Lasers, Microneedles, and Age Specific Skincare With Dr. Kelly Stankiewicz

We are back this week with Dr. Kelly Stankiewicz, our favorite dermatologist. Dr. Kelly is at the forefront of her field, specializing in laser skin treatments that combat the effects of aging and can even create a youthful glow — if that is your jam. In addition to discussing the latest and greatest in dermatology, we also break down the four core pillars of a sound skincare routine: cleanse, exfoliate, nourish, and protect. Lastly, I ask Dr. Kelly to give us some context around Jimmy Buffett’s tragic passing in terms of the skin cancer that he battled and what we can all do to protect ourselves. 

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 Key Moments:

“What’s important is that you’re hitting all four of the categories: sunscreens, antioxidants, exfoliants, and cleansers.”

“So people, when they hear that someone has died of skin cancer, they get very concerned because skin cancer is quite common. The type that Jimmy Buffett had is very, very rare. So all of my patients who’ve had multiple basal cell carcinomas and squamous cell carcinomas, which don’t typically metastasize, are, you know, kind of up in arms because they don’t really understand the difference.”

“When you’re doing fractional resurfacing, you’re decreasing your risk for skin cancer probably (or at least according to this one study) by about two times or maybe a little bit more.” 

Transcript:
David: 0:16

Hey Kelly, welcome to my house. 

Dr. Kelly: 0:18

Thanks, thanks for having me. 

David: 0:20

We almost never do these locally. They’re always on Zoom and great to have you here. You’re a dermatologist, so clearly we’re going to talk about all things skin First off, like top of mind. I find your job and people who are in plastic surgery, people who deal a lot with appearance, unlike the other forms of medicine I break my leg or anesthesiologists or something. There’s a real psychological component to what you do. People look in the mirror and I’m included. Sometimes they have these like fits of dysmorphia. It’s like oh my. God, I look like this Dr Kelly. Oh, my God, do you see this? How do you deal with hysterical people like me? 

Dr. Kelly: 1:00

Oh gosh, I mean I’ve been one of those. That’s how I deal with it. I mean, any sort of medicine requires a lot of empathy and in aesthetic medicine your empathy is kind of shifted away from empathy towards the sick and dying to empathy towards the people who really want to change or make something better. So I don’t know, that’s me. I think you have to put yourself in their shoes and you have to understand where they’re coming from and certain personalities. It’s easier to do. You have to listen, because sometimes you can’t go in with preconceived notions about how people should be acting, because you don’t know what’s going on in their life. So you have to go in and you have to be quiet and listen and then put yourself in their shoes and have empathy, like every physician should. 

David: 2:11

I can just foresee. I mean, this is like something I would do. I would like call you up and it’s like oh my God, you got to see me right away. I have this like thing on my face or something and there’s no thing there. It’s just like I’ve sort of imagined it and you would look at me and then you would have to sort of deal with me like a crazy person. I understand that you imagined this, but it’s not there. 

Dr. Kelly: 2:32

You know, that’s the first thing that I ask when someone says oh my gosh, this thing you have to look at, you have to get it off and I can’t see it. The first thing I ask is do you have a magnifying mirror? Because that is 100% of the time. Yeah, how did you know? That’s where I saw it. Well, okay, throw away your magnifying mirror, because nobody else is looking at your skin in a magnified fashion and, yeah, those things are horrifying. I mean, I don’t have one at home, but if I go to a hotel and it’s there, even I’m like what is that? So? But I, you know, I never think it’s trivial. I mean, you know, as a dermatologist I went through, you know, 13 years of school and you know five years of training or 16 years into dermatology, like it’s a very you know, hone, skill and so you can’t like assume that everyone’s going to know what you’re going to know. So I never would think anything is frivolous or anybody’s frivolous. But I love my mom. recently, you know, was in the clinic and you know what’s this or what’s that, or you know, and I’ll you know, give the answer and she’ll be like well, how do you know? Cause this is my job. This is my job, mom, that’s really funny. 

David: 4:01

How do you know? 

