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Skin Anarchy
Discover How the Skin Gut Connection is Transforming Eczema Treatment with Dr Barbara Paldus
00:49:36
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- [00:00]
Ekta
Hey guys, welcome back to Skin Anarchy. This is Ekta and I'm really excited to welcome back Dr. Barbara Paladas for another masterclass episode. It's great to have you back, Barb. I know last time we discussed the live probiotic serum and how you can improve acne by shifting the skin microbiome, but I would love to learn what's the latest news from Codex.
- [00:20]
Dr. Barbara Paladas
So the latest news is I just gave a TED talk in Prague on the skin, gut, brain microbiome, axes and skin problems. And what's really cool is that the more research we do, the more we're realizing that you have to improve gut health, reduce inflammation, balance hormones, support the gut and skin microbiomes in addition to functional skincare. And if you do this inside out approach, we're now seeing results that are up to three times the benefits of only skincare. And we basically focused the last six months are focus on eczema. And so Ekta, today I'm like beyond excited tell you that we now have like a complete inside out solution for eczema. And so this is the beyond scented soap that you loved and the Bfacial oil which is a great addition to it, which both have the seal of acceptance from the National Eczema association and my microbiome certification. But our, we now have clinical data on our onto skin barrier support supplement that we also talked about and our first OTC eczema relief lotion. So I think we'll be talking today about some gamechanging clinical data that we've just submitted to Dermatitis in the Journal of European Dermatology and Venerology and just about this whole inside and outside approach that's really exciting.
- [01:38]
Ekta
I'm, I'm excited to learn about it. So I want to actually recap for our listeners though, Barb, about eczema. You know, can you tell us and remind us what is important to know about the skin condition?
- [01:49]
Dr. Barbara Paladas
Sure. So eczema, it's also often called atopic dermatitis, is essentially a chronic inflammatory skin condition that causes red, itchy, rashy, dry skin and other symptoms. It can affect any skin area, but most often occurs where the skin flexes, so things like elbow creases or behind the knees. And it can also be associated with itch, sleep disturbance and other atopic conditions like asthma, allergic rhinitis, kind of that never ending runny nose obviously reduced quality of life as well as now leaky gut. And so unfortunately we don't know yet the exact causes and people say it's a result of a combination of genetic and environmental factors. And we don't have a cure. But modern treatments can help ease symptoms with creams, ointments to control the inflammation, or topical and oral medications, such as biologics like dupixent that are prescribed by dermatologist. And then some, maybe quick stats. It affects about 10% of the population, so that was higher than I expected. And up to 25% of children. And then it decreases in adulthood, so maybe like 3 to 5% of adults. So we're talking about somewhere between 30 and 40 million Americans and over 200 million people globally.
- [03:08]
Ekta
Wow. That's a big chunk. That's a lot of people. I mean, eczema is. It's kind of grown a lot, too. I mean, I remember 10 years ago, it wasn't nearly talked about as much as. As it is today. So it's definitely grown a lot in.
- [03:19]
Dr. Barbara Paladas
Terms of just prevalence, and it's still growing.
- [03:22]
Ekta
So just to remind our listeners that eczema starts when you're young. So about 60% of people with eczema develop symptoms by the age of one, and another 30% will experience symptoms by the age of five. But the good news is that it's not contagious. So, Barb, you mentioned that the cause of eczema is still unknown, though, right?
- [03:41]
Dr. Barbara Paladas
Yeah, that's. That's exactly right. Acta, we don't know, but we know that classic eczema. So this atopic dermatitis, as it's called by dermatologist. Dermatologist, is chronic. And we also know that the skin barrier is weakened or disrupted. And so that then leads to this vicious cycle of inflammation, itchiness, redness, scratching, infections. And so the problem is that these symptoms and what you do, like the scratching, that makes the skin barrier even weaker, which then it's like a negative feedback loop. And then you get skin infections, as I said, but you can also get asthma, hay fever, food allergies, sleep problems, leaky gut. And now they're actually showing that children with eczema are 50% higher risk for ADHD, too. So you could call that leaky brain.
- [04:25]
Ekta
Wow, I didn't know that. That's crazy. So, I mean, are there theories on any, like, any theories on, like, the root cause of eczema, even if we don't know for sure?
- [04:35]
Dr. Barbara Paladas
So there's two camps. So there's kind of two theories. And the main question is, is it systemic internal inflammation that disrupts the skin barrier, or is it the poor skin and terrier, kind of like the leaky skin barrier that causes internal systemic inflammation. So you have the camp, which is like the inside out hypothesis, where it says, okay, the inflammation weakens the skin barrier, allergens go through, basically. So it starts on the inside. So you have your leaky gut allergens make it through your gut. They cause systemic inflammation in your body that causes cutaneous inflammation in your skin. That inflammation impairs your skin barrier, and then that allows other transcutaneous penetration of allergens, like staph, for example, etc. So it's kind of from the inside out and then there's the outside in hypothesis that basically this leaky skin barrier dysregulates your immune system and they go more the genetic route, saying, okay, people with a Flaggren deficiency have. This is a skin structural protein. It's not, as, you know, prevalent. It breaks down. There's a lower natural moisturization factor in the skin that disrupts the barrier, that creates the systemic inflammation through the cutaneous inflammation. And then you develop the allergic diseases through asthma or food allergy. So we don't know.
