The Concierge Doc Podcast with Dr. Jason Littleton, M.D.
The Concierge Doc Podcast is hosted by Dr Jason Littleton, M.D., where he features medical content to make smart lifestyle choices for optimal health, wellness, energy, youthfulness, longevity, balance, and happiness.
The Concierge Doc Podcast with Dr. Jason Littleton, M.D.
Skin Deep: Understanding Your Unique Dermatological Profile w/ Tim Nyckowski, DO
Visit Dr Jason Littleton's website: https://www.jasonmd.com/
Follow Dr Jason Littleton on Instagram and Facebook: https://www.instagram.com/therealdoctorjason/
Watch Dr Jason Littleton on YouTube: https://www.youtube.com/@therealdoctorjason3340
Disclaimer:
Access to the Information and materials contained in this podcast is at your own risk. The information contained is presented for the purpose of educating the consumer on a variety of wellness and health care topics (the “Information”). Nothing contained is intended to be instructional for medical diagnosis or treatment. The Information contained is compiled from a variety of sources. The Information should not be considered complete and not exhaustive and should not be in place of a visit or consultation with your own primary care doctor.
The views, opinions and statements expressed by our guests are solely their own and do not necessarily reflect those of Dr Jason Littleton or the Concierge Doc Podcast. We do not endorse or take responsibility for any statements, claims or perspectives shared in this content. Viewers are encouraged to conduct their own research and form their own conclusions.
Dr, Jason Littleton:Access to the information and materials contained in this podcast is at your own risk. The information contained is presented for the purpose of educating the consumer on a variety of wellness and healthcare topics. The information Nothing contained is intended to be instructional for medical diagnosis or treatment. The information contained is compiled from a variety of sources. The information should not be considered complete and exhaustive and should not be in place of a visit or consultation with your own primary care doctor. Welcome to the Concierge Doc Podcast. I'm your host, ceo and founder of Littleton Concierge Medicine, dr Jason Littleton. Welcome to the podcast. Now today we have Dr Tim Nyckowski, who's a double board certified dermatologist and Mohs surgeon. Originally from the Chicago area, he came down to Central Florida to finish his medical training and has remained in the area since. He has authored many peer-reviewed dermatology articles and serves as an editor for various dermatology journals. He prides himself on forming good relationships with his patients by using a balance of medicine, education and humor. Welcome to the podcast. Welcome, dr Tim. How are you?
Tim Nyckowski, DO:Hey, thanks for having me on, Jason. Good to finally meet in this way.
Dr, Jason Littleton:Listen, I'm glad to have you on. I think my audience has a lot to learn from you and, you know, I think skin is something that is on the minds of everyone in a multiple facet way in terms of, like you know, looking good skin wise, but also skin cancer is a big concern and I just wanted to ask you start off with what are some of the top things you see in dermatology?
Tim Nyckowski, DO:Yeah, it's a very common, you know, issue of concern with patients. It's one that you can see when their concerns are there, when there's health issues, so definitely an important one to a lot of people. We see a lot of things. A big part of our practice here in Florida especially, is doing skin checks and finding growths on the skin and diagnosing and treating skin cancer. But you know, other than that, all kinds of rashes too, like you know, acne, psoriasis, eczema. You know various kind of, you know, bolus diseases, fungal diseases, childhood viral illnesses and just a mix of many, many things that can happen on the skin. Just a mix of many, many things that can happen on the skin.
Dr, Jason Littleton:Yeah, you know, like with what you see, what are some of the top preventative things that you would recommend to people? I mean, we hear things like you know put on sunscreen, moisturizers, you know, stay out of the sun. But what are some of your tips that you tell your patients and what do you do personally?
Tim Nyckowski, DO:Yeah. So that's a good question. I'd say intent is the key, now more than ever. We're living in the age of information and every time you log onto the internet or, you know, hear someone talk about skin especially, you know, when they're not, let's say, a dermatologist, I see a lot of just blanket state recommendations. You know that they're not, let's say, a dermatologist, I see a lot of, uh, just blanket state recommendations. You know that everyone should do certain things, but I think it all starts really with understanding your own skin and that's kind of where you can get, uh, the best guidance, like with, you know, at least opening the conversation with a dermatologist.
Tim Nyckowski, DO:But, um, you know, in general, things that are good for everyone, I'd say, is things like sunscreens for sun protection. But even on that note, I do have certain caveats for my patients, for example, I recommend mineral-based sunscreens, ones that are elemental only. There is a little bit of controversy that goes deep into the history books for that one goes deep into the history books for that one. But a lot of the chemical sunscreens were approved to basically be sold over the counter before the FDA was evaluating over-the-counter medicines, and let's just say that there is some controversy in terms of the safety with those. So I just generally recommend mineral sunscreens to all my friends, family and patients, things with zinc oxide and titanium dioxide. They're safe for everyone. They're safe for the environment. They're a little bit thicker, a little bit harder to find, but they're good sunscreens. Outside of that, it just comes down to just evaluating the individual whether they have anti-aging concerns or dry skin concerns or acne concerns, for example. Those are very different kind of types of ways to treat skin.
