Masterclass Monday: The New Era of Personalized Skin Science at Codex with Dr. Barbara Paldus

0:02Hey guys, welcome back to another episode of Skin Anarchy. I have one of my favorite people with us again today for a wonderful episode in the Masterclass with Codex Labs. So please welcome back Dr. Barbara Paldis. Welcome back, Barb. I'm so excited to host you. Thanks for having me, Ekta. It's a pleasure to be here and share my passion as usual. Yeah, you know, you are one of the smartest people I know. And every time we talk, I walk away knowing like entire textbook of information. So I'm really excited to dive in. For our listeners who may be unfamiliar with the past episodes we've done, can you explain Let's dive into integrative dermatology because I know that's what you're working on right now.

0:39Can you explain that to us? What does it mean, integrative dermatology, and how does it really differ from conventional dermatology? So integrative dermatology is, first of all, patient-centered, and it looks beyond just the skin. So while conventional dermatology often focuses on treating symptoms, for example, with topical creams or medications or procedures, Integrative dermatology seeks to identify and address the underlying causes of these skin conditions. So at Codex, we recognize that the skin is interconnected with the rest of the body. And this is something naturopathic doctors already know, such as the gut, the brain, the immune system.

1:17And so that means considering factors like hormonal balance or the skin and gut microbiomes that we've talked about, or basic things like diet, lifestyle, stress, when you're developing a treatment plan. And I know the word holistic might be a little bit overused, or some people might consider it woo-woo, but it's really, we like to call it a whole body. And so it's really about finding a comprehensive and personalized approach that finds that primary driver of the skin condition, but also promotes long-term health, not just temporary relief. Yeah, that makes a lot of sense. So it's almost like detective work, trying to uncover the root cause rather than just patching up the symptoms, right?

1:53Exactly. And that's what makes it so rewarding because it's not just about addressing the skin condition. It's also about empowering patients about their long-term health and sustainable changes. Makes sense. So let's dive right into the connection between the skin, the gut, brain, and then the microbiome. What is this connection? And why is it so important to consider all of these factors when we're treating skin conditions? So I've been talking about this with you for the last almost two years now. So I think we need to think of the skin, gut, brain, and microbiomes as complex and interconnected ecosystems.

2:27So the gut microbiome, which just to define it again, is the community of bacteria, fungi, and other microorganisms living in our digestive tracts, our intestines, plays a crucial role also in immune function, nutrient absorption, and inflammation. And when this gut microbiome becomes imbalanced, it can trigger inflammation throughout the body, including the skin. So the brain is involved through the gut brain axis, meaning that stress and mental health can affect gut health and in turn impact skin conditions like acne, eczema and psoriasis with flare ups. So we have to consider all these factors and the health care providers on Decode Me that we're launching can then create a more effective treatment plan that really goes to the root cause of the skin issue.

3:15Yeah, it sounds like a very delicate balancing act between all these components. What are some of the common signs that the ecosystem might be out of whack? That's a great question, Akta. So common signs can include digestive issues, you know, bloating, gas, constipation, diarrhea, or mental health issues like anxiety, depression, fatigue, and of course, skin blotches, blemishes, pimples, etc. Right. So how is an integrative approach to treating a skin condition different from standard dermatology platforms, particularly when it comes to diagnosing? So in conventional dermatology, the practitioner often relies on a visual examination or biopsy or standard allergy testing to diagnose the skin condition.

4:02And while these methods are obviously helpful, they don't often provide the complete picture of what's going on internally. And so integrative dermatology takes a more comprehensive approach and uses a wider range of diagnostic tools to assess the factors that can influence skin health. So those can include the gut microbiome that I mentioned, things like organic acid metabolites, inflammation levels, hormonal balance, nutrition deficiencies, as well as other factors that might be contributing to the skin condition. And so this allows our providers a more personalized and targeted treatment plan for the patient that addresses really the root cause of the problem.

4:42Interesting. So it's like having a more detailed roadmap to guide the treatment process, basically. Precisely. And it helps us understand the unique needs of each patient and tailor the approach accordingly. That's very interesting. So, you know, I want to address this because we keep hearing the term microbiome, especially recently. It feels like it's used literally everywhere from everything from skincare to oral care. Can you describe what is the skin-gut-brain microbiome access and what is its role in maintaining overall health, especially skin health? So this is one of my favorite topics.