- [05:54]
Ekta
Yeah. So it's truly like the scientific version of the chicken and egg situation going on.
- [05:58]
Dr. Barbara Paladas
Literally.
- [05:58]
Ekta
Yeah.
- [05:59]
Dr. Barbara Paladas
Yeah.
- [06:00]
Ekta
Well, I mean, it's interesting, you know, you brought up the Lagrange, because I know in medical school we learn a lot about the genetic skin diseases, you know, and how they manage, how they manifest. And, you know, for example, a few of them will result in things like excessive scaling, blistering, thickening of the skin, any unusual growths. A common example is the epidermolysis bullosa, which causes extremely fragile skin that blisters really easily due to any kind of minor trauma or friction. So if you. Even if you rub the skin on these patients, they'll blister very quickly.
- [06:31]
Dr. Barbara Paladas
Like that woman in Ireland where Colin Farrell ran that marathon recently to raise money, right?
- [06:36]
Ekta
Yeah, yeah, yeah, exactly. And, you know, it's just. It's kind of crazy, some of these diseases. I think we don't learn enough about them in the. The mainstream media, but they're very prevalent. That's one of them. And there's another one, the pachyonychia congenita, which is thickened nails and really painful calluses, you know, especially on areas like the feet. There's also ichthyosis that causes generalized scaling or certain forms of different types of eczema, like atopic dermatitis. You had mentioned this earlier. The last two are linked to the mutations in the FLAG gene. We do know that these diseases are genetic, right? There's some Sort of genetic predisposition. Can you tell us about more about eczema, then? Like, does eczema have this hereditary component as well?
- [07:21]
Dr. Barbara Paladas
So the answer is mostly yes. There's definitely a strong genetic component. And you're absolutely right about the flagran gene being one of the key genetic factors in eczema.
- [07:30]
Ekta
Yeah.
- [07:30]
Dr. Barbara Paladas
But there's additional genes that are also linked to high risk of eczema, and they're now being identified in research. But you're absolutely right. Most people with eczema do have a family history of the disease, and so you're essentially 50% more likely to develop eczema if both of your parents have it. But there's other risk factors that I find interesting, including being female, as well as other leaky membranes. So, for example, like asthma, which is like leaky lung, hay fever, irritable bowel syndrome, rheumatoid arthritis, and as we mentioned earlier, adhd, or being just on the autistic spectrum disorder in general.
- [08:10]
Ekta
Yeah, that's. That's really. It's crazy to think about how much allergens and just all of this stuff really ties in, you know, to overall health. I mean, it's total side note, but, like, it just blows my mind when I think about this. I want to go back to the flagran gene if you can tell us a little bit more about it. And also, like, what other genes are lined up with eczema?
- [08:30]
Dr. Barbara Paladas
There is a camp of science that believe that eczema is mostly caused by the genetic mutation. And essentially these genetic mutations prevent your skin from protecting itself, essentially, from the allergens and irritants that we talked about that are in the environment. And so prophylagran, which is related to filagran, is a protein that essentially plays a very critical role in skin barrier integrity. And it also prevents dehydration, and it blocks pathogens and irritants from getting through the skin barrier to cause that inflammatory response. So. So it's located on chromosome 1 for the kind of skin nerds. And FLG stands for filament aggregating protein. And it's essentially the gene that provides instructions for making the protein profilagran, and it controls its production. And so when this gene is mutated or, say, impaired, like, you don't have enough copies, then the formation of this prophylagrin protein is affected and you don't have enough of it, which makes your skin barrier not structurally sound. And so those with eczema do have, you know, fewer copies of this gene, and that results in less functional protein in the epidermis and also less natural moisturization factor. And all those lead to basically the leaky skin barrier that we talked about. You mentioned, you know, other genes. So there's additional structural genes that are also associated with the eczema. Most are found in what's called the epidermal differentiation complex region. And this is chromosome again for the nerds 1q21 that contains several genes and these help establish really the skin barrier. The kind of two additional, but I would say less well known skin structural genes are also associated with the dysfunction and these are barrier related proteins like loracrine and impelucrin or late corn defined envelope genes. And there's also another gene called KIF3A which is a subunit of the kinesin 2 motor protein and that helps transport these protein complexes and organelles within the cells. And then I would say another gene that is definitely associated with those who have ECZEM is the AQP3. We hear about that like for skin hydration. But essentially AQP3 facilitated water transport is involved in cell migration and it also is involved in accelerating healing of skin wounds. And so it's facilitated glycerol transport is not only in skin hydration and elasticity, but also on the humectant properties of glycerol and in cell proliferation. So essentially increased expression and altered cellular distribution of AQP3 is found in eczema. And this is why people with eczema tend to lose more water and why we always measure trans epidermal water loss. That's one of kind of the key metrics of is the skin barrier, you know, eczematic. But the thing is the actual genetics are even more complex and we're not going to get into that. But it's not just the skin barrier structural genes, but it's also genes that encode proteins for allergic inflammation. Like people may have heard of IL4 or IL13 or CARD11 and these are basically essential for the function of lymphocytes in our immune system and they basically defend us against infection. But as things leak through the barrier they get triggered and this is that constant allergic response inflammation. Allergic response inflammation.
