WEBVTT 00:00:02.320 --> 00:00:05.080 Welcome to the Don't Be Rash Pediatric Dermatology 00:00:05.080 --> 00:00:07.679 Podcast, the owner's manual for your kid's skin. 00:00:07.839 --> 00:00:10.820 I'm your host, Dr. K, board -certified pediatric 00:00:10.820 --> 00:00:13.640 dermatologist and father of two boys. I'm here 00:00:13.640 --> 00:00:15.839 to chat with you to promote dermatological education 00:00:15.839 --> 00:00:18.859 and improve skin health in our children everywhere. 00:00:19.480 --> 00:00:29.079 Let's get started. Welcome to Don't Be Rash, 00:00:29.280 --> 00:00:31.539 the pediatric dermatology show, coming to you 00:00:31.539 --> 00:00:33.659 from historic Bethlehem, Pennsylvania. I'm your 00:00:33.659 --> 00:00:35.899 host and board -certified pediatric dermatologist, 00:00:36.060 --> 00:00:38.380 Dr. Andrew Krakowski. On today's show, we'll 00:00:38.380 --> 00:00:41.079 discuss kids and social media skin trends. As 00:00:41.079 --> 00:00:43.520 a father of two young boys myself, this topic 00:00:43.520 --> 00:00:45.920 is near and dear to my own heart. Like it or 00:00:45.920 --> 00:00:48.859 not, social media has pervaded most of our lives. 00:00:49.439 --> 00:00:51.820 Platforms like TikTok and Instagram have given 00:00:51.820 --> 00:00:55.079 birth to skincare obsessions among kids such 00:00:55.079 --> 00:00:57.280 that we have nine-year-olds using anti-aging 00:00:57.280 --> 00:01:00.420 serums and wrinkle prevention products. And if 00:01:00.420 --> 00:01:02.060 you think your kids are immune to these trends, 00:01:02.159 --> 00:01:04.620 well, then you never heard of "slugging" or the 00:01:04.620 --> 00:01:07.420 "glass skin challenge" or the extremely dangerous 00:01:07.420 --> 00:01:10.780 "fire challenge." But don't worry. Today's show 00:01:10.780 --> 00:01:12.819 will help make you better aware of these trends 00:01:12.819 --> 00:01:14.859 and hopefully give you some tools for how to 00:01:14.859 --> 00:01:16.840 deal with them. Joining us today as our guest 00:01:16.840 --> 00:01:19.120 co-host is renowned pediatric dermatologist, 00:01:19.120 --> 00:01:22.519 Dr. Sheilagh Maguiness. Dr. Maguiness is double board 00:01:22.519 --> 00:01:25.560 certified in dermatology and pediatric dermatology. 00:01:26.040 --> 00:01:28.420 In addition to having a thriving practice in 00:01:28.420 --> 00:01:30.879 Minneapolis, Minnesota, Dr. Maguiness currently 00:01:30.879 --> 00:01:33.840 serves as the Immediate Past President of the 00:01:33.840 --> 00:01:37.319 Society for Pediatric Dermatology. Like me, she's 00:01:37.319 --> 00:01:39.799 a parent to two tween boys and she's a recognized 00:01:39.799 --> 00:01:42.900 expert on, among other things, the topic of kids 00:01:42.900 --> 00:01:45.819 and social media skin trends. Welcome, Dr. Maguiness. 00:01:45.819 --> 00:01:47.790 Thanks for joining me today. Thanks for having 00:01:47.790 --> 00:01:50.150 me. So what do you say to the parent who believes 00:01:50.150 --> 00:01:51.969 that their children are not being influenced 00:01:51.969 --> 00:01:54.450 by social media platforms like TikTok and Instagram? 00:01:54.969 --> 00:01:58.010 Oh, goodness. I would say I wish that were true. 00:01:58.129 --> 00:02:01.090 But unfortunately, we have strong data to the 00:02:01.090 --> 00:02:04.370 opposite of that. You know, over the last, I 00:02:04.370 --> 00:02:06.670 would say, two to three years, we've really seen 00:02:06.670 --> 00:02:13.180 a complete rise in interest, consumer interest, 00:02:13.639 --> 00:02:17.879 sales, et cetera, of teens and tweens getting 00:02:17.879 --> 00:02:22.439 extremely into skincare and often to their detriment. 00:02:23.180 --> 00:02:26.340 What's driving the interest? Well, I think it's 00:02:26.340 --> 00:02:28.479 the proliferation of social media, you know, 00:02:28.479 --> 00:02:31.219 with TikTok and Instagram and all of the users. 00:02:31.319 --> 00:02:34.659 You know, we have Gen Alpha, which is 2 billion 00:02:34.659 --> 00:02:36.659 people. It's actually the largest generation 00:02:36.659 --> 00:02:39.479 now. So Gen Alpha, anyone born, you know, after 00:02:39.479 --> 00:02:42.699 2010, these are the kiddos that are digitally 00:02:42.699 --> 00:02:45.479 fluent, Andrew. I mean, these kids are spending, 00:02:45.479 --> 00:02:48.909 we know, based on research studies. three or 00:02:48.909 --> 00:02:53.050 over three hours a day online. And much of that 00:02:53.050 --> 00:02:56.590 is on social media platforms. So, you know, as 00:02:56.590 --> 00:02:59.289 parents, we may not want to believe that our 00:02:59.289 --> 00:03:02.069 kids are taking part in this, but they absolutely 00:03:02.069 --> 00:03:05.270 are. So one of the benefits of doing a podcast 00:03:05.270 --> 00:03:07.770 like this is to raise awareness so that parents 00:03:07.770 --> 00:03:09.870 and their tweens and teens can really have a 00:03:09.870 --> 00:03:13.590 good discussion about the good, the bad, and 00:03:13.590 --> 00:03:16.430 the ugly about social media. And in this case, 00:03:16.449 --> 00:03:19.199 how it relates to how kids are approaching skincare. 00:03:19.539 --> 00:03:22.460 What age group are we talking about mostly you 00:03:22.460 --> 00:03:25.180 seeing this affecting? I think tweens and teens 00:03:25.180 --> 00:03:28.180 for sure. And we know that based on survey data, 00:03:28.280 --> 00:03:30.319 different studies that have come out, but also 00:03:30.319 --> 00:03:34.139 market data. For example, Andrew, did you know 00:03:34.139 --> 00:03:38.639 that households with teens or tweens are outspending 00:03:38.639 --> 00:03:41.800 other households that don't have tweens or teens 00:03:41.800 --> 00:03:46.340 by two to one, specifically on skincare? So the 00:03:46.340 --> 00:03:49.680 rise in sales at popular beauty outlets is in 00:03:49.680 --> 00:03:54.300 part largely being derived from sales that are 00:03:54.300 --> 00:03:57.879 from tweens and teens who are really into this. 00:03:57.919 --> 00:03:59.860 And you just have to go on social media before 00:03:59.860 --> 00:04:03.020 you'll be served many different videos with very 00:04:03.020 --> 00:04:06.680 young so-called "skinfluencers" as young as eight 00:04:06.680 --> 00:04:10.800 years old showing. "Get Ready With Me" videos, 00:04:10.979 --> 00:04:14.199 complex, really multi -step, inappropriate skincare 00:04:14.199 --> 00:04:18.100 being used by this population driven by this 00:04:18.100 --> 00:04:21.379 phenomenon. And is there a gender breakdown? 00:04:21.639 --> 00:04:24.720 Is it heavier weighted to females versus males? 00:04:24.939 --> 00:04:27.800 Or I mean, what are you seeing? So in my practice, 00:04:27.879 --> 00:04:31.399 and maybe you'll feel the same, and I do think 00:04:31.399 --> 00:04:34.879 this is largely female driven, especially when 00:04:34.879 --> 00:04:37.319 I myself have been kind of like a little spy 00:04:37.319 --> 00:04:39.779 on social media, going into those get ready with 00:04:39.779 --> 00:04:42.959 me videos. It is mostly tween and teen girls 00:04:42.959 --> 00:04:46.180 that I think are driving this market. And that's 00:04:46.180 --> 00:04:48.139 a really interesting point, because on the one 00:04:48.139 --> 00:04:50.579 hand, we have this dichotomy where the tween 00:04:50.579 --> 00:04:53.740 girls are kind of over consuming. And we can 00:04:53.740 --> 00:04:56.649 talk about this a little later, being targeted 00:04:56.649 --> 00:05:00.009 directly by the marketing tactics of these companies. 