Hi, I am Dr. Beverly Reed. And I'm Dr. Amber Klimczak, and we are Two Peaks in a Pod. Well, hi, welcome back, everybody. We are so excited today. This is a historic moment. It is the very first time we've had a guest on our podcast. And we're so lucky to have her. Yes, yes. And, um, she's going to be going over a topic that comes up a lot with our patients who are undergoing fertility treatment. Um, this, this is going to be covering dermatology questions that we hear quite a bit.
And Dr. K, has a friend who's a wonderful dermatologist that she's going to introduce for us. Yeah. So hi everyone. So today we have Dr. Shadi Damanpour and she is a board certified dermatologist and she's actually my dermatologist. So obviously I have a lot of faith in her and she does a good mix. I think of medical dermatology and cosmetic dermatology. So she can tell us a little bit more about her practice, but we have.
Tons of FAQs for her, from our patients, and even from ourselves, that we're really excited to dive into. So, Dr. Dan. I have to just interject real quick too, so I've, I've never met you before, but I already have to say, amazing work, because remember how I told you the other day, I'm like, what are you glowing today? Your skin looks amazing! And, so I was trying to already uncover all the secrets, so, yes, yes. So good job already. All right. Thank you for having me. I really appreciate it.
I'm so excited to be here and hopefully I can help answer some questions. Yeah, do you want to start out by telling our listeners a little bit about your practice where you guys are located if anyone's interested in coming to see you? Of course. So, um, like Amber said, I'm a board certified dermatologist. I practice at North Dallas Dermatology Associates. And I see a mix of cosmetic and. Medical patients.
Um, we see pediatrics, we do procedures, and um, you know, very comprehensive dermatology care. Amazing. Are you on social media? Are you on Instagram or anything? Do you wanna let us know your handle? I am on Instagram, um, Dr. Damour. Okay, great. How do you spell it? It's D A M A N P O U R. Okay, perfect. That way everybody knows where to find you. And then, do you see virtual patients? Because we do get patients, um, or people that listen from all over. Do you see any virtual patients?
So, it's tough in dermatology. I think, you know, to see virtual patients, it really is a case by case. situation. It depends on um, what they're being seen for, but definitely some patients we do. I would say most of our patients that we see in person. Amazing. Okay, great. Well, I think Dr. K has a whole list of questions for you.
You know, um, even just last minute I had mentioned to one of my patients that we were going to be talking with you and she sent me a bunch of questions on the patient portal. So we just have all types of things to ask. Amazing. Okay, so we'll dive into our questions. So just to our listeners, we did want to just make an announcement that none of this should be taken as medical advice.
This is just sort of us investigating and answering some of our own questions that we had, but we really Say that you should defer to your doctor. That's treating you at the time. If any of these are directly affecting, um, okay. So of course, Botox such a hot topic, I think everyone's into it. No matter what phase of their life they're in, we have young 20 year olds getting it, um, and then obviously as we age, we're really interested in getting it done.
So a lot of our patients who are trying to conceive are wondering, is it safe? slash would you allow patients who are trying to conceive to continue their Botox regimen and how do you manage that?
So I get this question all the time also and I think it's so hard because in general in pregnancy there's so many limitations, right, and you know people are not always looking and feeling their best and then we as, you Physicians are telling them, Oh, you can't do all these things that you used to do to make yourself feel good. So, um, you know, during pregnancy, we, we don't do any Botox treatments.
Um, when people are trying to conceive, it's tricky because, um, They don't really know if they're pregnant or not, which is the concern. So, um, you know, a lot of people will come in and they don't think they're pregnant and they'll get a treatment. And the week later they're like, whoops, I was pregnant and things are usually fine. Um, but that's kind of the reason we still caution.
Patients when they are trying to conceive Not that it would have a lasting effect You know should they were to become pregnant down the line, but if they happen to be pregnant and not know it Um, there's just not great research on botox in pregnancy. Um, and you know, there are a few retrospective studies, but no actual studies have been done.