Dr. Kelly: 4:02

How do you know? 

David: 4:04

I think only a mom can say that, though right. 

Dr. Kelly: 4:07

I would never say that Like how do you know? Of course, like trained professionals. 

David: 4:14

We were talking something. The last time I went to see you and you beautified me, there was a. You were talking about this like halo thing. So what’s a halo? It’s got a great name, by the way. Yeah, I love a machine called a halo. 

Dr. Kelly: 4:27

Yeah, yeah, it’s a great. It’s a great treatment. Well, the halo is a fractional resurfacing device. Fractional resurfacing is where we either remove or sort of cook like a tiny fractional column of skin and we do that all over the face in like a pattern. When we treat the skin with fractional resurfacing, it makes it more healthy and helps with brown spots, texture, fine lines and wrinkles, but it also decreases your risk for skin cancer and it kind of gives you this glow. Whenever you get a new collagen under the skin, it changes the way light reflects off your face and so we call it like the halo glow and that happens like about three months after. 

David: 5:12

How long does the halo go last? 

Dr. Kelly: 5:15

The halo. It doesn’t last forever, but it starts around three months after the treatment and it probably lasts about a year and then you need it again. 

David: 5:24

You know maybe a little less than a year, oh yeah yeah, yeah, that’s the thing about everything changes, right, cells in your body. They’re just living and dying and growing and changing and yeah. 

Dr. Kelly: 5:36

Yeah, I mean, I tell people, you know, when people ask me, like how long is this treatment gonna last, you know you want to say in your head it’s not lasting. It’ll know it’s in the moment it’s done. It’s good, your, because your body is changing. It’s changing all the time. Aging is relentless and it keeps going forward, and so anti-aging has to be relentless and therefore, sort of like a ritual. You know, something that you enjoy and something that you do in a, you know, a planned and regular fashion. 

David: 6:11

So, as you’re describing this, cooking of the skin sounds profoundly unpleasant. I’m guessing when you cook someone’s skin there’s some sort of anesthetic applied here. 

Dr. Kelly: 6:21

Yes, yeah, so for the halo we do topical numbing, and then I really don’t like to see people in pain, so we usually add a little bit of injected anesthesia as nerve box or in certain areas that are a little bit more painful, and then it’s really, really tolerable. 

David: 6:40

Does it smell bad? 

Dr. Kelly: 6:41

No. 

David: 6:42

I’m just thinking like cooking flesh. 

Dr. Kelly: 6:44

Yeah, I mean so we do use like a smoke evacuator, but I would so every single laser. I mean the ablative and non-ablative lasers. The whole principle of a laser is to selectively destroy a structure by heating it up but leaving the surrounding stuff intact. So you know, when you destroy a blood vessel you’re like cooking the blood vessel from the inside, but you’re leaving the normal skin behind, same, with brown spots. And then this is this particular laser absorbs, is absorbed by water. So the different wavelengths are absorbed different ways, but you know different strengths or different intensities by water. And the ones that are not quite as intensely absorbed by water are the ones that cook the skin and the ones that water absorbs really intensely remove the skin. So the halo is both non-ablative, which is the cooking, and ablative, which is the vaporizing or removing of skin. Yeah, so two wavelengths in one. That makes it a unique device in that sense. 

David: 8:02

I had the now very famous Brian Johnson on the show about I don’t know about six months ago and Brian, when he came on he had all kinds of like scabs, like wounds on his chest and a little bit on his face. And he was. He told me he does IPL laser like weekly. And it looked really messy. 

Dr. Kelly: 8:26

Well, he probably doesn’t do the same area weekly because, yeah, it takes about a week to heal from IPL on the face, on the body. It can take two and sometimes even three weeks to heal from IPL. So I, if I had to guess, I would say he’s doing one area and then doing another area and then just like rotating through. I think that’s pretty genius, but I’m biased. 

David: 8:51

Why do you think that’s genius? 