00:05:00.470 --> 00:05:03.170 And then we have tween boys like you and I, we 00:05:03.170 --> 00:05:06.689 both are parents to tween boys who have largely 00:05:06.689 --> 00:05:09.689 been left out of this conversation. So it really 00:05:09.689 --> 00:05:12.589 is a strong dichotomy. And yes, I would say that 00:05:12.589 --> 00:05:14.730 from my experience in clinic with my tween and 00:05:14.730 --> 00:05:17.490 teen girls coming in for various skincare complaints, 00:05:17.790 --> 00:05:22.000 a lot of them are carrying a huge bag of different 00:05:22.000 --> 00:05:24.939 products that they're using, sometimes all together 00:05:24.939 --> 00:05:27.839 at the same time, which is obviously not how 00:05:27.839 --> 00:05:30.560 products are intended to be used or tested for. 00:05:30.759 --> 00:05:33.959 Of course. So for the person, the uninitiated 00:05:33.959 --> 00:05:35.800 out there, walk us through what does a "Get Ready 00:05:35.800 --> 00:05:38.660 with Me" video look like? I mean, what would you 00:05:38.660 --> 00:05:41.600 see if you were a mom or dad logging on and watching 00:05:41.600 --> 00:05:43.639 the same thing that your son or daughter presumably 00:05:43.639 --> 00:05:46.819 would be watching? Well, I have seen "Get Ready 00:05:46.819 --> 00:05:49.060 With Me" videos all the way from six-year-old 00:05:49.060 --> 00:05:52.139 girls to, you know, 18. And there are very popular 00:05:52.139 --> 00:05:56.000 beauty influencers online who have millions of 00:05:56.000 --> 00:05:58.759 followers whose videos got tens of millions of 00:05:58.759 --> 00:06:01.860 views. And a "Get Ready With Me" video is simply 00:06:01.860 --> 00:06:05.019 this influencer, whether it's a tween teen or 00:06:05.019 --> 00:06:07.980 other, showing you their skincare regimen. And 00:06:07.980 --> 00:06:10.639 that might be, you know, washing their face, 00:06:10.740 --> 00:06:13.620 putting on a variety of toners and serums and 00:06:13.620 --> 00:06:16.199 moisturizers. et cetera, and then doing their 00:06:16.199 --> 00:06:19.680 makeup, et cetera, commenting on products. But 00:06:19.680 --> 00:06:23.620 there is a really hidden kind of rule for these 00:06:23.620 --> 00:06:25.939 "Get Ready with Me" videos. And that is that a 00:06:25.939 --> 00:06:29.339 lot of times these influencers are being paid 00:06:29.339 --> 00:06:31.740 by companies to show the products. They have 00:06:31.740 --> 00:06:34.500 been gifted the products by companies. You know, 00:06:34.500 --> 00:06:37.160 there's definitely influencers as young as six 00:06:37.160 --> 00:06:41.259 who are being given product by companies to show 00:06:41.259 --> 00:06:43.639 in videos. And of course, if you're a six- to 00:06:43.639 --> 00:06:46.800 eight-year-old on a medium like TikTok or Instagram, 00:06:46.939 --> 00:06:49.139 of course, the parents are actively involved 00:06:49.139 --> 00:06:52.500 in doing that and kind of involved in this influencing 00:06:52.500 --> 00:06:55.220 journey that their child is on and helping edit 00:06:55.220 --> 00:06:57.600 the videos, participating. the video so there's 00:06:57.600 --> 00:07:00.660 lots of layers to this and they're all not necessarily 00:07:00.660 --> 00:07:04.680 good. I think you hit on the "layers" right There 00:07:04.680 --> 00:07:06.600 literally and figuratively are layers involved 00:07:06.600 --> 00:07:09.620 in this uh 20 30 products being used at one time 00:07:09.620 --> 00:07:12.040 we in your experience when you've seen these 00:07:12.040 --> 00:07:15.579 videos do most or any or all of them seem to 00:07:15.579 --> 00:07:18.740 have some level of thought behind the order of 00:07:18.740 --> 00:07:20.980 use and what each product is supposed to be doing 00:07:20.980 --> 00:07:24.319 is being applied in some logical fashion or are 00:07:24.319 --> 00:07:27.000 the people who are using these products literally 00:07:27.000 --> 00:07:28.680 just putting it on their skin without really 00:07:28.680 --> 00:07:31.560 understanding what they're doing I think it depends 00:07:31.560 --> 00:07:33.579 on the age and the credentials. Of course, we 00:07:33.579 --> 00:07:36.240 have some healthcare professionals that do "Get 00:07:36.240 --> 00:07:37.860 Ready With Me" videos, and I think there's a lot 00:07:37.860 --> 00:07:41.519 more thought behind and evidence-based thinking 00:07:41.519 --> 00:07:43.740 behind what they're doing. But, you know, for 00:07:43.740 --> 00:07:46.319 example, one of the big trends right now is called 00:07:46.319 --> 00:07:48.959 a "skincare smoothie." And if you've never heard 00:07:48.959 --> 00:07:52.079 of that, it just means that you actually squeeze 00:07:52.079 --> 00:07:54.279 out a little bit of all the products, put them 00:07:54.279 --> 00:07:56.360 in your hand or on the top of the container, 00:07:56.540 --> 00:08:00.199 and then spread them all over. your face in a 00:08:00.199 --> 00:08:02.259 way in which they weren't designed or formulated 00:08:02.259 --> 00:08:05.100 to be applied to the skin. And this is really 00:08:05.100 --> 00:08:07.319 popular and trending right now, this "smoothie." 00:08:07.699 --> 00:08:10.740 So I would say that from the tween and teen standpoint, 00:08:11.019 --> 00:08:14.899 I don't believe there is a lot of understanding 00:08:14.899 --> 00:08:17.500 about some of the active ingredients that can 00:08:17.500 --> 00:08:19.899 be extremely harsh and inappropriate for young 00:08:19.899 --> 00:08:23.699 skin. And also, you know, about the order of 00:08:23.699 --> 00:08:26.259 application. And then I don't know, Andrew, if 00:08:26.259 --> 00:08:29.079 you heard about the recent really interesting 00:08:29.079 --> 00:08:32.080 study that was published, in June, in Pediatrics, 00:08:32.120 --> 00:08:35.259 like a very reputable journal. They looked at 00:08:35.259 --> 00:08:38.159 TikTok skincare regimens that had over a million 00:08:38.159 --> 00:08:42.700 views put out by tweens and teens. And the amount 00:08:42.700 --> 00:08:45.659 of products, the expense of the products, and 00:08:45.659 --> 00:08:48.399 the repeated exposure to potential irritants 00:08:48.399 --> 00:08:52.379 and allergens just shows you that, you know, 00:08:52.379 --> 00:08:55.580 we're really doing more harm than good by applying 00:08:55.580 --> 00:08:58.919 all of these things and causing irritation and 00:08:58.919 --> 00:09:02.980 even long, lifelong contact allergies. I mean, 00:09:03.000 --> 00:09:06.330 we know just in the world of acne itself. that 00:09:06.330 --> 00:09:08.250 they're not meant to be put on together. They 00:09:08.250 --> 00:09:11.490 can inactivate one another or they can exacerbate 00:09:11.490 --> 00:09:14.370 or amplify the side effects of one another when 00:09:14.370 --> 00:09:17.970 used in sort of a concurrent fashion. And here 00:09:17.970 --> 00:09:20.350 you're just describing lumping a bunch of stuff 00:09:20.350 --> 00:09:22.309 together and rubbing it on your face. That's 00:09:22.309 --> 00:09:25.309 not going to be necessarily a good thing. No, 00:09:25.429 --> 00:09:27.549 it's going to lead to a lot of irritation and 00:09:27.549 --> 00:09:31.009 rashes. You know, the active ingredients that 00:09:31.009 --> 00:09:33.330 are available over the counter are no joke. You 00:09:33.330 --> 00:09:36.490 can buy a 10% salicylic acid serum. You can 00:09:36.490 --> 00:09:39.809 buy a 10% glycolic acid serums. All of the AHAs, 00:09:39.809 --> 00:09:42.529 the BHAs that you're putting on that literally 00:09:42.529 --> 00:09:45.210 are kind of like almost prescription strength 00:09:45.210 --> 00:09:47.850 exfoliants. And if you leave that on, you will 00:09:47.850 --> 00:09:50.370 cause an irritant or almost like a chemical burn 00:09:50.370 --> 00:09:52.710 for parents listening. So we really have to be 00:09:52.710 --> 00:09:54.929 careful and pay attention to the ingredients. 00:09:55.129 --> 00:09:58.070 Because although the bottle may be pink and... 00:09:58.090 --> 00:10:01.029 pretty and very fruity scented. And of course, 00:10:01.029 --> 00:10:03.590 that just is a nod to the aggressive and maybe 00:10:03.590 --> 00:10:06.690 predatory marketing that's going on with respect 00:10:06.690 --> 00:10:08.730 to our young people. But it's important to pay 00:10:08.730 --> 00:10:10.370 attention to what the ingredients are because 00:10:10.370 --> 00:10:12.970 some of the actives can really do a lot of harm 00:10:12.970 --> 00:10:16.710 to a teen's developing skin barrier. So what 00:10:16.710 --> 00:10:19.789 do you think the draw is? If you're a tween and 00:10:19.789 --> 00:10:22.429 you're coming home from school, long day, you're 00:10:22.429 --> 00:10:23.730 sitting at home and you have a couple minutes 00:10:23.730 --> 00:10:26.169 to yourself. What's the draw to even watch something 00:10:26.169 --> 00:10:28.110 like this? I mean, is it peer pressure? Are your 00:10:28.110 --> 00:10:31.570 friends doing it or are they trying to glean 00:10:31.570 --> 00:10:33.970 information, education? What do you think the 00:10:33.970 --> 00:10:37.870 draw is to do this in the first place? Oh, gosh, 00:10:37.970 --> 00:10:39.649 Andrew, I think there are many reasons. So first 00:10:39.649 --> 00:10:41.730 of all, this is the "selfie" generation, right? 00:10:41.809 --> 00:10:43.789 We are looking at ourselves on social media. 