Subscribe on Apple 

Subscribe on Spotify 

While GLP-1 medications can lead to powerful health changes, they also come with lesser-known side effects, especially for your skin and hair. From sudden dryness and irritation to facial volume loss and unexpected hair shedding, these changes can feel confusing and even discouraging when you're working so hard to improve your health.

Recently, I sat down with Dr. Samantha Schneider, a board-certified dermatologist, to break down what's really happening beneath the surface. We explored what causes these shifts, from nutrient changes and inflammation to insulin resistance, and how to manage them before they become long-term concerns.

Whether you're early in your weight loss journey or navigating unexpected changes, here's what you need to know about protecting your skin and hair during transformation.

The Good News: Some Skin Conditions Actually Improve

Before we dive into the challenges, let's start with some encouraging news. Dr. Schneider has observed that GLP-1 medications can actually improve certain inflammatory skin conditions, including:

• Psoriasis
• Hidradenitis suppurativa
• PCOS-related skin issues
• Acanthosis nigricans (dark, velvety skin patches)

This happens because these medications have anti-inflammatory properties and work on similar pathways as these skin conditions. So if you have one of these conditions, you might be treating two issues with one medication.

Understanding "Ozempic Face" and Volume Loss

The term "Ozempic face" refers to the gaunt, aged appearance some people develop during rapid weight loss. Here's what's actually happening: when you lose weight quickly, you lose fat everywhere – including the natural fat pads in your face that give you a youthful appearance.

Dr. Schneider explains this using the "triangle of youth" concept. Think about a child's full cheeks that people love to pinch. As we age and lose facial volume, that triangle inverts, creating jowls and deeper lines.

What You Can Do:

• Work with a dermatologist during your weight loss journey, not after
• Consider treatments like fillers or biostimulatory options (like Sculptra)
• Focus on good skincare to support your skin barrier
• Remember: this isn't unique to GLP-1s – any significant weight loss can cause these changes 

Hair Loss: What to Expect and How to Handle It

Hair loss during weight loss is incredibly common and usually temporary. Dr. Schneider calls it "telogen effluvium" – your body's stress response to rapid change.

Why It Happens:

Your body doesn't know you're intentionally losing weight. It interprets this as stress and releases "sleeping" hairs to conserve nutrients for essential functions. Think of it like what happens after delivering a baby or a major life event.

The Timeline:

• Hair loss typically starts 3 months after beginning weight loss
• It continues until your weight stabilizes
• Regrowth begins a few months after stabilization
• Full recovery can take 6-12 months

Evidence-Based Treatments:

Minoxidil (Rogaine): The gold standard treatment

• Use 5% strength for both men and women (avoid the 2.5% "women's" version)
• Apply twice daily to clean scalp
• Warning: toxic to pets, so be careful if you have furry friends

Ketoconazole Shampoo (Nizoral): Available over-the-counter

• Blocks hormonal components of hair loss
• Use every time you shampoo
• Can follow with your regular shampoo if you don't like the smell

Supplements That Actually Work:

• Nutrafol: Attacks hair loss from multiple angles with ingredients like collagen, ashwagandha, and saw palmetto
• Hydrolyzed collagen: Provides building blocks for hair growth
• Skip the biotin: Despite popular belief, it doesn't help with hair loss and can interfere with thyroid tests

Protecting Your Skin Barrier During Weight Loss

Rapid weight loss can compromise your skin's protective barrier, leading to dryness, irritation, and premature aging.

Simple Skincare Fixes:

• Use a good moisturizer with ceramides (CeraVe and Cetaphil are dermatologist favorites)
• Choose face-specific products to avoid clogged pores
• Extend your facial skincare down to your neck and chest
• Wear sunscreen daily – yes, even computer light damages your skin!

Dr. Schneider uses a perfect analogy: skincare is like brushing your teeth. You don't just rely on your twice-yearly dental cleanings – you brush daily at home. Similarly, professional treatments work best when combined with consistent at-home care.

When Skin Conditions Improve: Acanthosis Nigricans

This condition creates dark, velvety patches typically on the neck and underarms. It's closely linked to insulin resistance, so as GLP-1 medications improve your insulin sensitivity, these patches often fade.

What Helps:

• Focus on improving insulin resistance through weight loss and medication
• Try AmLactin lotion for texture improvement
• Be patient – color changes take months to fade, even after the underlying condition improves

Managing Skin Fold Issues and Yeast Infections

As your body changes, you might develop yeast infections in skin folds. This isn't just a weight issue – it can happen to anyone with areas where skin touches skin.

Quick Solutions:

• Use Zeasorb-AF antifungal powder 
• Keep affected areas dry – use a cotton shirt to absorb moisture
• Change out of sweaty clothes immediately after exercise
• If you prefer creams, remember they add moisture to already damp areas

Prevention is Key

The most important takeaway from our conversation was this: Don't wait until you're unhappy with changes to seek help. Working with a dermatologist during your weight loss journey allows you to:

• Address issues as they arise
• Prevent problems from becoming permanent
• Maintain your confidence throughout your transformation
• Make informed decisions about treatments

Remember, this isn't about vanity – it's about feeling comfortable and confident in your changing body. You're doing incredible work to improve your health. Your skin deserves the same attention and care you're giving the rest of your wellness journey.

Want to hear the full conversation with Dr. Schneider? Listen to the complete podcast episode for even more detailed advice on these issues!

More about Samantha

Dr. Samantha Schneider is a board-certified dermatologist and fellowship-trained Mohs surgeon who specializes in medical, surgical, and cosmetic dermatology. She completed her dermatology residency at Henry Ford Hospital in Detroit, Michigan, followed by advanced fellowship training in Mohs Micrographic Surgery and facial reconstruction at Washington University in St. Louis.

Dr. Schneider cares for patients of all ages and treats a broad spectrum of conditions, including acne, skin cancer, pigment disorders, and rashes. She performs comprehensive skin exams, surgical procedures including Mohs surgery, and cosmetic treatments such as neurotoxin injections, dermal fillers, laser treatments, microneedling, and chemical peels—with a focus on natural-looking, confidence-boosting results.

 

TRANSCRIPT:

Disclaimer: The transcript below is provided for your convenience and may contain typos, errors, or grammatical inconsistencies, as it has not been professionally edited or proofread. Please enjoy it as-is and read at your own discretion.

Please note: The content shared in this podcast and blog post is for informational and educational purposes only and is not intended as medical advice. Always consult your healthcare provider for personalized medical guidance. 

 

 Welcome back to another episode of the podcast, everybody. I'm super excited today. We have a really great friend of mine, Dr. Samantha Schneider. Is it okay if I call you Sam today during the summer? Oh, sure. Okay. Because I'm like, I'm gonna mess up otherwise, she's been my friend for years and she's a, a Multiboard certified dermatologist.

She's gonna talk about all the areas that she works in, but I brought her on today because we've been having these interesting conversations about how do certain skin conditions improve with GLP one, use, different things like that. And then I was like, Hey, we need to talk on the podcast because people have questions all day long about I'm losing all this weight.

What can I do for my skin? And I just want someone who actually knows what they're talking about to answer this. Sam, can we start out, can you just introduce yourself, what patients do you love to treat, and why do you love dermatology?

Totally. So I am Dr. Schneider. I'm Sam, I am a board certified dermatologist and a board certified and fellowship trained most surgeons. So I see a little bit of everything in dermatology. I see medical patients, so I do skin exams, acne, skincare. And then I do surgery. So I treat patients with skin cancer and I remove their skin cancer with a specialized surgery called MO surgery.