- [11:52]
Ekta
But it sounds like this failure in the skin barrier integrity is really what sets off what's known as the atopic march. But atopic dermatitis is a complex disease, right? With inflammation and immune system dysregulation playing a significant part as well as many other triggers playing together to create this like perfect storm kind of effect. So just for our listeners, just want to mention, like atopic conditions consist of allergic or hypersensitive conditions like eczema, food allergies, asthma, any kind of allergic rhinitis commonly caused by things like hay fever. And just so you guys understand, the atopic march is a term that's used to refer to how these conditions may develop in a sequence, usually beginning with eczema in infancy, for example. Research and medical observations indicate that there is something called a skin gut biome connection in eczema. And I would love to dive more into this Barb, if you could tell us more about the skin, gut brain biome system.
- [12:51]
Dr. Barbara Paladas
Absolutely. This is kind of our core area of focus, like we call it sgbb. And so skin and gut, as we said earlier, you know, the chicken and an egg problem of what's leaky and what causes eczema. Is it the leaky gut causing leaky skin or vi versa? So they're connected. And because they're connected and the gut has a microbiome, we also know that this gut microbiome may play a very key role in the development and also in the severity of the condition. And so really the factors that can contribute to the development or say aggravation of eczema are the genetics that we just discussed, the impaired skin barrier that we just discussed, immune disregulation, so basically the overactive immune system that we just touched on, but also this impaired gut barrier, the gut and skin microbiomes, we'll talk about the skin microbiome too, but also psychological stress. And we've talked about stress for acne in the past, but definitely there's an effect of stress in eczema as well, and flare ups as well as environmental factors like pollution, the temperature, being out in the sun. But the good news is that there are holistic and integrative approaches now that can be taken to help in the management of this disease. And so these can be medications, supplements, skin care products, and also lifestyle factors. So you can in fact kind of manage it and beat it to where it's not kind of completely debilitating.
- [14:16]
Ekta
Yeah, I mean, at least, yeah, there are some options out there. But I mean, just to understand, let's parse through the skin gut biome piece by piece, if you don't mind. So we can cover everything. We started talking about the role of the skin barrier in eczema. Could you remind us what is that?
- [14:32]
Dr. Barbara Paladas
Sure. So like we talked about earlier when we were talking about for example our on tube, we usually visualize the skin barrier as a physical defense mechanism and it's a wall. And so the skin cells, the keratinocytes are the bricks. And they're kind of locked in place by the lipid matrix, which is kind of like your oily mortar between the bricks. And then the acid mantle, which sits on top of that is like a biological moat that sits on top of this wall. And that's basically your microbiome, your skin microbiome. And then when this stratum corneum is healthy, your skin's soft, smooth, plump, kind of the ideal skin. And when the barrier function is intact, it has a kind of the right amount of lipids, so the fats and this natural moisturizing factor so it stays hydrated. And this helps the skin retain water, and that makes it resilient and supple, so flexible and elastic. And, you know, we call that radiant, right? So when the skin barrier is protected, the inflammation also is reduced. Now, in the worst case scenario that we're talking about here, the compromised skin barrier leads to chronic inflammation. And that basically leads to kind of a rapid and very painful deterioration in skin integrity. And this is exactly an eczema. The barrier can become very highly degraded and permeable. And so allergens then can make the skin itchy, irritated. That's the scratching that can lead to the scaly patches also. And, you know, when it starts really going forward, the skin can crack, it can weep, it can become infected. It just gets ugly really fast.
- [16:09]
Ekta
It's a vicious cycle. And I, you know, I know that eczema flares are a big, big deal, and they can be really bad. So I would love to discuss, you know, what is the connection between the skin barrier and the skin microbiome, and why is the skin microbiome important in preventing eczema flare ups?
- [16:25]
Dr. Barbara Paladas
Basically, the skin microbiome influences the barrier function because it controls the. It's kind of that moat on top, and it controls the ecological factors. And so it helps us adapt to temperature changes, ph, hydration, and these changes can weaken the skin barrier, especially when you have that filagran protein structural deficiency in eczema. And so the problem is, when these pathogenic bacteria penetrate the barrier, that leads to the inflammation and itchy flare. So specifically, there's one bacteria, Staphylococcus aureus, and that's a primary bad actor. And it has now been linked with eczema flare ups. And Harvard recently published a mouse model which showed that they associated it with itch. And so what's interesting is that, for example, researchers have sampled skin of children, pediatric eczema patients before flare, during the flare, and after the flare. So they actually took skin microbiome samples. And what was interesting is they analyzed the microbiome composition with gene sequencing and they observed that definitely there was more of this S. Aureus in samples during the flares than in samples before and after the flares or from just healthy control samples. We're seeing more and more this association of this Staph aureus with eczema flares and exacerbating things like itch.
- [17:51]
Ekta
Wow, I didn't know that. I didn't know about that study. I'm gonna have to look at it. I mean, it makes sense though, because I feel like every condition is linked to some sort of, you know, like, itchiness as the. One of the first manifestation. Science and symptoms staff is involved in some way. So that does make sense to me. Just for our listeners, though, just to give a background. Like, staphylococcus bacterium is a gram positive, spherically shaped bacter, and it's a normal part of human flora. So it's going to be on your skin, inside your nose, et cetera. So it's supposed to be on our skin surfaces, on our body surfaces, but in a balanced microbiome, it's normally Benign. And about 30% of people on average are colonized by Staph aureus, where about 10% of healthy people are colonized, but 80% of those with eczema are disproportionately colonized. Reference. So when Staph aureus populations increase in the microbiome imbalance known as dysbiosis, they can form biofilms that are hard to kill and they can lead to severe infections. If the skin barrier is compromised and sleeky, like in the case of eczema, the bacterium can enter the bloodstream where it can become dangerous and can lead to things like sepsis and whatnot. Even more dangerous are strains of staph warriors that are resistant to antibiotics like mrsa. A lot of times we deal with, in critical care, I mean, mrsa, I deal with MRSA almost every day. So it's very, very bad, you know, to have that. But Barb, is there anything else you can do in terms of, you know, seeing a. In addition to seeing a doctor for treatment?