5:16So skin-gut-brain microbiome access refers to the bidirectional communication network between these four systems. So the gut microbiome influences the skin through immune signaling, inflammation, and nutrient availability. The brain influences the gut through the autonomic nervous system, which affects gut motility, secretion, and microbial composition. And then the skin microbiome influences the immune system and can protect against pathogens like staph infections, for example. So all these systems are constantly communicating with each other and disruptions in one system or one area can affect the other.

5:51So for example, stress, which comes from the brain, can alter the gut microbiome, leading to inflammation that exacerbates skin conditions like acne and eczema and causes flare-ups. That makes so much sense. So basically, managing stress can literally improve your skin health, is what you're saying. Absolutely. I can't say how important stress management is, but again, it's another component of this integrative dermatology treatment plan to minimize future flare-ups or breakouts. And you can apply, there's a variety of techniques, whether that's mindfulness, yoga, meditation, spending time in nature, walking in a park.

6:27All of these help reduce stress. They improve gut health and therefore there's fewer and less intense skin eruptions. Interesting. So how does the gut microbiome specifically influence the skin? What happens when that balance is disrupted? So as we were saying, gut microbiome plays a critical role in immunity, inflammation, nutrient absorption. And so when the gut microbiome is balanced, it helps regulate the immune system. It prevents it from overreacting to substances that can penetrate through the skin and cause inflammation, but it also produces beneficial compounds like the short chain fatty acids, which help nourish the gut lining and reduce inflammation.

7:08But when the gut microbiome is disrupted, on the other hand, it can lead to increased gut barrier inflammation, leaky gut, impaired vitamin production, and those can all manifest as skin problems like acne, eczema, psoriasis, and rosacea, kind of the core four that I always talk about. Yeah, leaky gut is another term we're hearing more and more about. I know this came up a few years ago, but now it's everywhere. Can you explain that a bit more in detail? What is leaky gut? Absolutely. And we're seeing more supplements, for example, on Amazon for that. So Leaky gut is essentially increased intestinal permeability.

7:43So it's a condition where the lining of the intestines becomes more porous. And so substances like bacteria, toxins, or undigested food particles can leak into the bloodstream. This then triggers the immune response and inflammation throughout the body, which can then contribute to a variety of health problems, including skin conditions, but not limited to skin conditions. Very interesting. So then on the other end, you have brain. So how does the brain or the central nervous system factor into skin health? Can you talk to us about this gut-brain-skin axis? Sure. So the brain and the central nervous system have a profound impact on skin health through that gut-brain axis.

8:23So stress, anxiety, and depression that we were talking about can all disrupt that gut microbiome, leading back to the inflammation and the impaired immune function, but also the brain influences the skin directly through the release of hormones and neurotransmitters that can affect sebum production, skin inflammation, and skin barrier function. So, for example, stress can increase cortisol, which can then trigger acne breakouts, or chronic stress can impair the skin's ability to repair itself, leading to premature aging or psoriasis flares. So that's where the integrative dermatology also needs to address mental and emotional well-being.

8:59Yeah. So everything you're saying, it really drives home that it's all connected. You know, if you're stressed, it's not just in your head. It's actually going to show up on your skin. Absolutely. I mean, the mind-body connection is very real and it's essential to address both mental and physical health for optimal skin. I have mild eczema. When I get stressed, oh, I start itching like crazy for no reason. And then all of a sudden I have a breakout. So it's very real. Wow. So given how complex this connection really is, how can telehealth platforms like DecodeMe help individuals really gain insight into their skin conditions and find really effective solutions?

9:35So telehealth platforms like our DecodeMe platform are designed to bridge the gap between traditional or conventional dermatology and integrative medicine by providing patients with convenient access to comprehensive diagnostic testing, right? all those diagnostic tests that are not normally done, as well as highly personalized treatment plans and then ongoing support because things don't clear up in a week. There's no magical pill or magical topical. Some of these skin conditions take three months or six months to really improve. And so by offering these at-home tests for gut microbiome or inflammation or hormonal balance and other factors that may contribute to skin conditions, they start connecting patients with these integrative medical practitioners for real feedback because they review their test results and they conduct virtual consultations.

