Thirty years of practice has led Idaho-dermatologist Carl Thornfeldt, MD, to a conclusion about skin disease and aging: much of it can be attributed to the breakdown of the skin’s natural barrier function and chronic inflammation. He treats skin disease with prescriptions but for obtaining maximum skin health he focuses on rebuilding the barrier function. Enter, Epionce, the skin care system that Thornfeldt created to repair the barrier and fight inflammation. The comprehensive range is infused with botanicals and can be customized to address a variety of conditions, including acne, eczema, hyperpigmentation, psoriasis, rosacea, and, of course, skin aging. Here, Thornfeldt tells Beauty in the Bag about his professional background and his insights into maintaining healthy, youthful skin.
Please tell us about your background. Why did you choose dermatology as your specialty?
I have struggled with dermatitis since I was a child. When I was a teenager, there were very few options available for treating dermatitis. The most common therapies were tar and sulfur being applied to the skin. It was a very challenging time for me and dramatically impacted me. I vowed I would grow up and try to find a better way to help people like me.
As a physician, how do you describe healthy skin?
I describe healthy skin as skin that has proper function and structure—the way it was originally intended to be. After all, the skin’s natural number one purpose is to interface between the dry air environment and our fluid filled body. If this barrier does not function properly, skin diseases occur. When the skin is healthy, other things we describe as “problem skin” tend to go away.
What inspired you to create and launch Epionce? How does it differ from other skin care lines?
I was inspired to create Epionce because I wanted something better for my patients. When I started as a physician, it was hard to help my patients get completely clear and maintain remission of their skin disease because so many of the prescription products adversely affected the skin barrier, really hindering their quality of life. Over time patients would rather just deal with the disease state than manage the medical options that have been available. This led me on a quest to answer the question—if we could optimize the structure and function of the skin, can we prevent skin disease and skin aging? Due to the complexity of the multiple processes we see as damaged skin, unique botanical ingredients were formulated to reverse these processes. Ultimately, to have products that improve skin is what led to Epionce. When I gave samples to my patients to try for their skin diseases, months later they came back asking for the “wrinkle” cream. We realized that Epionce was not only for diseases and conditions, but also anti-aging. We confirmed what Dr. Albert Kligman first published in 1988 that inflammation is critical in driving skin aging.
To my knowledge, no other skin care line addresses the underlying causes of how the damaged skin barrier and chronic inflammation contributes to skin disease, various conditions, and aging the way that Epionce does. We use a blend of unique botanical ingredients that work synergistically to reverse the abnormalities and to provide optimum therapeutic benefit to the skin. Then we did what no one was doing at the time—we started doing clinical studies against market leaders, including prescription products.
Can damaged skin really be repaired? What ingredients are effective in fighting signs of age?
Because of the world we live in, our skin will continually be exposed to things that will cause damage to the skin. So, while the skin absolutely can be repaired, it does require regular attention to continue the repair process.
The premise behind Epionce is that signs of aging are triggered and driven by both a damaged skin barrier and chronic inflammation in the skin. So, Epionce uses a variety of botanical ingredients delivered at therapeutic concentrations to specific skin cells to address both of those issues. Some of the ingredients we use that help repair the skin barrier are avocado, safflower, meadowfoam, and quercetin. Some of the ingredients that help stop chronic inflammation are date, apple, flax, and rosa canina.
Are there any new skin care technologies on the horizon that you find particularly promising?
I’m intrigued with some of the new research on proteonomics, metabolomics, and glyconomics. The theory seems good, but of course I will want to see the blinded clinical trial data with statistical significance of the finished product before coming to any conclusions about the use of that technology in skin care. Too often there is a lot of hype or buzz before enough research has been done. Many people have spent money on products that make promises based on theories that don’t pan out. That is why I fought so hard for Epionce to have conclusive clinical studies so I can say with confidence to my patients that they will see results, and it’s not just a fad.
What’s next for Epionce?
There is a lot of ongoing research into the functionality of the skin, and how to optimize it. We are always looking at ways that we might be able to improve how our products impact the skin for maximum therapeutic value. I always say, my patients never come in asking to get 40% clear from their disease or condition; they come in asking for 100% clearance and they want to stay clear. I am always pushing myself and my team to reach for that.