I also remove cancers and treat skin cancer patients with other treatments. And then I do cosmetics as well. Some lasers and neurotoxins, fillers, like I mentioned before, skincare. So kind of a whole range. And what really drew me to dermatology was that range. Honestly, when I went to med school, I thought I was gonna be an ER doc.

I was rotating in the ER from when I was a first year med student and I thought for sure that's what I was gonna do. And then my dad was like, you know what? Why don't you go check out dermatology because I think you might like it. And I was like, really? I don't know, it sounds boring.

Just like acne. And then I went and I was like, oh my gosh, this is so cool. And I realized the reason I liked emergency medicine was because you could treat kids and adults. And I was like, you can do that in dermatology. You can do medical and surgery. So I can see people and prescribe medications. I can also do interventions like cutting out skin cancer.

And then there's such a range. Every day is different. I see so many different people. The thing that really convinced me to do dermatology was the long relationships that I have with patients in the er. Right? Like, you don't know what happens, you help them. And I'm so grateful for ER docs. I'm married to one, yeah. It's like me and you, we like the long-term knowing patients and there's nothing wrong with that, but it might just not be how we're built. Totally. So that's one of the beautiful things is I see my patients for years and then I see some of their kids and even some of their kids, like the whole family and that's just such a special relationship.

That's kind of in a nutshell what drew me to dermatology. One of the reasons that I brought you on is that I know I personally, within my own practice have seen a lot of dermatologic changes when people use these, let's just say newer, although they've been around 20 plus years GLP one medications.

I wonder just in your own personal practice or just sort of within the literature, have you seen any either positive or negative changes that relate to the dermatology land when people are on these medications? Totally. And that's honestly been really interesting. And there's like most things, some of both, right?

There's good things and there's bad things. Let's talk about the good things first. This is really for people who have, other dermatology conditions and also have weight to lose. For example, people that have like psoriasis or hydradenitis, they're inflammatory conditions.

And one of the things with the GLP ones is yes, they help with satiety and making you feel full so you're not eating as much and all of those benefits, but they're also anti-inflammatory and they work on some of the same pathways as some of these other skin conditions. So it's been really interesting.

There have been se like I've seen it in my practice and there have also been case reports that psoriasis gets better, hydradenitis gets better, PCOS can get better. ECAs NI cans can get better. Things that we see that run with not only inflammation, but insulin resistance and obesity.

Honestly, that's been really cool because if you have one of these other conditions, you're kind of treating two birds with one stone. Depending on how quickly you lose your weight, you can get some changes in your face. They call it like ozempic face, right? Where like you're getting more gaunt, you're getting thin. And that can make you appear older. And there are also some changes to the quality of your skin that can happen as you lose weight, depending on how you do it, if it's quick.

And if you're not getting in the nutrients that you need, that can really affect like the radiance of your skin and leading to the appearance of aging, right? More jowls, more wrinkles. You just, you look older than your stated age. That's not true for everybody, but that's a possible.

Outcome. You know, the thing I wanna know though, isn't this the same for all weight loss, right? Like it's not unique to Ozempic. I just think we're just seeing higher percentages of people that are able to lose that amount of weight, right?

But the change is the same whether someone lost that 20% body weight with a GLP one versus without, right. Am I, am I right with that? Totally. No, I think you're right. But I think what's interesting and I don't know, you'll have to correct me because I don't know the weight loss data as well, but I would think that people are losing more quickly.

With the GLP ones and they would if they were losing on their own, is that not necessarily true? It depends on the person is the problem, right? Yeah. So usually what I see with the data is within the first six months to one year, if someone is going to be losing a lot of weight, that's typically how it will occur.

You, I think that the reality is less than one out of 20 ever could, statistically could get past the 10% weight loss and keep it off. And so I think that we literally were not ever seeing this percentage, even if someone was killing themselves and could do it, I think that people were still able to achieve this, but it was so rare. 'cause we're not wanting them to lose more than 1% per week, and that's not more than one to two pounds per week for the average person.

Right. So that totally, that's usually what people were trying to do anyway. Do you, when you get patients that have taken GLP ones and they're aging more than they would wanna look, what do you recommend for them?

So it's interesting and I think part of this is like working with somebody on your way down so that we don't get to a place where you're already like, ah, I don't like this. And we're managing it as it's happening and trying to prevent getting there is key. Yeah. skincare can help because one of the things that happens is your skin barrier gets impaired, meaning that protective layer between the outside world and the inside world.

You lose moisture through your skin and. It does get worse as you're losing weight. It does get worse on the GLP ones. Now, I don't know if that's compared to like regular weight loss, if that's true for that too. But certainly with the GLP ones, we've shown that it does affect the skin barrier.

And so doing good skincare can help. But then we're talking about maintaining your volume, because most of us that are trying to lose weight, we don't wanna look older and too thin in our face. You, but you wanna lose at other places. We just don't get to pick, right? Wouldn't that be nice?

I know, I know where you take it from, but that's not how it works. So you wanna kind of maintain the, we have normal fat in our face, like we call them the normal fat pads and those lose weight too. And then that's what can give you that kind of you know, sun in jowl, deeper lines, appearance. And so then you're talking replacing that fat, that's like things like billers.

Sometimes doing devices can help like lasers or radio frequency, like other devices. But generally when we're trying to replace volume, we're talking different fillers. I have a question with fillers. How long do they typically last? I'm just not that familiar with them. It's really interesting.

The companies will tell you like one to two years, depending on which product. Now if you're using more of a permanent filler the ones that don't break down as easily, they can last longer. But there's been some interesting research that came out recently where people were imaged that had not had fillers for like at least two years, some of them up to 12 years, and you could still see filler in their face. It stays around longer than we think. Now. There's a different type of, we still call it a filler. It's polylactic acid, also known as sculpt, and that is a biostimulatory. Molecule so it's injected into the skin. But the goal is to stimulate your body, to make collagen.

Your body reacts to that little molecule and its reaction is to build collagen. And then that molecule gets absorbed, it goes away, it's not in their long term, but you're building up your own collagen. And so it can help with volume, but it also helps with texture, with radiance, with hydration in the skin.

So it has a lot of other benefits. And what I have noticed for patients with that are on GLP ones that are losing weight, that's actually a good option. 'cause you're gonna get that improvement in the skin. You're gonna get some improvement in volume, but you're not putting in a hyaluronic acid filler on the way down 'cause you don't know totally where they're gonna end up.

My gosh, you're making me just wanna run to get a filler. I'm like, not even into all this stuff, but I'm like, oh my God, it sounds amazing. Wait, I wanted to, okay, everyone's gonna be taking like some massive notes. I wanna just remind people right now we have this all in the show notes, rant clinic.com/blog, or when you go on our website, you click on podcast and again you're gonna have all this written out.

So because we are gonna wanna know, but I wanna take a step back real quick. When you were talking about how the barrier gets affected and hydration, do you have any simple tips when people come in the clinic, you're like, Hey, do X, Y, z again, I know not medical advice, but just like what you generally recommend.

Yeah, so the thing that's interesting is because with the, GLP ones the goal is always right to have good nutrition as you're losing weight, but the nutrition might not be there. And so you lose these free fatty acids in the skin. That's what affects the skin barrier.