10:24And then they can develop based on the test results, personalized treatment plans, because every person is unique. And so by combining this advanced technology and testing, but really a whole range of these tests with this integrative whole body approach, the platform Decode Me can empower patients to essentially control their skin health, A, from the comfort of their own homes, but B, by understanding the root causes and what's going on inside their body. I love this. I mean, this is so education-based. It sounds like it puts a lot more power also into the hands of the patient. So how do you ensure that patients are properly educated about their results and the recommended treatments?

11:05So education, as you said, is critical. And part of our goal is to also make more informed consumers and more informed patients. So obviously, our providers will prioritize clear communication with detailed explanations of their test results. It's much easier to do something about something if you understand why. And so that's why we're going to be really supporting the healthcare providers in their efforts to truly do personalized recommendations, including diet, including lifestyle and supplementation, not just prescriptions. We want to offer ongoing education and guidance and we'll be developing those modules for patients and providers so that they can implement these changes and track process.

11:48I usually find myself, I understand why I'm doing something that motivates me to actually do it. Whereas if I don't understand, it might be like, yeah, whatever. And then for various reasons, you know, most medical providers today require training in integrative medicine, including interpretation of tests such as, you know, they don't teach gut microbiome or genetic testing in medical school yet. Naturopaths who will also be on our platform understand a lot of this already. And so with them, there won't be as much training because they actually already put this into practice. That's very fascinating.

12:22And it's a very good point that you brought up about they don't teach this stuff. So it's like a learning experience for everybody, kind of understanding integrative health. Now, many people are seeing that even the golden age of skincare did not necessarily offer the best products. So what standard products of dermatology do not necessarily address all parts of the issues a patient may face with skincare routine? So I have a few pet peeves, including topical steroids and antibiotics. And while they're very effective for specific issues, such as, you know, allergy-based response rashes or infections for temporarily relieving common symptoms, the issue I have is that they don't necessarily address the underlying cause of many chronic skin conditions.

13:05And in fact, the biggest pet peeve I have is that the long-term use of these medications may in fact worsen the problem because there's a disruption of the skin gut microbiome or the gut microbiome. There's a weakening of the skin barrier or the immune system and a contribution to antibiotic resistance if it's overused. And so the other issue is that many conventional skincare products contain a lot of harsh chemicals and irritants that can damage the skin barrier and exacerbate skin problems. So a lot of these golden age, you know, everything from the retinols to benzoyl peroxide, they're not exactly easy on your skin barrier for long-term use.

13:43And I don't think we understand what happens if you use these products for 20 years yet. Yeah. No, that's the levels we're using them because there's also competition between companies. Oh, I have 2%. No, I have 5%. No, I have 10%. No, I have 15%. So there's this gamesmanship going on in the industry. And I'm not sure that it's supported by science. Yeah, that's a really, really solid point you made. And I think with, especially with retinol, I personally have had my own pet peeve with this specifically. So that makes sense. It's almost like a cycle of symptom relief followed by more problems down the road.

14:19That's what it sounds like. That's exactly right. And the goal for us is to break that cycle by actually addressing the underlying causes, right, and supporting the body's natural healing abilities. Because, I mean, and again, pet peeve of mine, loading babies and children with corticosteroid for years on end, and some of these people have been on corticosteroids for 15, 20 years, is not helpful. And then it can lead to conditions such as topical steroid withdrawal syndrome, which is way worse than the original eczema. And so the goal of this modern integrated dermatology is to focus on using more gentle, typically microbiome supporting biotech based ingredients, which are now coming online, as well as again, going back to that mantra of root cause of the skin issue by adjusting lifestyle, diet and other interventions, including minimizing stress to help with the future skin eruption.

15:09So you want to minimize the number of flare ups and the intensity of the flare ups. Yeah. So you mentioned a phrase, topical steroid withdrawal. I'm seeing more of this coming up on the internet, social media, and I would love for you to tell us more about what this is and is this possibly an epidemic that we're looking at? So topical steroid withdrawal or TSW, also sometimes called red skin syndrome in Europe, is a condition that arises from long-term topical steroid use. And typically these people use it all over their body for, you know, 5 to 15 years. And while steroids can initially help to relieve the symptoms of skin conditions like eczema, they can also lead to dependence over time.

