In this episode of Shorr Solutions: The Podcast, “The Science Behind Skincare”, we welcome Carl Thornfeldt, M.D.! Dr. Carl, as he is known within the aesthetic community, discusses the ins and outs of how science applies in aesthetic medicine, understanding inflammation, and conducting safety studies on your products.

Dr. Carl’s Story:

Mara: Bring us back to the beginning. Can you tell our listeners, how you got started in medicine?

Dr. Carl: My father was a prominent pediatrician who was an allergist and was actually Chairman of Pediatrics at a major hospital and medical school in Portland for a number of years.  I suffered from a variety of allergies and skin conditions that were quick in incapacitating. My father also had a farm, and on that farm, we took care of nationally prominent sheep that were some of the top in the country. So instead of executing the animals, if there was an injury or disease, he would actually treat them with human medicine or veterinary medicine or bring out top surgeons, from the medical school, and his clinic to perform surgery on these animals. Consequently, when I was in sixth grade I was providing anesthesia for these animals that were worth over $1,000 a piece. In the early 60s that was a lot of money. Through watching these surgeons perform and seeing how medicine worked,  I developed this interest in understanding the medical aspect of life. The other thing my father did was, we would add pediatric illiquid vitamins that were given to the pediatricians but these were outdated samples, and we would mix them with molasses, and every night we would feed our animal high quality hay with molasses that was doctored with these nutrients. When we would go to compete in fairs across the western United States our animals were substantially larger, longer and taller than others that we would compete against, so I got to witness the value of nutrition.

Mara: This was just before the days of giving animals mass amounts of hormones to make them larger,  taller, bigger etc. You’re doing this through food, and the learning healing power of true medicine.

Patient Population and Quality Healthcare:

Mara: Tell us a little bit more about the patient population you serve and why you chose to focus on your small town?

Dr. Carl: I grew up in a small town and there was definite difficulties in getting quality health care, so when I decided to go into medicine, I decided that I would go into rural health care. For over 30 years I was the only dermatologist for 30,000 square miles in Eastern Oregon and southwest Idaho serving about 140,000 people, spread over that whole area. I focused on  providing top quality care for all aspects of Dermatology, not just all age groups, and not just a number of diseases. I had great interest in dermatitis having suffered greatly from widespread dermatitis when I was a child, but also with other chronic conditions that would appear with that. For example with hives, I would see many patients who also had asthma or allergic rhinitis and because of my work with allergy and immunology, I also had great interest in that and would take care of those issues as well. My real focus is to understand the underlying driver of what we see for skin disease. 90% of all the named skin diseases are a manifestation of an internal problem. I wanted to focus on the underlying driver to manipulate the foundation. I want for my patients, what I wanted when I was afflicted, that is get completely clear, not partially clear like many pharmaceutical companies were satisfied with, but I wanted to get completely clear, I wanted to stay clear, and I wanted the foundation to be affected.  Those are the foundations of the principle for my treatments. My real goal is to make that person’s skin and mucous membranes as healthy as possible and to rebalance the immune system and allow their body to function at its optimal.

Mara: You share so much that goes just beyond the skin but focusing on inflammatory disease, and autoimmune diseases. I love how you chose to take this all one step further. You are not just, and I say this very loosely, a dermatologist, which that in itself is huge, you founded the Epionce skin care line as well.

Dr. Carl: The purpose for that was that when I look at diseases and trying to understand the foundational problem, I really look at it from a molecular and cellular point of view. I think my greatest strength is being able to look at basic science, and actually realize how it could possibly apply to human medicine. I knew, having gone through phase three clinical trials when I was a dermatology resident, that the prescription medications were not the final cure and in the sense that, at that time, very, very few have ever produced 100% clearance rates. My research went into understanding the molecular and cellular problems going on, in other words, what we call the pathophysiology of the underlying disease. Basically, what I did was find that the medications, when I got out into practice, weren’t working out well. I also found that patients didn’t like them. I wasn’t the only one that was not enamored with the way the prescription medications for skin diseases, felt, smelled, and their lack of efficacy. After being having my practice for a year and a half, I was pretty discouraged because people weren’t responding as well as I thought. Then it hit me, everything that we’re using now is basically destroying the skin barrier, but the number one purpose of the skin is for protection. Could that be the problem, could that be the reason our high potency steroids were only getting 56% clearance rates? Well, at that time, there had been really very little research done on the skin barrier at all. I proposed that the stratum corneum is just a layer of cellophane you just have to blow through to get the products in and actually work.  I went back and started pondering this more, and basically then developed a theory about how the skin barrier was the underlying foundational problem and then the side effects of that abnormal barrier function triggered chronic inflammation, with an activated number of cells that release pro-inflammatory signals. Then, I had to figure out, can you develop products that actually modulate those abnormalities, and then can those products be introduced into the marketplace and impact people’s lives.

Evolution In Skincare:

Mara:  You have done a significant amount of product development over the years, and where do you think you have seen the most evolution in the past few decades?