As a medical and surgical dermatologist practicing in Portland, Maine, Michael Taylor, MD, MPH, was well aware of the prevalence of skin cancer and the risks that sun exposure pose to healthy skin. While doing free skin cancer screenings for Maine fisherman, he discovered that seaweed harvesters have utterly smooth and youthful hands compared to fisherman and lobstermen. This led to the investigation of the benefits of other marine plants and ultimately the creation of Ocean Elements, a science-based skin care line. With a focus on sun protection, the first product that Ocean Elements launched is called Sheer Daily Moisture SPF 30, formulated with five marine ingredients and physical sunblocks, the least irritating kind. On the cusp of rolling out a night cream, Dr. Taylor tells Beauty in the Bag about his background and inspiration for creating Ocean Elements.
Please tell us about your background. How did you transition from a practicing dermatologist to a skin care developer?
As a practicing dermatologist for more than 30 years, I was aware every day of the increase in skin cancers of every kind at every age. Public knowledge about the risk of sun damage is widespread and 100s of sunscreens are available, many of them very effective. Yet, few people protect themselves on a regular basis. There are several reasons for this disconnect, including differences in the “feel” of the sunscreen, color, odor, water resistance, irritation, allergic reactions, the use of damaging chemicals including PABA, parabens, and phthalates, the risks associated with chemical sunscreens, concern about nano-particles, stinging of the eyes, inhaling of sprays, cost, and on and on. Educating people about the benefits of sun protection is sort of like educating children about brushing their teeth, then giving them a fine toothbrush, and telling them to brush their teeth with pickle-juice. Or like touting the benefits of flossing twice a day which nobody really does.
As well as educating patients and the public, we needed to develop an effective sunscreen that felt good enough for people to use on a regular basis. We were fortunate to learn, during an annual American Academy of Dermatology skin cancer screening, that the harvesters of the Maine seaweed laminaria digitata have moist and smooth hands from handling the seaweed. That led to an investigation of other marine plants that might also provide photoprotection, vitamins, minerals, antioxidants, anti-inflammatories, and moisturizers. We were able to develop a moisturizer that incorporates five ingredients from the ocean that feels great, so it will be used, protects with a broad spectrum SPF of 30, and restores with antioxidants and nutrients.
So, the transition in my profession of dermatology has been a shift to education and prevention rather than treatment.
As a physician, what characteristics comprise healthy skin for you?
We believe that “healthy skin is beautiful skin,” so the two are paired. It’s easier to describe what comprises “unhealthy” skin—blotchy, uneven, discolored, sallow, tanned, wrinkly, sagging, spotty, veiny, thin, dry, and bruised. Healthy skin, adjusted for age, looks like the skin on your bottom—even toned, pale, firm and not thin, well hydrated, smooth, elastic, without bruises or surface veins. Sure there may be a little sagging due to changes in weight over the years, but the skin is still intact.
Although many people who seek cosmetic treatments might disagree with us, dermatologists accept skin that ages with the individual to be normal. It is not abnormal. This includes changes that we would not prefer and which can be helped by moisturization and protection in particular. Older skin becomes thinner and the barrier function—holding water in and toxins out—diminishes. This decay in function can and should be easily helped.
What causes unhealthy skin is primarily sun damage—all of the characteristics of “unhealthy skin” noted in paragraph one above are caused by too much sun. Add to that the significant risk of developing skin cancers, and there are good reasons dermatologists jump up and down telling their patients to protect themselves against sun damage.
Interestingly, a recent study divided teenaged girls into two groups. One group looked at a film of the premature “aging” effects of sun damage that the other group looked at a film showing the risks of skin cancer from sun damage. Guess which group changed their behavior, limiting their sun exposure. You guessed it, the group that saw the one on “aging.” The one on skin cancer hardly changed behavior at all.
What inspired you to launch Ocean Elements: And how is it different from other brands on the market?