So using a really good moisturizer that's gonna replace that free fatty acid, replace those ceramides. Something like, like CeraVe is a great brand. Cetaphil's a great brand. And everyone's skin is gonna be different. That's why it's hard to give product recommendations for a broad audience.

But you want something that's going to, certainly, if you're putting it on your face, it needs to say that it's for your face. You don't put body lotion on your face. Okay. 'cause you could break out. Why is that? What? Because it's usually too rich. It's gonna, it's gonna clog your pores. So you want one that says like non-com metogenic, which means doesn't form acne bumps.

Okay. And generally products that are made for your face are gonna be comedogenic. Okay. Okay. They're not gonna make those little like milia, those little white bumps people get, or those little closed little acne bumps that are so annoying to get rid of. That's usually from products that are either too thick for your skin or body products that we're putting on the face.

Now, that's not. Some people can handle it, but most people can't. Most people, yeah. This is interesting. I grew up, my mom is really good with skincare and so she always was like, look, use this, use that. So I feel like I've had that blessing, but most people don't have someone that's guiding them.

I find, and I've seen this with my stepdaughter, she just wants to like, throw random stuff in the cart and I'm like, hold on, let's look at the label. I don't want you taking something in a teenage year that is gonna potentially affect hair growth in the future. So it's like I think we, we have no idea.

So that was incredibly helpful. Okay, so we talked about like different fillers, different options. Now you made the comment to be working with someone as this is happening. So what, like how often do people see you then? Let's say they're on a GLP one, they're losing weight, they're like, I'm noticing changes.

They're going through perimenopause. How often do people typically see you? It's a great question and it depends on what we're doing, right? If you're doing something like neurotoxin, which is not necessarily related to weight loss, but sometimes what happens if as we're losing weight we're looking in the mirror more, we're trying on more clothes, we're like excited. And then you look and you're like, oh my gosh, I have wrinkles, or whatever's happening. And that sometimes draws people in, even if that was there before. And not necessarily related to the weight loss, but neurotoxins.

So something like Botox is generally every three months, fillers. It depends on what you're doing, but could be six months, every six months or once a year. Generally. We don't do fillers too often, but it depends on the plan you come up with the person that you're seeing. And lasers could be once a month or microneedling could be like once a month, something like that, to help with the skin texture again it's trying to stimulate collagen if you're really early into this and you're like, gosh, I don't know. I don't wanna do any of those things. That sounds like a lot, but I wanna talk about skincare. Then you might only need to see somebody one time, they can evaluate you and be like, okay, what are you doing at home?

Here's the things you can do while you're losing weight. And then when you get to a point where you're feeling like maybe we need to do something else, you come back and we talk about it yeah. So I can't recommend this enough to people because I feel like even just talking to you, I was like, look, here's my skin.

I'm like, let's go in the light. I'm sorry. That's the benefit of being at a co a conference with you. Right? I'm like, okay, here's the light. Tell me what to do, Sam. I can't recommend this enough. And you, okay. I wanna ask you one other question. This is so unrelated. We didn't plan for this, but we have to go there.

I feel like all the weight loss channels pedal, this neck cream that like it's gonna firm it, it's gonna tighten it. Is that BS? Or is there any reality to those like the neck creams and stuff? Yeah, such a good question. So neck creams. Can help a little bit. And here's what I always say about skincare. It depends on what you're treating, right?

But skincare at home, it's like going to the dentist, okay? So you go to the dentist twice a year to get your teeth cleaned, but then you go home and you brush your teeth. You aren't like, oh, it's cool. I saw the dentist twice and my teeth are good. No, I love this analogy because I give with no exercise the analogy of fuzzy teeth.

Yes. I love that you brought the dentist into this. Okay. Excellent. Yes. And that's it, right? This is the conversation I have with my patients. 'cause it's okay, we can do things in the office to help you, but you have to go home and be doing stuff at home, right? Yeah. Same thing with like neck creams.

There are things that it will help a little bit and here's the thing, do you need a neck cream specifically? Maybe not. You can use your face stuff and extend it down your neck, get your chest and get the backs of your hands. Those are the areas that give us away. Ah. Neck creams, like it may help a little bit, but is it gonna be like, a holy grail?

Like no. We want skincare 1 0 1 SPF, you need to be wearing sunscreen the sun leads to, to damage visible light from the computers, leads to damage and anything. Wait, how did I not know that? Are you telling me that the computer light damages the skin? Oh my gosh, that's depressing.

Yeah, so that's why we talk about using like tinted sunscreens. The tint, the iron oxide in the sunscreen will help protect you from visible light, like blue light from the computers, from our phones, from the lights above us. They help contribute to aging in brown spots. Okay, I hope I'm not the only one listening that did not know this. I don't mean to be stupid. Like I literally thought it was just sunlight outside. Like I did. Not real. No. And some of this is new, right? So some of this is not like we've known this forever and ever. This has come out, I don't know, maybe in the last five, 10 years that visible light also plays a role. And it tends to be worse if you have melasma, for example, which we call it the mask of pregnancy, right? Where you get that mustache and you get the, brown out here, that gets worse with visible light. So wearing a tint is really important. But it does like the environmental effects from being outside from the blue light does contribute to aging.

Wow, okay. This is so, so wearings, sunscreen, and then at night using a retinol. So back to the neck cream, you can take that retinol that you put on your face and extend it down your neck without needing to really jump into a neck cream. If you're not getting enough benefit from that, then sure, we can try neck cream, but that's the best place to start.

'cause you're already putting it here. Just. Go down. Yeah. Yeah. Maybe this is, I don't even know if you can answer this question, but I feel like people will also get potentially a plastic surgery, if they've lost a lot of weight, just sometimes the neck area just can't recover. That's just distressing because they just, they feel like, oh my gosh, I put in all this work. You know, it's kind of like loose skin around the lower stomach or arm area. What, when do you like do those last, or is that something where you wanna put it off because it only lasts so long?

No, that's a great question. I'm glad you brought it up because we talked about things that like I can do in the office to help people, but there is a point where you need surgery, right? Depending on what the issue is. And it might be cosmetic, meaning like it's, the look is bothering you, but it might be functional

If you have a lot of extra skin on your thighs and it's impairing you from walking or doing the exercise or activities that you want, then I'm like, yeah, you might need to have surgery, right? To get the loose skin. The skin can only take so much stretching. It has to do with how fast you gain the weight, how fast you lose the weight.

Can the skin kind of recover? And sometimes it can. Yeah. And the same is true with the neck. The neck skin is thin, it's delicate what I always tell people is anything in the cosmetic world, it's not permanent. Even something like a facelift, even something like a neck lift. Are you gonna get a lot more longevity out of something like that?

Meaning it will last a lot longer. Yeah. Yeah. But at some point, is it possible you'll need to do it again? Also, yeah. Will it last longer if you're like sunscreen extending down the net, right? Yeah, because that's gonna make it worse. Your wrinkles are gonna come back when I was already using a tinted moisturizer, but I'm, I feel like I need to get like industrial stock in it now

after conversation. But this is really good. I feel like a natural extension of this we have to talk about hair loss because, so I always explain to people, look, this is physiologic. It's a big stress on the body to lose weight. But when you lose significant amounts of fat, that hair loss, that you could have some hair loss that goes with that.

Can you explain a little bit what the process is? Maybe like the life cycle of hair. Is there anything that we can appreciably do about it? Like today, I already got it twice today in clinic. Totally. Hair loss is really common now, I will say, what's interesting is I was looking in the research, in the literature and.

