WEBVTT - Beneath the Surface: Understanding Stress and Skin 0:00:02.120 --> 0:00:03.720 I don't think that there are many people in the 0:00:03.720 --> 0:00:06.000 world who can claim that life isn't at least a 0:00:06.040 --> 0:00:10.680 little stressful sometimes, and that stress manifests itself in unexpected ways, 0:00:11.039 --> 0:00:13.760 like on our skin. But when it comes to alleviating 0:00:13.760 --> 0:00:17.840 our struggles, the relief of feeling seen and acknowledged is immense. 0:00:18.320 --> 0:00:21.000 He literally looks at me and goes, your poor poor guy, 0:00:21.320 --> 0:00:23.520 is like, I am so sorry that you have to 0:00:23.520 --> 0:00:25.760 go through this, and I literally almost cried. I mean, 0:00:26.160 --> 0:00:30.040 he just really felt and could see the pain and 0:00:30.280 --> 0:00:31.720 discomfort that I was going through. 0:00:36.159 --> 0:00:38.600 Hi, guys, and welcome. I'm so glad you're here. 0:00:38.880 --> 0:00:42.040 I'm Nicole Berry and this is Skin Queries, a show 0:00:42.080 --> 0:00:44.840 all about our skin and its health as we grow 0:00:44.880 --> 0:00:47.040 in age. Our skin is really a record of a 0:00:47.080 --> 0:00:49.760 life well lived, because there isn't one body part that 0:00:49.800 --> 0:00:52.159 I can think of that reflects our well being as 0:00:52.280 --> 0:00:54.760 clearly as our skin. So let's go on this journey 0:00:54.800 --> 0:00:57.840 together to really understand what's going on with our skin. 0:00:58.160 --> 0:01:03.360 Let's unravel the mysteries happening inside and out. Today we're 0:01:03.400 --> 0:01:06.080 going to talk about stress and its effect on our skin. 0:01:13.240 --> 0:01:15.080 I know, for me, when things get to be too 0:01:15.160 --> 0:01:17.760 much whether it's a stressful day at work or there's 0:01:17.800 --> 0:01:19.760 a lot going on at home. I can see it 0:01:19.800 --> 0:01:22.520 on my body. I can wake up feeling inflamed, I 0:01:22.600 --> 0:01:25.679 break out, and my skin can seem dull and lifeless, 0:01:25.959 --> 0:01:28.160 and then you know how it goes. Seeing a physical 0:01:28.200 --> 0:01:31.240 response to stress just causes more stress than it ends 0:01:31.280 --> 0:01:34.320 up feeling like a vicious cycle. This episode is going 0:01:34.360 --> 0:01:36.680 to be very personal because I will be bringing in 0:01:36.720 --> 0:01:40.360 my husband, Nick Moskovich, to share his journey with plaxoriasis. 0:01:40.600 --> 0:01:42.480 If you don't know what that is, it's a chronic 0:01:42.520 --> 0:01:46.440 disease that can affect the skin. Your immune system becomes overactive, 0:01:46.600 --> 0:01:50.280 which causes skin cells to multiply quickly, and that can show. 0:01:50.200 --> 0:01:51.400 Up all over your body. 0:01:51.520 --> 0:01:54.800 There can be patches of skin that becomes scay and inflamed, 0:01:55.000 --> 0:01:57.800 and it's often seen on the scalp, elbows, and knees. 0:01:58.160 --> 0:01:59.520 Stress is such a big. 0:01:59.320 --> 0:02:02.160 Factor when it comes to siiasis, so much so that 0:02:02.200 --> 0:02:06.240 the National Psoriasis Foundation recommends managing stress must be part 0:02:06.280 --> 0:02:09.640 of your treatment plan. We'll also be talking to Nick's dermatologists, 0:02:09.680 --> 0:02:12.920 who's going to explain why stress manifests physically on our 0:02:12.919 --> 0:02:17.320 skin and how to manage it. So let's get into it. 0:02:19.040 --> 0:02:22.920 So we are back here with the one and only Nick, 0:02:23.160 --> 0:02:23.840 my husband. 0:02:24.120 --> 0:02:24.960 A lot of pressure here. 0:02:25.040 --> 0:02:30.200 Yes, Nick and I have been married for almost ten years. 