Dr, Jason Littleton:Yeah, I love the answer. I also love something that you said. You said understanding your own skin. What does that mean?
Tim Nyckowski, DO:Yeah, so just understanding where your skin concerns are and depending on that, you get very different responses. For example, a lot of people who have rosacea think that they have acne because they see bumps on their face that look most similar to the most common causes of kind of bumps and pimples on the face, which is acne, and they use acne washes on their face and it just keeps getting worse. And they come in to me and they tell me you know, I spent a thousand dollars on you know 200 different acne products and none of them are working. And I say, well, you don't have acne. So it actually gets worse if you continue to use acne treatments, as a matter of fact, because it's basically targeting the wrong bacteria and allowing the kind of bad bacteria to overgrow on the face.
Tim Nyckowski, DO:So really, just understanding exactly what's going on with your skin, everyone has different kind of dry spots in their skin, everyone has different oily spots in their skin and everyone individually has different compositions of oils in their oil glands on their skin, different compositions of oils in their oil glands on their skin and, based on those different factors, you are more predisposed to certain types of bacterial colonizations on the skin. You're predisposed to certain types of rashes, whether it be dry skin, which tends to run with allergies and just sensitive skin issues, or oily skin, which tends to run with like cysts and pimples and rosacea and oil gland issues. And again, it's regionally different. Even you might have oily skin on your forehead, for example, is a common issue, and then you have dry skin on your cheeks or vice versa. So understanding how your skin is and how to treat it differently in different parts of your individual skin is really important when it comes to getting what everybody wants, whatever you asked me about, which is, you know, perfect and clear skin.
Dr, Jason Littleton:Yeah, I mean, I think you explained that so well and it makes me think should we be using, like, different types of soaps on our face, you know, like a soap for, like you know, our forehead, a different soap for our cheeks? I mean, what, how do you it's combination skin Like? How do we treat that? What's the best remedy for that?
Tim Nyckowski, DO:Yeah, no, that's a great question. Um, in general I'm a minimalist, so I'm very much like let's do the least amount possible to get you a hundred percent, uh, satisfaction. So, um, when I see people that, uh, for example, have combination skin, the way I explain it is this Most washes and acne products are designed to dry the skin out. So if you use those products in areas where your skin is oily, you might turn it into normal skin. But then if you use the same products that are drying products on normal skin in the combination areas where it's more normal, then you're going to dry that skin out and you're going to end up with too dry of skin. So, understanding the balance that you want to kind of apply the drying parts to the more oily areas and probably do less, if anything at all, to the normal areas, that will overall get you a balanced, even skin tone versus drying everything uniformly or keeping everything oily uniformly. So that's where it's important to understand even the regional differences of your individual skin.
Dr, Jason Littleton:That makes sense. That's well said. I mean, I think that's going to help a lot of people out, I mean, and I love that explanation you don't hear that very often, but I think that's I mean, I think that's an incredible explanation. I really like that. You know, another thing that I see a lot as a constricted physician is that people who have itchiness but they don't have a rash, and we're really trying to figure out why are they itching? What's going on? How do you get down to solving that problem? Or what do you do when you see a patient that has itchy skin but no clear cause?
Tim Nyckowski, DO:Yeah, this is a. This is a great question. I don't know if I'm a magnet for this, but I see this all the time, all the time in the community. Man, this is a tough one.
Tim Nyckowski, DO:So, first and foremost, when someone has itchy skin, you want to rule out, obviously, organic causes. So sometimes there's metabolic things, like you know kidney failure, liver failure, sometimes it's it's dry skin issues specifically. But usually when I see these kinds of issues, it's an interplay of issues with skin sensitivity, nerve sensitivity, and sometimes there's also a psychological aspect of it where there's kind of just a habit of picking the skin and there's a kind of interplay of these three things and I see it a lot. I kind of think about this. In many of these cases, when we rule out the organic causes, it's almost like a form of nerve sensitivity.
Tim Nyckowski, DO:So a lot of people, um, you know, are familiar with things like fibromyalgia or irritable bowel syndrome, where basically nerve sensitivity triggers like kind of somatic issues and this is just such, I feel, like an incredibly underdiagnosed condition in the skin too. I have so many patients who come to me with, just like you're saying, perfect, like, like beautiful, great skin. I look at their skin, I say it's so good, but they tell me they're itching all over and when I see that I usually know it's a nerve, inflammatory and sensitivity issue and there's more ways to work it up and diagnose it. But it's usually a pretty clear cut in those cases.