Ocean Elements includes five marine ingredients that protect, moisturize, and restore. Although, a few other topical products contain marine ingredients, no other moisturizer contains all five and few effective moisturizers for daily use have a broad spectrum SPF of 30. Ocean Elements is as natural as we could make it using only physical sunscreens. zinc and titanium. We use no chemical sunscreens that can be toxic, sensitizing, and endocrine disruptors. Ocean Elements is safe for the whole family, water resistant to 80 minutes, fragrance free, non-irritating, non-sensitizing, packaged in recycled and biodegradable materials, and PABA, paraben, and phthalate free. It does not sting the eyes, so kids don’t kick and scream. It is quite unique.
Where do you stand on the vitamin D question? If we protect our skin 24/7 from the sun, how can we generate enough vitamin D.
I stand on the side of truth and justice and the American Way when it comes to vitamin D.
Wouldn’t it be wonderful if we could get a tiny fraction of our patients, even those who have had skin cancers including melanoma, to protect themselves 24/7 from significant sun exposure? This is as unrealistic as having all Americans floss twice a day. So, let’s set the “24/7” straw man that is often brought up by the vitamin D advocates to argue in favor of sun exposure.
What is also true is that many of us who live in the northern regions of Europe, Asia, and North America have lower than normal levels of vitamin D when we are tested. This occurs especially during the three seasons of the year when we don’t have enough background sunlight to generate adequate amounts of vitamin D—with or without sunscreen. I take 1000 IU of vitamin D3 every day and recommend it to all of my friends and patients. Why argue over an issue that is so easy and safe to resolve?
Having to reapply sunscreen every two hours really keeps some people from adequate protection. Why hasn’t a long-term sunscreen been developed?
Wonderful question. It has been developed! It is called clothing!
There are many manufacturers of very effective sun protective clothing for children and adults. I highly recommend using sun protective clothing when outside and do so myself. You can leave it on all day, in or out of the water. It is safer, more effective, and less expensive than sunscreen. And while you’re at it, wear a broad brimmed hat and sunglasses.
Now, on the scientific and more serious answer to the question, it can be worn off. I have a good friend who is a surfer. The abrasive saltwater, clothing, and board rub his sunscreen off so that he has to reapply at least every hour. It has become part of his routine. The other reason is a biologic one. Our skin is constantly shedding—in fact we replace our outer layer (the epidermis) every 28 days. It doesn’t stop the process just because we have applied a lotion or a sunscreen on the surface. It is normal for our skin to shed the outer layers along with the sunscreen. This is one of the several challenges to using sunscreens.
What’s next for Ocean Elements?
Thanks for asking. We are well into the process of developing a restorative and rejuvenating night cream that will be effective in repair and anti-aging. This is being developed in collaboration with Bob Verdicchio of Verdi Enterprises in New Jersey and will be tested for effectiveness by Dr. Peter Elias at his laboratories in San Francisco. As well as antioxidants and anti-inflammatories, it will have retinol, which is to be avoided in the use of sunscreens because of potential phototoxicity, but is important for anti-aging and restoration. It is heavy in liposomes, has a pH that matches the skin’s, has ceramides, and improves the barrier function of the skin. It is going to be a great complement to Ocean Elements Daily Moisture SPF 30 daytime products.
Photo Credit: skinmedica.com
I recall the first time I met Dr. Richard Fitzpatrick, known by everyone in dermatology and medical aesthetics around the world as just “FITZ”. It was at a cosmeceuticals conference that I had organized in New York City and his lovely and devoted wife Betsy was there by his side, as always. I considered it such an honor and a privilege that a man of his stature would come all the way from sunny La Jolla to join the faculty of our little 2-day event in cloudy midtown Manhattan. For me, it was a special day.
From that day forward, I saw him at numerous AAD, ASDS and other conferences. I often tried to say hello but he was usually surrounded by hoards of fans and well wishers. Everyone always wanted to know what Fitz thought. He was one of the most beloved dermatologists of his generation, and there are many reasons why. First, he was brilliant and an innovator in laser technologies. Secondly, he had a spirit that was purely infectious and that drew people in. Even during times of illness, he seemed to always be smiling. He was the man who would not quit, and Betsy was the woman who wouldn’t let him. His loss marked a sad moment for so many people.