15:53And so we're talking about addiction, right? discontinuing the use of the steroid can then cause a rebound effect, resulting in symptoms that are much worse. And so it's important to work with a doctor when you're weaning off topical steroids and supporting not just healing of your skin, but re-regulation of your immune system. And so this is another great application for me of integrative dermatology, where the providers can treat the patient internally, not just at the surface with steroid creams that are pretty much a quick hack, but not a long-term solution. They keep upping potency of these corticosteroids over time because they stop working because your body adjusts around them.

16:29So I wouldn't say it's necessarily an epidemic per se, but it's now an awareness and a growing awareness of TSW because there's overuse of corticosteroids. And so it's my hope that we can educate both the medical community with partners like ITSAN to start taking a more integrative approach to eczema, not spot corticosteroids as the first line of defense on babies. Yeah, no, it makes a lot of sense. Now, for patients, you know, who haven't found success with these traditional treatments, what hope does integrative teledermatology offer them? So I would say integrative teledermatology is a new perspective.

17:10And because it's comprehensive, that is the key to me, in my opinion, to finding this long-lasting relief. And so by looking at this interconnectedness of the skin, the gut, the brain, the microbiomes, and identifying these root causes, again, it can lead to these personalized, individualized treatment plans for the underlying issues. And we often find that it can be helpful for patients who've tried everything else, right? But they're still struggling. That skin condition is still chronic. It's still completely destroying their life. And so it's really about addressing things like gut microbiome imbalance or gut inflammation, these internal problems that are likely driving the externally visible skin flare-ups, and then enabling the patients to take control of their long-term health with solutions that I would say are not as unsustainable for the planet.

17:59And obviously, we want it to be also sustainable for the planet, but really solutions that they can do day-to-day, solutions that are not so complicated, not 15-step routines or things that they can basically do every day to improve the quality of their life. Yes. You know, what's one of the biggest, I guess, aha moments you've witnessed with a patient who transitioned to a more integrative approach after struggling with the traditional methods? So there have been many, but I would say the one that stands out the most is we had, well, we have a patient with severe eczema and been using topical steroids for years, you know, with pretty much reduced success from year to year.

18:38And so we switched basically to an integrative approach. We focused on healing her leaky gut, reducing her chronic inflammation. That led to reducing managing stress. An appropriate diet turned out that she was allergic to dairy and didn't know it. And her eczema is now pretty much cleared up completely and she was able to stop using steroids. Now it was a six to nine month process. So I'm not gonna lie and say, nope, you know, again, we snap our fingers and a week later, everything's hunky-dory. But these kinds of things, if done properly, are truly life-changing. That's very interesting. So, you know, I guess my next question is, so in order to, like, really properly use something like DecodeMe, how are the healthcare providers urged to take care of their customers with all the tools provided to them?

19:22So, first of all, I have to state that, you know, ethical and responsible application of these tools is really paramount to us. It's of great importance at Codex. And so the healthcare providers on the platform are encouraged not just to look at this whole body approach through assessments and systematically reviewing factors that can affect the patient health, but they're also urged to consider the patient's situation when making a diagnosis. So really, it's on crafting that individualized therapy plan for both internal and external factors that might contribute to the skin condition and also to regularly monitor their patients for progress and make adjustments.

19:59You know, no one is perfect. No one is omniscient. And so if they need local care, like if they need, you know, be told to go get, you know, some other tests at hospital or other blood work, you know, to go do that. And so, for example, if a healthcare provider suspects skin cancer or some kind of lesion from an image that's on the platform, then they need to direct the patient to have a physical checkup because you need to go and you might need to get a Mohs surgeon. similarly educating patients on how to take the best photographs of their skin condition to optimize the parameters such as you know natural lighting and focus and not applying filters you know you don't want to be applying social media filters when you're trying to show a skin condition to a professional you know because what can work for instagram posts may obfuscate the actual skin condition and also then training the providers for skin of color because many conditions look completely different, right?

20:55Eczema can look ashy or gray versus red or pink. Same with psoriasis, same with rosacea. And so really being able to understand how to take the picture and then the provider how to interpret the picture for the right diagnosis. I really love this. And this sounds incredibly personalized and very comprehensive. I think that's my favorite part about this. Is that how DecodeMe is different from other teledermatology platforms, you would say? So we're hoping that our D-Cademy practitioners will combine modern dermatology with complementary therapies in the most complete manner. So all of them are aided to train the body as a whole and complex system and apply techniques for long-term health.

