You wear your skin every day, so it’s a good idea to take care of it. Best way to do that? According to Dr. Keira Barr, board-certified dermatologist and Chief Wellness Officer of Resilient Health Institute: “get naked.”
At team Gennev, we field a lot of questions about skin, and that makes sense, because skin changes as we age—lines, dark spots, melasma are all normal. Most of those changes are entirely normal, if not always welcome.
But some changes are red flags – “whispers,” says Dr. Keira. Your skin is trying to tell you that something is wrong. If you listen now, while it’s still whispering, fixing the problem will likely be easier than later, when it’s shouting. But you can only hear those whispers if you’re willing to get naked and get to know every nook and cranny of your skin.
Dr. Keira talked with Jill about the ways our skin communicates, what it might be trying to tell us, and when it’s time to take concerns to a professional.
Jill: First of all, thanks again for being here with us. Skin is probably one of the hottest topics for any woman because we wear it every day. In your journey in dermatology or into dermatology is a personal one, can you tell us a little bit about that?
Dr. Keira: It’s really interesting because I wasn’t aware of the connection between my childhood experiences and why I wound up choosing my medical career. I thought it was just in medical school I saw pictures of skin, I knew what they were, and I was like “wow, this seems cool.” And dermatology is a beautiful marriage of internal medicine, histology, surgery, all the things that I really enjoyed.
But, looking back, you know, I was born with two birthmarks on my face and, as a kid I didn’t really pay much attention to them until I went to school and kids made fun of them. And they called them “coffee stains.” And they called me “coffee-stain face,” and it was the first time that I became acutely aware that my skin could be such a source of shame and humiliation and embarrassment. So I quickly learned that if I could mask those stains by getting a suntan, it just felt much better to just hide behind that.
Unfortunately, I have very fair skin, my dad’s a redhead, so I would burn before I would tan. Over the years I accumulated tons of sun damage. Fast forward, I become a dermatologist, I learn just how dangerous my behavior was, had tons of atypical moles, and eventually had to diagnose myself with melanoma, which is the most deadly skin cancer there is. So, as a dermatologist, I’d now become my own worst nightmare of a patient.
Jill: Wow, that’s incredible. What a journey, to not only have experienced what you did as a child, but to pay the ramifications of that as an adult. So, you know, you’re a woman now, and you’ve come through that journey, and you’re doing incredible things and, you know, our audience obviously is women in mid-life. And skin is something I know I think about all the time. I look at face every day in the mirror, I look at my body, but one thing you call out a lot is women need to get comfortable looking at their naked bodies. Talk a little bit more about that.
Dr. Keira: Yeah, so, my biggest piece of advice is always “get naked” – for so many reasons.
First of all, your skin is your largest organ and it truly is a window to and reflection of your overall state of health and well-being, so understanding what is your normal, understanding the texture of your hair – is it changing colors or falling out, you know, what’s on your skin – those are clues that will allow you to dig deeper. If there’s more going on inside your body, whether that be a nutritional imbalance, whether you’re not sleeping enough, whether you’re not caring and loving on yourself enough… it all shows up on your skin.
So getting comfortable in your naked body allows you to, number one, feel comfortable in who you are, in your skin, that’s huge. And it was because I didn’t feel comfortable in who I was which is why I tried to hide it with a suntan, so I don’t want that experience for anyone else. But also getting naked to see what’s on your skin, especially with regards to skin cancer prevention and looking for spots that stand out from your crowd, there are certain things that you could look for… and I encourage everyone … Well you get naked every day, but specifically on the date of your birthday, for instance, it’s the same date every month, you are naked before you get in the shower, you look yourself over head to toe, every nook and cranny, and you’re looking for every uninvited guest on your birthday suit, any spot that just stands out from your crowd.
Jill: Fascinating. And so when you said there are things to look for, you’re looking for abnormalities, for new things. What else?
Dr. Keira: So, with regards to that, we always talk about knowing your ABCDEs, so especially with regards to melanoma and skin cancer…so, a spot on your skin that’s Asymmetric, so if you were to cut it down the middle it’s not the same on both sides, it has a very poorly defined Border, it’s kind of blurred edges, that’s one to bring to your dermatologist’s attention. Something that is varied in Color throughout it or is different in color than any of your other spots. D is for Diameter, that’s a very soft call. We always say larger than a pencil eraser, but I can assure you I’ve seen melanomas that are tiny. E is probably the most important, that is something that is Evolving, changing over time, and also sores that aren’t healing, we take for granted that “oh, it’s just a cut,” – but that sore that just persists…pay closer attention to it.
And even if some of your spots meet some of the criteria I was just talking about, it doesn’t automatically mean it’s something to worry about, but it is something to raise a flag and, you know, bring to your dermatologist.
Jill: You know, you talk about the sores that aren’t healing or the sores that even just come back, time and again, is something that I know I’ve witnessed in people…
Dr. Keira: Especially a precursor to cancer called an actinic keratosis, it’s a precursor to the type of skin cancer called squamous cell carcinoma and oftentimes it presents on the face or the hands as like a red, gritty, sand-paper like texture, and those are the ones that someone will say “oh, it peels off and it went away,” but it comes back. Those are spots to bring up.