Um, and so it's just hard, you know, as a physician, when you want to do no harm to, you know, give something to someone that you're not sure what the outcome would be. Yeah, absolutely. And I think this is just one of our biggest struggles is there's so many different medications or even supplements or things like that. And we get this question constantly too. Is it safe? And really for us to say 100 percent it's safe, we need to see a study.
And oftentimes they say, you know what, It's probably not ethical to be doing these studies in pregnant women, right? And so the only data we get sometimes is from those patients who maybe got the treatment when they were pregnant, didn't know they were pregnant, and then they can go back and look to see, well, did anything happen?
And so I think from what we know so far, it doesn't look like it necessarily causes any problems, but none of us would feel comfortable saying it's safe without seeing those studies that unfortunately are probably just never going to be done, right? Right, exactly. And Dr. Jaminpour, so tell us a little bit about Botox.
Is the idea about why it may be safe, even if we had a whoops, we accidentally conceived a couple of weeks later after getting the treatment, is the idea that it's just local or is the thought that maybe this is going to disperse and have some sort of effect in other places in our body? Botox is a very large molecule. And so when it's injected properly intramuscularly into the skin, there should be very little systemic absorption.
It doesn't really affect the rest of your body except for where it's injected. Um, and that's even in you. So for it to the thought that it might even cross the blood placenta barrier as this large molecule that is barely absorbed is very, very low. Um, but again, we don't know 100%. So that's why it's presumed that there you know, probably isn't any risk to the baby, but it's not, it's not in itself a teratogen. It's not known to harm a fetus. Right.
I think another kind of important point to point out to you is Another reason why it's so hard to study is for pregnancies, we know that 25 percent of pregnancies can end in miscarriage, right? So just because somebody did something and then had a miscarriage after doesn't mean that that's what's causing because miscarriage is so common to start with but I think again that's why a lot of us feel uncomfortable recommending things because we know that there's the psychology to it.
Uh, Oh, if a patient did it and she happened to have a miscarriage that she would have had anyways, she might go back and say, well, it was because I did this or that. So for example, I know of massage places, they will not massage you if you're in the first trimester. And do I really think it's because a massage can cause a miscarriage? Well, no, but they don't want to be blamed for it, you know, I know it's always a bummer when you're pregnant. That's when you need a massage.
That's when you need it most. I used to hate that. Okay, so a couple more questions about Botox, um, how do you feel about Botox postpartum and When are we allowed to maybe restart treatments after we deliver a baby? So postpartum no issue Breastfeeding on the other hand same same thing as during pregnancy because you know again big molecule probably doesn't absorb systemically, probably will not cross into the breast milk, but who wants to risk giving an infant botulism? Right.
So, um, that being said, that's, you know, this is not the opinion of every single dermatologist, and you know, you may find some people who will. You know, give Botox during to someone who is breastfeeding and, um, you know, babies and patients are probably doing fine. Um, but I think overall, um, most physicians will, you know, choose the safer. route.
I would say, and I haven't looked, so maybe this could be a good opportunity for a study, but this would probably be easier to study in that maybe you could find breastfeeding women that are done breastfeeding, they're about to wean, give them some Botox and then study the breast milk to see if there's any Botox found in the breast milk. Um, so that can maybe be something that at least is more realistic on being able to get an answer to at some point. Okay, so another question about Botox.
This is something sort of new I think that's circulating. I guess there's some data that's come out, but obviously a lot of our patients are going through fertility treatment such as IVF, which is one of our more involved treatment options. And there was Some question as to whether Botox during an IVF treatment may actually lead to poor outcomes because I guess Botox is, can cause vasoconstriction or kind of restriction of blood flow, maybe even to ovaries, follicles, something like that.
