Morning Rounds With Dr. Michelle Henry, MD - A Deep Dive Into Skin Health

0:00Hey guys, welcome to another episode of Skin Anarchy. This is your host Eksa and I'm so so excited about our guest today because she's truly a leader in her field of medicine and a pioneer in the space and a pioneer in the space of skin and a leader of skin and a leader of skin and a leader of skin and a leader of skin and a leader of skin and a leader of skin and a leader of the skin author. She's also a board-certified dermatologist and dermatologic surgeon. So welcome to the show, Dr. Henry. Hi, thank you for having me. Yeah, I'm really excited to chat with you and to learn from you and I'd love to get started if you could tell me what got you into dermatology.

0:45I just knew I was going to be a doctor. My mom was a nurse and I remember she took me on take your daughter to work day. I don't know if they still do that. I remember being there and being with the nurses and watching the doctors and just looking at their little huddle and feeling like there's some very important conversations going on over there and just being so intrigued by that part of medicine. And so my mom asked the doctors like, hey, can she shadow you? I think she may be more interested in what's going on here. And they got a little white coat for me and I followed them around. It was the greatest day ever.

1:17I was sold. That was it. But when I first went into medicine, I thought I'd be a breast cancer surgeon because my great aunt died of breast cancer. in the last six months of her life when I was like eight years old. We talked about all the things that I would be. We made our decision and I stuck to it. When I got to medicine, I realized that I did not have the temperament, not temperament, but I'm an empath. And it made me very, very sad. And I knew that if I went down that route of doing breast cancer surgery and oncology in that way, that it would affect me in ways that would be difficult. um so i my first mentor in med school was a moze surgeon which is skin cancer surgery um and i fell in love with it immediately i could treat and cure the cancer i could talk to my patients and then that's what kind of led me to the aesthetic um my aesthetic love because the reconstruction of those areas it's similar to plastic surgery we're using the same techniques um and then i became interested in how do i correct these scars and that brought me to lasers and then in order to do most surgery you have to do dermatology and so I kind of stumbled into dermatology because I loved surgery and then you know it was the perfect collision of all the things that I love because as a dermatologist you can kind of do everything you can do you know skincare, infectious disease, immunology, surgery, aesthetics and so it's just such a varied field and that's why I'm here.

2:43No I love that you have that background I mean yeah you're right I mean oncology is a very I feel like it's very trying you know all my friends were in oncology I'm like I don't know how you do it yeah and you have to know that about yourself you know like you can't you can only give if you're in a happy you know place where you you feel like um you feel very positive for me I'm I was becoming like this like wild vigilante you know I was like trying to fight everything fighting with insurance companies fighting with the doctors wanting to do this wanting to keep fighting um and so it would have been a very difficult um difficult career for me absolutely i could completely understand that now you mentioned though that um because of your interest in dermatology i mean skin cancer i feel like is a topic not a lot of people really know much about and i'd love to actually like you know really ask you for some general um information because i think we hear a lot about things like melanoma right we hear about everybody knows about melanoma.

3:42But what are some of the other types of skin cancer? If you could tell us a little bit in terms of the general population, things that people should know about, be aware about, and maybe some tips about how to approach it, you know, or approach our health from the standpoint of prevention. Yeah. So skin cancer, it's the most common type of cancer. There's a true epidemic of skin cancer. And as you mentioned, melanoma is the most dangerous form of skin cancer. So it's, that has the highest death rate. It's the most dangerous, it's the most aggressive. And then there are non-melanoma skin cancers, basal cell carcinoma and squamous cell carcinoma, which are both dangerous, but a little bit more slow moving.

4:28What they all share in common is that UV light can induce them. And so we know that UV light is a carcinogen. We know that just five burns before the age of 18 can double your risk for skin cancer.