Dr. Kelly: 8:52

Well, I mean. So IPL is one of those. So now we have we have data that fractional resurfacing lasers and we always kind of suspected this, but now we have clinical, like you know, data that fractional resurfacing lasers prevents skin cancer, both in non-ablative and no-ablative. So when you’re doing fractional resurfacing you’re decreasing your risk for skin cancer probably or at least by this one study by about two times or maybe a little bit, maybe a little bit more. But fractional resurfacing is kind of like not something you want to do all the time. It takes a lot more healing. You know there’s a lot more in that week while you’re healing. It’s a lot more. But IPL can be pretty mild and we have good data that IPL also is anti-aging, like it changes the gene expression in your cells towards a less aged. You know gene expression. 

David: 9:50

So it’s not just a collagen thing, it’s you’re changing the gene expression. Yes, oh, fascinating. 

Dr. Kelly: 9:55

Yeah, I mean, it was a small study that showed this, but they had control. They treated forearms, they had control arms of young skin, they had control arms of old skin and then they had the treated old skin arms, and the treated old skin arms gene expression looked like the young skin gene expression, whereas the old skin that was untreated didn’t. You know, I don’t know Brian Johnson, but I know that his goal is to change his you know chronologic age and that is a great way to do it and it’s a little bit easier. You don’t always have to look scabby or crusty after IPL. 

David: 10:35

IPL. Is that something that you can use on like any? 

Dr. Kelly: 10:38

skin. Yeah Well, it can be a hair removal device, and so you don’t want to use it on skin hair-bearing skin that you don’t want to remove the hair on. But yeah, you could treat any skin with it. 

David: 10:53

The risk reduction. With the ablative lasers I get that right. 

Dr. Kelly: 10:57

Mm-hmm. 

David: 10:57

Is that simply because you’re removing cells or you’re selectively removing damaged cells? 

Dr. Kelly: 11:05

Nobody knows for sure, but it’s probably because it induces, you know, a healing process that recruits, kind of like newer, younger cells. The mechanism is not known for sure because it could have gone the other way. You know, skin cancers and pre-skin cancers divide faster. So if you’re removing, like, a column of skin and you’re hoping for it to populate from skin that’s surrounding, there could have been the scenario where the faster dividing pre-skin cancers and skin cancers filled in that hole. Right. But it didn’t turn out. It didn’t. You know it doesn’t turn out that way. It actually improves the health of your skin. 

David: 11:49

I’m gonna be a totally non scientific idea here that what happens is, because the skin gets damaged, you have this strong immune response and then your immune system Sees their certain DNA damaged cells here that got to go, and then they remove them along with healing your face. I don’t know. 

Dr. Kelly: 12:08

Yeah, it could be. It could be that for sure. Yeah, I mean so fractional resurfacing doesn’t Create a scar, but it definitely, you know, turns on some sort of healing Response. You know, not necessarily the same wound healing response, that would create a scar, but, yeah, healing response. 

David: 12:28

Yeah, interesting. I saw what Brian looked like Her IPL. What happens with something like halo, which sounds like more invasive like? What does somebody’s face look like after you do that? 

Dr. Kelly: 12:40

Well, okay, I’m. So. The halo can be used in a variety of different ways. It could be used in a really low density, you know, non ablative way you, where you’re just using the non ablative wavelength and not the ablative wavelength. Or you could do it like I do it, where you’re doing a pretty aggressive Ablative, non ablative and I combine it with IPL. So you do the IPL first and then you do the halo. Oh, oh second, in that scenario you have a week of downtime. It takes a week for your face to heal. No matter what sort of laser, except for the most, the strongest, like fully ablative resurfacing All the lasers take a week for your face to heal. Off the face it gets longer. So the neck and the chest like 10 days to two weeks. The arms and the hands like two weeks to three weeks. The legs are more like four to five weeks. I’m six weeks, yeah, ouch, but these I’ve done these lasers and they can be done anywhere on the body. Um, so, just talking about the face, you have a week of downtime and here at high altitude the face really swells because you don’t have that atmosphere pressure like pushing back. Yeah so I tell people You’re gonna wake up in the morning, you’re gonna look in the mirror. You’re going to say who is that person? You’re gonna and I try to like over exaggerate like your phone isn’t gonna recognize you. You will have to put in your pin code, you’re gonna be swollen, you’re gonna look funny, you know. And then almost every single person calls and said I know that, you said that I’d have a lot of. So I’m, but is this what you meant? And they send a picture. So swelling is always with the halo the way that I do it, and then you have kind of redness and Like little dots on your face that look vaguely like sandpaper and then, as the swelling goes down, they feel like sandpaper and then you start to peel. So that’s the story with most fractional resurfacing devices. When you use the halo in a like a lower setting, it’s much less like less swelling, less, you know, scaling, less peeling, but yeah. 

