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James B. LaValle presented on the impact of oxidative stress, inflammation, gut health, and microbiome diversity on aging, performance, and vitality. He emphasized that chronic inflammation, also known as “meta-inflammation,” accelerates aging by creating a catabolic state, leading to conditions like sarcopenia, insulin resistance, reduced neurogenesis, and mitochondrial dysfunction. The gut-brain connection plays a key role in overall health; a healthy gut promotes vitality, whereas a leaky gut, caused by factors like poor diet or stress, triggers inflammation and is associated with conditions like IBD, heart disease, and diabetes. Microbiome diversity is crucial for immune balance, with disruptions from stress, drugs, or environmental factors leading to systemic inflammation, food sensitivities, and poor performance. The gut-skin axis highlights the bidirectional connection between gut health and chronic skin conditions such as acne, psoriasis, and rosacea. Probiotics can help mitigate oxidative stress and reduce inflammation. Antioxidants, obtained through diet or supplements, can also help mitigate the harmful effects of oxidative stress and protect the skin from aging by promoting elastin and collagen production, reducing inflammation, and supporting hydration.
Dr. Raja Sivamani discussed the concept of epigenetic modulation and use of various aging clocks to assess biological aging. Epigenetic modulation can control which genes are expressed or silenced, demonstrating that genes are not deterministic. Aging clocks like PhenoAge, Grimm Age, and DudeinPACE have correlated better aging outcomes with dietary factors—such as increasing carotenoids and reducing red meat—and lifestyle choices like exercise and caloric restriction. To integrate into clinical practice, dietary recommendations should emphasize lower caloric intake by consuming more whole fruits and vegetables, protein, and carotenoids while reducing red meat, alcohol, and refined carbohydrates. Lifestyle changes include smoking cessation and exercising with emphasis on weight training to preserve muscle. Providers may also consider checking for insulin resistance and fatty liver status.
Dr. Lev-Tov discussed the changing dynamics of the doctor-patient relationship regarding aging, emphasizing intrinsic and extrinsic factors. Intrinsic aging is linked to genetics, showing effects like epidermal thinning and decreased collagen production. The microbiome plays a crucial role, with a study showing that younger women had higher C. acnes levels compared to older women (Zhou et al. 2023, Oh J. Exp Dermatology). Extrinsic aging, influenced by environmental exposure, leads to skin roughness, elastosis (accumulation of disorganized elastin), and vascular changes like dilated and tortuous blood vessels. Key therapies include retinoids, sunblock, and nutritional support. The role of epigenetics in aging modulation was highlighted in that it is responsible for connecting the genotype with the phenotype. Dr. Lev-Tov also discussed the impact of caloric restriction and sirtuin-activating compound (SIRT1) on wound healing and aging. The more SIRT1 present, the greater the benefits as seen in various mouse model studies presented. Importantly, while caloric restriction can help with anti-aging it is not always the best for wound healing. Briefly, Dr. Lev-Tov notes that hair graying serves as a biomarker for aging.
Dr. Farris presented on the science behind skin products and how they can be used to address facial redness, hyperpigmentation, and rejuvenate skin. The first key takeaway emphasizes the importance of environmental protection, which necessitates the incorporation of UV filters, iron oxides, antioxidants, and DNA repair enzymes. Notably, vitamin C products, such as L-ascorbic acid and THD ascorbate, serve dual functions by acting as powerful antioxidants and facilitating the repair of photodamage through collagen enhancement and downregulating pigmentation. Additionally, botanical antioxidants, including polyphenolic compounds, have demonstrated efficacy. The second key takeaway highlights that retinoid precursors or cosmetic retinoids offer similar skin benefits to tretinoin, but with considerably less irritation, as evidenced by a 12-week study involving 0.1% retinol, which effectively reduced fine lines, wrinkles, and photodamage. Retinoids function by upregulating transforming growth factor (TGF) and stimulating the production of collagen, elastin, and hyaluronic acid. The third key takeaway pertains to the potential of exosomes in skin rejuvenation, particularly in post-procedure contexts, although further research is needed. Exosome products vary and include platelet-derived, fibroblast-derived, plant-derived, and fetal tissue-derived exosomes. The last key takeaway is that hyperpigmentation and facial redness, arising from UV exposure, barrier dysfunction, and inflammatory skin diseases, are cosmetic concerns that can be effectively treated with cosmeceuticals containing multiple beneficial ingredients, such as niacinamide, feverfew, chamomile, silymarin, and piperonyl glucoside.