Dr. Carl: We discovered the foundational problem for 14 major skin diseases and it was a  compromised or inadequate stratum corneum barrier, coupled with chronic inflammation. That was completely uncontrolled and refractory to therapy that those were the primary foundations that triggered, all these other pathways that would then cause tissue destruction. When we first applied to speak about it at meetings in the 90s, there wasn’t really any interest. Then in 2004, Andrew Weil was on the front of Time magazine about how understanding inflammation was going to change medicine. I think that the aspects that we’ve really contributed is teaching people about the importance of skin barrier and a lot of people now are talking about that for products, and also the importance of inflammation in the skin. Our focus for product development was along those lines. Further expansion of that was the cell types that were involved, and the implication of having an inadequate barrier as far as allowing pollutants and microbes to move in and continue to drive in disease and prevent long term remissions. We also knew that when patients are coming to me they expect the doctor to be a clearinghouse for information, they want to know what’s effective, and what’s safe. I felt that I had a moral and ethical obligation to provide products that were safe, or that are safe and effective. We do safety studies on our products, perform multiple clinical trials and we were the first to take on prescription products.

Mara: One thing that I have heard you say, again and again, is that you’re not against prescriptions when they’re truly necessary, but so many of the products can take the place of a topical prescription for certain skin diseases. Epionce is certainly a line that we recommend to our clients as well because one thing is that when our clients come to us, a key question is, should I sell skincare in my practice? For skincare, we always recommend to our clients to pick one or two of their favorite lines and look at your particular patient base and what is going to work best for them.

The Future of Epionce:

Mara: What do you have in mind, as far as, the next steps of what you want to see with the brand?

Dr. Carl: We’re focusing on manipulating, a number of pathways to a much greater degree than what we have today, as we understand issues on the different cells and tissues. What goes on to a deeper level now, we’re working on the manipulation of different pathways. We are doing quite extensive work in new botanicals and new ways to extract active ingredients from botanicals and we will continue to expand our over the counter drug group as well. We have a steady pipeline of new products coming out.

Getting Skincare Products to Your Patients During A Recession or Pandemic:

Mara: Can you tell us about how Epionce does dropship?

Dr. Carl: Yes, we have a program in place so that the practices will get their 40% credit for the products, and we will ship them directly from our manufacturing facility and with high-quality packaging. That was one of the aspects that was also important for us as I developed this company was to make sure we had high-quality packaging that was going to preserve the efficacy of the product. We make smaller batches more frequently so that the patients can have products that are fresh. When we do the clinical trials, we’re required to have manufacturing of the product done no more than a certain time period before. If you have a product that’s sitting on a shelf for a number of months you can’t expect it to work as well because of particularly active molecules. Chemistry happens in those jars and bottles, and things will break down or deteriorate. We make sure that you have the freshest and most effective product.

Selling Your Products on Third-Party Websites:

Mara: Even though Epionce sells on the dropship, you do not sell on any third party websites, right?

Dr. Carl: Correct, and Mara that’s really been a problem recently because we do not sell on Amazon and so there’s diverters who are selling on Amazon or walmart.com. We have actually purchased some of those just to see what it was like and they were literally a whole series of products just thrown in a box and the packaging was damaged and out of date and a lot, numbers have been scratched off. I mean it’s just poorly controlled. We have several websites that we do work with like Lovelyskin and Dermstore. Those companies we do guarantee product because we know they’re getting the fresh product. Products coming from Amazon or walmart.com, we do not guarantee the product, because the product is often not authentic, or has been poorly cared for, or has been expired.  The fact that we are in a chemical world and chemistry happens when you mix things together, manufacturing processes are incredibly important, but also the packaging quality and the care which it is packaged and then how it’s handled afterward, how it’s stored, and how it’s shipped. If you’re doing, for example, private label, or you’re working with many companies that will just contract manufacturer, it may or may not have the quality that you want. With Epionce, We are making it ourselves. We know that it’s got the quality through every step of the pathway.

Conclusion Questions:

Mara: What did you learn along the way that you want to share with our listeners? What would you do differently if you had to do all over again? Finally, either personally or professionally, what are you most proud of?

Dr. Carl: The thing that I’ve learned along the way is that the most important commodity or the most important ingredient in success is the people around you. Getting high-quality people that have certain characteristics that you need to build the company is really important. Yes, I’m the founder, but this company would not be successful without great marketing people, great salespeople, great manufacturing, great distribution, and my chief operating officer and chief financial officer. All of these people are incredibly important in making this machine work. All I do as a CEO is basically put together the team because I understand the product. I’m really gifted in certain aspects, but there’s a whole lot of the things I’m horrible at. My job is to put together that team. The most important commodity is the people that you surround yourself with, and I had some starts and stops early on in my career and things took longer to develop and cost more than I had originally anticipated because I hadn’t spent as much time and effort in putting together the team.  What would I do differently? The big thing, I would have done differently is hired more slowly, but then fired more quickly. I think one of the best business mentors that I had was Jim Collins’ book. He has a series of books about building businesses and I found those very helpful in putting together your team, and then how to work with a team. The second thing I should have been more cognizant of was having more time and resources set aside for overruns, or if we didn’t meet certain timelines. That put us into some situations that resulted in me having a second mortgage on my house and things like that. The most proud aspect, really revolves around the success of bringing products that are needed to the public, and having them change lives. Having people get well, and keep their skin clear, that’s where I get my greatest joy, and that would not happen without having a team that I enjoy working with and that I have great respect for because they do things that are way beyond my own capabilities.

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