00:10:43.830 --> 00:10:46.789 We are posting selfies. There's a lot of influencing 00:10:46.789 --> 00:10:51.100 culture that really. basically emphasizes and 00:10:51.100 --> 00:10:54.279 prioritizes appearance and beauty think of the 00:10:54.279 --> 00:10:56.740 filters a lot of these young people are seeing 00:10:56.740 --> 00:10:59.980 themselves and others curated very carefully 00:10:59.980 --> 00:11:03.299 by a filter and so what they actually look like 00:11:03.299 --> 00:11:05.840 is really not what's being showed on the screen 00:11:05.840 --> 00:11:08.639 and i think that is fueling also this interest 00:11:08.639 --> 00:11:12.779 in beauty and maintaining a youthful appearance 00:11:12.779 --> 00:11:16.649 etc and i think it's really becoming you know, 00:11:16.649 --> 00:11:19.230 at the point of an epidemic proportion here. 00:11:19.649 --> 00:11:22.350 And obviously, we know that that can impact not 00:11:22.350 --> 00:11:25.129 only skin health, but mental health for our young 00:11:25.129 --> 00:11:27.730 tweens and teens. Do the parents know what's 00:11:27.730 --> 00:11:29.809 going on? For the most part, do we have any statistics 00:11:29.809 --> 00:11:32.250 one way or the other that parents are aware that 00:11:32.250 --> 00:11:34.970 this is what their children are (A) watching and 00:11:34.970 --> 00:11:37.929 (B) doing? Or is it, hey, whatever happens behind 00:11:37.929 --> 00:11:39.750 closed doors is what's happening? I don't know. 00:11:40.330 --> 00:11:43.429 Well, I think if your tweener teen asks you for 00:11:43.429 --> 00:11:45.909 a gift card to a popular beauty outlet and you 00:11:45.909 --> 00:11:48.669 go with them and you see what's on the shelf, 00:11:48.750 --> 00:11:50.669 you probably have a good idea. So I would say 00:11:50.669 --> 00:11:53.049 moms of tween and teen girls probably do have 00:11:53.049 --> 00:11:55.370 a good idea. This is what people are gifting 00:11:55.370 --> 00:11:58.350 each other for birthday present at parties. I 00:11:58.350 --> 00:12:01.610 mean, there's a whole culture of sleepover parties 00:12:01.610 --> 00:12:04.370 that are skincare or self-care related where 00:12:04.370 --> 00:12:06.929 kids are putting on these, you know, irritating 00:12:06.929 --> 00:12:09.610 masks that smell like watermelon and getting 00:12:09.610 --> 00:12:14.009 a rash afterwards. I mean, it's a whole movement. 00:12:14.269 --> 00:12:16.610 So I think that some parents are aware, but they 00:12:16.610 --> 00:12:20.429 might not realize what they need to say no to 00:12:20.429 --> 00:12:23.490 and what they can enthusiastically say "yes" to. 00:12:23.990 --> 00:12:26.350 You know, in the study that I mentioned that 00:12:26.350 --> 00:12:28.429 was published by Northwestern, they looked at 00:12:28.429 --> 00:12:30.230 all of these skincare regimens and, you know, 00:12:30.309 --> 00:12:34.179 only a quarter. included a sunscreen, which you 00:12:34.179 --> 00:12:36.879 and I both know is arguably the most important 00:12:36.879 --> 00:12:39.779 step when you're this young. Obviously, when 00:12:39.779 --> 00:12:42.360 you're 12 to 14 or younger, you have the most 00:12:42.360 --> 00:12:45.019 collagen you are ever going to have. So protecting 00:12:45.019 --> 00:12:47.919 that by using a broad spectrum SPF every day 00:12:47.919 --> 00:12:52.379 is, you know, the most important part of any 00:12:52.379 --> 00:12:55.360 tween and teen skincare, yet it's often not even 00:12:55.360 --> 00:12:57.730 discussed. I love kind of where we're going with 00:12:57.730 --> 00:13:00.389 this. For the person out there who's not aware 00:13:00.389 --> 00:13:02.509 of what some of these kids are talking about, 00:13:02.549 --> 00:13:04.610 can you walk us through some of the specific 00:13:04.610 --> 00:13:06.889 media trends and "challenges" that you're seeing? 00:13:07.320 --> 00:13:09.519 Sure. Well, let's take it with the sun care, 00:13:09.659 --> 00:13:11.860 basically. You know, just last year, there was 00:13:11.860 --> 00:13:16.399 a social media trend going on about how to contour 00:13:16.399 --> 00:13:19.419 your face and look very bronzed in certain areas 00:13:19.419 --> 00:13:22.519 while not in others by only selectively applying 00:13:22.519 --> 00:13:25.139 sunscreen to certain parts of your face and then 00:13:25.139 --> 00:13:27.960 tanning the rest. Obviously, a tan means that 00:13:27.960 --> 00:13:29.860 your skin has been damaged. It's not good at 00:13:29.860 --> 00:13:32.539 any age, especially not when you're young. Most 00:13:32.539 --> 00:13:35.159 significant sun exposure when you're young is 00:13:35.159 --> 00:13:39.100 what is directly caused. related to risk for 00:13:39.100 --> 00:13:41.720 skin cancer over time, let alone photo-aging 00:13:41.720 --> 00:13:46.639 and looking visibly damaged from the sun. So 00:13:46.639 --> 00:13:48.940 we certainly don't want to be selectively applying 00:13:48.940 --> 00:13:52.419 sunscreen. You and I both know there was like 00:13:52.419 --> 00:13:54.700 a "sunburn challenge" or writing your name with 00:13:54.700 --> 00:13:57.940 sunscreen to like make various, you know, designs 00:13:57.940 --> 00:14:01.100 on someone's back with selective application 00:14:01.100 --> 00:14:03.440 of sunscreen. But all of those things are really 00:14:03.440 --> 00:14:05.759 dangerous. You know, they're trending. They go. 00:14:05.929 --> 00:14:08.250 viral. Kids look at it, they think, oh, that's 00:14:08.250 --> 00:14:11.570 cool. And of course, risk-taking behaviors is 00:14:11.570 --> 00:14:14.470 really rampant at this age group. So it's one 00:14:14.470 --> 00:14:16.570 of those things where as, you know, as parents, 00:14:16.649 --> 00:14:19.730 we can kind of be aware of it and be educating 00:14:19.730 --> 00:14:22.269 kids about how to apply the sunscreen appropriately, 00:14:22.590 --> 00:14:26.230 how, you know, high the SPF should be, educating 00:14:26.230 --> 00:14:29.169 about the UV index and what exposure is the most 00:14:29.169 --> 00:14:32.750 risky, and then of course reapplying. So all 00:14:32.750 --> 00:14:35.370 of those things are great to talk about. with 00:14:35.370 --> 00:14:37.730 your teen about and open a healthy conversation 00:14:37.730 --> 00:14:40.370 by maybe talking about this trend. Your teen, 00:14:40.450 --> 00:14:42.389 you might catch your teen by surprise. They might 00:14:42.389 --> 00:14:44.690 be excited to chat with you about it. What is 00:14:44.690 --> 00:14:47.120 this "glass skin challenge" I've heard about? So 00:14:47.120 --> 00:14:50.059 glass skin is, you know, I think there's a filter 00:14:50.059 --> 00:14:53.220 for this too, where you can look extremely dewy, 00:14:53.259 --> 00:14:56.460 like your skin is shining and glowing, like you're 00:14:56.460 --> 00:14:59.279 looking in a mirror or glass. And there are various 00:14:59.279 --> 00:15:03.299 serums and actives that people tout as being 00:15:03.299 --> 00:15:07.120 able to give you this glass skin look. And, you 00:15:07.120 --> 00:15:09.700 know, again, the focus on beauty and appearance 00:15:09.700 --> 00:15:12.759 here, I think, is negative. But the ingredients 00:15:12.759 --> 00:15:15.399 for this trend are probably less harmful than 00:15:15.399 --> 00:15:17.899 others. we might talk about because I think people 00:15:17.899 --> 00:15:20.820 are using things like snail mucin or hyaluronic 00:15:20.820 --> 00:15:23.379 acid. Those are things that are humectants that 00:15:23.379 --> 00:15:25.659 plump the skin that I don't think are necessarily 00:15:25.659 --> 00:15:29.980 bad for tween skin, but certainly not necessary. 00:15:30.340 --> 00:15:32.759 We did actually publish an article a couple months 00:15:32.759 --> 00:15:36.620 ago on a girl that came in and she was having 00:15:36.620 --> 00:15:38.960 an allergic reaction around her lips. Apparently, 00:15:39.179 --> 00:15:42.519 I mean, we'd have...we had heard of snail mucin, 00:15:42.539 --> 00:15:45.419 but had not really read up on it. And one of, 00:15:45.460 --> 00:15:47.539 apparently one of the specific things you're 00:15:47.539 --> 00:15:49.720 not supposed to do is put it on mucosal surfaces. 00:15:50.039 --> 00:15:52.519 And she had been using it on her lips and she 00:15:52.519 --> 00:15:54.929 wound up getting. basically had an allergic contact 00:15:54.929 --> 00:15:58.269 dermatitis looking rash around her face in that 00:15:58.269 --> 00:16:01.870 area. And we did attribute it eventually to the 00:16:01.870 --> 00:16:03.889 snail mucin. She stopped using it and it went 00:16:03.889 --> 00:16:07.809 away and got better. So in that sense, I guess 00:16:07.809 --> 00:16:11.269 it wasn't totally benign, but it sounds grosser 00:16:11.269 --> 00:16:13.870 than it really is. So this is one I've not seen 00:16:13.870 --> 00:16:17.409 or heard of myself yet in my kids' social network. 