Dr. Apple Bodemer discussed the impact of advanced glycation end products (AGEs) in skin aging. AGEs are stable molecules that form when sugars bind to proteins, lipids, or DNA through the Maillard reaction, a process accelerated by heat and dependent on sugar availability. AGEs interact with RAGE receptors, leading to the upregulation of inflammatory mediators like cytokines and chemokines. In skin aging, AGEs damage collagen and elastin, causing reduced elasticity and impaired remodeling. High-heat cooking methods like grilling and charring can increase AGE levels in foods by up to 100-fold, while slower, moisture-rich cooking methods like steaming and stewing minimize their formation. Although all foods contain some level of AGEs, plant-based foods have lower levels and a reduced potential to form AGEs compared to animal-based foods. Foods rich in polyphenols (nuts, berries, tea, apples, legumes) can help prevent AGE formation. Additionally, marinating foods in acidic ingredients like lemon juice or vinegar can reduce Maillard reaction activity. Finally, regular exercise is an effective method of combating the impact of AGEs on skin aging.
Dr. Jason Derico highlights the intricate relationship between mental health and dermatology/aesthetic medicine. Skin conditions can often correlate with mental health. A portion of patients who seek aesthetic treatments suffer from body dysmorphia and are rarely satisfied with their treatments. Mental health conditions can even be contraindications to aesthetic treatments. On the other hand, aesthetic treatments may benefit mental health, with studies like the HARMONY study showing improved psychological well-being outcomes after a multimodal approach to facial rejuvenation. However, Dr. Derico emphasizes the importance of setting realistic expectations and working toward improving overall well-being rather than offering a cure. Providers should carefully assess the mental health of patients before treatment and align with mental health professionals to connect affected patients.
Exosomes are a specific type of extracellular vesicle (EV), typically 30-150 nanometers in diameter that play a crucial role in cell-to-cell communication. They carry various molecular cargo, including proteins, lipids, and RNA, which can influence the behavior of recipient cells, such as promoting healing or modulating inflammation. Exosomes are being explored for their potential in regenerative medicine, wound healing, and treating skin disorders due to their ability to facilitate tissue repair and modulate immune responses. Dr. Badiavas has specifically studied exosome utilization in burn injuries and genodermatoses (eg, dystrophic epidermolysis bullosa (DEB)). DEB is a severe blistering disease due to a lack of type VII collagen. His research includes collaboration with McBride et al, who proposed that bone marrow-derived mesenchymal stem cells (BM-MSCs) enhance collagen production in DEB fibroblasts by delivering type VII collagen and its messenger RNA via EVs, indicating a promising therapeutic potential for DEB (McBride et al, Biochimie, 2018). Dr. Badiavas emphasizes the importance of adhering to regulatory guidelines to safely and effectively advance EVs. Collaborating with a high-quality manufacturing company is essential, as harsh production methods can damage EV’s biological activity. Donor variability, even among healthy individuals, significantly influences EV function, with regenerative effects varying based on the tissue source, including stem and progenitor cells. Additionally, donor comorbidities and age can affect the characteristics of the EVs. Overall, grasping the complexities of EVs and exosomes highlights their significant potential in creating effective therapies for skin conditions.