- [19:21]
Dr. Barbara Paladas
So normally you can start on kind of a mild antibacterial spray or ointment, but if it spreads, then you'll be prescribed antibiotics. And it's, as you said, it's really important to catch this early. You can also prevent it. Like a lot of moms will give their kids very dilute bleach baths or hypochlorous acid, which is now very popular. It's kind of spray version of bleach. I'm, you know, I hope in the future act I will be talking about another alternative to this as well. But typically right now, like what people should look for is the infection with aus will typically start by red bumps or streaks. The problem is then they can evolve into sores. Those go to pus filled blisters, yellow colored crusty things on the skin. And the problem is for people with eczema, that will usually lead to severe itch. So the thing is, if you have eczema and you have severe itch, you should definitely see your dermatologist because you may need to take an antibiotic or an antibiotic cream or even oral antibiotics. And the problem is with eczema, because you have that itch factor, you will scratch, you will bleed, and then the moment you open up, you know your body, then you can spread the infection like either with your fingernails and into the bloodstream. And as you said, then it can kind of get really ugly really fast.
- [20:38]
Ekta
Yeah, it really kind of. But I mean in terms of itch, that's really concerning that if people are, you know, excessively itching, I mean it can really lead to a lot of problems downstream. But you know, there's not a lot out there in terms of preventing just itching. So I want to ask you, is there, are there any tips that you have to prevent and soothe that itchy skin?
- [20:59]
Dr. Barbara Paladas
Yeah, there are. I mean, you know, are they perfect? No, I mean the first thing is just daily regular moisturization. And you want to make sure the products have lipids and ceramides or natural oils like sunflower seed oil. That's actually a great eczema friendly seed oil. We'll talk about that in our eczema lotion later, I hope. But also gentle fragrance free product. So you know everything from your lotions to soaps to laundry detergents, not forget those, to really minimize the potential of irritation. And we'll talk about our BN scented soap for that. Also colloidal oatmeal bath baths. This is where you know, especially for kids before bedtime, soaking them in a lukewarm bath with like Aveeno, for example, coital oatmeal or a sensitive skin soak. That can help if it's really itchy. A cool compress can sometimes help reduce that sensation of itch. And definitely like turning down the temperature in your bedroom and not having like heavy, heavy, heavy blankets. Like not heating up the body. And then in terms of like clothing material, I would avoid wool and use organic cotton clothing and also just loose fitting clothing. Like again, tight clothing that will rub will exacerbate that itch. And then, you know, I know this is really hard for kids, but for adults with eczema, just any kind of mind body practice for managing stress because stress will also trigger itch.
- [22:23]
Ekta
Yeah, it's really good to note for any parents especially. And so many people complain like, well, even with something like chickenpox, you know, it's like, how do I just stop it from itching? You know, like, how do I get my child to stop itching their skin? And it's just like, there's not much you can offer. But I want to talk about the BIA unscented soap. You had brought that up. It was actually one of the first for our listeners from the first my Microbiome certified soaps on the market. And I also remember, Barb, that you did clinical trials on it to show that it didn't strip moisture or sebum. So it really protects your skin barrier. It's also endorsed by both the National Eczema association and National Psoriasis Foundation. Foundation, right?
- [23:00]
Dr. Barbara Paladas
Yeah, that's right, Ekda. And I think it was like four shows or five shows back that we talked about it. Yeah, it took us a few years to develop. I know that sounds crazy for just a simple soap, but we wanted to have a cleansing product that was affordable, really easy to use. It's really easy to take with you on trips that could be used from newborns to, you know, the elderly, but that really had the quality to ensure that the skin surface stayed moisturized and balanced. And especially that we didn't strip the microbiome. And so yes, it was developed essentially with eczema and psoriasis in mind. And it basically helps soothe the damaged skin barrier. You'll find that it doesn't like foam as much because it's very high in glycerin content. But that's essentially why it doesn't strip.
- [23:48]
Ekta
Oh, wow. Because the glycerin content, that's exactly, exactly.
- [23:51]
Dr. Barbara Paladas
And there's no surfactants, like, there's no synthetic surfactants. And so that's where people kind of have to watch the difference between a cleansing bar and an actual soap. A soap has to contain glycerin.
- [24:02]
Ekta
So what about the BIA eczema lotion? Is this something that you just launched?