21:37So accounting for these physical, emotional, genetic, environmental contributing factors and really look for that root cause. And that's not easy. I mean, it's not simple and it's not quick. And so they can also, though, then draw, you know, from the latest therapies, from prescription biologics to herbal supplements to probiotics to JAK inhibitor topicals to compound pharmacy prescriptions like, say, vitamin B12 cream to also nutritional coaching and stress reduction. So, you know, when you think about it, you can also throw in allergy management or exercise. So it really will depend on the patient and the condition and the provider.

22:13But our goal is to bring back the personalization in medicine, which I think we're losing at a very rapid rate. And the goal here is not that you submit your condition and then the platform gives you back a generic form letter or a generic email with a standardized prescription for, you know, my pet peeves, antibiotics and steroids or isotretinoin. There's a lot of platforms out there that basically are like, oh, you know, you need a standardized, you know, cookie cutter solution. So our goal is to really understand each patient. Wow. So what about the testing aspect? Will you guys be offering testing on DecodeMe?

22:52And can you describe the types of tests you currently offer and why they're important? Yeah, so I mentioned at-home diagnostics. So many skin conditions, you know, the core four, have genetic or hormonal or immune system contributors. And so that onset of the flare-up can either be driven by allergies or infections or stress or that hormonal imbalance. Or if you look at it, weather, pollution, irritants, certain medications, certain fragrances. So our practitioners will start with lab results to understand this root cause. And then they're going to monitor the treatment of efficacy with actual recurring data.

23:28The issue is that if you don't measure it, you don't know. And if you don't know, you can't heal the person. And so we want to empower the patients and the providers to know. And so our tests include tests for skin and gut microbiome, neurotransmitters, as I mentioned, hormones, heavy metal toxicity, because that can sometimes appear as a rash, metabolism as well as inflammation. And so these are again designed to empower this integrative dermatology approach and make it easy to have data, which then helps more concretely identify the root cause. Like we don't want to just call it root cause practice.

24:02We actually want to have the data. Right, right. And that's very important data too that you mentioned, all of those factors. You know, can you give us some examples maybe of these tests and how they apply to something like acne or eczema. Sure. So I might talk for a little bit here because this is a favorite topic. So a lot of this might sound obvious, but as an example, our saliva hormone test is used in managing female adult hormonal acne. Hormones are the signaling molecules that are transported through your body, regulate your body and your behavior. But when they're not in balance, we start feeling the effects.

24:37So it goes back to disrupted sleep or weight changes, your body temperature feeling off or mood dysregulation and more. So they also affect skin processes like oil, that sebum production, collagen production, and moisture levels. So when these hormone levels fluctuate, they can lead to skin issues like acne. And hormonal dysregulation, which can happen at any point through a woman's life, is a key indicator. And so this test provides insight into any imbalances, and then the provider can help create a treatment plan. Whether the woman is going through puberty or menopause or perimenopause or before and after pregnancy, the goal here is to restore hormonal balance.

25:17Similarly for eczema, I have a huge kind of thing about the gut microbiome here and gut microbiome health playing a key role in inflammation and flare-ups. And so the gut microbiome and gut barrier influence, again, your gut, skin, and brain. and our test here measures the diversity, the profile of the gut microbiome, as well as the permeability, that leaky gut factor and inflammation of the gut using a fecal sample. And so gut inflammation, why is that important? Well, when the intestinal lining becomes irritated, you have that leaky gut because it becomes compromised, then toxins and undigested food are back in your bloodstream.

25:53You get the immune response. You know that in eczema, there's a dysregulated IL-4, IL-13 response. And so that's going to contribute to the flare-ups. And what do you look for? You look for poor diet, again, chronic stress, food intolerances, infections, possible overuse of antibiotics in kids like for ear infections. And then you go look at not just necessarily the biologics or the JK inhibitors, but also things like prebiotics, probiotics, diet. And so again, preventing eczema flare-ups would be the key. You know, it's obviously a chronic condition that can't be cured, but you can improve, for example, the gut systems.