0:02:30.240 --> 0:02:34.320 Next year will be our tenth anniversary time. Yes, and 0:02:34.360 --> 0:02:37.840 we have two little ones. And I remember when right 0:02:37.880 --> 0:02:41.040 after we had Jude, we were living in New Jersey 0:02:41.120 --> 0:02:44.520 with my mom and things were just really stressful, and 0:02:45.200 --> 0:02:49.000 you started to notice something happening with your hands, right, 0:02:49.080 --> 0:02:51.920 they got really dry and cracked, and we were figuring out, like, 0:02:52.000 --> 0:02:55.840 what is this, which eventually we came to discover that 0:02:55.919 --> 0:02:58.040 it was psoriasis, but that took a long time for 0:02:58.120 --> 0:03:00.680 us to figure out. So do you remember when you 0:03:00.720 --> 0:03:03.640 first started noticing something going on with your hands? 0:03:03.919 --> 0:03:04.320 Yeah. 0:03:04.360 --> 0:03:07.720 So, by the way, you look beautiful, very nice. Nice 0:03:07.720 --> 0:03:08.840 to see you from this cell. 0:03:11.040 --> 0:03:11.359 Yeah. 0:03:11.400 --> 0:03:14.200 We were in New Jersey living with the in laws, 0:03:14.360 --> 0:03:17.800 and I was helping out actually with relocating some items 0:03:18.000 --> 0:03:21.040 for your mom from the storage and then working on 0:03:21.120 --> 0:03:24.280 the house here. And it was a really stressful time 0:03:24.320 --> 0:03:27.000 because we were dealing with so many different factors of 0:03:27.080 --> 0:03:29.480 the house not being done, our son being born. 0:03:29.800 --> 0:03:31.320 Jude was like six months old. 0:03:31.639 --> 0:03:34.519 Yeah, so all of that started to snowball on me, 0:03:34.560 --> 0:03:36.080 and I could just tell that it was more and 0:03:36.120 --> 0:03:38.640 more stressful, and I thought it was just me using 0:03:38.640 --> 0:03:40.840 my hands a little bit too much, and you know, 0:03:41.000 --> 0:03:42.640 it was like, oh, I'll just put some lotion on it, 0:03:42.760 --> 0:03:43.400 just a guy thing. 0:03:43.640 --> 0:03:45.600 Maybe the soapa musing is not good or something. 0:03:45.720 --> 0:03:48.000 My hands are just kind of can't keep up with 0:03:47.640 --> 0:03:50.600 my mind and everything else is going in my life. 0:03:51.160 --> 0:03:53.480 And yeah, they started to get kind of chapped a 0:03:53.520 --> 0:03:57.480 little worn in, like almost like a callus's situation. And 0:03:57.520 --> 0:04:00.200 then the more work I was doing, the more it 0:04:00.240 --> 0:04:03.920 would just kind of spread and continue to evolve and 0:04:04.240 --> 0:04:05.560 never really healing fully. 0:04:05.760 --> 0:04:08.120 I do remember you were complaining about your callous hands, 0:04:08.120 --> 0:04:09.600 and I noticed that's what I thought it was. It 0:04:09.600 --> 0:04:11.600 looked like callous dry hands. 0:04:11.960 --> 0:04:13.960 Were they itchy? Was it painful? 0:04:14.360 --> 0:04:18.240 So it started with just just kind of annoying. Honestly, 0:04:18.279 --> 0:04:21.480 it wasn't even like that discomforting. It was just I 0:04:21.520 --> 0:04:23.320 was like, oh, maybe they'll get better, you know, I'll 0:04:23.320 --> 0:04:25.600 just keep putting lotion on. I found a couple of 0:04:25.600 --> 0:04:28.320 brands that seemed to help, but in the end they 0:04:28.320 --> 0:04:31.479 were doing anything. They were just kind of moisturizing it 0:04:31.560 --> 0:04:35.120 for that moment, but not continually doing anything for that condition. 0:04:35.320 --> 0:04:37.200 And that's when I realized it was something more serious 0:04:37.240 --> 0:04:40.240 because it kind of went from my thumb to my 0:04:40.560 --> 0:04:43.200 pointing finger, to the finger to the left of it, 0:04:43.279 --> 0:04:45.480 and then it started to go on the other hand, 0:04:45.880 --> 0:04:48.200 and it just kept going and going. There was just 0:04:48.279 --> 0:04:51.720 no kind of relief of any kind. And that's when 0:04:51.720 --> 0:04:56.360 I started to get kind of start to panic. Is panic, Yeah, yeah, 0:04:56.360 --> 0:04:58.920 it really. It was really stressful because I was like, 0:04:59.160 --> 0:05:02.159 I've never experience this. I would literally squeeze my hands 0:05:02.400 --> 0:05:04.880 just like make a fist, and I could feel those 0:05:05.320 --> 0:05:08.480 callouses kind of breaking, and it would just become really 0:05:08.480 --> 0:05:12.640 difficult to grip anything to lift the kids up to walk, 0:05:12.760 --> 0:05:15.960 and then after that it has to continue. 