Have you seen anything about this or do you have any more information for us? This was sort of new to me. I actually haven't, um, I haven't seen that. And I, you know, Botox doesn't have any vasoconstrictive effects. So I don't see why it would affect someone, um, during a fertility cycle, you know, in terms of their fertility or egg quality or, you know, blood flow or anything like that. Cause like I said, it's a, it's a nerve, um, inhibitor. So it shouldn't have any vasoconstrictive effects.
Okay. Yeah, I was really, um, surprised because I know you had mentioned that to me the other day too. I had not ever known or heard of any restrictions on that. Um, but I do, you know, and I'll have to look at, you know, um, the, the study. But one of the things I'm thinking about is maybe people that need Botox to start with. might be a different group of people than maybe somebody who's not on Botox.
So maybe somebody who's aging prematurely, maybe somebody who's a smoker or a heavy drinker, or, you know, maybe all these other factors that caused them to need the Botox in the first place may also be factors that would be associated with poor egg quality or lower egg number or things like that. So I wonder if maybe there's a factor like that. Um, cause it doesn't really seem to make sense that a facial Botox Um, set of injections would, would cause problems with eggs. That makes sense.
And also Botox is used by a lot of other doctors besides dermatologists for cosmetic reasons. It's used for a lot of medical conditions, like pain disorders by neurologists, by gastroenterologists. It's used kind of all over the body and used in much higher. quantities. Not that I think that that would necessarily cause vasoconstriction.
But again, like you said, those people might be on a host of other medications or have other conditions that are causing, you know, vasoconstriction or poor blood flow to other parts of their bodies. So, um, that might maybe a confounder. Okay. Yeah. So kind of your normal recommendation for somebody who's doing IVF where we have control. We know they're not about to get pregnant. You think it's probably reasonable for them to get Botox, right? Yeah. Right before the transfer.
Yeah. Yeah. I think that's kind of what you usually recommend. That's what I've been doing until this surfaced and then I got nervous. I was like, okay, we're going to tell them a little bit more about what, how did you find that? Um, I think it was like some data on social media that people were commenting on, other dermatologists actually were commenting on, is there a concern? Is there not a concern?
So we'll have to look more into like medical literature to see where, where is this coming from? Because I also, I don't know much about Botox, but I didn't think that it caused vasoconstriction. Cause I feel like that'd be an issue when you're injecting it. Like that's what my concern is. Yeah. Yeah. Okay. Perfect. So, um, one thing also that I think makes our patients a little bit different is that not only are they trying to conceive, but often they're trying to conceive for a long time.
Um, and so it's tough because there are restrictions on what you can and cannot use. And so I am curious about a couple other medications that maybe are not Botox, but can help with wrinkles, um, but are known to. you know, have pretty severe side effects. So, um, let's start off with probably the most extreme of that. Let's talk about like retin a, retinols. What are your recommendations for women trying to conceive with these topical medications?
Um, so retin tretinoin, um, or topical retinoids are, you know, one of our Go-to treatments for anti-aging acne. I would prescribe it a million times a day um, to everyone. I think it's a great medication. Um, there are definitely risks to the baby with oral retinoids. Um, and that's been proven, multiple studies, completely unsafe. Um, and so kind of the. Recommendations for topical retinoids are extrapolated from that.
Um, even though there is thought to be pretty low systemic absorption when you're applying a topical retinoid. Um, but because of that, I usually recommend, um, women who are trying to conceive to stop their topical retinoid, um, before they start trying. Um, again, it's tricky, you know, in fertility patients because they may be trying for months to years and it's kind of uncertain, um, when, you know, they're going to, get to that point of implanting.
So, um, I, you know, always recommend my patients speak to their fertility doctor and see, you know, what they're comfortable with. Um, I would, you know, for many, for select patients, I do say maybe just continue it until your transfer. Um, and then stop it at that point because. It's you know, again, it's a risk to the, to the fetus. It's not a risk to the egg.