David: 14:51

Wow, like yeah, don’t plan any dinner parties after halo. 

Dr. Kelly: 14:54

Oh, I went out to dinner after halo once. Yeah, I just sat in the corner like it’s remarkable, like how people don’t really notice. You feel very self-conscious when you know your face is on fire and you’re, you know, like puffy and swollen. Other people just don’t notice if you’re in a dark room sitting in the corner. Yeah, wow, Okay yeah, but yeah, that’s me. You know, we’re all different in that regard. 

David: 15:24

So what are some of the other things I mean? Clearly, the thing to do here is, you know, don’t DNA damage the cell? Oh, you know what? The other thing you wanted to ask you about this DNA damage. So if you’re if this, you have cells in your skin that are damaged by DNA. Did they circulate through your body at some point, causing other like does this Migrate to other places? 

Dr. Kelly: 15:48

No, no, no, no, it just, they just stay there. 

David: 15:50

Okay. So they can’t like suddenly they go somewhere into some organ and they start some trouble there. No, no, okay, that’s good to know. 

Dr. Kelly: 15:57

Yes, yeah, it has to be cancer to spread. 

David: 16:01

Okay, yeah, we don’t, we don’t want that yes. So people should be wearing mineral based sunblock. Mm-hmm if they go out in the sun, especially here, because we’re at high altitude and it’s sunny all the time. It’s like being in a microwave, especially when there’s snow. 

Dr. Kelly: 16:15

It’s just yeah, so, for I don’t know if you knew the statistic, but for every 1000 feet of altitude, the sun is 5% stronger. Yes, so we’re here probably like 65, something like that. 

David: 16:29

Yeah, so okay, we’re, that’s 30% 40% stronger yeah yeah, and then if you have it reflected off the snow, it’s just yes, coming from all directions. Yeah, so what are the other things that you’re telling people to do? Like, I know some people really love the whole ritual of Product and I’m gonna put this product on this. That the other thing in this. This is sort of their wind down method at night. I’m sort of semi in that camp. What are you telling people to do? 

Dr. Kelly: 17:05

Well. So some of the things have to go on in the morning, so it can’t just be your nighttime like wind down, routine. Things that go on in the morning obviously sunscreen and antioxidants, and then things that go on at night Like exclusively at night would be like retinoids, and then everything else can go on in the morning or at night, or both. I Divide. When I’m talking to someone about anti-aging skin care products, I like to think of things in a framework, because I don’t like to tell somebody you have to use this product, you have to use this product or whatnot, because everyone has their own favorite products that they use because they think feel good or whatever. And so what’s important is that you’re you’re hitting all four of the categories. So the categories are sunscreens, antioxidants, exfoliants, and that’s kind of like an over simplification of that category, because I put retinoids and glycolic acid in that category and they don’t do more than just turn over the epidermis. They go deep into the dermis and stimulate collagen production, but there there is some Thing to be said. Or there is an anti-aging effect of actually physically exfoliating dead skin cells and creating a turnover. So there’s physical exfoliants in that category too. And then the last one would be like regenerative serums, which are regenerative peptides. This is like a Really broad category, but generally there are molecules like small little proteins that signal the skin to do different things, like, for instance, there’s one that tells the skin to eat up dead collagen and elastin so that new collagen and elastin can be formed. There’s one that makes the epidermis thick, like turns on the stem cells of the epidermis, and you know an aging epidermis is thin and flat and a young epidermis is kind of undulating and thick, so that particular peptide thickens the epidermis. There’s one that goes into the skin and tells the skin to make more connections between the epidermis and the dermis, which makes the the connection or the skin more healthy. So it’s like the variety of these regenerative serums and you can’t use them all at once. 