0:05:15.640 --> 0:05:17.839 To get worse and flare up more and more. 0:05:18.160 --> 0:05:20.920 Is it went to my feet on my heel, it 0:05:20.960 --> 0:05:23.520 was almost felt like somebody just stabbing. 0:05:23.000 --> 0:05:26.200 My heel all the time. It was really really painful. 0:05:25.880 --> 0:05:28.599 So uncomfortable, that's awful. It would peel, it would just 0:05:29.040 --> 0:05:30.520 it was absolute worst. 0:05:31.720 --> 0:05:34.480 I think when someone is going through something, even if 0:05:34.480 --> 0:05:36.800 you live with them, even if you are incredibly close, 0:05:37.080 --> 0:05:39.880 you don't truly understand the struggle that they're going through 0:05:40.000 --> 0:05:43.040 until it starts to affect your relationship with them. And 0:05:43.080 --> 0:05:44.400 that's what happened with me and Nick. 0:05:45.040 --> 0:05:47.200 I'm out and I see a lot of people, and 0:05:47.360 --> 0:05:51.000 I meet people, and it became pretty uncomfortable for me, 0:05:51.400 --> 0:05:53.080 just of like somebody wanted to shake my hand or 0:05:53.080 --> 0:05:55.400 if I, like, you know, wanted to greet somebody, it 0:05:55.480 --> 0:05:56.479 just didn't feel right. 0:05:56.720 --> 0:05:59.120 It's self consciousness. 0:05:58.440 --> 0:06:00.280 Self conscious about the whole essageituation. 0:06:00.480 --> 0:06:03.360 So in insecurity, that's when I was like, I need 0:06:03.360 --> 0:06:05.880 to really take care of this and address what's going 0:06:05.920 --> 0:06:06.320 on here. 0:06:06.720 --> 0:06:09.920 Honestly, neither of us really knew what exactly was going on, 0:06:10.120 --> 0:06:13.440 but we knew something had to change. 0:06:13.720 --> 0:06:16.359 I don't have like the most fantastic diet like you do. 0:06:16.560 --> 0:06:17.479 You're very good at it. 0:06:17.560 --> 0:06:19.200 We're working on it. We're working on it. 0:06:19.279 --> 0:06:24.000 I am, yeah, I'm your lifelong project. But I was 0:06:24.080 --> 0:06:26.720 drinking like these juices and I thought I found something 0:06:27.120 --> 0:06:29.839 and had a cleaner sugar in it, but my body 0:06:29.880 --> 0:06:31.040 was not reacting well to it. 0:06:31.120 --> 0:06:32.520 I remember I went on like. 0:06:32.440 --> 0:06:36.640 A two three week like absolutely no sugar thing during 0:06:36.640 --> 0:06:37.480 that time as well. 0:06:37.720 --> 0:06:39.520 Might have helped. It might have been too late at 0:06:39.520 --> 0:06:42.000 that point too, but it didn't hurt, I'll say that. 0:06:42.360 --> 0:06:45.400 So when you finally decided that you've had enough with 0:06:45.520 --> 0:06:48.919 you know, home treatment and trying to like use lotions 0:06:48.960 --> 0:06:52.880 and potions, what was your journey in finding the right doctor? 0:06:53.080 --> 0:06:54.279 Did you find it right away? 0:06:54.800 --> 0:06:58.039 I spoke to a few specialists quote unquote, like you say, 0:06:58.320 --> 0:07:00.640 I could take on just about anything, like I can. 0:07:00.680 --> 0:07:03.520 Work through most things in my time. 0:07:03.640 --> 0:07:05.600 Talking to those doctors, I'll be like, oh, it's you know, 0:07:05.720 --> 0:07:07.599 it's just kind of annoying. It's this and that, but 0:07:07.640 --> 0:07:10.600 it's really inside, I'm just like screaming about man, this 0:07:10.760 --> 0:07:12.280 is driving me crazy. 0:07:13.000 --> 0:07:15.280 After a long time of searching and coming up with 0:07:15.320 --> 0:07:17.960 a lot of dead ends, a friend recommended we go 0:07:18.080 --> 0:07:21.360 to doctor Mitchell Klein, a dermatologist based in New York. 0:07:21.560 --> 0:07:24.080 You'll be hearing from him later. But when Nick walked 0:07:24.120 --> 0:07:25.640 into his office. 