Um, so if you're kind of going through, you know, retrievals and that sort of thing, then I think I would be okay with continuing it if, you know, if you were as their primary physician. Um, But definitely, you know, once the transfer happens, you'd probably want to stop. Can you clarify for our listeners? So you mentioned oral medication. So is that Accutane? What medications exactly are you? Yeah. Isotretinoin, Acetretin, um, are oral retinoids. And that was, you know, brand name is Accutane.
So one of our patient populations that really struggles with acne is PCOS patients, polycystic ovarian syndrome. And so we're always looking for treatment options for them, especially, you know, we have a lot of PCOS patients that maybe aren't trying to get pregnant. So what would you recommend for them for managing their acne? What's effective? And then also patients who do have PCOS and are trying to get pregnant are really struggling with acne. What would be your go to recommendations?
So PCOS, not trying to get pregnant. Um, I would say probably birth control and plus or minus spironolactone, um, which is an oral medication. And that is a medication that decreases. androgen production at the oil glands. So it works really well, not just for PCOS. I would say for all hormonal acne, but especially in PCOS patients. Um, I think the combination of those two is, you know, a game changer for a lot of people who struggle with hormonal acne.
Um, and there are several birth controls that are FDA approved for acne. So not all, um, oral birth control pills help acne. Um, you know, estrogen is the, um, ingredient that's a antiandrogen and some progesterones can make acne worse. So women who are taking like only progestin, um, birth control pills may notice worsening of their acne. So it's, it's also important.
you know, for people to know which birth control they're taking, um, because they might think that it should be helping, but it could actually be making things worse. I think that's just such an important point too, because on our side of things, oftentimes we're seeing PCOS patients just for fertility purposes, but this is something I do always mention to them, that in the longterm you may struggle with these things that you thought, or maybe just normal, or that you had to deal with.
And so I just love that there are So many amazing, safe, effective options to really help them with, especially the hair growth. I feel like a lot of times patients are even hesitant to tell me about it because they may find it embarrassing. So maybe they're shaving every day and not telling anybody or anything. Um, and so I think it's amazing to, um, have those as.
as options for when they're not trying to conceive and I will see commonly, I'll see people very comfortable prescribing birth control pills, but for some reason, a lot of people are a lot more hesitant to prescribe spironolactone and I'm not sure why. Maybe it's just because it's not as commonly, um, used as, as birth control pills, but, um, I agree they can make a huge difference, but it does usually take, I would say maybe about three to six months to see a really good effect.
Definitely, especially with the birth control, that can be slower. I think for the acne, um, spironolactone works a little bit quicker, um, when started for acne, but it does take a few months. Yeah, and I think the other benefit of them being paired together is that we do know Spironolactone can increase risk for birth defects in somebody who were to get pregnant. So at least when they're on birth control pills, we know that they're on a reliable form of contraception as well.
YEah, I think what's interesting too from a dermatology perspective is you may actually be seeing patients Who have not been diagnosed yet, right? You know, they may come for acne and hirsutism or hair growth, I guess I should say for our audience, and they may not know why they, they have this. And so I think that's probably interesting from your side of you might be the first person to raise the question, could you have a PCOS?
So tell us your favorite products for maybe acne prone or even PCOS patients struggling with acne who are trying to conceive. So um, because of the hair growth also with PCOS, one of the most common things that we see, um, with acne in this patient population is hyperpigmentation. and, you know, discoloration just because there's, you know, the acne and then there's the hair follicle and leads to just picking and, you know, a lot of scarring, unfortunately.
So, um, that's kind of the toughest thing to, that we want to avoid and prevent and because it's tough to treat. So, And with, you know, topical retinoids are great treatment for acne, hyperpigmentation, scarring. But, you know, obviously during pregnancy, we try to avoid that. So I would say definitely, um, I recommend that they incorporate some type of glycolic acid, like alpha hydroxy acid. And at low concentrations, these are safe during pregnancy.