David: 19:26

These things work. 

Dr. Kelly: 19:28

Yeah, they work, yes, they do. 

David: 19:30

This is a silly question, but what you’re describing sounds like Kind of magical. 

Dr. Kelly: 19:35

Yeah, I think that the topical products that have good science behind them are very Overlooked part of anti-aging. I think that the Is probably the most important thing that we do Like. If you can’t do lasers or injectables, topical products make a difference. 

David: 19:55

In normal skin care. Seemingly people can say anything about anything. It’s like oh you know, looks, you look youthful after seven days or you know, I mean radiance, luminosity. How does, like a normal person, discern? Like, if I want a peptide that’s gonna better link my my dermis with my epidermis? How do I know that this works? Like, how do you discern? 

Dr. Kelly: 20:24

well, I think so there is. There are a couple like broad categories where you can get your skin care products from, like one would be the drugstore, one would be the department store and the one would be a Spot, and then another one would be your medical you know dermatologists office and dermatologists and other you know medical professionals tend to like to see like the clinical evidence. We like to see randomized, controlled trials, we like to see objective measurements, like you know. Oh, this really does increase. Like I took a skin biopsy and I can see there’s more collagen and elastin in there, and so that segment of skin care products are, you know, what you, I think you can really depend on, and there you know variety of different brands and things. 

David: 21:18

So I’ll just ask you yeah, yeah, just ask me. 

Dr. Kelly: 21:26

And then I would say like I’ll give you a grid with those four categories sunscreen, antioxidants, exfoliant and I would tell you to put you know them in your those four categories, what you’re using, and then if you want to change stuff in and out, I think it’s helpful, I think it Um boosts, you know, the look, the improvement, if you’re changing things all the time. 

David: 21:48

Wow, okay, that’s so interesting. I Feel like sometimes I should know so much about these things and I don’t and I Like, okay, I didn’t, I didn’t know. This was like a peptide thing that did that, that was yeah, fascinating. 

Dr. Kelly: 22:03

Yeah, I’m waiting for you to say how do you know that? 

David: 22:05

Oh, oh well, I know how. You know that you’re highly educated professional. That would be like somebody, Like in my old career. If I said you know, I think we need to change the lens on the camera and do this and somebody said how do you know that? 

Dr. Kelly: 22:29

Knowledge I have. 

David: 22:32

Okay, so I had a reader question. Okay which this may not be completely out of your sphere, but maybe you know something about it. So the question was about lymphatic drainage and Something called Brazilian lymphatic drainage. Do you know? I don’t know anything about these things. Is this something you ever heard of? 

Dr. Kelly: 22:50

No, I mean we do refer people to physical therapy for lymphatic massage and lymphatic drainage and usually in scenarios of swelling, either lymphedema or lipedema, which is where you get extra fat and it’s painful. So Massaging, you know, the areas where there are high flow lymph areas, like in the grind, and and moving fluid up and then wrapping the body Is a medical, you know strategy, but I’m sorry I can’t, okay, answer anything about Brazilian lymphatic Strain. 

David: 23:32

In front of anything. It just sounds like exotic and like, oh, it must be better. It’s yes. 

Dr. Kelly: 23:38

Yes, I think so too yeah your husband is Brazilian. 

David: 23:43

so clearly I mean yeah, husband, are you seeing any interesting things out there on the horizon technologies, peptides, stuff and machines, things that you think are interesting, that may be coming to market, that people should know about? 