0:07:25.400 --> 0:07:28.080 He literally looks at me and goes, you're poor, poor guy. 0:07:28.240 --> 0:07:30.560 He's like, I am so sorry that you have to 0:07:30.600 --> 0:07:33.000 go through this, and I literally almost cried. I mean, 0:07:33.240 --> 0:07:37.400 he just really felt and could see the pain and 0:07:37.680 --> 0:07:40.280 discomfort that I was going through. And I've never had 0:07:40.280 --> 0:07:43.360 anybody react that way in terms of not only did 0:07:43.400 --> 0:07:46.200 he care but he understood. We talked, and we talked 0:07:46.240 --> 0:07:48.760 actually for at length, and he said, you know, I 0:07:48.760 --> 0:07:50.720 have other clients who have this condition. 0:07:50.880 --> 0:07:52.280 There's different things we can do. 0:07:52.480 --> 0:07:55.040 And and you write away that it was ciriasis, what 0:07:55.240 --> 0:07:58.360 version of csoriasis it was? And he said that, you know, 0:07:58.520 --> 0:08:01.240 you're obviously in a very strong whole situation. He's like, 0:08:01.320 --> 0:08:03.760 this does not typically happen with just like a healthy 0:08:03.760 --> 0:08:06.120 thirty year old. So I told him I have a 0:08:06.160 --> 0:08:08.480 stressful job, I have two kids, we have run a 0:08:08.480 --> 0:08:10.520 business together. There was a lot of things going on 0:08:10.560 --> 0:08:12.120 at the same time, and he said, listen, you got 0:08:12.120 --> 0:08:14.520 to find time for yourself to let go of some 0:08:14.560 --> 0:08:16.800 of those things, you know, take some deep breaths and 0:08:16.840 --> 0:08:19.440 like go for a walk and whatever time you can find. 0:08:19.520 --> 0:08:21.120 You have to like let go of some of the 0:08:21.160 --> 0:08:23.880 things that you're doing, that you're carrying, and that will 0:08:23.920 --> 0:08:25.760 help with your medical issue. 0:08:25.880 --> 0:08:29.560 Doctor Klein prescribed a treatment for Nick's blacksriasis. 0:08:29.400 --> 0:08:31.880 And within forty eight hours, I mean, it was it 0:08:31.960 --> 0:08:34.120 was magic. He said it was going to be like magic, 0:08:34.160 --> 0:08:35.719 and it was just that what was. 0:08:35.679 --> 0:08:38.520 The feeling that you had when he said I know 0:08:38.600 --> 0:08:40.079 what this is and I know how are we going. 0:08:40.040 --> 0:08:40.520 To fix it? 0:08:40.800 --> 0:08:45.960 Disbelieve I could not believe him, just because of you know, 0:08:46.040 --> 0:08:50.520 dealing with the condition for two years plus minus. You 0:08:50.600 --> 0:08:52.680 just kind of think that there's just that this is it. 0:08:52.720 --> 0:08:53.920 I'm going to live with this for the rest of 0:08:53.920 --> 0:08:56.840 my life. And that was really scary to me because 0:08:56.880 --> 0:08:59.480 I was really uncomfortable and really I'm not happy with 0:08:59.520 --> 0:09:02.160 what I was faced with. And the more he talked, 0:09:02.160 --> 0:09:04.560 the more I was like, I'm on board, let's try 0:09:04.640 --> 0:09:07.439 I'm willing to try anything at this point. And when 0:09:07.520 --> 0:09:09.439 he told me about some of the options and how 0:09:09.440 --> 0:09:11.880 he's treated patients before, the more it began to like 0:09:12.040 --> 0:09:16.280 kind of feel relief and comfort and everything that he 0:09:16.360 --> 0:09:18.840 was saying. And that was, honestly the first time I 0:09:18.840 --> 0:09:21.040 had somebody who was like, I got the answer for it. 0:09:21.080 --> 0:09:22.720 We just got to figure out how do we get. 0:09:22.600 --> 0:09:25.600 You to continue to improve once I set you on 0:09:25.600 --> 0:09:26.800 this path of treatments. 