- [24:06]
Dr. Barbara Paladas
So this is probably like my favorite favorite favorite product at this point. And it's because it's a formulation that not only helps hydrate but it rebuilds the skin barrier and it helps with scaliness and it relieves it. So that to me, it's kind of like it's the first product that is so multifunctional. And it also contains our new BIA 2.0 complex which we just were awarded the patent on. And so that is now biotech plant stem cell extracts from Calendula and Haberleya, which we'll talk about later. That's like the Dracula plant, as well as a comfrey infusion and sunflower oil. And what was interesting is that the oil infusion for the country comfrey worked better than a biotech stem cell version. So we always go with what works best. And then we also have hyaluronic acid in there, the ceramides. We talk an emollient with tannins which are again anti inflammatory, like meadow foam seed oil, which is a really cool new ingredient and everything's formulated an allergen free sunflower base. But we also have this new marine macroalgae extract from this plant called Padina pavonica, which stimulates hyaluronic acid production in the skin, which is really cool and supports moisture retention and make it OTC. We obviously have your 1% colloidal oatmeal, but essentially we know that it's not the oatmeal doing the heavy lifting. That was really essentially so that we could use the word eczema on the label of the tube.
- [25:32]
Ekta
I know you sent me clinical trials that you did in Europe with the soap and the lotion. They were really impressive. Just to recap that you were able to reduce eczema scorad by 95% in 100% of the test subjects in eight weeks. And for our listeners, scorad means scoring atopic dermatitis. It's a clinical tool used to assess the severity of atopic dermatitis. So saying scorad Is decreased by 95% means that you're clearing the eczema. So Barb, can you tell me more about what else that trial showed?
- [26:04]
Dr. Barbara Paladas
Yes, acta. So this is a great trial because we compared skin that was having a flare and was treated using the lotion with neighboring skin that was healthy that wasn't treated. So we kind of had a self reference in the same person in the same body. So that gave us the baseline for each subject and that really tested the true capability of the product to return the inflamed eczema prone skin back to normal. But yeah, I'm gonna have to brag a little bit first.
- [26:31]
Ekta
So yeah, please, do you have full bragging rights at this point?
- [26:36]
Dr. Barbara Paladas
So we had about 33 subjects with mild to moderate eczema. And so in those eight weeks we increase hydration by 78%, which beats our facial oil, our B A facial oil. We reduce skin barrier leakage by 40%, which is as good as our onto serum, but which doesn't hydrate as much. And we improved roughness. So that's really the desquamation, the removal of the dead skin layers and skin barrier integrity by 65%, which is as good as our best exfoliator, which is the shot clay mask. So essentially this one lotion does everything our best in class products do just for one function alone. And what was really cool was that this, as you said, the inflamed red scaly skin went back to normal and drove the score ad to pretty much zero. And then on top of that, we reduced itch by 93% and kind of that burning sensation by about 79%. So like we really got the itch down, which was cool.
- [27:32]
Ekta
Wow, that is so impressive. Oh my gosh. And that's game changing. You know, for people with mild to moderate eczema, that's really huge. But Barb, we're not done talking about the skin gut brain biome, by the way. I want to go back to that. So talk to me about the gut and the gut microbiome as it relates to eczema them up.
- [27:53]
Dr. Barbara Paladas
So let's start maybe by taking a step back and let's look at, I don't know if people know, but the skin and the gut barriers are very similar and they both have four layers. So there's that microbial kind of that moat, then there's the biochemical, then there's the physical, and lastly there's the immune barrier. And so that means that both of these barriers are very complex. But to me it's just fascinating that they both have four layers also just, you know, as I was was doing research on this, you know, the gut surface area is about 15 times larger than the skin surface area. So like if you took your guts out and like laid them out versus your skin, and that's about 200 square feet versus 20. And so when you think about it, the gut barrier is really critical to people with eczema because that's a much, much larger surface area. Like 10 to 15 times that allergens can enter the body. And trigger inflammation. And so anything that disturbs, say the gut mucosa, like the slimy layer inside your gut, the micro, the microbiome, overgrowth of bacteria in the small intestine, all of these can trigger rashes, flares, and even the onset of eczema. And so to me, it's just fascinating how it's this inside out story. And so really that's where the skin, gut, brain biomaxis comes in again and again, because you can explain correlations with the gut microbiome with emotional states, systemic inflammation, immune system. And so this increase in intestinal permeability triggers this inflammation and immune response. And we know actually that about 20% of people who suffer from inflammatory bowel diseases have skin diseases like eczema. So that's like one in five. And also Crohn's is often.
- [29:30]
Ekta
I was just thinking about Crohn's, literally was just think, yeah, exactly.
- [29:34]
Dr. Barbara Paladas
And now we see that actually gut skin AIs studies show now that there's definitely a link between the gut microbiome and eczema. And recent research even suggests that the gut microbiome may be another factor in the development of eczema. So it may not just be leaky gut, it might be the gut microbiome in this. And so this imbalance is in fact one of the drivers of inflammation and the immune response. And so another study found that the gut microbiome of infants, so this is like the beginnings of eczema, differed from that of healthy infants. And so they found species like Escheria or Shigella or even Clostridium in these infants with eczema. Whereas bifidobacterium, which is kind of like that keystone species that keeps things balanced, was more abundant in the healthy infants. So maybe we can start shifting people's microbiomes kind of from birth if they have this imbalance. And maybe we can stop that atopic march earlier. And so, you know, what, what else? You know, plant based, anti inflammatory rich diets, fermented foods, those are things people with eczema should be eating and should be having their kids eat. So it means maybe we can start slowing down or even stop this atopic.
- [30:44]
Ekta
March from what I'm understanding all about reducing systemic inflammation. Right. So I mean, I guess it makes sense to start, you know, in the gut to minimize the flares. And I think this is also like a really good segue point to talk about the onto skin barrier support supplement with your M3 antioxidant. I remember that this oxidant is A combination of three plants from Patagonia. I think you mentioned that to me before and there was very compelling anti inflammatory properties that were mentioned. So I want to talk about that and also how you use it in the onto skincare collection.