Dr. Kelly: 24:05

So I really keep my finger on the pulse of lasers. That’s my subspecialty within dermatology and as far as laser technology goes, it’s usually pretty quiet for like decades, more at a time, and then there’s like a big burst in technologies and we’re sort of kind of in a quiet spot right now. But I do believe that soon there’ll be some new devices fractional resurfacing devices and technologies but the latest right now is an anti-aging treatment called elicor, which is called micro-corning. So instead of removing skin with lasers what we just talked about and when you remove skin with laser, either by cooking it or by vaporizing it, it usually leaves a cuff of coagulation around it so that those holes don’t collapse. The improvement you’re seeing is from a wound healing response, or a healing response not from actually taking out skin, like you’re not getting tightening from taking out skin. So elicor is micro-corning, which uses no heat at all. It’s just a tiny needle that removes a core of skin and so you do get that collapse and in addition to the wound healing, so it’s like a tight. Yeah, well, yeah, because it’s tight. 

David: 25:27

Oh, because it’s evenly tightened yeah. 

Dr. Kelly: 25:29

So it’s like a micro-face lift. You’re removing 8% of the skin or less with each treatment and the holes close down and you have 8% less skin and then you do it again same thing. So that’s kind of the latest on the horizon. 

David: 25:50

Is that hurt like heck. 

Dr. Kelly: 25:51

It’s a device that needs numbing for sure, but I don’t think it hurts like heck, and certainly while you’re healing it doesn’t hurt like heck but it doesn’t need general anesthesia. We do the same topical numbing and nerve block kind of situation. 

David: 26:08

There’s something called microneedling. Is that right? Is that sort of like this, but with a machine? 

Dr. Kelly: 26:14

Well, the difference between micro-corning and microneedling is that microneedling is a solid needle that goes into the skin and makes a hole, but then the whole collapses right away. So it’s just like penetrating and it’s just like a wound healing response. Micro-corning is a hollow needle that removes a core of skin. And the origin of this device? I think we talked about this a little bit last time. We had a little podcast chat. The origin was a theory called skin copying that came out of Dr Rox Anderson’s lab at Mass General. He’s the one that invented fractional resurfacing, along with Dieter Manstein at Harvard at Wellman Center for Photomedicine. And they said well, if you can damage fractional columns of skin and the skin heals without scarring, could you harvest those tiny columns of skin and then put them in a burn scar for some, everything in aesthetics started with a burn scar origin, anyway, and put it in a wound like a burn scar? Could you do skin grafting that doesn’t leave a scar? 

David: 27:25

in the harvesting site. 

Dr. Kelly: 27:27

And it turns out it works. If you can take those little tiny micro-corps and spit them into a wound, it heals with a better looking scar, a skin that’s more normal more normal than a scar. They’re still working on it. I don’t think it’s been perfected yet, but it’s been being studied for more than 10 years now and it works. And I think that the one major challenge of skin copying was the engineering of the needle. Like how do we make a needle that’s so small, that’s hollow, that can take a core of skin out and still doesn’t leave the harvesting site with a scar? So there’s a size of a column that you can remove from the skin without creating a scarring, wound healing response. And once they figured out the engineering of that needle, then it was moved into the aesthetic space as well as being studying for skin copying. 

David: 28:33

So Just imagining the thickness of the wall of the hollow needle. 

Dr. Kelly: 28:40

Yeah. 

David: 28:40

Wow. 

Dr. Kelly: 28:43

It looks like a regular needle. You don’t notice that it’s hollow. 

David: 28:48

Yeah, wow, impressive, technology. 

Dr. Kelly: 28:51

And then the other cool new laser that’s out has nothing to do with anti-aging but has to do with acne. So there are two new lasers that are focused on the sebaceous gland, so a brand new novel wavelength that’s selectively absorbed by sebaceous glands and when you kill sebaceous glands you shut down kind of the fuel to the fire of acne. So those are up and running and working well. 

David: 29:20

What causes acne? 