Dr. Neal Bhatia discussed the connections between the gut and the skin, the balance of diet, stress, and lifestyle factors for acne and rosacea, and the correlation to neuroendocrine influences, as well as therapeutic approaches. The first key takeaway is that it is essential to optimize vehicles for topical treatment, especially in severe disease when combined with systemic treatment, as these are often chronic treatments for patients. The second key takeaway is that the consequences of systemic therapy may manifest elsewhere aside from the skin, such as oral antibiotics and their associated side-effect profile. Notably, there has been a resurgence of the use of topical minocycline for rosacea, which controls inflammation by inhibiting matrix metalloproteinases (MMPs) and neutrophil activation. This formulation boasts a favorable side-effect profile, reducing issues like hyperpigmentation, vestibular symptoms, and lupus-like symptoms. Other effective treatments for rosacea include topical ivermectin, known for its anti-inflammatory and anti-parasitic properties, as well as benzoyl peroxide. Importantly, studies have shown that a daily dose of 40 mg of doxycycline is as effective for rosacea as 100 mg, which may minimize side effects. The third key takeaway is that new therapeutic innovations need to be supported when efficacy and tolerability surpass less effective generic options. A study involving an exogenous heparan sulfate analog in rosacea patients revealed significant improvements in skin radiance, smoothness, and a reduction in facial redness and flushing after 12 weeks of treatment. Additionally, ingredients like cucumber, grapefruit, and thyme can hydrate and soothe rosacea-affected skin, while licorice root and aloe vera provide beneficial effects for acne treatments. The fourth key takeaway is that it is essential to keep the patient’s goal of improvement of erythema as a priority, as patients often see erythema as persistence of activity in rosacea. Notably, rosacea in darker skin is not uncommon, but erythema may be more difficult to recognize. Paying attention to symptoms, like burning and stinging, is essential.
Dr. Katherine Varman emphasized that although mineral-containing sunscreens are essential, it is important to adopt a broader approach to protecting the skin from the complex process of photocarcinogenesis and photoaging caused by UV-B, UV-A, and visible light. She highlighted novel photoprotection strategies, including the use of antioxidants like vitamins C and E, DNA repair enzymes, niacinamide, and polyphenols such as Polypodium Leucotomos and green tea extract. These agents help reduce oxidative stress, enhance DNA repair, reduce inflammation, and protect against photo-induced immunosuppression to mitigate the harmful effects of sunlight. Other emerging photoprotective agents that were discussed include ER-beta agonists, omega-3 fatty acids, and melatonin. To further protect the skin from within, Dr. Varman recommends eating a colorful diet abundant in polyphenols, carotenoids, and omega-3 fatty acids. For individuals at high-risk or with significant sun exposure, supplements such as omega-3s, carotenoids, niacinamide, proanthocyanidin-rich extract (grape seed) or green tea were recommended to provide additional defense.
Dr. Michelle Jeffries introduces the CortisolClock and highlights cortisol’s release from the skin in response to stress. Cortisol impacts a wide range of organ systems and fluctuates with circadian rhythm and can be measured via blood, saliva, urine, or hair. Disruptions in the CortisolClock can affect short-term and long-term health, as inflammatory skin conditions are associated with disrupted cortisol rhythms. She discusses our body’s response to stress and how stress hormones change according to each stage in Selye’s General Adaptation Syndrome. The concept of “Chronobeauty” encourages aligning skincare and lifestyle habits with the body’s natural cycles to reduce stress and improve skin health. Dr. Jeffries emphasizes creating and cultivating a Sacred Space that focuses on alignment with nature through circadian synchronization, inner being via mindfulness techniques, nourishing meals, and herbal support, and the connection of nature and inner being through skincare alignment.
Dr. Rubaina Dang highlighted the numerous options beyond medications to address hair loss and emphasized the importance of investigating its root causes. She reviewed a range of factors contributing to hair loss, including genetics, lifestyle choices, hormonal imbalances, and nutrient deficiencies. When lab results appear normal, Dr. Dang urges us to consider conducting urine hormone testing, salivary cortisol testing, or further exploring the individual’s health history.
She discussed establishing foundational health through hydration and nutrition, with a focus on adequate protein intake—targeting ½ body weight in grams daily—as essential for keratin production. A varied amino acid profile is crucial, along with omega-3 and omega-6-rich foods, which help increase hair density and reduce the percentage of hair in the telogen phase.