- [31:20]
Dr. Barbara Paladas
Absolutely. So the dietary supplement had this M3 plus antioxidant for gut and systemic inflammation. And so we, we're trying to avoid here that breakdown of the skin barrier. And the goal with the antioxidant which is rich in anthocyn, flavanols and flavanols is to scavenge those free radicals in the gut as well as repair and support the skin barrier. But what actually is amazing is if you look in the literature now, for example, so M3 is Matico, Maki and Morta and Matico, for example, because it has a lot of promise in wound healing of gut and skin barrier because it actually promotes fibroblast growth growth and it has a strong antioxidant effect. It's also now been found to be rich in this thing called stigmasterol, which protects gut mucosa and it reduces colonic inflammation and it changes, it modulates the levels of short chain fatty acids like butyrate, which is important for gut barrier integrity. Now they're produced by the microbiome, so it can actually improve intestinal barrier function. And people are now looking into using it to type certain types of, of Crohn's disease and some of these, some of the other plants basically like Morta, basically have again strong antioxidant activity against reactive oxidative production. But lipid peroxidation, super oxide anon production. So all of these basically help really reduce that gut inflammation and tighten up the gut barrier. But then it also has 4 grams of L histidine. So that's an amino acid that's a key building block of filagrin, you know, that protein that we talked about as well as natural moisturization factor that we talked about. And so essentially we know that people with eczema have fewer copies of this gene. So if we give them more amino acid, we can make sure that the gene copies, they do have kind of work full time to produce as much prophylagran as possible because they're not missing raw materials. And so then studies have actually shown that daily supplementation with L histidine, so kind of 1 gram in children, 4 grams in adults, have reduced eczema severity. And there's two great papers from 2017 and 2020 on this topic. And in fact we're super honored to be working with Dr. Neil Gibbs on this, and he's the one who originally discovered the benefits for histidine for eczema. So, you know, you couple the histidine, you add in this antioxidant that you know is now being found to help with inflammatory bowel disease and Crohn's, and you really have an amazing inside out piece of the solution.
- [33:59]
Ekta
Histidine has been so, like, widely studied. It's used and it's such an interesting amino acid to me. I remember even when I was learning about it in biochem, I was always like, very intrigued by all the, the different ways that you can really supplement with it. It's very, very interesting, but that's really exciting. Now I want to talk about the second clinical trial, though, that you sent me. You had patients, I believe, with more moderate than mild eczema. You showed a score out of 34 versus 25. They used your soap lotion supplement over 8. See that you had similar results in terms of 93% reduction of scorad in 100% of the patients again. So I would love to talk more about that.
- [34:38]
Dr. Barbara Paladas
Absolutely. So the first study that we did just with the lotion and the soap, our scorad was about 27. And so mild eczema starts around kind of, for the, for the listeners, mild eczema starts around 25. On the scorad scale, severe eczema is 50. So when we shifted the average of the patient population to 34, we're now definitely in that kind of moderate eczema category, not severe yet. And we in fact had a couple patients in the study that had scores of like 45. So they were borderline severe because we wanted to get closer to that cutoff at 50. And so again, we compared skin that was having a flare that we treated with the lotion with skin that was relatively more healthy and that wasn't treated. But because the subjects were taking the supplement, it was cool because the untreated zone this time gave us the baseline reference, reference point for the effect of the supplement. Because. Right. Once you, what you ingest goes into your whole body and covers all your skin versus the zone that was specifically treated with the supplement and the lotion. And the results were like, to me, they were like, again, astonishing because we had about 33 subjects again, that completed the study. And in the eight weeks we, in this case, we increased hydration by 117% in 91% of the subject subjects, which beats the lotion by factor of 1.5.
- [35:57]
Ekta
Right.
- [35:57]
Dr. Barbara Paladas
So the Supplement is definitely having an effect. We reduce the skin barrier leakage by about 29%, which is excellent because the eczema is actually 30% worse. So it's kind of more like 60% versus 40% improvement. And we also improve the roughness through the desquamation by 83% in 97% of the subjects. So we know now they have skin barrier integrity, which is about 22% better than the lotion. So, again, again, the supplement really does play a role. And what was interesting is we also saw the hydration and desquamation improve statistically in the untreated zone. So that really indicates the body's producing the natural moisturization factor, it's healing the skin barrier, because the tape stripping indicates, like, how cohesive the skin barrier is versus the transepidermal water loss that is more like leakiness. So essentially, we took this inflamed, red, scaly skin, we turned it back to normal, which drove the score out back to zero. And then again, we reduced itch by like 80% and burned by 84%. So very comparable results to just the lotion, but essentially for moderate eczema. And we also saw a significant positive effect on mental health. So we actually did PANAS questionnaires in both the studies, and it was really cool to see the impact on, like, the brain and to see also the consumer feedback piece of the study support the measure Data. And essentially 100% of them said their skin condition improved, they felt more comfortable, they tolerated the product, and 97% reported they itched less and were less dry and felt more Sue. So basically, I could not ask for more active.
- [37:34]
Ekta
You've really outdone yourself with this. I think that, you know, what Codex is doing is you guys are providing real solutions. You know, the dermatology just hasn't. I don't know, we haven't reached there yet in allopathic medicine, or so it seems. What do you think you need to do to really convince the dermatology community that you have created something revolutionary?