Dr, Jason Littleton:So a nerve inflammatory sensitivity issue?
Tim Nyckowski, DO:Yes.
Dr, Jason Littleton:Yes, and then what? What medicines work for that really well.
Tim Nyckowski, DO:Well, again, going back on an individual basis, sometimes it comes down to things like reforming habits. Sometimes it comes down to finding ways for people to do things with their fingers when they're feeling bored or when they're feeling nervous or when they're feeling itchy. A lot of my patients tell me when they itch. It's almost unanimous that they tell me they itch more at nighttime. So having something next to their bed as an anti-itch option is very, very useful in those cases as well, because that's when they'll be itching more and they can't sleep. Then it becomes like a cyclical thing.
Tim Nyckowski, DO:There's also nerve acting medicines that I use commonly in those cases, sometimes anti-inflammatory medicines, sometimes medicines that intentionally just make people more sleepy in general to help them to kind of sleep through again that itchy period of the night and oftentimes it's a combination of those things and addressing any other underlying issues that are causing them to feel stressed in life. You know, like maybe they lost a job recently, or having marital issues and ideally looking for a better outlet for their stress than picking their skin. So I love encouraging people I'm always doing it to get out and exercise to release those catecholamines, release those stress hormones, so that they don't end up building them up throughout the day and then at night they're just sitting in bed and they're feeling all stressed and they start picking their skin. I see it a lot.
Dr, Jason Littleton:Great answer. I think that's going to help a lot of people. That's, you know, that's that's big. I know a lot of people are going to want to come and see you because of that, because that's something I see in the community a lot as well, you know. Are there any supplements that you recommend to having better skin?
Tim Nyckowski, DO:Yes, there's many, and it depends on the different kind of conditions that people have. So for things like rosacea and hydrogenated separtiva, it's good to take zinc as a supplement, for example, I love recommending zinc, and a pro tip if you're someone who suffers from those is you want to take it on an empty stomach. That's very important. It's a micronutrient, so if you take it with a full meal, you're going to absorb minimal amounts of zinc. So I recommend zinc on an empty stomach. Specifically If somebody has a lot of sun exposure, I like mineral-based sunscreens. Also, there is a supplement that's based on an herb called HelioCare that can be useful for preventing sunburns In people that have a high risk of skin cancer and especially immunosuppressed patients. I love recommending to use niacinamide, which is vitamin B3. No-transcript.
Dr, Jason Littleton:And then there's just many other supplements, depending again on understanding the individual's needs. That's good. That's good, very helpful, very helpful. Now, you know I I talked to you, um, prior to the podcast. You know I always ask people about they move, eat, drink, sleep, and I want to know a little bit about you and how you move, eat, drink, sleep, um, let's start with the move part. What do you do for exercise?
Tim Nyckowski, DO:Um, let's start with the move part. What do you do for exercise? Yeah, oh man. So I love these topics too. Uh, we've talked about this specifically. I'm like you the best medicine in general is a diet, sleep and exercise. That's what I'm telling everybody. Um, so, starting off with moving though, um, personally I'm always changing my goals and it's always based on my intent, so um. So sometimes I'm trying to rehab from an injury, sometimes I am trying to fast for different kind of metabolic benefits and concentration help with that. Right now, for example, I'm actually adding weight for the first time in a few years, intentionally I'm bulking. So it just really depends on the individual goals that I have at the time and, depending on that, I'll change my movement, my diet and even my sleep to kind of be congruent with those things. But right now, I guess I'm bulking, so I'm doing heavy weights for relatively low sets, relatively low volume and large rest periods, and that's what I'm doing at the time, right now.
Dr, Jason Littleton:Very cool, very cool. As far as eating, are there any go-to foods that you like to enjoy as you work on your fitness?
Tim Nyckowski, DO:Yeah, Um, yeah, I think diet is just probably the most important part of the pillar. To be honest, I'm a big proponent of whole foods, as many organic foods as I can get to. Yeah, I don't want to get into that, but you never know what's in your food, and the best chance you have, at least, is getting, I think, organic and whole foods. I'm a big fan of cooking foods myself at home yeah, to that note. And so right now I'm eating, specifically at this time of my life, again bulking, so I'm eating a lot more carbs than I usually do. I'm eating a ton of fruit, just tons of it. Like, I think I bought 15 pounds of fruit last week, yeah, and me and my wife we've already eaten it. I went back, got some more. So, um, a lot of that, just in general, whole food sources and, um, you know, getting adequate amounts of protein to, uh, one to one and a half grams per pound. You can go a little bit lower when you're not bulking, but, again, that's just what I'm doing right now.
Dr, Jason Littleton:So, yeah, that's very good. What about hydration? How do you stay hydrated?