Dr. Dang encouraged engaging in moderate activity weekly, managing stress through meditation and therapy, and optimizing digestion with adequate fiber and probiotics. She reported that women under stress are eleven times more likely to experience hair loss compared to those who are not stressed. Correcting nutrient deficiencies, addressing toxin exposure with quality water and air filters, and using non-toxic hair care products were also briefly discussed. Hair-supportive vitamins, minerals, and researched botanicals for hair growth were emphasized as beneficial.
Lastly, Dr. Dang analyzed advanced support methods for hair loss from a healthy aging and integrative perspective. The use of PRP (platelet-rich plasma), which contains growth factors that stimulate collagen proliferation, promote cell differentiation, and support angiogenesis, recommending 3-4 sessions monthly with maintenance sessions. She highlighted exosomes for their role in supporting the proliferation of growth factors. Red light therapy was also noted for its ability to increase ATP production, decrease reactive oxygen species, aid in protein synthesis, and support vasodilation, with a recommendation for low-level laser therapy at 660 nm for 6-20 minutes, 3-5 times a week. Overall, don’t overlook the influence of diet and lifestyle; a poor diet and high stress are classic triggers for hair loss.
Dr. Michelle Tarbox discussed the holistic care of hair loss from a nutritional, psychosocial, and physiological perspective. She began by illustrating the hair follicle, emphasizing that the hair follicle stem cells are necessary for repair after injury. Notably, dermal papilla cells are sensitized to androgens, and these cells are involved in the pathogenesis of androgenetic alopecia. The normal anagen:telogen ratio is ~14:1 to 12:1 in healthy individuals, while androgenetic alopecia has a ratio of about 5:1. Restoring a healthy ratio is a goal of many therapies. In inflammatory conditions, hair cycles from the anagen to telogen phase and there is cellular infiltrate of inflammatory cells, such as substance P, which mediates stress-induced hair loss and alopecia areata. High-fat and high-sugar diets may also contribute to hair thinning and loss, as well as chemical and heavy metal exposure, such as mercury, thallium, and arsenic. Also crucial in alopecia in some patients is prolonged DHT exposure, which leads to follicle miniaturization and hair loss. 5-alpha-reductase inhibitors like pumpkin seed oil and saw palmetto oil can reduce DHT levels and slow hair loss. Improving the estrogen to testosterone ratio in women can help slow hair loss, and can be achieved with a well-balanced diet and high-intensity exercise. Stress management, vitamins B and D, omega-3 fatty acids, iron, zinc, and selenium deficiencies and a protein-rich diet can also slow hair loss. Scalp massages, low level laser therapy, microneedling, and platelet-rich plasma treatments have been shown to promote hair-growth and have patient satisfaction.
The panelists used cases and live cooking demonstrations to discuss the impact of nutrition on aging, specifically highlighting the benefits of carotenoids in providing photoprotection, reducing insulin resistance and improving triglyceride levels. Chef Kimber Dean shared a recipe rich in carotenoids called “Pumpkin Alfredo Spaghetti Squash” made with freshly roasted pumpkin, cashews, nutritional yeast, garlic, and onion. The panelists discussed methods to help reduce spikes in blood glucose including starting your meal with leafy greens, using cinnamon, or doing a 10-20 minute walk after a meal. The benefits of oat consumption was highlighted, including their ability to reduce triglycerides. Two oat recipes were shared including “Overnight Oats and Seeds” made with mashed purple sweet potato, vanilla protein powder, maple syrup, flax seeds, and diced apples as well as a “No Bake Chocolate Banana Oat Bar” made with mashed bananas, maple syrup, raspberry leaf concentrate, maca powder, coconut oil, raw cacao powder, and ashwagandha. Finally, several potential benefits of caloric restriction were discussed including hormonal control and improved aging parameters. The panelists recommend a fasting pattern that includes a larger breakfast within the first hour of waking and a smaller, early dinner as this pattern has shown reductions in fasting insulin, fasting glucose, and insulin resistance.