It's kind of mixed, like some studies and they're small, right? They're small case groups, so it's not like we're gonna hang our hat on any of this. But some are like, no, some glide doesn't cause any hair loss. And some were like, yes it does. And some were like, it's just related to the weight loss.

I think it's related to the weight loss. I don't think it's a side effect of the drug. Most people that you're talking to that are on these medications that are losing a lot of weight, it's gonna be that stress related hair loss. It's the kind that for those listeners who had a baby and afterwards, three months after their hair is just coming out in chunks.

It's the same hair loss. Okay. We call it telogen of flum. So the hair cycle, there's three types of hairs, but really for the all intents and purposes, there's two types of hairs. There's growing hairs and there's sleeping hairs. Telogen Eluvia is when the body releases the sleeping hairs.

Okay? The body's we don't have enough nutrients. We're stressed out. We've gotta fight the battle here, right? Because your body doesn't know that nothing bad is happening. Your body is like, this is a stressful moment and we need to conserve. It's releasing those sleeping hairs, which is why a lot of them start falling out.

You don't go bald from this, okay? This is not that kind of hair loss. It will come back, but it comes back after the stressor has ended, usually starts three months later. So as soon as you go on this med, you're not, it's not like your hair's gonna start falling out and it lasts until your weight is stabilized and it comes back a few months after that and they come back slowly.

And it's like I said. Pregnancy is a common reason to have it. Delivery, I should say. Not necessarily pregnancy, but delivery being hospitalized for some reason. Major life events getting divorced, losing a job, those are things that can do it. And then it takes time for the hair to grow back. So if you're noticing that you're losing your hair, there's a couple things that you can do. The holy Grail that a pretty much any dermatologist is gonna recommend is using Minoxidil. Topical Minoxidil brand name is Rogan. You don't need the brand name for men. And for women it's 5%. There is a women's version, it's 2.5%.

It is more expensive. It does not work as well. Women need 5%, so don't buy it. Don't buy the women's it's like the pink tax that everybody talks about. You use it twice a day. Now it's either a liquid or a foam. It doesn't really matter. I always tell people like, whatever your preference is what you should use.

'cause it's like how I feel about SPF. You gotta put it on, so you have to find one you like. So pick one that you like. You put it on twice a day. It's not safer on pets. If you have pets at home, be really careful. It is dangerous for them. But that's the first thing that most people would tell you to do. It's basically like fertilizer for hair. So it will help you grow hair, but it takes time. Anything in the derm world takes time and I went through Telogen Effluvium a couple years ago. Guys, it's still growing back.

It takes a while. Can you say, when it takes a while give us a ballpark. Is it like half a year? Give us a range. So anything you try, you wanna use it for three to six months for Rogan. But your hair imagine your sleeping hair fell out and now it's your rogan is switching those sleeping hairs to growing hair.

So they're growing like all the way from the root. Right. So it's gotta, my hair's longer, it's gonna take. A year or more for it to kind of grow all the way out. Now I feel like what I've always heard about, mono rogan, whatever name we're using, that once you start using it, you have to keep using it.

Otherwise, when you stop all of what you retained new is gonna come out. Is that true? Are you committing to using this for life then? Such a great question because it depends on what you're treating. So for this, once your weight is stabilized. Your hair, your stress response is gone. So your hair should go back to normal. That's what happens with telogen Nephi if that's what you have. It's like you delivered the baby, your hair fell out and now the baby's out. So your hair's gonna come back. So then the answer to that is no, you don't need to use it forever. Okay. Now, if we're treating like age related or hormone related hair loss, we call that androgenetic alopecia.

Alopecia just means hair loss. It's a generic word for hair loss then. Yeah, if you stop it, you still have your age and you still have the hormonal component in here that's contributing and so you, it will revert back to what was before. When we're talking about this, I really wanna stress that I think people need to work with a dermatologist like you, because I usually, it's multifactorial, like yes, I wanna say probably 95% is what's acutely happening with the fat loss the stress of that.

But I think that there's some of these patterns beforehand that are present, I'm just so worried that someone's gonna go out there, buy a random thing, think that they're helping themselves, and then suddenly they're like, oh my gosh, when something goes wrong.

I love that there's this education that people even know there's an option. But I still think, just like I say with me, like they need a supervision from someone that knows what's going on because you just talked about all these different scenarios and I, gosh, it's phenomenal, but it's also like kind of scary, right?

Oh totally. And that's the thing, absolutely what you said. Sometimes what happens is the weight loss leads to telogen, effluvium that stress, hair loss, but it unmasks if you will, another type of hair loss. And so then you're not addressing the whole picture. Totally. Because think about older gentleman, right?

That have that stereotypical baldness, like that's age related hair loss. Do we still use topical Rogan? Yeah, but do we have a lot of other stuff too? Yes. Yes. So like there's a lot of other things you can use if you're at home and you're like, gosh, I don't know, I wanna start something, then yes, start Rogan.

We use it for almost any type of hair loss. It's a good place to start, but that might not be all you need. That's a great point. What's the difference between if they're using the topical version, which they can get over the counter but then there is also prescription oral. Are there differences between taking it orally versus uh, I mean obviously there has to be, otherwise one would be there wouldn't be a prescription versus not. Totally for Minoxidil orally, generally we start with a low dose, two and a half milligrams or even 1.25 milligrams. So you get a pill and you're cutting it into little pieces. And it can have some side effects. It's a hair, it helps you grow hair. So for women the most frustrating side effect is it can grow hair places you don't want.

And as you're getting into menopause, perimenopause, you're growing hair, you don't want getting some little chin hairs and stuff. Yeah. Like it can throw beard hairs, mustache hairs that you were trying to get rid of. So that can be frustrating for people. Okay. Some of it's like nice 'cause it's convenient you're taking a pill instead of a topical because the reason I'm asking is because the topical I've just seen with people, it's a pain in the.

Ass. Like it's not convenient. This twice a day I don't even know how people keep their hair clean with using it. That's why I'm asking you about the totally. It's not the easiest and the most convenient, but it also really doesn't have the, side effects because it's topical.

The side effect would be, growing. You can still grow hair where you don't want it, using it on your head. And irritation of the skin or the scalp or your hair looks greasy and you don't like it. But when you take it by mouth, there have been, now it's super, super rare, but there have been some cardiac side effects, which is why you wanna make sure you're working with a doctor and that assessing your history, making sure you're a good candidate for it.

If you have an autoimmune disease like lupus that can have heart problems and we don't wanna, and you're having hair loss, like maybe we don't wanna put you on this 'cause it can have heart issues. So I have a question. With the topical stuff, when you put it on, like, okay, let's say it's the morning time.

Are you able to, after 20, 30 minutes when it's dry, are you able to then shampoo normally and move on with your day? Or does it have to be the last thing you do in the morning? It should really be the last thing you do. Which is why a lot of people don't like it. Because you don't want it to, you don't wanna rinse it off.

That's what I thought and that's why I'm like, I just don't see this being such a great I don't know. Do your women stick with it? I just don't, I just hear them hate that. Yeah, it's not easy, especially for women. For men it's a little easier 'cause their hair is short and it dry eyes like whatever.

But for women it's more difficult. And a lot of us don't wash our hair every day, which could be a whole nother conversation because some people do need to wash their hair more often. Okay. I'll just throw that out there. Yeah. But, um, you know, it can make it look greasy. It can be messy.

