much, not too often, because then you're going to dry up the scalp and then you'll get more itching from the dryness.

30:44And then we've added, you know, a really nice conditioner that people can use a couple times a week, you know, leave it on for five or 10 minutes and then rinse it off, you know, for the hair. And then we've got another product that does not have salicylic acid. That's a two-in-one general wash. So that has sodium hypochlorite and glycerin, but no sal acid. So if the scalp is really dry already, then, you know, you can use that or you can alternate it with the healthy scalp shampoo, which has salicylic acid. So you can mix and match. But I just think on the scalp, we're over, we're over treating it.

31:24We're over shampooing it. I think we're obviously, there are a lot of, you know, colors and so on and so forth. And more is not better. more cleansing is not better actually it may make it worse because what happens is you may have really dry scalp but the follicles are all plugged up you clean it up and then it doesn't become dry but then if you keep washing it oh this is good i'm going to do it more and then it dries out again right so you're dry for the wrong reason and then as far as the the hair i think people know best for themselves you know on what's going to work for their hair versus yeah yeah no that makes sense I mean it's interesting because the scalp is like you know we have we don't have a lot of um I guess targeted education out there about scalp health I mean I think it's become a very broad I guess topic that's being discussed but really it's like you know you talk about dandruff or like you had mentioned you know redness in the scalp I mean, have you noticed anything that is like an underlying concern when it comes to scalp health that we should be aware of as consumers?

32:36I mean, I guess we could say inflammation, right? I mean, that's kind of a given. But anything that we can really target, I mean, what was Clean's approach to targeting scalp health from like a molecular perspective? i i think it's you know this the scalp has you know the hair follicles right and the hair follicles you know have a lot of sebum the microbes are different you know there's more you know you know fungus there really we put when we added the product with sal acid it just had a disproportionate positive response it became our best seller surprisingly and you know our body wash is you know still the top seller but it the shampoo just just took off the only reason that i think it took off is we just understand the basic science hey there's a follicle there's more oil there's you know more fungus you need a little bit deeper cleansing with that and the sal acid does wonders and just just a very small amount of sal acid you know at 0.5 with sodium hypochlorite is enough.

33:49And if you go higher, it's going to be drying. So salicid had a really kind of a difficult situation. So to get approval for scalp psoriasis or dandruff or so on, you need to have 2 % salicylic acid. Well, at that level, I think it might be more drying. We were able to get the synergy of sodium hypochlorite and salicid. and it just worked well for for the scalp no and i can't say that we designed it like that at the beginning day one we thought theoretically would help because our foundational product really did well and then the sal acid has been kind of magical for scalp help and also acne you know again a follicular problem you know follicle problem yeah that makes sense actually yeah Yeah, that makes a lot of sense because I guess the exfoliation aspect also intrigues me about scalp health.

34:47You know, we saw acylic acid is a very small molecule, you know, so it's able to really get in there and clear out a lot of stuff. I'm just curious about where this niche is going to go in the future. You know, and that really leads me to my next question, which is about where is the future headed for clean? I mean, do you guys have any new products on the horizon or anything you can share with us? Yeah. So I think we're moving in two directions. One is we're building out our hypochlorite hypochlorous franchise. So we're adding a spray, a hypochlorous spray where, you know, a lot of our, you know, dermatology customers want.

35:29So that'll be available in, in, in June. So we'll have hypochlorite and hypochlorous. and we really understand the you know the chemistry of those two and that's our home and then we've added some moisturization products just these are adjunctive products you know such as the we're going to have a body moisturizer with two percent colloidal oatmeal for eczema because we deal daily with eczema. So why not provide one of our products to them? So it's a complimentary product. And then we also found, surprisingly, people like variety in sizes for travel and so on. And I hadn't really realized that at the beginning that people want so many different sizes.