So it would be less than 10 percent can be used. Um, Facials are really great. Um, during pregnancy. Um, because you know, they're safe. There's no, there's no medication. Um, extractions can help to kind of clear those breakouts without leaving as much scarring. Um, azelaic acid is another great ingredient that can, um, help to prevent acne. It's gentle, um, and it can help with, you know, redness. Some people have an overlap of rosacea as well.
Um, and you know, sun protection I would say is really, really important for that hyperpigmentation component. What SPF do you recommend women wear on their face? 50. 50. Okay. Go big or go home. Yeah. I mean, at least above 30, but most people don't apply enough, um, to, for it to be effective. So I tend to recommend at least 50, especially for people who are prone to hyperpigmentation. Um, and, um, and I, I think it tends to work better. It's good.
We can be like kind of spotty with our application of 50. Um, okay. So we kind of went over your favorite, favorite acne products. Um, and then you were mentioning hyperpigmentation. So a lot of our patients do have melasma. So is that similar recommendations? What are some of your best melasma treatments?
So, um, during pregnancy, um, sunscreen, 100%, um, with melasma, I always recommend a tinted sunscreen as well, not just SPF 50, but something tinted, um, that has additional properties that help to prevent hyperpigmentation. Hats, I would say, are, um, Key any kind of sun or heat exposure can really really worsen melasma So it doesn't have to be sun like sitting in a sauna or sitting outside in, Texas in July Can worsen melasma?
unfortunately Vitamin C serum is a great treatment and that's safe as well during pregnancy topical outside of pregnancy retinoids, um, are great. Um, hydroquinone we use topically, but that has been shown to have high systemic absorption. So we don't use that during pregnancy or breastfeeding. Um, and topical tranexamic acid is also another, um, safe and effective. Uh, topical treatment for melasma.
And I guess I should mention too, because sometimes we'll see this on our part, if we do have a patient who's not trying to get pregnant, who's taking birth control pills, there are some patients where birth control pills can actually contribute to that as well. So, um, sometimes that's a discussion as to what is the reason we're on birth control pills.
Should we continue and just, you know, treat the melasma versus would it be reasonable to stop the birth control pills and try, you know, something else. So that's kind of something that happens on our side of things sometimes as well. I thought that was really interesting what you mentioned about tinted moisturizer. So is there another ingredient in traditional tinted moisturizer that is actually changing the tone of the skin? How does that work?
It's called zinc oxide, um, and it protects against blue light specifically, um, which is known to worsen hyperpigmentation. Interesting. So that's not a basic SPF sunscreen that we would use. No, it would be, it would be in your tinted, um, SPF. Okay. That's really good to know. Yeah. Um, okay. So we have a little bit more and you can definitely say if this is out of your scope of practice, but we have some more esoteric questions for you. Have you ever seen a skin allergy to progesterone?
Cause we have a lot of patients that take progesterone supplementation and is that something that you've ever seen happen? I have and a friend actually, um, and it's very rare. There, there are two types of progesterone, um, dermatitis and both are very rare. One is, um, a reaction to your own progesterone that you're producing. So those people. you know, kind of get this cyclical dermatitis and get misdiagnosed as eczema.
And, um, you know, it goes on for years and years until someone finally does like a, a skin allergy test. And it turns out that it's progesterone. Um, and then there's, um, what are some of the symptoms of that? Is that like only in the second half of your menstrual cycle, you're affected in that? Right. Okay. Um, and then there's there people can have progesterone hypersensitivity, which is, you know, kind of like an allergy to exogenous or prescribed progesterone.
I don't know if you see this frequently, but it's pretty. I've only seen it a handful of times, um, and it can present like any allergy, like hives or, uh, or rash and can lead to anaphylaxis in the, you know, more severe cases, but it's very rare. Do you see it often? I've never seen it. See a case in fellowship, which was more the first one that you were talking about, where she would have cyclic eczema and things like that.
But I'll say what we probably more commonly see is that they end up having an allergy to the oil. Mm-Hmm. that the progesterone is. compounded. So for example, one of the most common oils is sesame oil. That progesterone is compounded, but sesame is an allergen for many people, including actually my own son. He has anaphylaxis to sesame. Um, so if we do have somebody who takes their progesterone injection, it's getting red and itchy and all the rest of it.