It can be frustrating to use. Absolutely. Yeah. There's no doubt about that. Okay. I didn't even mean to ask all these questions, but I'm just so intrigued and you're such a wealth of knowledge. Okay, so you were going down the rabbit hole of telling us what people could do. So there was first, there's minoxidil that they could try.

Totally. What else for as far as helping with hair loss? So there's a shampoo that's over the counter called Ketoconazole shampoo and it can help with hair loss. Now it's interesting and part of it, not necessarily with stress related hair loss, but listen, like if you're gonna just, try some things and like why not? Because it blocks that hormone. So that hormonal component of hair loss at the hair follicle when you put it on. And so that can be helpful for more of that. You had a little bit of hair loss, maybe your ponytail wasn't as thick, then you went on the medication, you're losing weight now chunks are coming out.

So you kind of have a little bit of both, right? You have a little bit of age hormone related, a little bit of telogen, effluvium, stress related that it can help. Is it gonna dramatically stop the shedding or all of a sudden your hair's gonna be back? No it can help. So I think that's a reasonable thing to try.

Ketoconazole, the brand name is Erol shampoo. Okay. And then over the counter things, other things we're talking about are gonna be like supplements. Wait, real quick, how often do you use the this over the counter shampoo that you just talked about? So, I mean, I like to tell people to use it every time they're washing their hair.

And I guess the other thing I should say is if you're getting dandruff you're getting some, itching and a little bit of flaking, it will treat that, that can also sort of contribute to hair loss. So it kind of is killing multiple birds with one stone. Head and shoulders is great, but it's a different mechanism. Cell, some blue different mechanism doesn't have that ketoconazole, which blocks that hormone part. Even if you're using those things, you might wanna try this if you're getting some hair loss. 'cause it'll give you you know, little bang for your buck. I like to tell people to use it.

Every time you're shampooing. If you hate the smell of it or whatever, you don't like how it feels, you wanna use your stuff so your hair smells different. I just tell people, put conditioner on the bottom. The bottom of your hair doesn't need shampoo. So you wanna protect the bottom, do your ketoconazole, and get it all fluffy in there.

Rinse it all out together. And then if you wanna do your, another shampoo to get your smell in there, whatever else you feel like you need, go for it. And then you can do, I was literally gonna ask you that. You are answering the questions that the people have, yes. That's exactly, that's the problem is, some of them are just less than amazing.

The smell and everything, like a medical shampoo it wasn't made to be like delicious scents and cosmetically elegant. So you wanna do that part of your routine. Do it. Yeah. Okay. I love that. Anything else as far as like nutritionally what they should be doing or supplements? Like you hear about neutrophil all the time, all that kind of stuff.

If I'm saying anything, totally. I love neutrophil. I mean, I take neutrophil. I love it. Step back. People think biotin's great for hair loss. It's really not. Maybe at one point we thought it was helpful, but it actually doesn't really make a difference. And um, I'm glad you're saying that because I never saw it help.

So I'm like, the fact that you're saying that thank you because I just, it doesn't make a difference, I found. Yeah. So like when you go to the store and you see like the skin, hair, and nail vitamin, you look at it, it's like biotin, like it's, it's not, it's not helping. And I'm gonna throw out there, if anyone's listening it, you gotta stop at days before you do thyroid labs and things like that.

Correct. So this is one of those things where people are just like taking random stuff at home. They're not disclosing to primary care, obesity, medicine, derm, whoever they're talking to. Then labs are super screwed up. And if we actually knew some of this stuff, we would know, oh, it's because of X, Y, Z. And then you get all scared thinking your thyroid ConEd out on you, and it's like, no, you just didn't know to stop it.

So anyway, so a hundred percent. Okay. So biotin, maybe not the answer. Now is it's in one of, at least one of the formulations of neutrophil. But don't take. My recommendation don't take extra biotin and if you don't want biotin, the vegan version of neutrophil does not have biotin in it.

The reason I like neutrophil is 'cause it's attacking the. Hair loss issues from multiple angles. Okay. So you have collagen in there to give you the building blocks. You need to make hair you need your amino acids to help build your hair. So it's got some collagen in there. It has ashwagandha, it has saw palmetto, so it helps with some hormonal components.

So stress components. There's a lot of different, and they really spent a lot of time formulating it. They did some studies to show that it helps increase hair diameter, it helps increase hair density. So there are other ones on the market that have done studies as well. I'm not as familiar with them, but like I said, I take neutrophil, I recommend neu neutral to my patients.

But if you were like, I don't wanna do neutrophil, then like collagen, I would do co I would take collagen. I would skip the biotin, don't waste your money, right? Put your mo put your money where there's value. Get topical minoxidil. Get ketoconazole shampoo and get collagen. There was something that Rosemary oil would help and like the data's pretty unconvincing. That. Okay. I'm glad that you bring that up.

'cause someone told me God, it was too like essential oils or something and they're like, well I've added it to my shampoo. 'cause they were asking me things to do and I was like, I don't like, they're like I don't think it can hurt, but I don't think we have a robust data on it.

No. And it's kind of mixed. And at first we were like, oh yeah, use it. And now the derm field is more like it doesn't really seem to be doing what we thought it did. So the thought was that it's increasing blood flow to the scalp and that's what's helping. And here's what I always tell everybody.

'cause some people will swear it's helping. Listen, not all patients read the textbooks, right? Meaning just because we say it doesn't work, if it's working for you, go for it. You don't have to stop. The only caution is with any of these things is as you're putting things on your skin could react to it, right?

You get a rash, it could get more irritated. So you just wanna listen to your body. But the chance that it's gonna hurt is very low. I mean, listen I really think I would try all the things in the land as well. I mean, I'm, I'm sorry, like just being real here. It is so distressing to women when their hair, uh, starts to thin or, or there's pattern changes that I can see that people are grasping for anything.

But I like your approach, what you're talking about, and I say this with patients too, but have to document what you're doing so we know if it works or not, and then be willing to let go of things that no longer serve us, because otherwise we end up with a supplement cabinet that has a million things and then that creates its own problems when you're doing 900 things, right? Absolutely. So I had someone that, a patient that was getting a really bad rash all over and they ended up identifying it was one of the supplements and when they cut it out. And so it's really interesting. So we had to seek out different brands, and I know a lot about this because of my parents' nutraceutical company that.

All these companies are not created equal. Even the ashwagandha in things, it matters where they're coming from. There's with Neutrophil, I know there was like a case study like liver toxicity and there's, there are problems that come with these things. They're not just because they're over the counter, there's no challenge.

So I love that we're just talking about some of the different angles. Now you mentioned collagen, so is that just like one serving a day that you recommend or what, what's the thought on that? Yeah, and the thought is that it should really be hydrolyzed collagen. So it does matter which type.

I would at least start with once a day. Here's the thing. With any of these things, we have to, like you said, know what you're doing and have a way of following it, and so. What I usually tell people is to kind of add things one at a time. Like I know you're like, yes, do everything, but then we dunno what worked and we don't dunno what isn't working.

We don't know what to stop or if you have a reaction, we don't know what did it. So, and I think, yeah, no, I'm totally, I'm totally not about shotgun. Things have to be in a systematic way. Even in my clinic, I'm like, we are not ever gonna start two meds at the same time. Foolish. I'm not talking about generic contrave guys, if you're listening.