00:16:17.590 --> 00:16:19.629 And I guess I'm oblivious when I'm walking through 00:16:19.629 --> 00:16:22.090 the aisle at Target. I'm not seeing "charcoal" 00:16:22.090 --> 00:16:25.990 out on the aisles. So I've missed this one. There's 00:16:25.990 --> 00:16:28.210 some popular brands that contain charcoal-containing 00:16:28.210 --> 00:16:31.190 cleansers, etc. And making all kinds of claims, 00:16:31.289 --> 00:16:33.370 that's another whole topic we could have today, 00:16:33.590 --> 00:16:36.029 Andrew, that you and I both know that the health, 00:16:36.070 --> 00:16:38.850 wellness, and beauty industry is not regulated 00:16:38.850 --> 00:16:41.629 by the FDA to the same scrutiny that the pharmaceutical 00:16:41.629 --> 00:16:45.190 industry is. So a lot of times when parents are 00:16:45.190 --> 00:16:47.509 trying to find guidance by looking at a bottle 00:16:47.509 --> 00:16:50.710 and seeing all these great claims that are printed 00:16:50.710 --> 00:16:54.129 right on the label, they have to know that there's 00:16:54.129 --> 00:16:56.940 really a... A strong lack of regulation here 00:16:56.940 --> 00:16:59.139 and companies really don't have to answer to 00:16:59.139 --> 00:17:01.580 anyone. They can put anything on the label. So 00:17:01.580 --> 00:17:03.799 you really do have to be very careful when you're 00:17:03.799 --> 00:17:06.480 selecting products for, you know, children. And 00:17:06.480 --> 00:17:08.720 that's true for baby care all the way up to tweens 00:17:08.720 --> 00:17:11.339 and teens. The one I get really sort of nervous 00:17:11.339 --> 00:17:13.519 about are the retinols. Can you talk a little 00:17:13.519 --> 00:17:15.059 bit about that? What's your experience seeing 00:17:15.059 --> 00:17:18.420 people use those? Oh, I mean, that's part of 00:17:18.420 --> 00:17:21.319 this whole so-called "Sephora kids" trend is that 00:17:21.319 --> 00:17:26.059 young kids are using retinol products at a very 00:17:26.059 --> 00:17:29.759 young age and doing so with the idea of maintaining 00:17:29.759 --> 00:17:31.900 a youthful appearance, you know, obviously at... 00:17:32.359 --> 00:17:34.519 ages 6 to 12, that's completely unnecessary. 00:17:35.119 --> 00:17:37.960 And of course, retinol, even over-the-counter 00:17:37.960 --> 00:17:40.220 retinols or prescription strength like we use 00:17:40.220 --> 00:17:43.700 for acne or other indications, they are very 00:17:43.700 --> 00:17:46.559 strong exfoliants and they can cause a lot of 00:17:46.559 --> 00:17:50.200 skin barrier breakdown and damage. And also, 00:17:50.319 --> 00:17:53.680 you know, that leads to an impaired skin barrier 00:17:53.680 --> 00:17:57.319 that can then be more primed when you apply other 00:17:57.319 --> 00:18:00.339 things on the skin to then develop more irritation, 00:18:00.720 --> 00:18:04.390 allergy. or even sometimes skin infections. And 00:18:04.390 --> 00:18:06.750 I have seen that in children who are using harsh 00:18:06.750 --> 00:18:10.049 exfoliating acids or retinols, yes. And then 00:18:10.049 --> 00:18:12.890 they've participated in dermablading. Do you 00:18:12.890 --> 00:18:15.210 know what this trend is? I have, but please share 00:18:15.210 --> 00:18:17.069 it with the audience just so everybody's on the 00:18:17.069 --> 00:18:19.730 same page. Yeah, so dermablading is the act of 00:18:19.730 --> 00:18:21.950 kind of removing the small vellus hairs on the 00:18:21.950 --> 00:18:25.150 face. And you can blow this, you know, kind of 00:18:25.150 --> 00:18:27.970 chalky substance onto the face and see all the 00:18:27.970 --> 00:18:30.549 tiny hairs. And then with a very sharp razor, 00:18:30.650 --> 00:18:32.859 just... like you would shave with, you actually 00:18:32.859 --> 00:18:35.319 shave the face. And people do feel like that 00:18:35.319 --> 00:18:39.019 allows them to achieve what you just talked about, 00:18:39.059 --> 00:18:42.140 this glass skin dewy finish. But at the same 00:18:42.140 --> 00:18:45.119 time, with a straight razor, you're irritating 00:18:45.119 --> 00:18:47.299 the hair follicles. You're making some small 00:18:47.299 --> 00:18:49.400 micro tears or abrasions in the skin. Of course, 00:18:49.420 --> 00:18:52.819 you can cut yourself too. And then boom, you've 00:18:52.819 --> 00:18:55.079 got an irritated face with little portals of 00:18:55.079 --> 00:18:57.940 entry for bacteria. And you can then develop 00:18:57.940 --> 00:19:01.000 impetigo. Yeah, I've definitely taken care of 00:19:01.000 --> 00:19:02.839 a couple of kids who have burned themselves with 00:19:02.839 --> 00:19:05.480 over-the-counter strength retinols, not even 00:19:05.480 --> 00:19:07.420 the prescription strength retin-A type medicines 00:19:07.420 --> 00:19:11.000 that we're talking about for acne. And when they 00:19:11.000 --> 00:19:12.880 ask about dermablading, I say it's like using 00:19:12.880 --> 00:19:14.579 a cheese grater on your face. You just can't 00:19:14.579 --> 00:19:18.099 see the damage that you're doing and try to get 00:19:18.099 --> 00:19:20.359 them to avoid doing it. But it sounds like 00:19:20.720 --> 00:19:22.740 all bets are off when you're on social media 00:19:22.740 --> 00:19:25.180 and talking about it behind a microphone or a 00:19:25.180 --> 00:19:27.539 camera. Oh, yeah. And they show themselves doing 00:19:27.539 --> 00:19:31.420 it. And with magnification, it's really interesting, 00:19:31.500 --> 00:19:34.740 but also very damaging. What do you see as the 00:19:34.740 --> 00:19:36.759 role of the pediatric dermatologist in all of 00:19:36.759 --> 00:19:39.059 this? Other than the direct - obviously - "we're 00:19:39.059 --> 00:19:40.740 there to answer your questions when you see us." 00:19:40.779 --> 00:19:43.779 But have you taken more of an advocacy position 00:19:43.779 --> 00:19:46.180 here at all? Or do you see us maybe doing that? 00:19:46.680 --> 00:19:49.039 So I think there are two ways to do this, one 00:19:49.039 --> 00:19:51.220 of which is what's happening right now with us 00:19:51.220 --> 00:19:53.400 discussing this and giving parents, you know, 00:19:53.400 --> 00:19:57.339 a real good education from two, you know, board 00:19:57.339 --> 00:19:59.480 certified experts who see it all the time. So 00:19:59.480 --> 00:20:02.420 this is a great way to help educate. You can 00:20:02.420 --> 00:20:04.500 do it on an individual basis in clinic. As I 00:20:04.500 --> 00:20:07.039 mentioned, I have these young girls come in with 00:20:07.039 --> 00:20:09.440 all of these products. And guess what we're doing? 00:20:09.579 --> 00:20:13.160 Every single time we are paring it down. And 00:20:13.160 --> 00:20:15.720 so telling parents what they can say yes to. 00:20:16.079 --> 00:20:19.039 So you can say yes to a gentle cleanser. You 00:20:19.039 --> 00:20:21.720 can say yes to a moisturizer. And you definitely 00:20:21.720 --> 00:20:25.200 want to enthusiastically say yes to sunscreen, 00:20:25.480 --> 00:20:28.839 SPF. So those are the real backbones of any skincare 00:20:28.839 --> 00:20:31.779 regimen for myself, for you, and for our tweens 00:20:31.779 --> 00:20:34.539 and teens. But guess what the surveys tell us 00:20:34.539 --> 00:20:37.039 that they're actually buying in all of these 00:20:37.039 --> 00:20:40.390 beauty outlets? It's actually treatment and toners. 00:20:40.390 --> 00:20:43.829 That's the highest number of products. Yes, sunscreen 00:20:43.829 --> 00:20:46.430 doesn't even make the list, Andrew. So this is 00:20:46.430 --> 00:20:48.529 our opportunity. I knew sunscreen wasn't on there. 00:20:48.910 --> 00:20:52.730 I mean, you know, that's probably not surprising. 00:20:52.769 --> 00:20:55.410 But toners and a nine-year-old, geez, like, 00:20:55.470 --> 00:21:00.609 wow, okay. Toners, yes. Exactly. Toners and treatments 00:21:00.609 --> 00:21:02.910 and serums. Those are the top categories for 00:21:02.910 --> 00:21:05.890 retail sales over the counter. And it's driving 00:21:05.890 --> 00:21:08.190 billions of dollars of growth in the industry. 