The best way to remember Fitz is by reading what some of his closest colleagues have to say about the man, his incredible career, and his timeless contributions to advances in laser technology and topical skin care.
“I was privileged to work with Dr. Fitzpatrick (‘Fitz’ as he was commonly referred to by friends and colleagues) for several years. He was an icon in the skincare industry who epitomized the word “pioneer.” His brilliant innovations, including the founding of SkinMedica were second only to his immense passion and enthusiasm for the industry and improving outcomes for his patients. His exuberant personality touched those who had the pleasure of knowing him, and his contributions to the world of medicine touched all of us. He will be deeply missed but forever remembered.” – Ted Schwarz, Vice President Global Commercial Operations for SkinMedica
“Dr. Fitzpatrick (‘Fitz’ or ‘The King of Lasers’) was a man of quiet accomplishment and was a genuine colleague with whom I collaborated for over 20 years. He was someone whose professional views and personal thoughts I trusted and whose insight was critical to my own professional development. His sense of irony and humor were very much a part of what was so attractive to all of us who knew him. I will miss him very much.” - Tina S. Alster, MD, Director, Washington Institute of Dermatologic Laser Surgery, Washington DC
“What always struck me about Fitz is that he was a man who was so successful academically, clinicall,y and financially but remained completely without arrogance. He always had a happy twinkle in his eyes —early in my career, I saw him at a Dermatology Foundation reception and asked his advice about a patient who scratched up her face after CO2 laser resurfacing. He reassured me that I’d done everything correctly then said ‘a trichotillomaniac came into my office asking for hair transplants’ …an educational example told like the start of a joke… He made me feel better then and I remember two decades later.” – Heidi A Waldorf MD, Director, Laser & Cosmetic Dermatology, Mt. Sinai Medical Center, New York, NY
“Fitz was the Father of Resurfacing. I have notes from a lecture he gave in the 1990s about CO2 lasers that I still refer to for information that is applicable today. He never stopped even when he was ill and that was inspiring, to see how much he loved practicing. He always had the absolutely best before and after photographs, he was a true master of aesthetics.” – Amy Forman Taub, MD, Medical Director, Founder, Advanced Dermatology/skinfo, Lincolnshire, IL
“The greatest thing about Fitz was his true passion for lasers—he always wanted to know exactly why things worked and was always working to tackle tough cases. He was also bold enough to talk abut his own complications. Once we were staffing a dermatology clinic at UCSD together and he recounted how he would spend up to 2-3 hours meticulously treating a port wine stain with the old argon laser by hand with a 600 micron spot—no scanner! It really was like the famous ‘wax on wax off’ lines from The Karate Kid movie. I also recall that he would be so nauseous during his treatment that he would have to take a break, head to the restroom, but would still return to see more patients— now that is tough!” – E. Victor Ross, MD, Scripps Clinic Laser & Cosmetic Dermatology Center, San Diego, CA
(via Facebook) “It is not too often that you come across an individual that profoundly impacts your life. Fitz was one of those individuals. Fitz not only taught me lasers, but also shared with me his contagious love for life. My friend, my mentor: rest in peace. I will miss you.” – Cameron Rokhsar, M.D, Dermatologist, New York, NY
(via Facebook) “We owe a lot to Fitz and he will be sorely missed. I like to remember him the way I saw him at the 2013 ASDS meeting in Chicago. Laughing and hanging out with colleagues at the hotel bar late into the wee hours of the night.” – Vivian Bucay, M.D., Dermatologist, San Antonio, TX
(via Facebook) “The world who knows Fitz will always grieve his loss. His intelligence and wit was only outmatched by his generosity of heart. All who knew him will always cherish his memory. To Betsy, always remember you are one of the luckiest women in the world. The more you loved, the more it hurts…. And while the hurt may at times be overwhelming, it is only because your love was as well. He wants you to be happy…. sending you strength!” – Karyn Grossman, MD, Grossman Dermatology, Santa Monica, CA