0:09:27.920 --> 0:09:31.720 It's interesting, I've always perceived Nick as our rock. He 0:09:31.880 --> 0:09:35.080 is the foundation when it comes to our family, our friends, 0:09:35.360 --> 0:09:38.240 and also at work. So seeing how much he was 0:09:38.240 --> 0:09:42.559 suffering physically and mentally was extremely painful for us to see. 0:09:42.840 --> 0:09:46.040 At the time, I really was not realizing how much 0:09:46.040 --> 0:09:49.200 stress was playing a huge factor in Nick's flare ups, 0:09:49.520 --> 0:09:51.760 and once I found out that stress can be a 0:09:51.760 --> 0:09:55.640 major trigger for psoriasis, I actually felt a lot of guilt. 0:09:56.080 --> 0:09:57.520 I started to think of all. 0:09:57.360 --> 0:10:00.480 The ways that I personally was adding to the stresses 0:10:00.480 --> 0:10:03.680 of his life and kind of felt a little shameful 0:10:03.840 --> 0:10:04.520 and hopeless. 0:10:04.880 --> 0:10:06.679 Obviously, the feeling of shame. 0:10:06.480 --> 0:10:10.320 And guilt around Nick's diagnosis were irrational. Of course, it 0:10:10.400 --> 0:10:14.080 wasn't my fault, and thankfully we found doctor Klein, who 0:10:14.160 --> 0:10:17.480 was a lifesaver for Nick and myself, not only because 0:10:17.480 --> 0:10:19.720 we could get to the root of the physical problem, 0:10:19.880 --> 0:10:22.840 but the compassion and the understanding he met us with 0:10:23.200 --> 0:10:27.360 was such overlaf and also very essential. After doctor Klein 0:10:27.520 --> 0:10:30.800 helped Nick reset his system, they worked together to develop 0:10:30.880 --> 0:10:33.360 better ways for him to manage his stress and his 0:10:33.360 --> 0:10:37.080 flare ups. We'll get into that later. First, let's talk 0:10:37.120 --> 0:10:39.959 to the one and only doctor Klin about the relationship 0:10:40.000 --> 0:10:43.160 between stress and skin and how you can protect yourself 0:10:43.160 --> 0:10:46.080 from the effects of stressors in your life. Right after 0:10:46.120 --> 0:10:59.120 this break, welcome back to skin Queries. Let's unravel how 0:10:59.160 --> 0:11:01.439 stress shows up about our skin and what you can 0:11:01.480 --> 0:11:04.720 do to manage it. I'd like to introduce doctor Mitchell Klein, 0:11:04.920 --> 0:11:08.840 Nick's personal dermatologists and an academic with a private practice 0:11:08.880 --> 0:11:09.720 in New York City. 0:11:09.960 --> 0:11:11.760 Hi, doctor Klein, how are you hi? 0:11:11.840 --> 0:11:12.200 Nicole? 0:11:12.360 --> 0:11:13.520 How's everything great? 0:11:14.080 --> 0:11:16.280 Thank you for joining us. I kind of feel a 0:11:16.320 --> 0:11:19.920 little guilty because the person that we met through is 0:11:19.960 --> 0:11:22.920 my husband, Nick, who's not here to defend himself, but 0:11:23.600 --> 0:11:26.760 you're Nick's doctor and dermatologist. And then he also recommended 0:11:26.800 --> 0:11:30.600 our daughter, See who's now five years old. And you know, 0:11:30.640 --> 0:11:34.520 you really had a profound impact on Nick's life and 0:11:34.559 --> 0:11:37.719 his quality of skin, as well as our daughter. So 0:11:37.920 --> 0:11:39.840 I'm so excited for you to join us today. 0:11:39.960 --> 0:11:42.080 Oh well, thanks, it's my pleasure, my pleasure to be 0:11:42.160 --> 0:11:42.880 here for all of you. 0:11:43.200 --> 0:11:45.560 Do you mind telling us a little bit about yourself 0:11:45.559 --> 0:11:46.480 and your practice? 0:11:46.640 --> 0:11:50.080 Sure. I'm a clinical assistant professor in dermatology at while 0:11:50.120 --> 0:11:52.960 in New York Presbyterian. I trained an internal medicine at 0:11:53.000 --> 0:11:56.240 the University of Pennsylvania after medical school there, and then 0:11:56.559 --> 0:12:01.079 switched to dermatology at Cornell Memorials On Kettering and Rockfeller 0:12:01.520 --> 0:12:04.680 started private practice immediately after. And I've been in practice 0:12:04.720 --> 0:12:06.640 for a long enough time that I don't want to 0:12:06.679 --> 0:12:10.200 say how long. And I like all aspects of it. 0:12:10.240 --> 0:12:15.960 Dermatology has general cosmetic medical and so I enjoy engaging people. 