00:21:08.369 --> 00:21:11.390 And guess who's taking notice of it? The brands, 00:21:11.609 --> 00:21:14.589 right? So then all of a sudden, these techniques 00:21:14.589 --> 00:21:17.069 of aggressive and I would even venture to say 00:21:17.069 --> 00:21:19.529 predatory marketing to tweens and teens where 00:21:19.529 --> 00:21:23.089 they know they can get you. And part of that 00:21:23.089 --> 00:21:27.930 is blurring the line between education. and marketing 00:21:27.930 --> 00:21:31.390 or entertainment and marketing. But that's really 00:21:31.390 --> 00:21:34.470 getting very fuzzy out there. And our tweens 00:21:34.470 --> 00:21:36.190 and teens don't know how to spot the difference, 00:21:36.410 --> 00:21:38.829 right? So that's where we need to have a great 00:21:38.829 --> 00:21:41.210 conversation about them. And as parents, you 00:21:41.210 --> 00:21:43.390 could ask them, hey, what are you seeing? Have 00:21:43.390 --> 00:21:46.009 you seen a "Get Ready With Me" video? Let's critically 00:21:46.009 --> 00:21:48.470 appraise this video together. Why do you think 00:21:48.470 --> 00:21:50.630 she's using all of these pink, fruity-scented 00:21:50.630 --> 00:21:54.250 products that cost $120? Where do you think she 00:21:54.250 --> 00:21:57.119 got them from? Teach them to look down at the 00:21:57.119 --> 00:21:59.720 video and see if it's an ad or a paid partnership 00:21:59.720 --> 00:22:02.259 or if they're tagging the companies in their 00:22:02.259 --> 00:22:05.079 videos. And use it as an opportunity to tell 00:22:05.079 --> 00:22:08.519 the kiddos, hey, just have a degree, an index 00:22:08.519 --> 00:22:10.819 of suspicion when you're watching these. Are 00:22:10.819 --> 00:22:12.680 they actually trying to tell you something that's 00:22:12.680 --> 00:22:15.339 good for you? Or are they being paid to show 00:22:15.339 --> 00:22:17.900 you this content? Most of the conversations, 00:22:18.079 --> 00:22:21.240 if not all, that I've had around this topic in 00:22:21.240 --> 00:22:26.319 the clinic usually were prompted by dads asking 00:22:26.319 --> 00:22:30.279 me, does my daughter really need to use all this 00:22:30.279 --> 00:22:33.160 stuff? I haven't really noticed moms asking me 00:22:33.160 --> 00:22:35.700 that, maybe because they've already weeded out 00:22:35.700 --> 00:22:39.980 what they feel is good or useful and aren't bothering 00:22:39.980 --> 00:22:42.940 me with the questions. But dads will do it. I've 00:22:42.940 --> 00:22:47.980 found them to be very receptive for the scaling 00:22:47.980 --> 00:22:50.420 down for one good reason. It's going to save 00:22:50.420 --> 00:22:54.599 them about 200 bucks a month, right? They are 00:22:54.599 --> 00:22:57.579 very happy to hear that they don't need their 00:22:57.579 --> 00:23:01.819 daughters using 100 products...that maybe two or 00:23:01.819 --> 00:23:04.559 three would suffice. And ultimately, I think 00:23:04.559 --> 00:23:06.660 I've had some of the kids kind of smile and say, 00:23:06.779 --> 00:23:09.539 "Oh, that's good to know as well. I can use my 00:23:09.539 --> 00:23:14.559 money better elsewhere!" How do you bring up the 00:23:14.559 --> 00:23:18.259 topic of enrolling the parents in this process 00:23:18.259 --> 00:23:20.799 of getting them educated about this and maybe 00:23:20.799 --> 00:23:24.140 peeling back a little bit? Well, I think it's 00:23:24.140 --> 00:23:27.180 a really nice opportunity to talk about what 00:23:27.180 --> 00:23:29.500 is healthy hygiene habits. And isn't it great 00:23:29.500 --> 00:23:31.819 that your child is interested and wants to start 00:23:31.819 --> 00:23:35.269 early, right? And we know that the girls are 00:23:35.269 --> 00:23:37.930 looking to mom because mom is modeling this for 00:23:37.930 --> 00:23:40.690 them. Mom is using her cleanser, her moisturizer, 00:23:40.930 --> 00:23:43.309 her whatever serum. So the little girls are getting 00:23:43.309 --> 00:23:46.029 that modeled for them by mom and often will even 00:23:46.029 --> 00:23:48.789 borrow from mom to use their products or, you 00:23:48.789 --> 00:23:50.549 know, kind of use that as a jumping off point. 00:23:50.710 --> 00:23:54.470 But then, you know, in clinic or, you know, with 00:23:54.470 --> 00:23:56.710 educating moms to say, you know what, your skin 00:23:56.710 --> 00:23:59.230 doesn't need this yet. Here's what we can do. 00:23:59.289 --> 00:24:02.569 We can go together and you can actively participate. 00:24:02.569 --> 00:24:04.970 Participate with me and we will pick out a good, 00:24:05.069 --> 00:24:08.630 safe, and really appropriate, age-appropriate 00:24:08.630 --> 00:24:10.609 skincare regimen together. That's kind of a nice 00:24:10.609 --> 00:24:14.269 bonding experience for them to do. And then for 00:24:14.269 --> 00:24:16.470 the dads, you're right. Of course, they don't 00:24:16.470 --> 00:24:18.609 want, you know, to be spending all this money 00:24:18.609 --> 00:24:20.730 having their kids use all these expensive products 00:24:20.730 --> 00:24:23.309 when they're literally making problems for their 00:24:23.309 --> 00:24:26.769 skin and not helping at all. In fact, it is detrimental. 00:24:26.849 --> 00:24:29.630 And that's what the big study in pediatrics showed 00:24:29.630 --> 00:24:32.269 us. But this is a nice time to say, hey, you 00:24:32.269 --> 00:24:35.470 know, get the dads involved and say, hey, you 00:24:35.470 --> 00:24:38.109 know, what do you think a healthy hygiene habit? 00:24:38.519 --> 00:24:42.960 starts with and getting those boys to start washing 00:24:42.960 --> 00:24:45.599 their face or taking more showers or just taking 00:24:45.599 --> 00:24:48.680 more of an interest because it is really important 00:24:48.680 --> 00:24:51.980 to start good hygiene practices early. And self 00:24:51.980 --> 00:24:55.119 -care is a really important thing for both young 00:24:55.119 --> 00:24:57.000 boys and girls. So we need to make sure that 00:24:57.000 --> 00:25:00.319 we're getting it across in both avenues. How 00:25:00.319 --> 00:25:04.000 do you broach the topic to the patient, the tween, 00:25:04.000 --> 00:25:06.859 without pushing? too much so that you're starting 00:25:06.859 --> 00:25:09.059 to get them to worry about their own self -esteem 00:25:09.059 --> 00:25:11.140 or, you know, there's that balance, right? So 00:25:11.140 --> 00:25:13.940 how do you involve them more directly in the 00:25:13.940 --> 00:25:15.859 process of understanding what's important and 00:25:15.859 --> 00:25:18.140 what's not and kind of getting them to understand 00:25:18.140 --> 00:25:20.740 that there is a fine line maybe between going 00:25:20.740 --> 00:25:23.460 overboard and now you've kind of gotten yourself 00:25:23.460 --> 00:25:26.519 into some trouble psychologically. Yeah, I think 00:25:26.519 --> 00:25:29.640 when that population shows up with a big bag 00:25:29.640 --> 00:25:31.980 of products and you have that opportunity to 00:25:31.980 --> 00:25:35.160 pare down and to educate and to show them that 00:25:35.160 --> 00:25:38.779 and teach them that repeatedly exposing your 00:25:38.779 --> 00:25:41.160 skin to these potential irritants and allergens 00:25:41.160 --> 00:25:44.099 over and over again is going to make you potentially 00:25:44.099 --> 00:25:46.460 allergic to some of these ingredients for the 00:25:46.460 --> 00:25:48.200 rest of your life. That's a really important 00:25:48.200 --> 00:25:51.339 thing to hone in on because a lot of the products 00:25:51.339 --> 00:25:55.009 have. fragrance, essential oils, harsh botanical 00:25:55.009 --> 00:25:58.390 ingredients. And so telling the kids and they 00:25:58.390 --> 00:26:00.710 will know, Andrew, they know the ingredients. 00:26:00.769 --> 00:26:03.589 So you can name it by name and it will give you 00:26:03.589 --> 00:26:06.150 amazing street cred with your tween and teen 00:26:06.150 --> 00:26:08.849 patients. If you can say, you know, here's what 00:26:08.849 --> 00:26:11.130 you need and here's what's safe for you. You 00:26:11.130 --> 00:26:13.309 know, it's okay to use a glycerin. It's okay 00:26:13.309 --> 00:26:15.730 to use like a petrolatum for slugging. It's okay 00:26:15.730 --> 00:26:19.309 to use, you know, certain ingredients, but it's 00:26:19.309 --> 00:26:22.769 not okay to use harsh exfoliating acids or retinols 00:26:22.769 --> 00:26:26.200 right now. Maybe save if you want to splurge 00:26:26.200 --> 00:26:29.240 on something really fancy that you've seen. Maybe 00:26:29.240 --> 00:26:31.539 that's the time to splurge on sunscreen. And 00:26:31.539 --> 00:26:34.759 that's what parents can say yes to. Yeah, I totally 00:26:34.759 --> 00:26:36.619 agree. Since you brought it up, do you want to 00:26:36.619 --> 00:26:40.210 explain what "slugging" is? Of course. Actually, 00:26:40.250 --> 00:26:42.609 in dermatology, we've got to say that we are 00:26:42.609 --> 00:26:45.450 big fans of slugging. So slugging is the act 00:26:45.450 --> 00:26:47.609 of putting like a thick, thick occlusive moisturizer 00:26:47.609 --> 00:26:50.369 on your skin, most commonly a petrolatum -based, 00:26:50.430 --> 00:26:53.769 so plain Vaseline or Aquaphor, et cetera, to 00:26:53.769 --> 00:26:56.569 try to trap water in and, again, achieve what 00:26:56.569 --> 00:26:59.589 people would call that glass skin type of appearance. 00:26:59.829 --> 00:27:03.329 And it can be very, very nice to help restore 00:27:03.329 --> 00:27:05.430 the skin barrier. We use this technique actually 00:27:05.430 --> 00:27:07.990 a lot in our kids with eczema and dry skin. sensitive 00:27:07.990 --> 00:27:10.869 skin. We usually call it the "soak and smear" technique, 00:27:11.009 --> 00:27:13.569 but slugging is certainly what's trending online. 00:27:14.650 --> 00:27:17.750 Yeah. Now, speaking of trending online, there's 00:27:17.750 --> 00:27:20.170 a little bit of a darker side to this. And it 00:27:20.170 --> 00:27:22.750 wasn't just a recent phenomenon. This is something 00:27:22.750 --> 00:27:25.269 that we've heard over the last 10, 15 years. 