Jill: Now you recently published a book titled The Skin Whisperer, which I highly recommend for everybody, we’ll talk a little bit more about that or put up information on the blog of the podcast afterwards. But you talk about, I think, one key thing in the book is you talk about the messages that your skin is sending to you, tell us a little bit more, what do you look for, how do you listen?
Dr. Keira: So, yeah, the title of the book, even though I’ve been called a “Skin Whisperer” because I can see what’s on the skin and give you a diagnosis, the key is to hear the messages your skin is sending you when they are just a whisper. Not shouting at you, which, unfortunately, that was my story, I was deaf to the messages my skin was sending, I was having biopsies of changing lesions on my skin every couple of months, didn’t think anything of it and BOOM, I get skin cancer. It led me down that path because I wasn’t notice of how I was living my life.
So, hearing those messages – what I was saying before: is the texture of your hair changing, are you losing your hair, are you breaking out in new types of rashes, is your skin drier than it normally is, you know, sores that are persistent. These are clues that your body is sending that a dermatologist may be able to look at you and instantaneously give an assessment.
But sometimes it takes more investigative work, so you yourself looking at your own skin, looking for things that are not what they typically are – drier skin, oilier skin, you’re breaking out like crazy, new onset acne in an adult woman, right? – these are things, clues that your body is saying “I need some help here, I need some help. I need either you yourself to kind of take stock of how you’re eating, sleeping, moving, any new products you may be using or hey, get yourself to a board-certified dermatologist who can help you work through these things.”
Jill: So, a couple of the things you called out – dryness, oftentimes they can be linked to hormonal changes in the body, and the adult-onset of hormonal acne in menopause. How does a woman decipher, you know, between the two. Because I bet you get some coming into your office where that’s kind of more the symptom, or don’t you? I guess, is that, how do you help women think about “is this related to hormonal changes or is there something else,” or should you just get it checked out regardless?
Dr. Keira: Well, I think it’s always helpful to get yourself checked out because there may be multi-factorial components like layers of the onion.
I think especially, as we are maturing, there are changes that occur, our skin … collagen production does goes down, skin barrier, you know, the lipids in our skin are decreasing, so we are a little more vulnerable to drier skin, a little more sensitivity.
Products that we’re using because we think we want to fight the aging process, your skin Is naturally slightly acidic, so if you’re using products that are altering that PH, you think you’re doing some good because that’s what the commercial says, but you’re actually disrupting your normal PH value and disrupting your permeability barrier, you could wind up with a rash, you could cause a flare of your acne.
And then the hormonal component. You know, as we mature, our hormones are going to fluctuate, but especially if you’re stressed, in midlife, we are juggling a lot of things, you’re juggling a career, a relationship, kids, or pets, so many things, and your cortisol levels could be going through the roof. Now that in and of itself is going to set off a cascade of inflammation that can easily exacerbate acne, eczema, psoriasis, any of these other conditions, so it’s kind of taking stock of every facet and seeing where can we get the smallest wins the fastest because sometimes just the smallest shift can make a dramatic difference, and allow you to then – now, what’s the next step – do we even need medication, or suggest “you need to take a breath.”
Jill: Yeah, probably take a breath! You know, I think, what you just talked through, it’s complicated. Where does a woman start, or a man start? And I think one thing you call out a lot is there’s four pillars: lifestyle, nutrition, movement, and mind-set. How do you talk people through those four things? Because I’m assuming for anybody those four things are contributing to the health of their skin.
Dr. Keira: Absolutely. And even though I would love to start with mind-set, because I think all of us could benefit from a little reframe, that’s probably the thing that would come last.
So one of the first places I start is with the nutrition piece and simple things – you know, that was my wake-up call, at the time of my diagnosis I thought I was eating healthy. I was running ultra-marathons, I was wearing sunscreen and protective clothing, all of that, and clearly my body was telling me it was very wrong.
So one of the first places I started was nutrition and just reading labels. I had, I mean, I was like “this is magic!” And it’s the simplest thing, I mean, I worked actually with a nutritionist and she said “let me show you two cartons of chicken broth,” and we just read the labels of each. One had sugar and some stuff I don’t even think I can pronounce and it was like water, vegetables, spices. And I was like “oh, I’ll pick that one.” And it was just that simple, just taking notice of what we are consuming. If it has more than four ingredients, or you can’t decipher an ingredient, put it back on the shelf.
And really, I learned how to cook for the first time. And many women… it’s expected that you cook. But my husband for all of our relationship, he was the chef, ‘cause I thought roasting was something very complicated. I didn’t realize you just turn the stove to 400, a little olive oil, salt, and pepper, and you put in and that’s roasting.