Dr. Peter Lio discussed new thinking, new therapies, and new treatment goals for itch, atopic dermatitis (AD) and prurigo nodularis. The JTF guidelines for AD provide alternatives to topical corticosteroids (TCS), which patients often prefer because of steroidal adverse effects. One topical steroid alternative is topical ruxolitinib cream (JAK 1/2 inhibitor). This therapy is approved for patients aged 12+ years. Another option is delgocitinib ointment for chronic hand eczema (PAN-JAK inhibitor), although it is not yet approved in the U.S. Yet another topical option is tapinarof cream (activates epidermal aryl hydrocarbon receptors), which will likely be approved soon for eczema. Topical roflumilast (phosphodiesterase-4 inhibitor (PDE4-i)) is another option for AD. This can be used once daily and is ideal for mild-moderate disease maintenance. Topical difamilast (PDE4-i), still being studied in Japan and the U.S., can be used for kids and adults and has shown to have few application site reactions. Topical naltrexone 0.1% has also been shown to be efficacious in managing pruritus. Nemolizumab with TCS use has been shown to be helpful in adults with moderate-severe AD and severe pruritus, although it is not approved yet. Other medications being studied include anti-OX40 ligands (amlitelimab, telazorlimab, rocatinlimab). When choosing therapy, start with choosing topical agents (eg, TCS, triamcinolone, topical PDE4-i, topical JAK-inhibitors (JAK-i)), and then considering biologics (eg, dupixent, tralokinumab) if refractory. If biologics are not efficacious, consider JAK-i (eg, baricitinib), and if there is still a high disease burden, consider conventional immunosuppresants (eg, cyclosporine, methotrexate). Efforts should be taken to avoid systemic corticosteroids due to their poor side-effect profile. Nonpharmacologic treatments include a massage for 10-20 min, mindfulness and self-compassion sessions, as well as acupuncture.
Dr. Jason Hawkes reviews current and emerging treatment options for psoriasis, emphasizing the need to address existing clinical gaps. His session offers a brief overview of biologic treatments while primarily concentrating on oral therapies, highlighting findings from ongoing research.
Dr. Hawkes reviews oral TYK2 inhibitors. TYK2 inhibitors target the JAK-STAT pathway by blocking the TYK2 enzyme, preventing the phosphorylation and activation of downstream STAT proteins. This disruption reduces signaling from pro-inflammatory cytokines like IL-23, IL-12, and IL-6, leading to decreased inflammation and immune response. Dr. Hawkes highlights Deucravacitinib, a first-in-class oral TYK2 inhibitor, that offers many advantages such as no black-box warnings or laboratory requirements, minimal gastrointestinal issues, and a once-daily regimen. Additionally, PDE4 inhibitors like apremilast are compared to TYK2 inhibitors, focusing on their side effects, non-selective blockade, and the twice-daily dosing regimen that may cause clinicians to hesitate in prescribing them. Emerging therapies are also highlighted, including the oral IL-23R inhibitor JNJ-77242113, which has already shown significant PASI improvements in Phase II data, and small IL-17A inhibitors like Izokibep, first tested in psoriatic arthritis.
Dr. Hawkes discusses the recently FDA-approved IL-17A/F inhibitor Bimekizumab. Bimekizumab specifically targets both IL-17A and IL-17F, blocking the activity of these cytokines by preventing their interaction with their receptor. This mechanism allows it to address a broader range of inflammatory pathways involved in psoriasis, making it effective for treating the disease. This therapy has shown a remarkable PASI100 compared to all other biologics. It does carry the risk of increased risk of candidiasis because IL-17 serves as the body’s natural defense against this infection. Patients usually experience this side effect within the first 16 weeks of treatment. While the risk of infection is heightened during this period, most patients do not experience reinfection once treated.
Finally, Dr. Hawkes addresses treatment challenges, particularly for conditions like palmar plantar pustulosis that do not respond well to IL-17 or IL-36 therapies, suggesting that JAK inhibitors may be more effective.
Dr. Steven Daveluy updated us on the current role of biologics and JAK inhibitors in treatment of dermatologic conditions, particularly psoriasis, vitiligo, and hidradenitis suppurativa (HS). Biologics are proteins derived from a biologic source that is administered systemically due to its large molecular weight. Small molecules like JAK inhibitors are small synthetic organic compounds that are heat-stable and available in topical or oral formulations. There are multiple different molecules in the JAK/STAT pathway that JAK inhibitors can target for. Ruxolitinib in particular is a pan-JAK inhibitor.