00:27:25.390 --> 00:27:28.430 Things have, quote unquote, gone viral. And there 00:27:28.430 --> 00:27:30.029 are these challenges that I'm talking about. 00:27:30.190 --> 00:27:32.690 Are you familiar with what I'm referring to? 00:27:33.699 --> 00:27:36.940 Yes, absolutely. Risk-taking behavior and challenges 00:27:36.940 --> 00:27:41.059 have definitely percolated and gained momentum 00:27:41.059 --> 00:27:44.420 on social media for sure. And always seems like 00:27:44.420 --> 00:27:46.519 there's a new one. I mean, that's the bummer. 00:27:46.539 --> 00:27:48.759 Someone can come up with something crazier or 00:27:48.759 --> 00:27:51.700 more dangerous to do. But the ones that I wanted 00:27:51.700 --> 00:27:53.500 to share with the audience and make sure that 00:27:53.500 --> 00:27:55.779 people are aware that they're out there were 00:27:55.779 --> 00:27:58.740 ones that I've actually seen myself. So are you 00:27:58.740 --> 00:28:00.900 familiar with the "Salt Ice Challenge?" I sure 00:28:00.900 --> 00:28:03.599 am. Yep. Okay. Can you explain what that is? 00:28:03.700 --> 00:28:06.180 Oh, goodness. So this is where teens will... 00:28:06.180 --> 00:28:07.940 You might not be able to explain it because it 00:28:07.940 --> 00:28:12.339 makes zero sense to do it. I know. Well, I think 00:28:12.339 --> 00:28:15.240 that the challenge of pain and how long you can 00:28:15.240 --> 00:28:17.400 tolerate something is sort of a common theme 00:28:17.400 --> 00:28:19.700 to several of these. And there are some similarities. 00:28:19.880 --> 00:28:23.599 So the salt ice challenge is when the kids will 00:28:23.599 --> 00:28:26.460 put salt on the skin. And having salt on the 00:28:26.460 --> 00:28:29.599 skin lowers the freezing point of water. And 00:28:29.599 --> 00:28:32.200 if you put an ice cube on, you will rapidly 00:28:32.200 --> 00:28:34.900 achieve lower temperatures than you would with 00:28:34.900 --> 00:28:37.000 just a regular ice cube. And of course, that 00:28:37.000 --> 00:28:40.819 results in a frostbite kind of burn injury to 00:28:40.819 --> 00:28:44.480 the skin. We've all been in - many pediatric dermatologists 00:28:44.480 --> 00:28:46.359 have been in - the emergency room asked to look 00:28:46.359 --> 00:28:49.680 at these very geographic type burns with blistering. 00:28:49.700 --> 00:28:51.680 And then if you, you know, probe a little further, 00:28:51.819 --> 00:28:54.599 you might find that this is an "external job" from 00:28:54.599 --> 00:28:57.319 our salt ice challenge. And it's similar to the 00:28:57.319 --> 00:28:59.299 "deodorant challenge," if parents don't know about 00:28:59.299 --> 00:29:02.000 that one. But that's when you hold an aerosolized 00:29:02.000 --> 00:29:04.160 deodorant, which does have accelerators and different 00:29:04.160 --> 00:29:06.839 chemicals that are quite cold, very, very close 00:29:06.839 --> 00:29:09.319 to the skin. And again, you're basically inducing 00:29:09.319 --> 00:29:12.119 a thermal injury that way. Those ones look circular 00:29:12.119 --> 00:29:14.799 because, of course, the diameter of the spray. 00:29:15.079 --> 00:29:17.000 But that's another one that's out there, too. 00:29:17.059 --> 00:29:20.380 And those two are quite similar. Another painful 00:29:20.380 --> 00:29:22.660 one that gives you a hint because it's a geometric 00:29:22.660 --> 00:29:24.819 pattern you often are looking at sort of in a 00:29:24.819 --> 00:29:27.920 rectangle is the "eraser challenge" where, as 00:29:27.920 --> 00:29:31.220 I understand it - and we wrote this up a couple 00:29:31.220 --> 00:29:34.140 of years ago, it was back in San Diego. There 00:29:34.140 --> 00:29:37.099 were, pardon the pun, a rash of kids who were 00:29:37.099 --> 00:29:41.140 taking. school erasers and just grinding it into 00:29:41.140 --> 00:29:43.480 their skin until they basically peeled off the 00:29:43.480 --> 00:29:46.140 top layer of the epidermis, maybe even down into 00:29:46.140 --> 00:29:48.099 the dermis a little bit. They definitely could 00:29:48.099 --> 00:29:50.440 get scarring. That was one of the big risks. 00:29:50.559 --> 00:29:54.960 You won the challenge by going. longer and deeper 00:29:54.960 --> 00:29:58.019 and harder than the guy or gal you were competing 00:29:58.019 --> 00:30:00.619 against. So I remember we ended the article by 00:30:00.619 --> 00:30:03.359 saying there were no winners in the eraser challenge. 00:30:04.180 --> 00:30:07.180 There aren't. And I think our tweens and teens 00:30:07.180 --> 00:30:09.519 don't realize that what they're doing can cause, 00:30:09.660 --> 00:30:13.059 you know, a really deep abrasion, erosion. Even 00:30:13.059 --> 00:30:14.720 if they get into the dermis, they can have a 00:30:14.720 --> 00:30:17.440 scar. And that, of course, the post-inflammatory 00:30:17.440 --> 00:30:20.480 changes to the skin, whether it's hypo- or hyper-pigmentation, 00:30:20.680 --> 00:30:24.180 can last for years. they may carry around these 00:30:24.180 --> 00:30:26.200 wounds with them for a very, very long time. 00:30:26.420 --> 00:30:30.279 Yeah, this is a definite example of a couple 00:30:30.279 --> 00:30:33.200 of split seconds of bad decision you might be 00:30:33.200 --> 00:30:35.700 having to carry around for a lifetime. Have you 00:30:35.700 --> 00:30:37.859 heard of the "tooth filing" challenge? The tooth 00:30:37.859 --> 00:30:40.259 filing one is really upsetting because, of course, 00:30:40.299 --> 00:30:43.529 if you file down a permanent tooth, that... that's 00:30:43.529 --> 00:30:45.990 for life that's permanent unless you get a cap 00:30:45.990 --> 00:30:49.730 on and so yes some kind of like desire to make 00:30:49.730 --> 00:30:52.609 the teeth more pointy using a very coarse nail 00:30:52.609 --> 00:30:56.410 file and filing the teeth into a point is definitely 00:30:56.410 --> 00:30:59.490 something that has been on tiktok and going around 00:30:59.490 --> 00:31:03.730 and obviously This is one of the more detrimental 00:31:03.730 --> 00:31:06.390 challenges out there because it's so long term. 00:31:06.650 --> 00:31:09.769 And also when you file the enamel off the teeth, 00:31:09.829 --> 00:31:11.690 you can have a whole host of dental problems 00:31:11.690 --> 00:31:13.809 down the road. So this is something that is really 00:31:13.809 --> 00:31:17.490 not a good thing to do. And we would hope that 00:31:17.490 --> 00:31:20.190 it doesn't gain any more momentum than it already 00:31:20.190 --> 00:31:23.190 has. Yeah, that one's crazy. I mean, you would 00:31:23.190 --> 00:31:25.650 think as a parent that you would be able to spot 00:31:25.650 --> 00:31:29.089 that. But the problem is by the time you see 00:31:29.089 --> 00:31:31.170 it, the damage has been done. You can't reverse 00:31:31.170 --> 00:31:34.309 that. So...totally nuts! How about the "fire challenge?" 00:31:34.490 --> 00:31:37.069 Have you heard of that one? I haven't seen it, 00:31:37.130 --> 00:31:39.890 but I guess setting fire to flammable liquids 00:31:39.890 --> 00:31:42.150 on the skin. I mean, that's, again, like a recipe 00:31:42.150 --> 00:31:44.549 for a complete disaster. Yeah, I've seen videos 00:31:44.549 --> 00:31:47.430 of this on YouTube where kids do this. They'll 00:31:47.430 --> 00:31:50.650 put something on. Actually, the one that I did, 00:31:50.940 --> 00:31:54.319 do remember seeing was DEET, the insect repellent 00:31:54.319 --> 00:31:57.099 that we do, or at least I do recommend. Was it 00:31:57.099 --> 00:31:59.440 an alcohol base maybe? Yeah, it's, it is flammable. 00:31:59.480 --> 00:32:01.200 And there were, and there were a couple challenges 00:32:01.200 --> 00:32:03.799 around, you know, being near a campfire with 00:32:03.799 --> 00:32:05.799 your DEET on and what you could do with it. So 00:32:05.799 --> 00:32:11.490 that's nuts. Oh my goodness. Right. The good 00:32:11.490 --> 00:32:14.490 news is conversations like this, not all social 00:32:14.490 --> 00:32:17.450 media is bad. I mean, we can actually use this 00:32:17.450 --> 00:32:20.490 as a as a foothold for educating our patients, 00:32:20.569 --> 00:32:23.089 educating our families. Right. You know, is there 00:32:23.089 --> 00:32:26.349 any sort of regulations that you would like to 00:32:26.349 --> 00:32:29.890 see put in place as an advocate? Or what can 00:32:29.890 --> 00:32:32.670 we do at a higher level to prevent kind of this 00:32:32.670 --> 00:32:36.109 some of these crazy things? Well, we did talk 00:32:36.109 --> 00:32:38.720 about. the general lack of regulation in health, 00:32:38.740 --> 00:32:41.839 wellness, and beauty. And luckily, people are 00:32:41.839 --> 00:32:44.259 starting to take notice and want to do better. 