- [37:52]
Dr. Barbara Paladas
Yeah, so first I had to convince myself and my son has eczema, and this, like, totally keeps his eczema under control. But what we're also seeing is, you know, then we gave it to a group of moms to basically get their feedback. And again, it was unanimous. Like, it didn't burn their children. Like, a lot of products out there on the market burn. So they could tell immediately, like, from the first application? No, my child. Child tolerates this. Now, in terms of dermatologists, we're giving the product to them for testing and they're starting to see the same results. So we're getting incredibly positive feedback. But that being said, if we really want to make an impact and really help people and prevent things like topical steroid withdrawal syndrome, and you know, I'm, I'm now a part of that community that, that's my biggest fear for my son. Like that keeps me up at night with like night terrors that he would someday develop that, that we need to convince dermatologists kind of unequivocally that this system can match corticosteroids. And so we're going to have to run a double blind study against corticosteroids in patients with moderate eczema, not just mild eczema, but moderate eczema. Now the irony here actually is that our results from these, you can think of them as preliminary trials on mild to moderate, are so good that we're going to have to run everything on a tougher SCORAD score. And we also need to get data on babies. We need to get data on kids like 3 to 12. These studies were like 18 to 70 in terms of age. And so but if we can really show that we can slow the cytopic march, then we have a real solution with anyone being born with eczema today. And I think we can prevent topical steroid withdrawal in people in the future. And then if we can learn to genetically screen free topic dermatitis is I think we're at a revolutionary cusp in how we treat eczema. When you think about it, the next challenge will be making the products affordable. Like while we've gotten the total cost of the whole system down, you know, for an adult to about $150 per month and for a child to about $100 per month, it's still not affordable for everybody, especially for low income communities. And while it's way cheaper than a biologic, you know, like a thousand dollar biologic topical or 3000 biologic, you know, injectable, it's still too much for some people, but I would say it will now boil down to doing a large scale double blind study directly against corticosteroids. And then we will see cannot, you.
- [40:16]
Ekta
Know, congratulate you enough and, and really commend you for this. Like, I really mean that.
- [40:21]
Dr. Barbara Paladas
This is first time in 70 years I think steroids are truly going to be challenged.
- [40:26]
Ekta
This is, I mean that's insane. It's amazing. Having studied medicine in my life, I would love to see stero get out of this space. Like, I genuinely mean that because I just see so much damage that comes from these drugs.
- [40:39]
Dr. Barbara Paladas
It's not that they don't have their place and yeah, they do nation quickly. But the thing is when they were developed in the 70s, there were warnings of don't use them more than three to five days. And there are people who've been on them for 26 years.
- [40:51]
Ekta
Yes, exactly. See, that's exactly what I'm talking about. And it's like somehow this community, like the medical community got on this bandwagon of like steroid. You should be long term and it should never be be. I don't believe in that at all personally. You know, I know it's a total side note, but I, yeah, I agree with you. It's. It's crazy. It's gotten out of control and I, I think it's more than due time that things change.
- [41:14]
Dr. Barbara Paladas
Steroids are used very sparingly in emergency cases and as they were originally intended.
- [41:20]
Ekta
Yes, exactly. I mean it's complete suppression of your immune response. That's really what they do for our listeners. Like, you know, steroids are totally like suppressing what your body is normally supposed to do from the immunology standpoint in fighting disease. And then what happens is this rebound effect and it just exacerbates whatever condition that you might already have or, you know, create a new condition like a.
- [41:43]
Dr. Barbara Paladas
Autoimmune and a constant growth and children can get Cushing syndrome. I mean, you thin the skin. I mean it's.
- [41:51]
Ekta
Yeah, I really want for our listeners, you know, just for them to understand. Barb, what would you recommend from Codex for basic eczema skin care in addition to the system of the soap lotion. Supplement.
- [42:02]
Dr. Barbara Paladas
Supplement, yeah. So basically in addition to that, you know, in the winter time you can add the biafacial oil as kind of a final layer. Protects against wind and protects against pollution. You can use the BIA cleansing oil. If you wear makeup, you know, you can use that to remove makeup. We just launched the BIA lip Chile, which actually is anhydrous. And so basically that's for very sensitive lips and it's hypoallergenic. And then there's the sensitive skin soak, you know, if you need a colloidal oatmeal soak. But I would say, you know, so the, the facial oil, you know, that just addresses the moisture retention. So it's kind of like the seal and lock and moisture. It'll also soften and smooth rough skin. So you can mix it in also with the eczema lotion or put it on top if you have really, really rough patches. And because it has seaweed foucaultins, it's really also good for itch and dry, flaky skin. Like, also, if you get eczema around the eyes, it's eye safe, and it's really, really gentle. Cleansing oil, as I mentioned, for makeup, like, especially for mascara. Again, if you have eczema around the eyes and then the lip chile, I mean, you know, again, people with eczema tend to get cracked lips, parched lips. This thing will increase hydration by 77% in an hour. So it's kind of really great. And because of its ingredients, it also provides antibacterial protection. Like, the last thing you want is an infection in your lips. Lips. And then the sensitive skin soak or poultice really is designed to soothe the burning and the itch as well as disinfect. And so, you know, you have Epsom, which is a gentle antimicrobial, but it. Then it has chickweed. Chickweed is a really cool Irish plant that's been used for a long time to soothe itch. Gotu kola, that kind of reduces redness. Jojoba oil that helps you moisturize. And obviously oat seed oil oil for calming everything down. So that's kind of the. You can either, you know, put the poultice, put it, you know, in a bowl, make it more concentrated, stick a towel in there and then wrap it around, like we were saying, kind of keeping it damp. Or you can make. If you have a little baby, you can make a little baby bath and just sit them in there in lukewarm water and let them just kind of slosh around and get soothed.