Yeah. That's a no, that's different combination. Okay. Yeah. So that's just like answer questions before they occur. Totally. So it would say on it hydrolyzed, correct. That's the way that I've seen it. Yeah. And that's what we've seen has worked better now this is all a newer field.

Like this may change, this is what we know right now, but. Collagen and it does also seem to help with like skin radiance, skin texture so it has other benefits besides helping potentially with hair too. Okay. Something I just need to look into. I'm sorry. We might cut this out if it doesn't make sense, but I have the built puff bar, strawberries and cream.

Okay. Yeah. So it's made with collagen. Can we look at what type of, does it say the type of collagen? I'm just wondering, partially hydrolyzed whey protein isolate collagen, so who knows? I mean, it's probably not hurting. Okay. I'm just so curious. See, this is where I'm really a fan of really digging into what you're using because probably.

Not only is it not a complete protein, but it's maybe not getting us like the beauty effects that we might want as well. Right. I dunno. Hundred percent. And it's like what you were talking about with the supplements, right? Like you have a whole cabinet and you don't realize that biotin is in this and like it's also over here.

Or maybe curcumin's a good example, they're kinda like throwing it in places 'cause it's got some cool skin benefits, but you're taking all these different things, like maybe you're taking too much. Yeah, yeah, yeah. Okay. We went way down a rabbit hole, but anything else as far as nutrition? I feel like I'm always telling people look at actually like the macronutrient distribution.

You not undereating. Is that, is there validity to that or am I just saying that? Yeah, because, yeah, because if you're undereating and you're not getting the nutrients and like that is what affects, your skin. Like the collagen in your skin, the elastin in your skin. It.

Pres your skin aging. So yeah, you do need those nutrients. And it's not just like the big macronutrient nutrients, right? Like you need the minerals, the vitamins, like all of those things play a role. So it does make a difference. Like eating healthy exercising strength training actually can help your skin.

Like what that is so cool. So like doing these things that we know that patients need to be doing when they're on these medications has an added benefit with their skin too. Yeah. So definitely no one wants, you know, no one wants to hear it, but strength training unfortunately is the answer to a lot.

It's the answer to a lot, right? Here's the other thing that no one wants to hear starting in your late twenties, we start losing collagen. Okay? And we lose 1% a year in your skin. So doing what you can to keep what you've got, I mean, is so important. God, it's such a decline to death when I think about the rate of muscle loss, the rate of collagen loss.

Totally. But, and strengths training helps with both muscle and collagen. and I mean, listen, I'm not someone who I, I'm actually very much so a fan of, of aging naturally, all the things. But I do think, listen, if we can pop a little collagen in the coffee in the morning and we don't even know, and it's unflavored and it's organic and all the things, I'm just I think we're at the point where it's we do realize that some of these things move the needle.

So I think it's very helpful. Is there anything, like when we use moisturizers and stuff, does that help the elasticity of the skin as you lose weight or that's just the genetic draw of what's gonna happen? It can, because it can help improve, the hydration status. It can help with your barrier, it can help it decrease trans epidermal water loss drying out your skin.

And so it can help the suppleness, the elasticity of your skin. Some of it depends on the ingredients that are in there. But yeah, it can help. This is all, gosh, we went so different than what I thought we were gonna talk about, but yet I know everyone's gonna, it's gonna be like the best episode, trust me.

Let me come back to acanthosis nigar cans. So can you explain to people what is it who gets it? Is it reversible? Just going over that. So a Acanthosis Niger cans, is that sort of brown, velvety, sometimes waxy skin appearance that people can get? Generally it's gonna be underarms behind the neck.

You can get it in like the skin folds on the thighs. Some people can get it on the face, you can get it other places, but the most common's gonna be back of the neck or kind of sides of the neck. And then underarms, it tends to go with insulin resistance. So it doesn't necessarily mean you have diabetes, but it means that your body just, it's, it takes more insulin to know that it's there.

You're becoming resistant, which we see in a lot of people who are obese. That's just something that happens. And skin changes can be distressing for people. Absolutely. And it can be one of the first signs that you're maybe headed down that path towards diabetes in the future if changes aren't made.

There is a little caveat that there's a small a rare subtype that can come with cancers so if all of a sudden you're like getting it all over, that can be more concerning and then you definitely need to see somebody to make sure that everything else is okay.

But for the vast majority of people, it's related to insulin resistance. You know what else is, which is interesting too, is skin tax. Yeah, that's always a fascinating one, right? Yeah. And is it just generally can you explain like what the skin tags like and friction areas are where they occur?

Mostly. Totally. So they're usually in friction areas. The way I like to explain it to people is you think about pilling on a sweater, like when you're wearing your favorite sweater and you're walking around and you get those little balls in the armpit, it's kind of the same idea. But we also know that insulin resistance puts you at more risk of getting them compared to other people, like not everybody.

It is, gets them as heavy and not everybody who's heavy gets them. Yes. Some of it has to do with the way your body moves. So underarms is common in the, thigh, groin area is common, but eyelids from blinking, like your neck from just turning areas where your skin is just rubbing skin is where they appear for the most part.

So can these things get better? They can and often what before the GLP ones, what we would recommend is lifestyle changes, like trying to lose weight and it can help but it can also be very frustrating to get rid of and it can take a long time. Yeah. Things that you could try on your skin as long as it's not getting too irritated.

And I would start with your neck compared to underarm skin is just so sensitive. Like I wouldn't start with anything there. Yeah, yeah. Is something like AmLactin. Or ammonium lactate, which is over the counter. It has ammonium lactate in there, which helps break down thicker skin. And so you can try that and sometimes that can help a little bit at least with the texture.

But the color that can take a long time to fade. And that's true with any sort of color changes on your skin. If you get a rash and you have a color change left behind, that can take months. It doesn't mean the rash is still there, it's just, we call it post-inflammatory and then whatever color it is, and it can take a while to fade.

And that can be what happens too with this. 'cause I notice while we're on this subject with things taking a long time to fade, let's say someone does a GLP one injection. I don't know if you've seen any of those reactions afterward, where it can be like weeks and months of, you can see the little circle, around like, sort of like a quarter size if not more.

And even if the itching goes down and the redness and all of that. It's just that I tell people sometimes might be months until that goes away. And then what's really interesting is it's like it's periodic, people might not have it the first few months of doing weekly injections, then they get it for.

Weekly for a few months and then it goes away. Is there any insight into that in the literature or is that just something that I'm seeing? No, I mean, I know people are seeing it. I don't know if anyone's written about it in the literature. 'cause it's real. It's like an injection site reaction, right?

Yeah, yeah. But what happens is because you get all that inflammation in the skin, that's what's giving you the redness, giving you the itching. Afterwards. It can just take time for that to fade. And that's not true for everybody. But there's certainly people where the redness, if you're like fair, like me, the redness is gonna stay for a long time.

If you have more pigment in your skin, it might be brown. And that brown could stay for a long time. You know what's interesting though is when I was in primary care, I didn't ever see this type of reaction with using insulin. And the volumes were the same. And so that's why I think it has to be something either related to the medication, a preservative, like there has to be something going on there.

Oh, totally. It's not like a generalized allergic reaction, right? They're not, no, no. Anything like that. It's a reaction. Yeah. No, no, no. It's a local skin reaction. And I would agree, it's to either some component of the medication or more likely, something in the vehicle, is it a preservative or, you know, we have all kinds of other things in there with the medication to keep it simple so that you can inject, for example, some of my patients tell me like, sometimes when they inject it, it stings and sometimes it doesn't. And the same concept. So sometimes your body just might be like, Ooh, this is a little different. We're gonna mount a little response here. Obviously if it's escalating, it's getting worse and you need to talk to the prescriber and figure out what's going, is this okay?