00:32:44.299 --> 00:32:47.400 For example, I think just a few months ago in 00:32:47.400 --> 00:32:50.220 California, there was a bill that was proposed 00:32:50.220 --> 00:32:53.299 that would actually ban the sales of these kind 00:32:53.299 --> 00:32:56.359 of anti-aging ingredients to teens and tweens 00:32:56.359 --> 00:32:58.799 or anyone under 18. Now, I'm not sure if that 00:32:58.799 --> 00:33:02.259 will pass or how practical it would be to obtain 00:33:02.259 --> 00:33:05.420 ID at any of these retailers, but at least we 00:33:05.420 --> 00:33:10.210 have... some health policymakers taking notice. 00:33:10.549 --> 00:33:14.190 And one of the biggest advancements we had, actually, 00:33:14.210 --> 00:33:16.789 Andrea, was the development of MOCRA. Are you 00:33:16.789 --> 00:33:18.849 familiar with that? It's called the Modernization 00:33:18.849 --> 00:33:21.650 of Cosmetics Regulation Act, and it was signed 00:33:21.650 --> 00:33:23.950 into law by the Biden administration in 2023. 00:33:24.470 --> 00:33:28.109 And that was really a first step at getting more 00:33:28.109 --> 00:33:30.730 regulatory authority into the hands of the FDA. 00:33:30.930 --> 00:33:33.529 Because before that, before MOCRA was signed 00:33:33.529 --> 00:33:36.579 into law, you know, Companies were not mandated 00:33:36.579 --> 00:33:39.660 to remove products from the shelf, even if they 00:33:39.660 --> 00:33:43.160 were dangerous or had, you know, multiple adverse 00:33:43.160 --> 00:33:45.619 events, you know, with them. And the FDA did 00:33:45.619 --> 00:33:49.000 not have legal jurisdiction to make companies 00:33:49.000 --> 00:33:52.220 have recalls of products that were unsafe. Now 00:33:52.220 --> 00:33:55.759 that's changed. They do. But there's still so 00:33:55.759 --> 00:33:58.599 much of what I like to call the Wild West out 00:33:58.599 --> 00:34:01.960 there in the beauty industry where, you know, 00:34:01.980 --> 00:34:04.420 we have unregulated claim making, unethical. 00:34:04.430 --> 00:34:07.309 marketing practices. We have, you know, facilities 00:34:07.309 --> 00:34:09.829 and manufacturers who may not even be registered 00:34:09.829 --> 00:34:12.010 with the FDA. So there's a lot of cleaning up 00:34:12.010 --> 00:34:14.550 that we need to do. And so drawing attention 00:34:14.550 --> 00:34:16.849 to it and raising awareness is really important 00:34:16.849 --> 00:34:20.010 so that if people feel so, you know, politically 00:34:20.010 --> 00:34:22.710 inclined, they might be, you know, able to bring 00:34:22.710 --> 00:34:26.909 this up with one of their representatives. So 00:34:26.909 --> 00:34:29.469 that's definitely one way to approach, you know, 00:34:29.489 --> 00:34:32.090 the lack of regulation. Another is education. 00:34:32.449 --> 00:34:35.969 So you and I both know that pediatric dermatology 00:34:35.969 --> 00:34:39.010 is a very tiny subspecialty of medicine, right? 00:34:39.150 --> 00:34:42.429 So there's only 400 of us board-certified pediatric 00:34:42.429 --> 00:34:45.389 dermatologists in the whole country practicing. 00:34:45.789 --> 00:34:49.889 And we can do a lot of good in clinic, but we 00:34:49.889 --> 00:34:53.369 also need to kind of battle misinformation and 00:34:53.369 --> 00:34:57.329 provide educational assets to patients and families 00:34:57.329 --> 00:34:59.880 in a variety of settings. And that's one of the 00:34:59.880 --> 00:35:02.219 reasons why I myself actually started a social 00:35:02.219 --> 00:35:05.199 media presence. So I am on TikTok. I am on Instagram. 00:35:05.659 --> 00:35:08.780 But in my work with the Society for Pediatric 00:35:08.780 --> 00:35:12.219 Dermatology, we've created a wonderful page filled 00:35:12.219 --> 00:35:15.159 with helpful resources for patients, families, 00:35:15.300 --> 00:35:17.940 and even primary care providers who may not have 00:35:17.940 --> 00:35:20.480 as much experience. So giving that education, 00:35:20.820 --> 00:35:23.639 getting it out there, making it free and accessible 00:35:23.639 --> 00:35:26.400 and easy to digest, that's a really important 00:35:26.400 --> 00:35:28.340 way that we can start. to make a difference. 00:35:28.639 --> 00:35:31.000 I totally agree. And it's not just having the 00:35:31.000 --> 00:35:34.280 resources to educate, it's having the time. And 00:35:34.280 --> 00:35:36.539 I mean, let's be honest, you have to have the 00:35:36.539 --> 00:35:40.340 conversation 20, 30 times before you can get 00:35:40.340 --> 00:35:43.079 it into a... a package that's just efficient 00:35:43.079 --> 00:35:45.800 enough to reach either the patient or the parent 00:35:45.800 --> 00:35:48.699 of that patient in the 10 or 15 minutes that 00:35:48.699 --> 00:35:51.800 we get for a skin visit, let alone the pediatrician 00:35:51.800 --> 00:35:53.980 who's trying to do, you know, head to toe care 00:35:53.980 --> 00:35:58.659 on a kid - vaccines, development, etc.. They don't have 00:35:58.659 --> 00:36:01.260 the time for that. So I love it that the patient 00:36:01.260 --> 00:36:04.119 handouts and all the resources that the Society 00:36:04.119 --> 00:36:07.639 for Pediatric Dermatology has out there are invaluable, 00:36:07.920 --> 00:36:12.510 I think, for. that mission um you'd like to think 00:36:12.510 --> 00:36:15.389 or at least i would like to think that geez the 00:36:15.389 --> 00:36:18.789 answer here is just educating the kids but i 00:36:18.789 --> 00:36:21.920 i mean just thinking of my own boys right I get 00:36:21.920 --> 00:36:24.340 them alone and I can see that there's a message 00:36:24.340 --> 00:36:26.500 that's received, right? But then they get in 00:36:26.500 --> 00:36:28.300 with their three or four other friends and it's 00:36:28.300 --> 00:36:31.059 like all of the social mores and norms that we've 00:36:31.059 --> 00:36:33.940 tried to impress on them can go right out the 00:36:33.940 --> 00:36:37.119 window pretty quickly in the group. So I don't 00:36:37.119 --> 00:36:39.440 - I hear that. You get what I'm saying? So I'm 00:36:39.440 --> 00:36:42.739 not sure if it's gonna come down to just, is 00:36:42.739 --> 00:36:48.179 it simple as teaching confidence and self -perception? 00:36:48.760 --> 00:36:50.760 Yes, I'm sure that's part of it. But for me, 00:36:50.920 --> 00:36:54.179 the real answer is, and you've sort of alluded 00:36:54.179 --> 00:36:58.530 to it, is trying to become. partners with maybe 00:36:58.530 --> 00:37:01.809 the platforms that are kind of the most guilty, 00:37:01.949 --> 00:37:05.849 Facebook, Instagram, TikTok. To me, that's where 00:37:05.849 --> 00:37:08.769 we're going to have to have some discussion, 00:37:09.090 --> 00:37:11.489 some partnership. And I'm using that word very 00:37:11.489 --> 00:37:13.769 specifically because there'll be a quid pro quo 00:37:13.769 --> 00:37:17.050 there. But there has to be some level of trying 00:37:17.050 --> 00:37:19.590 to do better for these kids in terms of what 00:37:19.590 --> 00:37:22.530 messages they get. I'm involved in a project 00:37:22.530 --> 00:37:27.219 slightly related to this. It's regarding... Minors, 00:37:27.219 --> 00:37:30.840 so under the age of 18 years of age for the most 00:37:30.840 --> 00:37:34.639 part, who are seeking elective cosmetic procedures. 00:37:34.880 --> 00:37:37.000 And there's some guidelines that we're putting 00:37:37.000 --> 00:37:41.239 together. Murad Alam and Kristen Kelly were working 00:37:41.239 --> 00:37:43.199 on this. Yeah, it's an important project. I'm 00:37:43.199 --> 00:37:44.940 aware of it. Thank you for the work you're doing. 00:37:45.079 --> 00:37:48.300 Society for Peds Derm has supported it. And I 00:37:48.300 --> 00:37:51.519 was surprised. This was not something I knew 00:37:51.519 --> 00:37:54.940 going into the project, but someone did a... 00:37:56.240 --> 00:37:58.320 research literally like i guess a little secret 00:37:58.320 --> 00:38:01.159 investigative they went undercover as an underage 00:38:01.159 --> 00:38:04.420 under 18 years of age woman on Facebook open 00:38:04.420 --> 00:38:08.460 an account put a few blogs in about how she, as 00:38:08.460 --> 00:38:11.039 the undercover agent, was concerned about how 00:38:11.039 --> 00:38:13.539 her nose looked and i think - i want to quote this - 00:38:13.539 --> 00:38:17.619 in, in less than four hours she had an ad come 00:38:17.619 --> 00:38:20.800 to her from a plastic surgeon willing to do the 00:38:20.800 --> 00:38:23.699 nose surgery...the nose job... the rhinoplasty 00:38:24.590 --> 00:38:27.110 Wow. You know, that's scary. That's pretty scary. 00:38:27.369 --> 00:38:29.809 And geez, could we do better than that? Right. 