Oftentimes our first intervention will be to switch to a different type of oil. So a lot of times I'll use ethyl ole instead. Um, patients seem to have much less reaction, um, to that one as well. But I think that was most of our questions. Did you have any other questions? Do we want to? Yes. Um, hair loss. So, you know, certainly we know that hormones can contribute to hair loss.
So for example, it's not uncommon for patients after having a baby to lose a lot of hair or, um, or even just maybe after a stressful or traumatic event and everything. Yeah. Because we're hormone doctors, we get people who will come to us because people always tell them, check your hormones, check your hormones. And sometimes we'll check the hormones and they're totally fine.
So I was just curious if you could share a little bit more about how we should evaluate somebody for hair loss and then some effective treatment options that they could take when they're trying to get pregnant. So, um, hair loss is, like a gigantic topic and it's such a broad category and there's so many different causes of hair loss and so many different diagnoses and the treatments are very specific to what type of hair loss a person is having.
Um, So, I would say if someone is struggling with hair loss that's, um, not your classic telogen effluvium which is, you know, rapid shedding after birth or like you said, some kind of traumatic event or hospitalization, illness, COVID, something like that, then, um, I would just recommend they see a dermatologist.
Um, I don't think hormone testing I don't think it really provides any value, um, because, and I tell my patients come in all the time wanting, um, to have their hormones checked for their acne and, you know, that sort of thing. And I just tell them it's not clinically relevant to, um, you know, what we're going to do in terms of your treatment. It's not going to change the management and it might not even correlate to what we're seeing. Um, just because there's such a wide range.
I'm sure there are other reasons why their hormones should be checked, but, um, I would say acne and hair loss are probably not. up there, um, except for very, very few select cases. Um, so for telogen effluvium, when someone has happened, you know, rapid, um, shedding, then unfortunately, like reassurance is key. Um, most people are. Sure, they're going to go bald and you know, I'm, I'm sure we've all had it and it's terrifying and yeah, it's of hair, you know, just coming out floors cover.
It's devastating for any woman. Um, but it is temporary and it's not scarring, which means the hair follicles find the hair will grow back. Um, things that can help our, uh, vitamin supplements. Yeah. Um, like Nutrafol or Vivascal are great supplements to take, um, in general for hair. Real quick, I want to know, are those ones they can take while they're doing IVF or trying to conceive? I do get that one quite a bit. That's why I'm asking about the, about those two.
Yeah. Um, I would, I would say no. I would, you know, during, I would just have a, use a prenatal during that time. Then your hair is also going to be great. That's true. Every natal vitamin. Um, but biotin on its own, which most people come in and are already taking is not effective at all. Um, for any kind of hair loss. So I try to tell people all the time, like save your money. Um, well, with some of our lab essays actually as well.
So, right, um, so, you know, definitely, um, vitamins can help time, um, topical Rogaine. is very effective for telogen effluvium. Um, some people do, uh, PRP, which is platelet rich plasma injections. And that's done in a dermatologist's office. If someone's really struggling, um, with telogen effluvium, but most importantly, it's you know, all gonna grow back. Yeah. And for Rogaine, that's something they probably shouldn't do while trying to conceive as well, right? Both male and female side.
Just, yeah. Okay. Just want to make sure on that. Yeah. Yeah. Thank you. Very, very helpful information. This was awesome. I learned a lot. Yeah. I appreciate it. Okay. Well, I think we have actually so many questions. Maybe we should have a part two at some point. We really appreciate your time, everyone. This is her day off. So we just want to say thank you for spending time. Thank you for having me. Yes. Well, thank you so much. And thank you for being our very first guest.
You made history today. So excited. Okay, great. Well, thank you guys. We will see y'all next week. Have a good one. Bye. Bye.