4:46So, you know, skin cancer is something that no one's immune to. And, you know, you know, we, two people die every hour in the United States from skin cancer. So it is a true epidemic. It affects all of us. We all know and love someone who has or will have skin cancer. So it's really important that we think about how to protect ourselves. and one of the first ways we protect ourselves is through just you know sun safe practices sunscreen protecting yourself at the height of the sun um you know making sure you're not trying your best not to burn throughout the year and then having good um surveillance by seeing your dermatologist annually yeah makes sense and thank you for shedding light on that because i think it just never gets talked about enough you know and i've known some you know just some friends along the way there they were shocked you know they had they got a diagnosis they're like i never thought I'd be a person that had skin cancer you know and it was it can be shocking so yeah yeah it's good to know um but and in kind of like you know in conjunction with that I think we talk a lot about like I know in media there's a lot of information about acne and a lot of these um very common skin conditions but what are some things that you wish received a little bit more attention some pathologies that you wish received more attention in mainstream media or just awareness for consumers, you know?

6:02Yeah, there are so many. I mean, one, I see a lot of women, women tend to have a condition called hydrodenitis superativa more often. There could be a hormonal component. We see that it flares with their periods. And what hydrodenitis superativa is, It is this chronic inflammation that presents in nodules and cysts and drainage and scarring of the underarms under the breast area and the groin. So these very, very sensitive areas, areas that when they are inflamed and oozing, it really impairs a woman socially and affects her psychologically. and there's currently no cure for it. You know, we manage it with creams and oral medications and now we have a biologic injectable medication we can use.

6:58But a lot of women are just kind of suffering in secret and in private. They don't want to talk about it. They're afraid that they did something to cause it. It's in the groin area. So it's something that you don't share with your friends. Limits you with dating and, you know, sexual relationships. So it's really crippling to a lot of women. I see a lot of it. it's it's it's really underdiagnosed and undertreated so i wish there was more knowledge about this so that women wouldn't like shame themselves and feel comfortable sharing so we could help women everywhere um so that's one of the conditions that i wish we talked about more yeah no i mean that's yeah i i can't lie i haven't seen anything about it you know especially in like mainstream media i know right now there's a lot of um you know wonderful people out there that want to educate but i just i also wish there was more information especially if it's affecting women, I think it can be very detrimental when you don't know what to do, you know.

7:51Exactly. But in terms of, you know, like just, I guess, overall emotional well-being, right? I feel like skin health plays such a huge role in that. Have you seen that a lot in your practice? I mean, in terms of this emotional connection that we have with our skin? Yeah, I think it's pretty well documented that we have a really tight skin-mind interface. So, you know, stress can really affect many conditions, including acne. Stress can flare your eczema. We notice that when people are stressed or even are ill and see flares in conditions like seborrheic dermatitis. um so we know they're a really tight mind body interface when our cortisol levels go up that can affect our hormones um and many other cascades in our body um so we know that um there's an intimate link between our skin our mental state our men and our mental health our men and our mental health okay no it's it's really interesting to me to see this like in terms of now more than ever because I think I think people are becoming more aware I would say about mental health I think back like 10 years ago you know you didn't see much about it you know in the mainstream or even on social media and now I feel like people just are more open to talking about just emotional well-being so I thought yeah in terms of um you know people wanting immediate results versus just really maintaining long-term skin health what are some examples you've seen or maybe just give us some feedback on that because I feel like that must be difficult um in your field to manage you know there's a long long-term skin health yeah like as in like if somebody wants like immediate results versus like really just you know being more preventative and wanting better skin health you know I mean do you see that a lot I mean yeah I mean and those things are um are one in the same right so someone may want to come in and like have a quick fix or they're having acne and they want it gone today?

9:52And yes, we can do things to fix the immediate problem, but how do we, you know, dermatology is really a specialty of chronic illnesses, you know, so many things that we have, there's not a cure for it. So, you know, there's not a cure for acne. There's not a cure for psoriasis. There's not a cure for eczema. So most of our conditions are chronic. And so we can have the quick fix to fix like the acute flare or acute state, but really the way we keep your skin healthy is through your daily practices and your daily practices that include not only the things that you put on your skin, but the things that you consume, you know, the, your, your sun safe practices.