00:38:29.849 --> 00:38:32.170 I mean, that seems to me such an easy technological 00:38:32.170 --> 00:38:35.309 fix. You can't get these ads if you're under 00:38:35.309 --> 00:38:38.309 this age. And it's just not happening because 00:38:38.309 --> 00:38:40.010 I think you hit the nail on the head. There's 00:38:40.010 --> 00:38:43.199 too much money involved in it. There's huge money 00:38:43.199 --> 00:38:46.800 involved. Yeah. And the techniques are very, 00:38:46.880 --> 00:38:50.280 very sophisticated for how they know who the 00:38:50.280 --> 00:38:53.139 person is, the content that that user is creating, 00:38:53.219 --> 00:38:57.500 and then have the exact ads targeted to that 00:38:57.500 --> 00:39:00.300 exact population. So they know that the yield 00:39:00.300 --> 00:39:02.579 is going to be really high for the next click 00:39:02.579 --> 00:39:06.530 or the next purchase. Yeah, and it's a constantly 00:39:06.530 --> 00:39:09.829 moving target. I mean, as these platforms change, 00:39:10.130 --> 00:39:12.630 we went from Facebook to Instagram to TikTok 00:39:12.630 --> 00:39:15.710 as sort of being the source of information that 00:39:15.710 --> 00:39:17.449 the population we're talking about, at least, 00:39:17.449 --> 00:39:19.969 is getting their messaging from. That's going 00:39:19.969 --> 00:39:21.349 to change, right? Who knows what it's going to 00:39:21.349 --> 00:39:23.630 be next? What role does artificial intelligence 00:39:23.630 --> 00:39:27.489 play? I mean, right now, I don't know if you 00:39:27.489 --> 00:39:30.809 use AI at all in your life, but I still am kind 00:39:30.809 --> 00:39:33.670 of in the realm of where I'll use it more as 00:39:33.670 --> 00:39:38.300 a more evolved Google search, right? If I want 00:39:38.300 --> 00:39:41.239 to dive deep into a topic I'll use, I could see 00:39:41.239 --> 00:39:43.500 that being very helpful in certain ways, right? 00:39:43.599 --> 00:39:47.519 Where you could maybe load your proposed regimen 00:39:47.519 --> 00:39:51.039 into an artificial intelligence platform and 00:39:51.039 --> 00:39:53.099 have it spit back out, hey, you shouldn't use 00:39:53.099 --> 00:39:56.079 product C and D together because it could cause 00:39:56.079 --> 00:39:58.920 a very well-known problem. Or what you're missing 00:39:58.920 --> 00:40:01.960 from your regimen is, in fact, a sunscreen. Wouldn't 00:40:01.960 --> 00:40:04.300 that be kind of cool, right? That'd be great, 00:40:04.360 --> 00:40:07.079 right? But I don't know. Have you seen anything 00:40:07.079 --> 00:40:10.579 like that? Or do you have any hope? Not yet, 00:40:10.599 --> 00:40:12.960 because I think consensus is really hard to get 00:40:12.960 --> 00:40:15.679 online. I mean, there's just a lot of different... 00:40:16.699 --> 00:40:19.480 I would say stakeholders, right? Because we have 00:40:19.480 --> 00:40:22.699 the doctors and the dermatologists, the pediatricians 00:40:22.699 --> 00:40:25.260 who would give a certain set of recommendations. 00:40:25.300 --> 00:40:27.260 And then we have a whole host of other people 00:40:27.260 --> 00:40:29.780 who are recommending something completely different. 00:40:30.079 --> 00:40:32.260 So because there are so many different stakeholders, 00:40:32.559 --> 00:40:35.940 what AI might generate may or may not be science 00:40:35.940 --> 00:40:38.340 or evidence -based. So it's really, I think we're 00:40:38.340 --> 00:40:41.579 still in the infancy of all of this and it is 00:40:41.579 --> 00:40:44.360 really tricky. And unfortunately, I do think 00:40:44.360 --> 00:40:48.710 that more regulation is going to be at least 00:40:48.710 --> 00:40:52.050 part of the answer. How can we limit targeted 00:40:52.050 --> 00:40:55.750 ads to kids under 18 or at least under 12? You 00:40:55.750 --> 00:40:57.510 know, I mean, we have to draw the line somewhere. 00:40:58.289 --> 00:41:00.570 12 years of age is kind of also on the parents, 00:41:00.670 --> 00:41:03.369 I feel, right? So where's the money coming from? 00:41:03.530 --> 00:41:05.949 You gotta have a discussion with your kids. Like, 00:41:05.949 --> 00:41:09.250 I'm giving you $50 a month, where's it going? 00:41:09.489 --> 00:41:11.429 Well, if you're purchasing online, it shouldn't 00:41:11.429 --> 00:41:13.550 be that hard to find that, right? And then it's, 00:41:13.550 --> 00:41:15.250 well, what's in this bundle that you brought 00:41:15.250 --> 00:41:17.909 home? Oh my goodness, I don't even understand 00:41:17.909 --> 00:41:20.130 what half of these things are. Great, bring them 00:41:20.130 --> 00:41:22.550 into the dermatologist or your pediatric dermatologist 00:41:22.550 --> 00:41:24.630 if you're lucky enough to have one. And then, 00:41:24.650 --> 00:41:27.519 but maybe you as a parent could. Put some of 00:41:27.519 --> 00:41:30.000 these things into a search engine and find out 00:41:30.000 --> 00:41:32.300 what they're being used for and what the dangers 00:41:32.300 --> 00:41:34.360 around them are. Right. I mean, that to me seems. 00:41:34.480 --> 00:41:37.760 Yeah, I love that. I mean, using this as an opportunity 00:41:37.760 --> 00:41:41.460 to connect with, educate and, you know, grow 00:41:41.460 --> 00:41:44.000 with with your child, because I think it's really 00:41:44.000 --> 00:41:45.860 important. You want to know what they're doing, 00:41:46.019 --> 00:41:47.360 what they're applying, what they're spending 00:41:47.360 --> 00:41:51.550 their money on and use it as a chance to. I don't 00:41:51.550 --> 00:41:53.889 know, advocate, but also have fun with it, right? 00:41:53.989 --> 00:41:56.409 Because at the end of the day, that's what skincare 00:41:56.409 --> 00:41:59.730 should be. It should be easy, accessible, age 00:41:59.730 --> 00:42:02.349 -appropriate, safe, and fun. I love it. Yeah, 00:42:02.409 --> 00:42:06.710 that really is the trick. And I think we're going 00:42:06.710 --> 00:42:08.590 in the right direction here. I mean, the fact 00:42:08.590 --> 00:42:11.969 that you're an expert in this topic and are drawing 00:42:11.969 --> 00:42:14.610 so much attention around it, the idea that there 00:42:14.610 --> 00:42:18.300 was this wonderful... an important article to 00:42:18.300 --> 00:42:20.960 come out in what I think many people would consider 00:42:20.960 --> 00:42:24.639 at least one of the top two pediatrics journals, 00:42:24.699 --> 00:42:27.590 if not the top one in the country. Great. the 00:42:27.590 --> 00:42:29.989 American Academy of Pediatrics hopefully will 00:42:29.989 --> 00:42:33.030 be spotlighting this issue more and more as we 00:42:33.030 --> 00:42:35.469 go along. So I think this is just the start of 00:42:35.469 --> 00:42:38.489 it. I think we're right at the point where we 00:42:38.489 --> 00:42:40.929 can get involved as much or as little as we want 00:42:40.929 --> 00:42:44.150 around this topic and make some big strides in 00:42:44.150 --> 00:42:46.449 the right direction. Me too. So thank you so 00:42:46.449 --> 00:42:49.190 much for highlighting this topic. It's one that 00:42:49.190 --> 00:42:51.429 is both, you know, a little bit fun and a little 00:42:51.429 --> 00:42:53.989 bit scary to talk about with families. Well, 00:42:54.030 --> 00:42:56.070 with that, I'd like to thank Dr. Sheilagh Maguiness 00:42:56.070 --> 00:42:59.250 for joining me today. She's coming from Minneapolis, 00:42:59.570 --> 00:43:01.650 Minnesota, where she is a practicing pediatric 00:43:01.650 --> 00:43:03.929 dermatologist. So you can try to book an appointment 00:43:03.929 --> 00:43:06.610 with her to discuss your very complex skin regimen 00:43:06.610 --> 00:43:09.070 for you or your tween. And I also want to thank 00:43:09.070 --> 00:43:12.170 her both in her role as a colleague of mine, 00:43:12.230 --> 00:43:14.110 but also as the Immediate Past President of the 00:43:14.110 --> 00:43:16.889 Society for Pediatric Dermatology for bringing 00:43:16.889 --> 00:43:19.030 this issue to light. Have a wonderful day. Thanks 00:43:19.030 --> 00:43:23.539 for joining us. Thanks for tuning in to this 00:43:23.539 --> 00:43:26.039 episode of the Don't Be Rash Pediatric Dermatology 00:43:26.039 --> 00:43:28.619 Podcast. I'm your host, Dr. Andrew Krakowski. 00:43:28.760 --> 00:43:30.900 Don't forget to subscribe to our show on your 00:43:30.900 --> 00:43:34.000 favorite podcast platform and check out dontberash 00:43:34.000 --> 00:43:37.119 .org for more information. A special thank you 00:43:37.119 --> 00:43:39.719 to our nonprofit sponsor, the St. Luke's University 00:43:39.719 --> 00:43:42.280 Health Network, for making this episode possible. 00:43:42.460 --> 00:43:45.619 Until next time, remember, keep calm and don't 00:43:45.619 --> 00:43:46.099 be rash.