- [44:10]
Ekta
Wow. So, I mean, in addition to that, are there any other tips for other supplements in addition to the skin barrier? One with the L histidine and three Antioxidant.
- [44:20]
Dr. Barbara Paladas
Yeah. So vitamin D is actually the first one that comes to mind. And there's actually a significant association in the literature between vitamin D deficiency and eczema risk. And so people with severe eczema have found to have lower vitamin D levels compared to those who have mild or moderate eczema. And there also is research coming out with the potential benefit of vitamin D supplementation for eczema. But careful, because too much vitamin D, you know, too much of a good thing is a bad thing. And you don't want to get vitamin D toxicity from buildup. Basically, that that's a buildup of calcium in your blood like hypercalcemia, which can then cause nausea, vomiting, weakness, etc and bone pain and kidney problems. So just be careful. Like take vitamin D but don't overdose it. Like I think the UK had its first, first death like this year from overdosing on vitamin D, which to me is just crazy. But and then I would also say support your gut microbiome. So first is a prebiotic. Prebiotics are great for all of us, they're low risk. Ideally you want a prebiotic that has resistant starch in it, your oligosaccharides, insoluble fiber, antioxidants, superfoods. You basically fortify that intestinal barrier, you fix your gut mucosa, you support these beneficial bacteria and you just generally help digestion. So we did launch a prebiotic that now we're actually studying. So that's going to be a topic for next time when we talk, when we have our clinical data. And then we also have launched a probiotic that we're also finding. People need to take the prebiotic to condition their gut before they take the probiotic, otherwise they're throwing their money out. And the probiotic we've developed for eczema has specific keystone species like this bathidobacterium that we found, you know, that I mentioned earlier, children with eczema are deficient in, but it also has lactobacillus which is a very anti inflammatory bacteria. And then we also found a really cool bacterium called, it's a streptococcus. It's not a reus, it's thermopolis that actually through your gut helps you build ceramides, which is just crazy to me. Again, like you can help create ceramides for your skin by, by adding this bacterium in your gut. But what I would say there, it's probably best to first take a gut microbiome test and talk to your professional provider before delving in because you don't want to screw up the microbiome. And we still don't really know what a healthy or unhealthy microbiome is. So that's, that's kind of the, that's we're going to be studying next year are basically, we know the prebiotic works really well, but you know, how does this probiotic, because nobody's ever looked at really treating eczema with probiotics. Like in a very scientific way.
- [47:07]
Ekta
Everything that you do, it's very, very exciting. I'm excited to see how you're unraveling this piece by piece. Like it's really it's really evolved even in the short time that we've been doing our master class, you know, and it's very exciting. I want to summarize for our listeners, Barb, if they can take one message away from our conversation, say, what would that be?
- [47:27]
Dr. Barbara Paladas
Oh boy, I'll try here.
- [47:28]
Ekta
So I hate this question.
- [47:31]
Dr. Barbara Paladas
Yeah, you've got to restore both your gut and skin barriers. It's all about your barriers. You've got to support your microbiome and you've got to reduce inflammation. So you do need a moisturizer that treats the symptoms. That's the outside in part. But you have to, I like to, it's cheesy, but restore from the core and kind of, that's what we do at Kodak. And if you do the inside out solution, you will have up to three times the benefit of just a moisturizer. And yeah, I'm excited that we're going to be the first to bring these clinically proven derm recommended inside out solutions for skin conditions.
- [48:10]
Ekta
Certainly covered eczema pathogenesis today. You know, from gut microbiome dysbiosis to staph aureus colonization, from leaky skin and gut barriers to inflammation and itch. It's so exciting to see how your skin gut brain solutions can address not only the surface symptoms but also like you mentioned, the internal root causes, especially by treating from the inside and the outside. You know, that's very, very exciting to see how you've basically, you've closed the therapeutic circle from the time you only had skin care, you know, when we discussed the shant and the onto collections and you've really come full circle. You're building something I think, think that's just remarkable and especially with all of the work that you've done around acne, I'm really excited, you know, to see what's in the future and to hear more about the future benchmark trials that are going to be against the steroids that you had mentioned to us. You know, I hope you guys will go back to some of the previous episodes as well and kind of refresh your memories. But also I want to ask, you know, for those professionals out there, like the estheticians and the dermatologists who are interested in working with Kodak on this inside out eczema solution. Please feel free to reach out to us us or you can email support codexlab support.com and you know, we can give you any information that you need. But Barb, what an honor to host you again. You're, you're truly like you're a well of wisdom. Every time I talk to you, I learn so much. So thank you.
- [49:35]
Dr. Barbara Paladas
Thank you. Acta.
- [49:37]
Ekta
Hey guys.
- [49:38]
Unknown
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- [50:39]
Ekta
So check us out, leave us a.
- [50:40]
Unknown
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- [50:42]
Ekta
Be back next time with another episode. Thank you.