But if you're getting like the little quarter size, little spot and the pink is taking a long time to fade, that's normal. We call that post-inflammatory erythema 'cause it's pink. Mm-hmm. And what I tell people is to just keep, most of us. That's not an area that's gonna be seen a lot of sun, but if it is like keeping it protected from the sun it will make it stay pinker for longer or it will tan faster than your normal skin and it will undo that kind of fading.

That you're already working on. Oh my gosh. This is like disaster zone. I'm actually glad we're talking about that because I'm gonna make sure that this airs before summer. Okay, Sam, I'm gonna guarantee this. Well, that's true because what if you're injecting on your leg and then you're gonna go to the pool and wear a swimsuit?

Then like that's totally, no, this, it's happening on mass. This is why I know this episode's gonna be so well received. And again, this is totally random. I didn't even mean to ask you, but like I know that this is not just GLP one injections. There's also. Biologics and stuff that you prescribe. Do you, is there any validity to like that people really experience significant different symptoms, whether it's in the stomach that they're injecting or the leg or the arm, because I know people will swear this site works better than that one side effects.

So it has to be an absorption thing. Right. What are your thoughts on that? I guess that's interesting. So you're saying they think like one site works better or like it feels better? Yeah, so there's like folklore. So there is a study, like there's been two studies actually that I know of where they looked at specifically for GLP one, they looked at absorption

and they saw that overall it was roughly the same, but. Per person. Per site, you can see patterns, like when you look at each person and p patients will tell me, oh, when I do it in the let's say they do it in the leg, they're like, I'll notice so many more side effects compared to the stomach or vice versa, right?

And then anecdotally they'll be like, oh, I lose more weight if I shift the site. I've never seen that like clinically really pan out. But I was just wondering from the other injections that you do, is there any validity beyond just not doing the same site all the time? To not make like little hard to absorb areas, but anything beyond that's really interesting?

You definitely wanna rotate the site, but for me, I would say, because I don't write for the weight loss medication, so I do see patients with this, but we're not necessarily talking about that. I write for more of the atopic dermatitis, the psoriasis injectables. And patients will tell me I don't like doing my leg because it hurts more.

Compared to my stomach. Yeah. But they, I've never had a patient tell me oh, but if I do it in my leg, it works better or it works worse. It's usually related to the comfort. Okay. So ease of doing I action. I'm gonna leave this in with the interview because this is where, I think it's just this like grimy weight loss community where they're like trying to like prey on anything.

You know what I mean? Everyone's trying to tell their anecdotal story instead of just like listening to evidence-based medicine. So that's why I'm glad we're having this talk because I agree. I think it's more of like a, can that area handle getting some fluid under it. I feel like the stomach is just like easier, a little bit more malle, the skin compared to sometimes that's thicker with a thigh.

I do not enjoy a thigh injection. I don't know who's signing up for that, but like, no, but like, it's not fun. When we teach in the office, we generally teach in the thighs and like people tell me it hurts. Why is that Also the stomach? Because it, is it because people don't wanna show their stomach?

Is that it? I don't really know, honestly. But I always ask patients, we can do your arm, we can do your thigh, we can do your stomach. What would you like to do? And I think for some people, I think they think it's gonna be easier to do their thigh see it. Yeah. And to be trying to do their stomach.

Totally. Here's the other side is if somebody told me like, oh, but if I do it in my thigh it works better, I'd be like, great then for you do it in your thigh. But you know what? Don't do it in the same spot in your thigh. Switch it to the other. If you do it in the same spot, it's gonna be a problem.

You gotta rotate. But I think the challenge becomes when they ask you that they want me to be like, this is the site. When you do this, it's better. I can't subscribe to that. Honestly, I tell people to do their stomach because there's less nerve endings in your stomach.

Yeah. Yeah. So the chance that it's gonna hurt is lower. The chance that you're gonna actually hit one of those nerve endings when you stick the needle in is lower. It's not gonna hurt. Yes. Your life's gonna hurt, your arms gonna hurt. Yeah. And the arms, I don't know how people are pushing the bottom of, whatever injector even to push it, to get it to go.

If it's autoinjector I don't even understand the physics. Like I've looked at it, I've seen the videos and I don't teach it because I just, yeah. I don't get, but here's the thing, everyone has their personal preferences like my mom is. She's on a biologic for a derm condition, but, and, but not not a weight loss medication necessarily.

She likes to do it in her thigh. Yeah, she does. We're gonna just say to each their own, but you got to hear us debate this for a minute. Okay. So back to Acanthosis nigra again. So it can, with better control of insulin resistance, it can decrease. There's potentially some products you can use, but you do see it that it could potentially go down if there was maybe some better control of the insulin resistance.

Totally. There was a case report that came out that looked and granted case reports in science, for those listeners that are listening, like case reports are like our lowest level of evidence, right? Yeah. Because it's not a randomized trial. We didn't pick a whole bunch of people and then see what happens.

This was somebody did this and then they had this result and then we publish it. 'cause people need to know. But honestly that's where a lot of research starts because we have to kind of get a sense of what's happening and then we're like, Ooh, we should study this more. So it was a case report and she was on either one of the GLP ones, I think it was Semaglutide and had a high A1C.

So she was on it for diabetes and most likely, and obesity I think. So she was getting the weight loss benefit too. And she had Acanthosis Nier cans and when her A1C came down to, she got down to 5.7, her Acanthosis Nier cans. Basically went away. So there is hope that it can get better, right? Yeah. But like I said, everyone's an individual, so hopefully for you that will be true, but it may not be true for everybody.

I think it's cool, honestly, when we treat something and there's like a visible change in the skin, I think that's wild. I think it's amazing how our body can speak to us in that way. Because I remember when I did medical school, I trained with an endocrinologist and she said, look, when you go in the room, these are the things you have to look out for.

She's like, you are gonna know so much from them already with looking at the labs, with looking at their body. We've basically lost the skill of physical diagnosis, actually being able to do an exam and look in front of us. And so I think that's, it's quite magical to be able to see the skin tags that you can't, the sneer cans, like I think it's really magical.

So we've talked about so many things we sure have. I don't think we're gonna touch on all of it, but I love it. Do you think that there's anything that we missed that someone that's working on a weight management journey, maybe they're on these medications, they're having rapid skin changes. Did we go over the hit list of how they could support themselves?

Or is there anything else that you think is like, no, they need to hear this. If they came into my office, I would make sure that they hear this. Honestly, I feel like we hit on most of it. I mean, could we dive deeper into things? Oh, always. Absolutely. And will there probably be questions Definitely yes.

'cause as we're talking, it's bringing up more ideas and questions and areas to think about. But I think we hit the highlights, right? As you're losing weight, think about the changes that you're seeing in your skin. And it might not be for everybody, but you may need to see somebody to start managing these things as you're losing weight so we don't get to the end result.

Because here's the thing, if you get to the end and you're like, oh, I'm not happy, I look too gaunt. My skin is like not radiant, it's not, the lusters gone, it looks dull. I look old, right? And I guess what I should say is.