Jill: Not only are you The Skin Whisperer, you’re the culinary you know…
Dr. Keira: So you know, it’s just those simple things of like, OK, what is in your pantry, can we clean up your pantry, can we just simplify your life? And chopping vegetables, I found it very therapeutic. Peeling, giving yourself permission to just take that time, you know, and by doing that, by having a wide variety, a colorful array of fruits and veggies, like, you just boosted your antioxidant supply through the charts. Like, little things. And what I found is, “oh, my skin is clearing up,” “oh, I took out dairy for a little bit” or “I cut out gluten” and for some people it does make a big difference.
Jill: Yeah, you know, I think also what you’re doing is just reminding people of the simpler things, you know what if you were to… OK, complicated space, lots to factor in… if you were to narrow it down at least to three things that a woman can start to take notice of or start to own in terms of listening to her skin and helping it be the most healthy it can be, what are those three?
Dr. Keira: Yeah. With regards to nutrition, it’s not just what you’re eating, but how are you eating – are you actually giving yourself permission to sit down and eat a meal? Because your autonomic nervous system, you’re in that fight or flight mode, so allowing yourself to rest and digest, because if you don’t, your body and your skin is not getting the nourishment and nutrients it needs.
Jill: Not like eat the piece of toast running out the door, like I did this morning
Dr. Keira: Exactly. Sit down so your body can digest it and you can…because again, cortisol, stress, it messes with your skin, permeability, inflammation, all of that. The second is how are you sleeping?
And especially as we get older, our sleep cycles can be disrupted, but sleep significantly impacts your skin. Melatonin is what we produce when we sleep, and it has to be very dark for that to switch on. And melatonin is the most potent antioxidant that our body can produce, and it protects you from UV damage, it promotes production of other antioxidants that your body needs to fight environmental stressors.
So how you’re sleeping is important, and taking notice, most importantly, of how you’re loving … most importantly of how you’re loving on yourself. I think most women, especially in midlife, they are so worried about everyone else, other than themselves, and you really need that introspection. And I’m learning this myself on a daily basis. It makes a huge difference, you know. Those bags under your eyes, the dry, flaky skin, it’s the stress of also acknowledging you are just not taking care of yourself, so those would be my three very long, drawn-out, explanations.
Jill: Yeah, I think they’re perfect. Your skin is beautiful, Dr. Keira, and it’s apparent that you are listening to your skin and have made this amazing transformation, and you share it in your book. You also… if people go to your website, which is chooseresilience.com, people can book a 20-minute breakthrough session with you. Talk a little bit about that.
Dr. Keira: Yeah, so it’s an opportunity for us to explore, you know … Can I help you, what are your biggest challenges? Because what I’ve learned through this journey and through working with other people is that I can give you tools and strategies, but ultimately the outcome depends on you, the person. Are you willing to put in the work because there is no quick fix, there is no magic lotion-potion, this is work to be done, so really explore that together – is it a good fit.
You know, I really do want everyone to be successful, but that success really is dependent on the person coming to me to seek that out.
Jill: You know, what I’m finding in this conversation is my typical fun about a dermatologist is you book a dermatologist, you see them, but even what you’re talking about so much, especially in your 20-minute breakthrough session, so much of it is a mind-set. You’re almost like a therapist.
And I know for me personally, even if you can’t do those full three things you brought up earlier, or all the tips that you bring forth in your book, if you focus on one, you can make a difference.
When I left my corporate career to start Gennev I was like, “I’m gonna get eight hours of sleep a night.” I always compromised sleep, I would go five or six and think that I could keep going and I’ll catch up on the weekends and even though this job takes it all out of me, I still prioritize sleep, and it’s made an incredible difference. Not only my health, but my skin. So even prioritizing just one of those things, it’s progress.
Dr. Keira: Absolutely, and I mention this in the book too, that whole idea of negotiate your non-negotiables. What are the things that you just absolutely will not negotiate on, what do you stand for, what you and will you not tolerate, and if that’s picking up your kids every day, that’s a priority, or scheduling actual date nights, or scheduling sex, or, you know, a bath. It doesn’t have to be monumental, it has to be something that you can hold firm. When you do this thing for yourself, like, you know, you’re taking a stand for your health and your emotional well-being.
Jill: That’s a perfect way to end. You know, figure out your non-negotiables and go there. Thank you, this has been great. It’s brief, but there’s so much more to learn, I think. The Skin Whisperer, by Dr. Keira Barr – check it out. Any final closing words you wanna share?
Dr. Keira: I think I touched on it earlier, but the most important is get naked. For so many reasons. Have fun with it. Never underestimate a good romp in bed, it’s good for your stress, that’s good for your skin. But also get familiar with your skin. Every nook and cranny of it. Because it’s beautiful, it’s yours, no one’s going to protect it like you can.
Jill: Thank you.
Not quite ready to give up podcast-land and join the real world? We’re got more. Our conversation with Dr. Lisa Mosconi on the link between Alzheimer’s and menopause is a fascinating wake-up call to start feeding our brains right: menopause, Alzheimer’s, & eating for retirement, part 1 and more of that same conversation in part 2.