In psoriasis, biologics utilized focus on targeting TNF-alpha, IL-12/23, IL-35, IL-17, and IL-23. Bimekizumab is of particular interest due to its ability to block both IL-17A and IL-17F, which are believed to be implicated in chronic inflammatory skin conditions. JAK inhibitors such as tofacitnib, upadacitinib, and deucravacitinib are potential therapies for psoriasis.
For vitiligo, topical ruxolitinib is approved for patients. Combination therapy of UV-B phototherapy and a topical JAK-inhibitor has also shown good response. There are a variety of JAK inhibitors being investigated for management of vitiligo.
Two approved biologics for HS currently exist: adalimumab and secukinumab, which have both showed improvements in HS Clinical Response (HiSCR) scores in treated groups. Bimekizumab is also expected to receive acceptance as a therapy for HS in the near future. There are a variety of HS treatments being investigated, targeting TNF, IL-17, JAK, and more. All in all, biologics and JAK inhibitors have shown to have promising potential in treating inflammatory skin conditions.
Recent advances in non-steroidal topical treatments for psoriasis, seborrheic dermatitis, and atopic dermatitis have demonstrated promising efficacy and safety. Tapinarof, roflumilast, and Indigo Naturalis have shown significant results in the treatment of psoriasis. Tapinarof, a topical aryl hydrocarbon receptor agonist, inhibits key proinflammatory cytokines such as IFN-gamma and TNF-alpha, increases antioxidant activity via the Nrf2 pathway, and normalizes the skin barrier. Indigo Naturalis, used in traditional Chinese medicine, has shown potential in targeting the IL-17 pathway for psoriasis in small studies. Roflumilast, a topical PDE-4 inhibitor, has demonstrated superiority over placebo in treating psoriasis, seborrheic dermatitis, and atopic dermatitis. Other emerging treatments in the management of atopic dermatitis include Ruxolitinib (a JAK inhibitor), Tapinarof, and Roflumilast. Delgocitinib is another JAK-inhibitor that is specifically useful in hand dermatitis. A standardized coconut and sunflower seed oil cream has also shown efficacy in atopic dermatitis. Alongside novel options, phototherapy remains a reliable treatment for psoriasis and atopic dermatitis.
Dr. Joseph Alban teaches about the art of Chinese medicine in age and skin management. Chinese medicine is an ancient concept that focuses on extending lifespan by expanding HealthSpan, focusing on boosting our qi, or our energy to function, grow, heal, and repair. Chinese herbal medicine is used according to their tastes and temperatures, which are thought to dictate their function. The herbs he focuses on today are ginseng, tremella mushrooms, and goji berries.
Ginseng is a widely recognized herb used for strengthening qi and is thought to improve digestion, blood sugar levels, immune function, stress, and even sexual health. Studies have shown that ginseng can inhibit collagen degradation and stimulate collagen and hair growth. Ginseng’s active ingredient ginsenoside has been shown to inhibit telomere degradation and the mTOR pathway involved in aging. Tremella mushrooms are used to strengthen yin, or calmness. Studies have shown that tremella mushrooms can reduce oxidative stress and stimulate SIRT1 to regulate cell stress and death. Goji berries can tonify blood and nourish the physical body, used to improve eye health and immune function. Goji berries can be easily incorporated into the regular diet and mitigate age-related oxidative stress, with studies showing improvement in skin carotenoid levels.
Dr. Meena Julapalli’s presentation focused on the concept of joy as both a state of being and a practice. She discussed the significant impact of chronic skin conditions on various aspects of health, noting that they impair quality of life more than many other chronic diseases. Common issues include poor sleep, low self-esteem, and social isolation.
Dr. Julapalli introduced the Broaden and Build Theory from positive psychology, which posits that positive emotions help build skills and resources over time. She emphasized the importance of coherence between the heart, brain, and body for overall well-being, linking emotional health to physiological responses.
