Transcript
Lisa Swanson: Hello, everybody, and welcome to another episode of the Type 2 Inflammation Journal Club with Practical Dermatology. I'm Lisa Swanson, thrilled to be here with a new friend, Dr. Kartono. And Dr. Kartono, tell everybody who you are.
Dr. Kartono: Hi. So I'm a private practice dermatologist and I practice medical dermatology as well as a little bit of surgical, cosmetic, and clinical trials actually too in private practice in Michigan.
Lisa Swanson: You do everything?
Dr. Kartono: A little bit.
Lisa Swanson: Yeah, which is great. That's wonderful. That's wonderful. So this article gets a little bit basic sciencey for my taste, but I tried to kind of absorb useful information from it. And so, for this episode, I have a notepad, you guys, because I needed notes. But the article was in the International Journal of Molecular Sciences, it was entitled “The Role of Oxidative Stress and Antioxidants in the Course of Atopic Dermatitis.” And while the basic science of it all was tough for me to get through, I am excited and interested in the role of oxidative stress on atopic dermatitis. I think this is very real and very important, because I have observed in Boise, Idaho, that whenever we get wildfire smoke, our eczema patients, their skin goes crazy. And so, I think that oxidative stress from the pollutants is a really big deal. Have you observed situations where oxidative stress seemed to play a role? Maybe somebody lived in a home with a smoker and the cigarette smoke was causing it. Anything that you've picked up on?
Dr. Kartono: Yeah. So I think big picture-wise, I think environmental triggers and environmentally whenever there's a lot of free radicals, our skin just gets irritable that we see anecdotally in real life. But then since I do clinical trials, then we dive into some molecular pathways and we know, for instance, a lot of the topicals that we use even aim to target free radical reduction as well. And it seems like then when the free radicals are eliminated by the use of some of these anti-inflammatory topicals, especially particular non-steroidal anti-inflammatory topicals that aim to treat atopic dermatitis, you reestablish the skin barrier.
Lisa Swanson: Yeah. Yeah. And they actually mentioned that in the article. They mentioned something called the aryl hydrocarbon receptor and that that helps reduce oxidative stress. So if you can agonize or encourage the aryl hydrocarbon receptor, you can actually fight oxidative stress. And we do have a topical called tapinarof, where that is actually its mechanism of action. And so, I read that part with great interest. I was like, "Oh, wow, here's another way to kind of explain the action of aryl hydrocarbon receptor agonizing." I don't know if that's the right... Do we call it an agonizer?
Dr. Kartono: It's an agonist.
Lisa Swanson: Agonist. An agonizist.
Dr. Kartono: Less of an enemy if you call an agonist productive.
Lisa Swanson: Yes. Yeah.
Dr. Kartono: Agonizer.
Lisa Swanson: But in the article it describes all the kind of sources for oxidative stress on our skin. Of course, environmental factors like cigarette smoke, pollutants in the air, wildfire smoke, physical sources, which they describe as being like living a stressful lifestyle. And by that definition, I'm surprised I don't have eczema.
Dr. Kartono: Me too, then.
Lisa Swanson: Things are kind of crazy. And then psychological stress actually has an impact creating oxidative stress in your skin. Isn't that kind of fascinating?
Dr. Kartono: Yeah. I think it all ties down to our ways of living as well. And so, I think then you bring in nutrition, dietary stressors too on top of the lifestyle changes. So I think if you want to go from an integrative approach, holistic approach even too, it makes even more sense. But coming from the medical point of view, for sure, molecularly it's one piece of the puzzle, but not quite the whole thing. But then if you take a step back, it seems like you can apply that theory to a lot of aspects of the patient.
Lisa Swanson: Yeah, I think you can. And I love how you mentioned nutrition, because they talked about that in the article and they particularly said that a diet where you're low in fruits and veggies and instead you have high sugar in foods, that creates more oxidative stress. They recommended even some vitamins like vitamin C and vitamin E, which have antioxidant properties, and even supplementing with coenzyme Q10 in doses that vary wildly from 60 to 1200 milligrams. I am not talking to patients about this, but I might start. Do you mention these things?
Dr. Kartono: I don't mention. As I was reading the journal too, I don't quite make a note to mention it in my atopic dermatitis patients because I already have to harp on so many things, I think.
Lisa Swanson: I know. There's a lot to cover.
Dr. Kartono: But when I see a patient for a cosmetic consult, it's one of the top three things to talk about, whether those contents are in a topical formulation or whether they're in an actual dietary part in their daily life. So yeah.
Lisa Swanson: Yeah.
Dr. Kartono: So I think I should start talking about it.
Lisa Swanson: And it's kind of interesting, because we do have topicals that contain vitamin C for rejuvenation and aging gracefully and everything. I don't know if I've seen any topicals with vitamin C for eczema and I wonder if maybe that would be a thing.
Dr. Kartono: It could, except those antioxidants, when they formulate it for the cosmetic patients, it's a double-edged sword. If they are too acidic, the pH isn't just quite right, you can embed it. For instance, ascorbic acid for sure is one that you don't want to see it in an ingredient list. I patch test a lot too for contact dermatitis. And so, when I screen through people's cosmetic ingredients, it's an antioxidant, it's potent, but the vehicle that it's in, the isomer or the formulation that you can embed it into the vehicle matters.
Lisa Swanson: Oh, interesting.
Dr. Kartono: So certain formulations of vitamin C are better than others, actually.
Lisa Swanson: Oh my gosh. I'm learning so much.
Dr. Kartono: In terms of irritation.
Lisa Swanson: Yes. I'm learning so much. My skin is so sensitive. I don't even try any of those things. I'm like, Vanicream all the way.
Dr. Kartono: Exactly. For eczema patients, I already shut it down when they want to do vitamin C, I say, "Nope."
Lisa Swanson: "No, don't do it. Keep it simple." I also thought it was interesting, they talk about key biomarkers of oxidative stress and they all have really long names. And one is urinary 8-hydroxydeoxyguanosine, one is malondialdehyde, the other one is glutathione. I've heard of that one at least. But they noted that these biomarkers actually correlate with eczema severity, which I found very interesting, that they're definitely, oxidative stress is playing a big time role and you can see that on a molecular level when you check for these things. It's really remarkable. I think this opened my eyes to the joy of diving deep into a little bit of basic science about oxidative stress. And hopefully we've helped create a dialogue in an interesting and absorbable way so that you guys took something from this. Thank you so much, Dr. Kartono.
Dr. Kartono: Thank you.
Lisa Swanson: Thank you so much. Thank you.