10:33And as we know, there's a tight mind skin interface. It's also going to be your overall mental health. You know, it really is long-term skin health is really a holistic approach. And we really have to think about so many factors to keep the skin healthy. Yeah, that makes sense. It really actually brings up the question for me about nutrition as well. I mean, what are your thoughts on just overall nutrition and our skin health? I mean, are there foods that are better for us than others when it comes to maintaining healthy skin? Yes, for sure. Think about healthy skin. We think about those foods that are skin healthy.

11:06We think about those healthy fats, those lean proteins that are going to keep our skin both strong and pliable. So you want really strong, tight skin. That's elastic that maintains its kind of snap back. And that comes with taking a lot of the right foods. So lean proteins, things like salmon that also contains those healthy fats, you know, those healthy fatty acids, those omega threes, those things that we're going to also get from foods like avocado, walnuts. Those are also really, really important thinking about antioxidants and getting them from foods like berries and all those sorts of foods.

11:43So, you know, all the things that we preach about in a well-rounded diet are good for all of our organs, including our skin. And then those things that you want to potentially avoid, and some people, you know, dairy may flare things like their acne, it contributes to a pro-inflammatory state. We may want to avoid things like sweets, you know, anything that causes your kind of insulin to spike also can make your pores sticky and make you more prone to acne. So those are the kind of decisions you can make if you're trying to tailor your diet to one that best suits healthy, beautiful skin. That makes sense.

12:21I need to make some adjustments. Yeah, add some good foods into my diet. You know, I think a lot of foods that are very good for our gut health as well. And I can't help but ask, you know, there's a lot of buzz. I think there's been a lot of buzz in the last year or so around the microbiome and this whole like gut brain skin connection. And I'm just curious your thoughts on that. I mean, do you think we're like onto the right path with this, you know, in terms of our thinking about the microbiome or what is your approach to this overall? Bacteria is both good and bad. Like for instance, even in our skin, there are certain bacteria that promote acne and there are actually certain good bacteria that lessen inflammation and lessen likelihood that you will have acne.

13:10So you want to have a good diversity of healthy bacteria on your skin and your gut. So yeah, I think we're learning more and more and more about this gut skin, gut mind interface, how to optimize and keep us healthy. But, you know, we want to have the appropriate diversity of healthy bacteria. And when we kill off that healthy bacteria, whether it's the gut or the skin, we allow those pathogenic or pathologic bacteria to multiply, and then we start to have problems. So that balance in the ecosystem of both our gut and our skin is really important. Yeah, no, I think it's interesting to see so much information come out now about the microbiome.

13:51I think, you know, for me, when I first learned about it, it was like, literally, like, I think my father was the first to introduce it to me. And he said, it's like a fingerprint you know no one's microbiome is the same and so that just makes me think more about like personalized medicine and truly the rise of personalized medicine especially when it comes to dermatology I mean you work with so many patients with such diverse backgrounds and I'd love to know I mean what are some treatments especially for melanin rich skin I really want to ask you this because I think with aesthetics there's not enough information that I've seen as a consumer and as a patient like what are some things that are unique to more melanin-rich skin that we should know about in terms of going and getting aesthetic procedures, for example?

14:34Is there anything we should avoid or anything that we should lean towards when it comes to technologies or advancements in aesthetics? Yeah. So whenever we're treating melanin-rich skin, for those who don't treat a lot of melanin-rich skin, they may mistake the fact that you can't see redness as readily on melanin-rich skin for it not being as sensitive. And in many ways, melanin-rich skin is exquisitely sensitive because you don't see the red. But what you do see, you may see some red, but you can see long-lasting hyperpigmentation. And that can be quite disfiguring. So in many ways, we have to be very, very careful to not trigger inflammation in darker skin types because of this long-lasting hyperpigmentation.

15:15You know, things to look for. You want to, you know, with my, I do a lot of laser in my practice. A lot of patients are sent to me from really all over the world for pigmentary conditions. And what we want to do is we want to use lasers and treatments that are going to limit collateral damage. We want to limit the amount of heat that we introduce to the skin. We want to limit the amount of trauma. We want to use lasers that are really, really precise and can bypass all of the pigment on the surface of our skin and get deeper to really access the target that we're treating. So oftentimes with a lot of the procedures we use in skin of color, they're going to be, I always say, long and low.