To cultivate joy, she suggested practices like gratitude—shifting from “I have to” to “I get to”—and play, including curiosity and laughter. Research shows that higher curiosity can significantly increase longevity, while nature walks focused on awe boost joy and social connection. Humor and movement also enhance emotional regulation and cognitive function.
The presentation incorporated a gratitude and visualization exercise. Dr. Julapalli stresses the importance of social connections and celebrating small wins.
Venous leg ulcers (VLUs) are the most common type of leg ulcer, accounting for about 80% of cases. They are characterized by an irregular shape, dermal fibrosis, erythema, and yellow fibrinous exudate. Risk factors for VLUs include age over 55, a history of deep vein thrombosis (DVT) or pulmonary embolism (PE), higher BMI, and physical inactivity. In chronic venous insufficiency, calf muscle pump failure causes venous reflux, resulting in abnormally high pressure in the veins, ultimately causing edema, dyspigmentation, dermatitis, and ulceration.
Management primarily involves compression therapy, leg elevation, and calf muscle exercises to improve venous return. For management of ulceration, medications such as aspirin and pentoxifylline can accelerate healing, while other treatments like horse chestnut extract and statins show promise. Stanozolol can be a helpful treatment for associated pain. Techniques like negative pressure wound therapy and skin substitutes also help stimulate healing. Debridement and newer topical treatments, such as timolol eye drops, can assist in treating hyperproliferative wound edges.
Dr. Rajani Katta walks us through management of patients with allergic contact dermatitis (ACD) affecting the face and eyelids. Since ACD is a delayed hypersensitivity reaction, symptoms classically show up 48-72 hours after exposure and can last up to 8 weeks following removal of the trigger. When facial contact dermatitis is suspected, consider four sources of common triggers: things directly touching the eyelids, things close by, such as hair care, airborne substances like essential oil diffusers, and transfer of allergen from the hands or other sources. Top allergens in North America consist of mostly fragrance additives or preservatives. Topical antibiotics like neomycin and bacitracin are also possible iatrogenic causes. Managing facial contact dermatitis begins with the avoidance of these common allergens and irritants, often found in our skin, oral, nail, and hair care products. Seek out products that contain as few or none of the top allergens as reported by the North American Contact Dermatitis Group. Topical hydrocortisone then tacrolimus may be used to reduce inflammation. If symptoms do not improve after these initial interventions, patch testing may be considered.
Carine Camara, LAc, presented on facial wellness through a Traditional Chinese Medicine lens, emphasizing the connection between mind, body, and spirit. She highlighted how facial features can provide insights into a person’s health and emotions, with specific indicators like dark circles linked to the kidney meridian. Wrinkles result from repetitive muscle movements and can be aggravated by factors like sun exposure and hormonal changes. Facial acupuncture is designed to relax these muscles and address emotional states, such as irritation or frustration reflected in the glabellar region. Carine Camara, LAc introduced acupressure techniques that involve both motor and trigger points, which can be incorporated into treatment sessions. She detailed a facial acupressure massage method, encouraging upward movement from the neck to the face, using gentle pressure on specific areas for 20-30 seconds. This holistic approach aims to release emotional tension, improve blood flow, and foster self-acceptance, ultimately promoting a radiant appearance. Additionally, she discussed the connections between acupressure points and overall health, reinforcing the benefits of these techniques in client care.