0:12:16.120 --> 0:12:17.760 I do it for the people that I treat. 0:12:18.040 --> 0:12:20.520 I love that and that really comes through as a 0:12:20.559 --> 0:12:24.080 patient in your practice. And I'm so interested to hear 0:12:24.520 --> 0:12:27.560 your take on how things like stress and this is 0:12:27.600 --> 0:12:31.200 something that I actually learned later in life, that stress 0:12:31.240 --> 0:12:35.280 can really affect your physicality, specifically your skin. So can 0:12:35.320 --> 0:12:38.600 you talk a little bit about the relationship between stress, 0:12:38.640 --> 0:12:42.120 which essentially is a mental thing and it manifesting as 0:12:42.120 --> 0:12:43.000 a physical thing. 0:12:43.360 --> 0:12:47.160 Sure, so let's start with a mind body connection. It's 0:12:47.240 --> 0:12:50.520 the same, right, The brain is an organ, the skin 0:12:50.600 --> 0:12:53.160 is an organ. It's connected through all of the body. 0:12:53.240 --> 0:12:56.320 Chemistries that all the other organs are connected with so 0:12:56.600 --> 0:13:00.160 I don't really distinguish. And I think that you under 0:13:00.160 --> 0:13:02.679 stand that just as the brain and stress affect the 0:13:02.720 --> 0:13:05.240 heart and people know that well, it affects the skin. 0:13:05.320 --> 0:13:09.439 And in so many ways, there's well known science behind 0:13:09.480 --> 0:13:11.200 all of it. And I think that you know, it 0:13:11.240 --> 0:13:13.480 was a lack of understanding in the medical community for 0:13:13.520 --> 0:13:16.240 a long time that there was a brain out there 0:13:16.360 --> 0:13:19.480 and that there was this body and this skin, and 0:13:19.520 --> 0:13:22.160 that these two things were not connected, and how could 0:13:22.160 --> 0:13:23.640 that not be r right. 0:13:23.760 --> 0:13:26.160 It's so refreshing to hear you say that. As far 0:13:26.200 --> 0:13:30.000 as dress manifesting itself in the body and on the body, 0:13:30.240 --> 0:13:32.320 what can that look like? What have you seen in 0:13:32.360 --> 0:13:33.040 your practice? 0:13:33.120 --> 0:13:36.600 Well, if you think about the conventional problems that people 0:13:36.640 --> 0:13:39.719 talk about, like exema, psoriasis, which we'll talk about a 0:13:39.760 --> 0:13:43.280 little bit today, and all of the dermatosis, all of 0:13:43.320 --> 0:13:47.559 those things get worse or flair when you're stressed. And 0:13:48.000 --> 0:13:50.640 that's because people think of the immune system as being 0:13:50.679 --> 0:13:53.640 strong or weak, but it's very complex, and it's that 0:13:53.679 --> 0:13:57.320 the immune system changes and it activates all kinds of 0:13:57.320 --> 0:14:00.440 proteins and chemicals in the body, sometimes through nerves and 0:14:00.520 --> 0:14:05.480 sometimes actually through circulating chemicals. It can be hormones, cytokindes, interferons, 0:14:05.760 --> 0:14:08.599 and all of those things have an effect on the 0:14:08.640 --> 0:14:11.600 immunity of the skin, which causes blood vessels to dilate. 0:14:11.920 --> 0:14:15.040 It causes the skin to get thicker or thinner. It 0:14:15.080 --> 0:14:17.559 causes the skin to maybe get spots, to be more 0:14:17.600 --> 0:14:22.560 susceptible to spots and wrinkles, and also rashes. It changes 0:14:22.640 --> 0:14:26.440 those rashes very often much, much worse. So we always 0:14:26.480 --> 0:14:29.400 see this dramatic effect when we see somebody coming from 0:14:29.520 --> 0:14:32.920 a place of great stress, emotional or physical or both, 0:14:33.400 --> 0:14:36.920 because physical causes emotional stress, but emotional stress as well. 0:14:37.120 --> 0:14:40.560 And you see all of these things occur in the skin, 0:14:40.800 --> 0:14:44.080 and you see these breakouts of all sorts, and then 0:14:44.360 --> 0:14:46.840 you know it's apparent, and you know somehow that it 0:14:46.960 --> 0:14:47.960 just doesn't look right. 