15:52So we're going to use more treatments with lower energy. It's all about reducing collateral damage, reducing heat, reducing the risk for inflammation. So oftentimes with my patients of color, if I'm doing aesthetic procedures, I am doing everything I can to minimize trauma. So I may use a lower concentration peel. If I'm doing fillers, I'm going to try to do fewer insertion sites. so that that's just less trauma and less inflammation. It's just all about taking a very gentle approach because any trauma will cause inflammation and can then possibly create scarring in the fat. And we call it scarring, but patients often call it scarring.

16:29It's not a true scar that can create a poor aesthetic outcome in the form of post-inflammatory hyperpigmentation. That's very interesting. Yeah, so really it's about more care. Like you have to be very careful with richly pigmented skin. I mean, I think I've spoken to some aesthetics professionals and there's still so much like lacking in the space. I feel like when it comes to knowledge, I mean, do you agree with that in terms of just the information we have? About skin of color overall? Yeah. Yeah, for sure. For sure. Our textbooks are really lacking. So, you know, in our actual dermatology programs, it's not standardized.

17:05So if you're not in a city where you may see darker skin patients in your clinic, you may never treat a darker skin patient. Our academic curriculum doesn't focus on it. So there are a lot of things that are missed, not understood and signs that are under recognized. Even our textbooks don't represent enough diversity in skin conditions. And we're a very visual field. And if you've never seen it and it presents differently in darker skin, you may not be able to appropriately diagnose it in a patient. And with no fault of your own is that our curriculum is not preparing us for that. So I think that's been highlighted.

17:44And I think a lot of the textbooks are trying to change that. I know a lot of the derm programs are trying to make sure that it's a part of their curriculum so that, you know, my goal is that every patient can walk into every, every office and see any doctor and know that they know how to recognize everything on your skin. Um, and we're not there yet, but I think there's a definite push for us to get there. Yeah, no, I, I really hope that they start integrating it more, you know, in the training programs, because I think it's just, it's long overdue. And with that, I want to ask, I mean, I think, you know, when I look at dermatology and, and related fields i just see them to be very fast-paced fields in terms of growth and and trying to keep up with you know the latest advancements and research and so what what's your um personal like you know opinion about where you think we're going in the next 10 years you know with personalized medicine and dermatology and and overall aesthetics i think we're going to have hyper personalized medicine i mean even today we take um you know tests to look at certain markers to see how responsive you will be to lots of medications, you know, hair growth medications.

18:54Are you a candidate for monocidil? Are you someone that typically responds well to it? And I think we're going to continue to see hyper-personalized medicine, either it's by, you know, checking your microbiome and making sure that you have the right probiotics to create an environment that's not pro-inflammatory, whether it is like checking to see if you can tolerate medications or if a medication is going to work for you so that your treatment course is shorter and more effective. As we collect more genetic data, we're going to have more patterns and more trends to help us do preventative care for patients.

19:29So I think what we're going to see over the next 10 years is just a really hyper personalized, individualized form of medicine that's going to help us treat patients with less, more effectively, faster, with more confidence that we're treating the right condition. So I think we're definitely moving in the direction of more data is better. And so while a lot of things that we do are clinical diagnoses, I think we're going to be able to lead on data and lead on that information to make sure that we're giving that patient the treatment that's specific and unique to them. yeah no i i really hope so because that would be really wonderful to see more personalized you know approaches to pretty much everything you know you go in and you have like a whole profile about you yeah exactly and we know immediately that we when we get your genetic thumbprint or you know we know immediately that okay this patient has this problem clinically but from looking at their you know genetic data i know i can't give them this medication this medication or this medication, but I can give this, you know?

20:33So I think it will keep patients safer and make patients happier in the long run. Now, what are your thoughts on, I guess, skincare? I mean, do you think we should have personalized skincare or what is like, I mean, I guess, what's your viewpoint on skincare overall in terms of what we feel? I mean, I love skincare. It's a big part of what I do. I think it can be transformative when it's the right product. I think there's a lot of noise on the market. So part of my job is to help patients figure out like what is the appropriate product for them, what works, what doesn't work, what's worth investing in, what's worth committing to.