This panel brought together Raja Sivamani, MD MS AP, Nikki Mann, LE, Mila Grass, AP LE LC and DeJarra Sims, ND, discussing how estheticians and licensed medical practitioners can work together to care for aesthetic related concerns. The panel began with a discussion regarding how to collaborate with other practitioners. One way to build trust with patients is to direct patients to the proper professionals to get the care they are looking for. Naturopathic doctors are best at taking a holistic approach, estheticians know what ingredients to look for in certain products, and when practicing ayurveda, the mind-body connection is addressed. Next, suggestions on how to find a collaborative dermatologist were discussed, which included looking for dermatologists that support a holistic approach, searching for their mission statement, as well as their beliefs on other professions’ value in the field. Going to community events, being active on social media and staying curious can also help build one’s network. Next, compensation structures were discussed. For an esthetician, retail comprises a lot of their compensation, and when looking for products to carry, it is best to find brands that truly align with the esthetician’s philosophy. When being an independent contractor, estheticians can buy products wholesale, potentially receiving a higher commission than when being an employee; however, if an employee, an employer funds purchasing of the products, certifications, CME courses, as well as insurance, which provides a financial safety network. Products that estheticians should consider carrying depend on the specialty of the estheticians, which experience and patient population will help determine. When patients are looking to find integrative practitioners, researching the background and training of the provider is useful, with LearnSkin.com also having resources for patients.
Stress and trauma are deeply connected to various skin conditions like acne, rosacea, psoriasis, and atopic dermatitis. This link exists through the nervous system, where stress triggers the autonomic nervous system (ANS), acting like a personal alarm system. Traumatic events can cause the ANS to go into overdrive, leading to nervous system dysregulation, immune system impairment, and hormonal imbalances. This dysregulation can impair skin health by slowing collagen production, wound healing, and compromising the skin barrier. Chronic stress also increases cortisol and other stress hormones, affecting thyroid, reproductive, and mood-regulating hormones, further impacting the skin. Healing involves creating a “felt sense” of safety by fostering bodily awareness, intentional breathing, and mindful touch. Products can also become a vehicle for felt sense and somatic awareness. Helping clients regulate their nervous system through these integrative techniques promotes better skin and overall health outcomes.
Licensed esthetician Douglas Preston explains the importance of comedone extractions in managing acne and how estheticians and physicians can work together to treat acne in a way that is compatible with the patient’s needs. Comedones develop when the skin expresses hyper-sebaceous activity and accumulates dead skin cells in follicles. Comedones may progress to inflamed lesions when the inflammatory response of removing bacteria from the follicle is unable to escape the occluded follicle.
Physicians seldom perform comedone extractions and often treat acne with oral or topical pharmaceutical products, but most of these therapies are only as effective as long as the patient continues with it. Extractions can clear congested follicles to reduce this inflammation response and infection cycle, so estheticians properly trained in comedone extractions can be valuable to patients who decline pharmaceutical therapies. Thus, collaboration between physicians and estheticians creates mutually beneficial relationships between patients and providers. Patients are treated faster, and physicians form referral relationships with estheticians that serve as resources to manage conditions outside of their respective scopes of treatment.
In her session, Arlene Strugar, PhD, PsyD, LE, ChT, focuses on achieving optimal health through a holistic approach. She explores how sports psychology enhances mental resilience, the connections between brain, gut, and skin health, and the benefits of exercise on cognitive and digestive functions.
Dr. Strugar defines peak performance as achieving one’s best capabilities, whether physically, mentally, or both. It represents a state of optimal functioning and flow, often described as a “peak experience.” She stresses that the key to peak performance is preparation that leads to mastery.
Olympic athletes recognized for their “mental toughness” are trained to implement a performance readiness plan, set realistic goals, develop “if-then” strategies, and assess their strengths, weaknesses, opportunities, and threats to enhance their preparation for success. Visualizing goal achievement is also essential. Crucially, managing emotions plays a vital role in reaching peak performance. The Emotion Wheel is emphasized as a tool that illustrates how thoughts and emotions influence performance.
Dr. Strugar also discusses the gut-brain-skin axis. The vagus nerve connects the gut and brain, while gut microbes help regulate inflammation. Stress can weaken the gut barrier, spreading inflammation and contributing to aging. She emphasizes the link between brain inflammation and depression, encouraging her clients to prioritize their self-care. Exercise further supports this axis by enhancing gut health, reducing stress, and promoting overall well-being.
* This blog is for general skin, beauty, wellness, and health information only. This post is not to be used as a substitute for medical advice, diagnosis, or treatment of any health condition or problem. The information provided on this Website should never be used to disregard, delay, or refuse treatment or advice from a physician or a qualified health provider.