Dr. Kelly: 29:22

Ooh, thanks for asking. I love that question. Well, OK, so there’s four components to the cause of acne, or the origin and we’re talking teenage acne here because there’s the teenage acne and then there’s the female hormonal cystic acne, which is a totally different animal, but they both are related to overproduction of sebum. So you have a hair follicle, you have an oil gland that empties into the hair follicle. In hormonal acne there’s a lot more oil production. It’s controlled by your hormones, so mostly testosterone. So if you block the testosterone receptors in the skin, female adult hormonal acne gets much better. Teenage acne also has a component. There’s more oil production, but there’s a component of plugging of that hair follicle. That’s where retinate comes in, because that exfoliates off that plugging of the hair follicle. There’s a bacteria on our skin. It lives in the follicle, it doesn’t like oxygen and it eats oil. So a plugged pore with more oil production is like heaven for that bacteria and it overgrows. And when that bacteria overgrows then the inflammatory cells come in to attack it. So you’ve got inflammatory cells, bacteria, plugging of the pore, and if you could shut down oil production then all of those things wouldn’t happen. 

David: 30:51

What do you need? Oil production in around a hair follicle. 

Dr. Kelly: 30:56

That is a mystery, some people say, and that it’s like an evolutionary vestige of the past. So you know how you have sweat glands, that when they secrete water so that when you’re hot you get cool by evaporative cooling. Well, oil may do the opposite where it shuts down evaporative cooling so you produce more to keep yourself warm. And what is interesting to me about that theory is that every year, no fail, and it’s going to happen this year too. Hasn’t happened quite yet, but right around this time, like into October, everybody comes in with an acne flare. Oh, my acne was so good over the summer and it’s just so terrible right now. And some of it probably is, because you know you’re back at school. Like there is UV light does help kill the bacteria associated with acne. You’re probably eating differently, you’re stressed. But the other component is the weather is starting to get cool and so, you know, do we make more oil production? You know, do we make more oil when it starts to get cold, just to keep ourselves warm? I mean, it doesn’t have a function now, but yeah, I mean because, we wear clothes, but we’re all animals. We’re all animals. 

David: 32:19

Wow. 

Dr. Kelly: 32:20

But yeah, the sebum like and sebaceous gland like. Why it’s there is kind of is a mystery. You know there are stem cells and sebaceous glands that are good, you know, responsible for healing. These lasers don’t remove sebaceous glands, so we have to assume that they will. You know your skin will still heal the same. They’ve been studied for long enough that I think we know that that’s the case. But yeah, other than that, there’s no real reason why we have sebaceous glands except to give us acne. Wow. 

David: 32:58

I never knew any of this Really. 

Dr. Kelly: 33:00

Oh great, oh good Okay. 

David: 33:05

I don’t really anticipate an acne flare in my 65 year old future, but I agree, I agree. 

Dr. Kelly: 33:11

And if you have something that looks like acne, that flares, it’s probably not acne, it’s probably rosacea or perioral dermatitis, which is very common at high altitude. 

David: 33:21

I don’t want any of that. I just had surgery on my knee like like 10 days ago, so that’s like enough. Yes, okay. 

Dr. Kelly: 33:29

Agreed, agreed. 

David: 33:31

Jimmy Buffett, you getting a lot of questions about that. 

Dr. Kelly: 33:34

Well, a lot of questions all day. Yes, since we learned of his passing. 

David: 33:40

And what do people want to know about Jimmy Buffett? 

Dr. Kelly: 33:42

So people, you know, obviously when they hear that someone has died of skin cancer they get very concerned because skin cancer is quite common. The type that Jimmy Buffett had is very, very rare. So all of my patients who’ve had multiple basal cell carcinomas and squamous cell carcinomas, which don’t typically metastasize, are, you know, kind of up in arms because they don’t really understand the difference. 

David: 34:09

I see, so he had this rare carcinoma, skin carcinoma. What was it? 