21:07But I think, yeah, I think skincare can be transformative. A lot of patients can't tolerate maybe stronger prescription medications or don't want to use them for whatever reason. Maybe they don't have access. So I think that, you know, cosmeceuticals have become better. Technology has become smarter. And I think that we're only going to see that continue um and we're going to get more and more effective over-the-counter treatments whether that is for things like eczema or things like anti-aging that makes sense no there's just so many options out there that's why i asked because i feel like a brand pops up every day now you know literally yeah i know for sure yeah so in terms of like you know just i i think for a lot of us the the idea is just have healthy skin i know for me it is you know um i love skincare as well.

21:56I have a whole podcast about it, I guess. But for me, it really is healthy skin. I want to ask you if there was one piece of advice you could give us about really, truly maintaining and having healthy skin for the long run, what would that really be? You know, it's all about, you know, commitment and consistency. You know, healthy skin is a journey. Just like we get up, we brush our teeth every day. That's a part of our overall health. We know all the consequences of not doing that. Same with our skin. You know, we have to get up and do you know good skin care cleanse our skin make sure we're moisturizing to protect our skin barrier to keep that immune organ healthy and appropriately hydrated if we want to keep it beautiful it's a journey just like you know internal health comes from you know decades of good eating and exercising and taking care of yourself and not you know taking lots of risks and consuming things that are bad for you the same with our skin if you want beautiful skin at the end of the day, if we consider alcohol to be something bad, consider sun the alcohol of the skin, right?

22:57Every time you have a little bit too much, you're creating longstanding damage that could ultimately, you know, really harm you. So it really is just about a long, consistent journey, listening to your skin, knowing that it changes throughout the course of your life, depending on your hormonal state and, you know, where you are. But yeah, I would say the biggest thing is like, it's absolutely consistency. Makes sense. Now, Dr. Henry, I have to ask you, you know, because you're such a prominent figure, you're so accomplished. I would love to get your advice about any of the, you know, any budding dermatologists out there, anyone aspiring to go into dermatology, any advice you have, you know, for going down this career path and, and, you know, just being a success.

23:44You know, it's just being committed, you know, keep trying, you know, if someone says no, I take any no as a, okay, not from you or not now, not, not, not ever. Right. If you want it, you will get it. And if someone won't let you get there, you know, traditionally you found your, you find your route to be able to participate in the area of medicine that you love. Right. So it's just about keeping your head down, working hard, you know, dermatology is very competitive. So, you know, it is, excellence is important. So working hard to get the grades, finding the right resources, if you're struggling in anything, because first and foremost, you are going to have to have that.

24:28And then when you're in, you know, just learning as much as you can, finding the right mentors, consuming as much information as you can, because the first day of work, when it's just you and your patient, there's no longer an attending to lean on, isn't a textbook to immediately reference. It's very scary, but it's much less scary if you know that you've done the work. So that's my advice is do the work. There aren't any shortcuts to it. And when we take shortcuts, not only do we hurt ourselves, but more importantly, we hurt patients, you know, innocent patients who are just here trusting us.

25:01So I think that, you know, it sounds like a cheesy phrase, but people say heavy is the head that wears the crown, You know, when you have great responsibility, when you're given the gift of caring for patients, it's a great responsibility, something that I don't take lightly. And it takes a lot of work to be able to get there, care for our patients safely, and make sure that we continue to promote the field in a way that is positive. I love that. Thank you so much for sharing that. And I hope anyone listening out there, you truly take that to heart. But thank you so much, Dr. Henry. It's been such an honor to host you.

25:36you're very welcome thanks for having me thank you hey guys so i hope you love that episode please make sure to hit subscribe if you're tuning in to us on any podcast platform we are available on so many different platforms so wherever it is that you're tuning in just go hit subscribe you will be immediately notified when we publish new episodes this way you're able to tune in to amazing insights from experts brand founders industry leaders authors all the wonderful people that we host and that's very important for me because I love to hear from you guys and really understand what you love and what you want to hear more of.

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