0:14:51.760 --> 0:14:53.960 Do you think that there or have you been able 0:14:54.000 --> 0:14:57.360 to identify certain triggers when it comes to a flare up, 0:14:57.400 --> 0:15:00.560 whether that is exima or psoriasis or other kind of 0:15:00.560 --> 0:15:01.520 skin inflammation. 0:15:02.240 --> 0:15:06.160 So the story usually goes that I didn't have anything, 0:15:06.360 --> 0:15:09.800 and now I suddenly have spots. That's called guttap'soriasis, and 0:15:09.840 --> 0:15:12.920 it's often from a strep throat. It can be stress, 0:15:13.080 --> 0:15:15.880 but also strap and so usually you ask questions about 0:15:15.880 --> 0:15:20.520 a sore throat because infections, infections that run through the body, viral, bacterial, 0:15:20.880 --> 0:15:24.600 cause stress and they also can cause a flare of psoriasis. Okay, 0:15:24.720 --> 0:15:27.680 so that's guttaped psoriasis, and you can go to other 0:15:27.800 --> 0:15:30.440 forms of psoriasis that affect other parts of the body. 0:15:30.640 --> 0:15:34.280 And again you see this and you hear from the patient, Well, 0:15:34.320 --> 0:15:37.080 I've had this chronic condition of my scalp, or I've 0:15:37.080 --> 0:15:39.680 had this rash on my elbows, or maybe my hands 0:15:39.680 --> 0:15:44.120 have been uncomfortable, but suddenly it's so much worse. I'm uncomfortable, 0:15:44.560 --> 0:15:47.480 And that immediately begs the question, well, what have you 0:15:47.560 --> 0:15:50.320 been through as they've been through a life stress? Has 0:15:50.320 --> 0:15:54.440 somebody been ill, somebody passed away? Are their family stresses? 0:15:54.720 --> 0:15:57.680 Do you have job stress or personal stress? And once 0:15:57.720 --> 0:16:01.280 you sort of elicit that history, it helps you because 0:16:01.600 --> 0:16:04.440 you're giving somebody insight into the fact that what they're 0:16:04.480 --> 0:16:07.440 going through is causing some of the problem. And we 0:16:07.480 --> 0:16:09.440 all know that we don't go through what we go 0:16:09.560 --> 0:16:12.920 through forever and that you know eventually as the stress 0:16:13.360 --> 0:16:17.000 kind of settles down, the skin will settle down, and 0:16:17.360 --> 0:16:20.240 you see this, you know, everything's worse. The skin's redder, 0:16:20.480 --> 0:16:23.960 the spots are scalier, they're more numerous, they're covering new 0:16:24.040 --> 0:16:26.360 areas of the body. Sometimes you feel like it's taking 0:16:26.400 --> 0:16:28.960 over your body because previously it was maybe one or 0:16:29.000 --> 0:16:32.200 two patches and now it's widespread or on your scalp, 0:16:32.200 --> 0:16:36.120 which can happen with people with psoriasis, and so you know, 0:16:36.240 --> 0:16:40.160 all important questions and always important to reassure someone again 0:16:40.320 --> 0:16:42.920 that you know, this is not going to remain this way, 0:16:43.000 --> 0:16:45.600 not with the medications and not with the treatments we 0:16:45.680 --> 0:16:47.640 have these days, and not with the fact that the 0:16:47.680 --> 0:16:49.040 stress is going to go away. 0:16:49.360 --> 0:16:53.479 You mentioned treatments, So what are the types of treatments 0:16:53.560 --> 0:16:55.640 that you treat psoriasis with? 0:16:56.120 --> 0:17:01.239 So there really are a thousand and so and foremost 0:17:01.360 --> 0:17:05.000 reassurance and then you move to well, what's easy. Well, 0:17:05.000 --> 0:17:09.560 they're topical creams. Sometimes they're steroid creams. People are terrified 0:17:09.600 --> 0:17:11.679 of that, no reason to be. We know how to 0:17:11.760 --> 0:17:14.760 control how much stereoid goes into your body with the cream, 0:17:15.080 --> 0:17:18.560 and sometimes we move after that into light therapy, but 0:17:18.640 --> 0:17:21.760 that's a little more evolved, but it also covers more 0:17:21.760 --> 