Dr. Kelly: 34:15

As far as I understand from the news reporting, he died of a skin cancer called Merkel cell carcinoma. Merkel cells live in the skin. They’re associated with nerves. We consider them like the cells of touch or touch cells, so they live kind of in the epidermis, they live in the hair follicles and they transmit touch sensation. It’s a cancer that shows up on the skin. It’s not subtle in any way. It’s quite obvious. It’s rapidly growing. It looks angry. It’s not something that you would miss on your skin. It’s commonly deadly. You know it spreads inside kind of quickly. Yes, just like other skin cancers it’s found on sun exposed areas, but it’s associated with a virus. A research team that found the virus associated with Kaposi’s sarcoma was looking specifically for viruses and they found this new virus that’s called the Merkel cell polyomavirus. It integrates into our cells and creates the skin cancer. That’s neuroendocrine in origin. 

David: 35:25

What I’m curious about is normally skin cancer I think of like sun UV, but this is something else. 

Dr. Kelly: 35:32

Well, it’s definitely seen on sun exposed areas and there probably is an association with UV light. But it may not be as simple as UV light damaging DNA or our DNA, which is how we think of other skin cancers, which is why old sun exposure presupposes you to skin cancers today. Even if you’re very good about sun protection now, it can come back to haunt you in the form of damaged DNA, and that’s not necessarily true for Merkel cell carcinoma. But there probably is a component of sun exposure because UV light is very immunosuppressing in the skin. When UV light hits the skin, it chases away the immune system in the skin and allows you know, a virus like that to reactivate or integrate. 

David: 36:26

There’s a certain group of people out there that feel like more sun better, like I’ll be healthier if I get more sun on my skin and. I’m tan, but maybe not. 

Dr. Kelly: 36:40

Those people should spend a week with me in the clinic and just look and see what sunlight does to your skin. It’s devastating. I mean, if you live that way, you’re going to look like a leather bag, and that doesn’t mean you shouldn’t enjoy outdoor activities, but you should do it in a sun-safe sort of way, wearing sunscreen and hats and sun protective clothing. I mean it’s unequivocal that UV light causes skin cancer and I think that Jimmy Buffett’s situation has, kind of you know, brought that to the forefront that skin cancer can kill you. So I don’t think it’s a longevity strategy. 

David: 37:24

No, well, I agree with you. 

Dr. Kelly: 37:26

I mean, we talked about vitamin D levels and how that’s important for the immune system and having a good immune system, but you don’t need the sun to get vitamin D. You can get it from a supplement and if you’re not good at absorbing that supplement, you take more and you check your levels. I’m one of those. 

David: 37:46

I check my levels every quarter and it took me about six months Like mine were, I think, in the high 20s and to get them up into the 40s I had to take 10,000 IUs a day, and then to get it over 50, I still had to take almost 10,000 IUs a day, and now I think they’re about 58 now. So I sort of alternate like 10,000, 5,000. 

Dr. Kelly: 38:11

I like how you’re doing that, because you can definitely overdose on vitamin D. I actually had an elderly patient who was in the hospital with vitamin D overdose. 

David: 38:21

Ooh, how much were they taking? 

Dr. Kelly: 38:22

They weren’t taking very much at all, but we had recommended narrow band UVB treatment for a skin condition I can’t remember what it was. This was a while ago and as soon as he started getting the light treatment, he overdosed. So yeah, I like how you’re doing that, it’s good. 

David: 38:43

Really big on testing yeah. 

Dr. Kelly: 38:45

Smart. 

David: 38:46

If somebody wants to get in touch with you. I know you’re in Park City, but if somebody wants to get in touch with you, how would that happen? 

Dr. Kelly: 38:53

Ooh, that’s a great question. Could they get in touch with you and you give them my information? Sure, yeah, okay. 

David: 38:59

I can do that. We’ll put them in the show notes. Okay, absolutely. And if you’re in this neck of the woods, everybody I know who’s like really knows what’s going on. I’m like, oh, kelly is their dermatologist. I’m just saying. I’m saying a lot of other physicians I know go to see you. Thanks so much for coming over. It’s so nice to see you and have someone here in person. Thank you so much I love blabbering on about random things. Thank you, absolutely. 

Dr. Kelly: 39:32

Anytime. 

David: 39:33

All right, take care now.