Tim Nyckowski, DO:Well, every morning it starts off for me with some cold brew coffee that I make at home, and that's a lot of hydration there, and then I just kind of drink water throughout the day too. That's for me never been an issue. I'm always just drinking water all the time.
Dr, Jason Littleton:Yeah, excellent. And when we talk about sleep, uh, what time do you go to bed?
Tim Nyckowski, DO:So pretty, uh, pretty strict about it. Uh, even with the newborn at home now, um go to bed um between nine and 10 PM. So, as we'll wake up around 10 PM to feed the newborn, but uh, yeah, go to bed between nine and 10 PM and then wake up um anywhere between like uh five and six, 30 AM, depending on the day and the needs of the morning.
Dr, Jason Littleton:Yeah, yeah, any um you know sleep hacks that you do to get great sleep.
Tim Nyckowski, DO:Yeah, so many things on that one geez. Um, one thing is is keeping the house temperature between 68 and 72 degrees. Um, one thing is is keeping the house temperature between 68 and 72 degrees. Um, I like to to have a little bit cooler in the room, um, in the summertime. Uh, I have a bed jet, specifically. Um, I don't know if you've heard of this, but it's basically something that, in short, blows air underneath the covers to recirculate the air.
Tim Nyckowski, DO:Um, it's just, yeah, allows a little bit more like localized fullness, um, into the bed. Um, right now I'm I'm having really really uh, good sleep these days, um, but in times where I was having more difficulty sleeping, um, I really locked into a lot of. The Huberman podcast has really good tips in terms of how to sleep better and I do consult patients a lot on this one. But you want to make sure that if you're having issues sleeping, you can actually reset your pineal gland circadian rhythm in three days with really good kind of strict techniques of being up when the sun is rising, catching sunrise light rays in your eyes. Being up when the sun is setting, catching sunset light rays in your eyes. Being up when the sun is setting, catching sunset light rays in your eyes, and, very important is, after the sun sets.
Tim Nyckowski, DO:If you're having sleeping problems, you should not be exposing yourself to any lights over your head, so you can use candles below eye level, for example, or low hanging lamps are fine, and this is the hard one for people no blue screens. If you do that for three days after um, uh to to reset your circadian rhythm, and if you also, um, don't take any naps during those three days, you will be very tired. That's the hardest part about it, probably. Um, if you do that, you can completely reset your sleep schedule, even if you flew from here to Japan. Um, you can completely, uh completely, get back on track with that one.
Dr, Jason Littleton:I love it. Those are awesome tips, Awesome tips. I love what you said about the air jet. I mean that's going to help lower the temperature, recirculate the air. I'm sure that's going to improve people's sleep. Where can people get something like that?
Tim Nyckowski, DO:So Amazon is one place you can get it directly, the bed jet jet from the, uh, from the manufacturer themselves. Um, I got it about a year ago and I only used it during the summer months, so I don't remember exactly the price now, but it does run. Uh, it's like I don't know 500 bucks or something in that ballpark it's. It's not the cheapest thing, um, but it is. It is comfortable, it recirculates the air. You got to check it out. I mean, it's just kind of hard to describe.
Dr, Jason Littleton:I'm going to have to check it out. I mean, that's awesome.
Dr, Jason Littleton:I think a lot of people who have, you know, sleep difficulties. You know that could really come to a great advantage. Man, this is, these are wonderful tips. You know this is awesome. I think how you move each drink sleep is going to help a lot of people, a lot of listeners, a lot of um, my audience, um really just major, like I mean, I I'm so I gotta have you back on. I thank you for coming on. I want to know where can people find you?
Tim Nyckowski, DO:Yeah, thank you so much, man. Definitely Uh things that I'm passionate about, so, uh, thanks for uh allowing me the space to speak on them. Um, you could find me, of course. I'm in Lake Mary. I work as a derm Lake Mary, florida. I work as a dermatologist there now um five days a week. Um, easiest way to find me is to Google me. My last name is Nikowski. Uh starts with NYC, like New York city, uh, and uh, yeah, that's probably the easiest place to find me is is is over there in Lake Monday through Friday.
Dr, Jason Littleton:All right, tim M-Y-C, it's easy to remember. Yes, sir, thank you, thank you for coming on. And you guys, you know you got to check him out Awesome dermatologist. I go and see him myself. He's great, and I just think that you know he gave a lot of great information today, a lot of tips. So you're going to want to save this podcast? Um, definitely, um, come and see me at my handles, you know Facebook, instagram, linkedin, check out the podcast, apple, spotify and I. I can't wait for our next. Uh, sit down, I got to have you back on town. All right, for sure, you guys, come see us next time. Thank you for listening.
Tim Nyckowski, DO:Thank you, Jason. It was a pleasure man Appreciate it, You're welcome.