0:17:25.680 of the body surface area before we get into systemic drugs, 0:17:25.840 --> 0:17:29.080 oral drugs or injectable drugs. In each one affects a 0:17:29.080 --> 0:17:32.240 different arm of the immune system, and all of them 0:17:32.280 --> 0:17:35.960 work to sort of slow or diminish the inflammation in 0:17:36.040 --> 0:17:40.080 the body, not just psoriasis, but psoriasis comes with arthritis, 0:17:40.359 --> 0:17:43.600 ziausis believe or not, comes with heart disease and stroke 0:17:43.720 --> 0:17:46.320 and all of these things which are risks if you 0:17:46.359 --> 0:17:51.400 have severe versions are managed and controlled with these biologics, 0:17:51.440 --> 0:17:52.800 which is why they're so popular. 0:17:52.960 --> 0:17:55.399 When you do talk to your patients, do you recommend 0:17:55.760 --> 0:17:58.120 or ask them questions about how to treat their stress 0:17:58.400 --> 0:17:59.680 in a non medical way. 0:18:00.160 --> 0:18:02.560 To get into that, because when you have something that's 0:18:02.600 --> 0:18:07.040 really profound and you're dealing with something that needs something 0:18:07.080 --> 0:18:11.320 that goes beyond the medicines you're applying, leaving that out 0:18:11.440 --> 0:18:14.800 of the concoction is a mistake. You know, if you're 0:18:14.800 --> 0:18:18.760 not talking about addressing depression, which can be addressed with 0:18:18.960 --> 0:18:22.960 you know, therapy and help and sometimes medication, you're talking about, 0:18:23.160 --> 0:18:25.480 you know, what are the social circumstances that you're in 0:18:25.560 --> 0:18:27.880 that are problematic that you might be able to do 0:18:27.920 --> 0:18:33.240 something about. And then also again very broadly, thinking about 0:18:33.640 --> 0:18:36.280 how do you get to those blue zones? You know, 0:18:36.400 --> 0:18:39.480 how do you get a piece of nature where I 0:18:39.560 --> 0:18:43.080 love meditation and exercise, you know, as a way of 0:18:43.160 --> 0:18:45.400 burning off that anxiety and stress. 0:18:45.320 --> 0:18:50.080 Shifting back to specifically storisis or other skin inflammation. I 0:18:50.119 --> 0:18:52.639 feel that at least for Nick, you know, he and 0:18:52.720 --> 0:18:55.640 many other people, they're usually run to the drugstore and try, 0:18:55.680 --> 0:18:58.960 you know, everything on the shelf and become their own 0:18:59.040 --> 0:19:02.560 kind of treatment mint guru until it comes to a 0:19:02.560 --> 0:19:04.919 point where he said, you know, I need to see someone. 0:19:05.200 --> 0:19:09.000 And my perception was that natural is better, but in 0:19:09.040 --> 0:19:12.280 certain cases it's not. So what would you say to 0:19:12.280 --> 0:19:14.200 people who are kind of at a loss? 0:19:14.560 --> 0:19:17.080 Right, So you try things, and I don't think there's 0:19:17.080 --> 0:19:19.879 anything wrong with that. In general. For skin, things that 0:19:19.960 --> 0:19:23.919 hydrate and moisturize are always going to help all aspects 0:19:23.920 --> 0:19:26.160 of the skin. And then you know, if you think 0:19:26.160 --> 0:19:29.600 about it, and just in a really basic common sense way, 0:19:30.160 --> 0:19:32.679 it's when you say to yourself, you know, I'm not 0:19:32.720 --> 0:19:35.440 getting any better, maybe worse, but not getting any better. 0:19:35.520 --> 0:19:39.199 And who is it out there who has some expertise 0:19:39.280 --> 0:19:42.159 or training. It might I even not Alie with my 0:19:42.240 --> 0:19:44.200 way of thinking. You know, maybe I think of only 0:19:44.880 --> 0:19:48.720 traditional Eastern methods and natural methods. But I need to 0:19:48.760 --> 0:19:50.880 find somebody who's going to give me something that's going 0:19:50.960 --> 0:19:52.680 to give me relief and put me in a different 0:19:52.680 --> 0:19:57.639 direction because I'm uncomfortable, I hurt, I itch, or I 0:19:57.680 --> 0:19:59.640