We call it the triangle of youth. And if you look at a little kid and you see those cheeks, remember like people would be like, I'm gonna pinch your cheeks. Yeah, yeah, yeah, yeah. That's like a normal thing, right? It's the triangle of youth. We have our, our cheeks up here, and so when you are, heavier and you're carrying more weight.

You often do look a little bit younger because you have more volume in your face. Right? And so as you then lose that, we call it the the inverted triangle, it starts to kind of drop, right? Then you have the jowls and everything's hanging and that's what makes people look older and it takes time to correct.

That is what I would say. So as you're going down, there are things you can do without having to do any inter procedures and interventions, like good skincare at home, wearing sunscreen is the number one thing. But those are things if you can address it as you're losing weight, I think a lot of people would be happier.

Because I know you mentioned you're a fan of aging naturally. I am too. Like I actually tell people no a lot in my office. I love that we're not doing that. I'm not making you look weird, but there's ways to still age. Gracefully, look your age, but just be taking really good care of your skin and doing little things where people don't know necessarily that you had something done and it makes you feel good.

That's the whole point about all of this is I guess I should say that's the whole point about all this is like, we want you to feel good, right? Like you're doing all this hard work to lose the weight and if you're getting to the end and I don't feel good now. 'cause I. Look what happened.

I look old. Then we need to see you as you're losing your weight, so we don't get to that place. I really love that you're bringing this up because again, for me it's never about aesthetics, but we're talking about this because aesthetics can get in the way of, honestly, mental health, functional abilities, what you're talking about, like with excess skin and stuff like that.

And so it reaches the land where I feel we do need to talk about it, I think that if you've been doing this skincare on the way down and you've been doing what you thought you could reasonably do, you've been taking a supplement, you've been having the collagen, you've been eating the foods, you've been strength training, the skincare, well then at the end you can really be at peace and acceptance with what's there.

And it's not like, well, I just treated my body like a trash can for two years, right? That's the opposite. And I find that then we can do the mindset aspect and be happy with it. But what you're saying, I think it's much more empowering than it is saying we have to change things.

That's really not what we're saying here. No, but I don't think it's nice that there's options that people wanna do it. And by the way, I'm not shaming anyone that. Wants to get all the, filler, Botox, whatever. I always said if I was ever able to lose enough weight, I a hundred percent would get a skin removal surgery, like a hundred percent because it's just not functional at some point with the yeast infections and stuff like that.

Actually, can we touch on that? 'cause we, I'm sorry, we forgot to touch. Okay. So when we have, when we've lost a lot of weight and there's a yeast infection in between, and again, we can call it intertrigo people that are listening, it's like red, it like smells disgusting. All of that usually like kind of damp in there.

Yes. So what are things that people can do with that? Let's say they're starting to get more of that. They, or some women, even underneath the breast tissue, they can get this forget weight or not. This is not like unique to the overweight or obesity population. What are the best creams, the best practices, what are things that people could do?

So it's really interesting, and I'm glad you brought up that it's not necessarily related to weight because like women with larger, we call 'em pendulum breasts. The larger hanging ones, like they can get it under their breasts. You can get it in the skin fold. So you can get it in your thigh creases.

Everybody has a thigh crease. That's how we move our legs not just related to weight. And you can get it when you're, before you've lost weight, you can get it when you've lost weight. Yeah. But basically it has to do with our microbiome. Okay. Which is like the bacteria and the yeast and stuff that lives all over us all of the time.

But in areas where skin touches skin, it gets damp and humid in there and we get an overgrowth of that yeast that's why it kinda has this like smell to it. It can be, and it's wet. So usually, there used to be this old adage, which I really hate, but if it's wet, make it dry.

If it's dry, make it wet. And that's what people used to like, make fun of derm. They'd be like, oh, it's wet. Make it dry. But in this case, it's wet. We gotta make it dry, the yeast likes that like dark, wet environment. So using something like a powder can be very helpful. What I usually tell my patients, there's an over the counter powder called zor.

AF for antifungal, although I love that it's called Zor af. Yeah, I was gonna say, are we gonna broach that? Yeah, I love it, but it's for antifungal. And it is helpful because a powder will absorb some of that moisture and it has that antifungal in there that will help, with that overgrowth of the yeast.

Now, if you are somebody who's, I want a cream, yeah, you can use a cream, but cream's gonna add more moisture in there. If you're already pretty moist, that might not be the best thing to use. But like I said, everyone has to figure out what works for them. The other thing I tell people is literally if you're home and you're hanging out and you're watching TV or something, take off your bra, take a cotton shirt, and if it's under your breast for example, stick it under there.

Try and suck up some of that. Moisture because that's what makes it worse. That's why people usually get worse in the summer. It's humid. They're exercising, they're trying to get out there and it's too wet. Totally. And they're staying in clothes after the gym and things where I'm like, let's just take a shower.

Let's not, yeah. You gotta, yeah. And not re-wearing, right? Like you gotta wash your gym clothes in between there's bacteria on our skin. It's getting on our sweat, it's getting on our outfits. we could do a whole talk about this. Yeah. Oh my gosh. Do your body odor. What to do after the gym.

Oh my God, I have all these things I could tell you. I wanna say, if anyone's listening, you know right underneath the episode we have fan mail, you're gonna have a million questions. Go ahead and submit them right now. 'cause we're gonna bring Sam back like the end. Because literally as we're talking, and I even talk to you often, I'm like, I have 900 more.

And I know that we have to at some point have an end, but Sam, you have just gone over so many amazing things today. Can you tell everybody where can they find you? Tell us both, physically your clinic, where you're located, and then online, because you do amazing stuff on social media as well. And I know that everyone doesn't necessarily live by your clinic.

Totally. I am at Pacific Crest Dermatology. That is my clinic, and I practice in Carson City, Nevada, which is near Northern Nevada, near Reno, lake Tahoe area. So you can find me there. My website for my clinic is Pacific, like the Ocean Crest, like the top of a mountain dermatology.com. And then I am on social.

I'm on Instagram, I'm on TikTok. My handle's the same for both. It's Samantha Schneider, md. And I am on Facebook also. My name is Samantha Schneider, so you can search for me. My picture's there. That's probably the best way to find me if you're gonna do Facebook. I love it. We're gonna make sure to link everything again in our show notes.

People underneath where you're listening, or again, renta clinic.com. You click on podcast, it's forward slash blog. We're gonna link to all of this. Everybody should follow Sam, Dr. Schneider here because she makes videos. I don't even care about skin. Okay. I feel like this is something where I'm just, I'm not that right?

I'm like, confession time. I'm not that into it. And I watch your videos and I'm like, ah, I didn't know that. Or you also bring things up or I'm like, oh, I should care about that when I watch the videos. You're really someone great to follow and thank you for coming on today. It was my pleasure. I hope there were like at least a couple little gems that people can take away. Things they can start using in their own life in the meantime, because skin is one of those things where I feel like we don't talk about it a lot.

I don't know, maybe we do, but I just feel like we, oh, in med school for example, we have two weeks of dermatology. We just don't learn a lot about it out. If you're not in my world and I just wanna share my world with other people, a hundred percent. What's talked about maybe are some of the scary things, but we don't talk about just the day-to-day things.

Like I'm so glad that we talked about how to support the skin on the way down. And yeast infections, these are things that are happening every single day to my patients and there's not good resources on them. Who wants to go read a stuffy journal article, no one wants to do it, but listening to something like this is a lot more approachable.

A hundred percent. Yeah. Well, thank you for having me. It's been my pleasure. Thanks.