289: Using Herbs To Support Chronic Skin Conditions w/ Cassandra Quave, PhD

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I'm going to say it. You CAN have reactions to all natural herbs. That's just how it goes. Natural does not mean safe and that you could NEVER react to it. To go into all the science behind herbals, I brought in a medical ethnobotanist, and she gives it to us straight!

Today's guest is Cassandra Quave, Ph.D. She is a disabled writer, speaker, podcast host, professor, mother, explorer, and ethnobotanist. She works as the herbarium curator and associate professor of dermatology and human health at Emory University, where she leads anti-infective drug discovery research initiatives and teaches courses on medicinal plants, food, and health. Dr. Quave is a Fellow of the Explorer’s Club and recipient of the National Academies Award for Excellence in Science Communication. Her award-winning science memoir, The Plant Hunter: A Scientist’s Quest for Nature’s Next Medicines, was published in 2021.

Have you had a reaction to an “all natural” herbal or cream? On the flip side, is there something that you feel really helped you? I'd love to hear about it in the comments below!

Or, listen on your favorite app: iTunes (Apple Podcasts) | Spotify | Stitcher | TuneIn | Subscribe on Android

In this episode:

  • Differences between herbs, essential oils + extracts
  • Why you should be REALLY careful what you apply to a broken skin barrier
  • What about herbs during pregnancy?
  • Wound healing herbs like calendula + St. John's wort
  • Thoughts on psychedelics + kratom
  • How herbs can impact the liver's detox systems NEGATIVELY
  • Dosing with antimicrobial herbs to fight off viruses + colds


“I think that calendula is really great for wound healing. There's been a lot of research to support this too by various groups showing that it has, you know, good barrier restorative activities.” [15:47]

“These are powerful, powerful medicines, and the things that are sold on the market right now, there are a lot of challenges, especially with kratom, about identity. Do you have the right plant and do you have the right chemotype because you may have the correct species of kratom, but not all kratom produce the same group of molecules at the same levels.” [23:53]


Find and Follow Dr. Quave on her website | Instagram | Facebook | TikTok | YouTube

Buy your copy of Dr. Quave's book: The Plant Hunter: A Scientist's Quest for Nature's Next Medicine

Want to try some skin products with herbals Dr. Quave mentioned (like calendula and St. John's Wort)? Try Quell Nourish and Daily Butter!

Healthy Skin Show ep. 030: Natural Remedies For Eczema Rashes w/ Abby Lai


289: Using Herbs To Support Chronic Skin Conditions w/ Cassandra Quave, PhD FULL TRANSCRIPT

Jennifer Fugo: Dr. Cassandra Quave, thank you so much for being here today.

Dr. Cassandra Quave: Thanks so much for having me. It's great to see you again.

Jennifer: And we're saying this because we actually met in October, well, September, October of 2022 at the Integrative Dermatology Symposium. You were a speaker there. And, you know, we got to chatting after your talk, and I was so fascinated by what you do, number one, and that your research is geared toward researching the different properties of herbs and such. I use herbs in my practice. Many of the listeners know about this. I've talked about this on the Healthy Skin Show before. And so I thought you'd be the perfect person to talk about herbs because not everybody uses herbs in their practice, whether you're a doctor or a nurse practitioner, um, or maybe even another nutritionist or dietician or acupuncturist. And I think there's a lot of things that we can do and bring to supporting people with herbs. So, do you wanna talk a little bit, first off about what herbs are like? How do you define…? I know it's a really simple question, but I think a lot of times, especially from the more consumer or patient standpoint, they might not actually know what an herb…what, what do we mean by herbs when we talk about that from using them medicinally?

Dr. Quave: Yeah. Well, first of all, if you are a practitioner and you don't know much about herbs, it's okay because many people don't. Um, this is because it's not really well integrated into our medical school or pharmacy school curriculum. Um, however, there's a lot that you can learn about herbs. So let's start with the definition. Um, if you're thinking about it from a culinary perspective, an herb is kind of a leafy, um, you know, soft plant that you can include in the diet. Um, but from a larger scale, medicinal herbs are really any plant that can be used, um, as a medicine either topically or internally. We have an incredible 374,000 species of plants on earth and get this around 9% of those- So that's over 34,000- have been used as a form of medicine by some culture at some point. And it's been recorded. There are a lot of medicinal herbs out there.

Jennifer: That's awesome. And so in your job, uh, let's, let's get a little nerdy into your job and what you do, because I don't think people even realize that this exists. I actually didn't fully realize that people were out there doing what you do. So what is it that you do?

Dr. Quave: Yeah, so I'm a medical ethnobotanist. I study how people use plants in traditional systems of medicine to heal a variety of different diseases. I'm actually in the dermatology department at Emory where I'm really fascinated with the study of topical applications of plants for the treatment of infections and skin inflammation. And so this job literally takes me all over the world. I've done research in the Amazon, in the Balkans, in islands around the Mediterranean. And actually next week I'm heading off to Egypt, where I guess people think of Egypt as like a big desert, but there are plants there, especially in the oases. So I'll be working along the Nile Delta and also in these specialized oases, really looking into the history of how some of these herbs were used in ancient Egyptian medicine and then bringing those back to my lab where I study their potential as pharmacological agents for future drug development.

Jennifer: Very, very cool. Yeah, it was so great to talk to you too, because you're like, you know about a lot of these herbs, you're very familiar with them and it's refreshing because a lot of times I do hear from doctors that they're a little gun shy in terms or maybe a lot gun shy cuz they're just not really sure how herbs work. They don't have much training in them, if any at all. And so, you know, I thought this would be a great introduction not only for those listeners, but also for those of us who, you know, are more on the patient side of things and maybe you've never considered that herbs could be a helpful part of your protocol. So in terms of herbs, this is the thing… they're natural, which we associate natural with being good for you. But I'm always cautious because people will ask me, even on Instagram, they'll message me. “What should I take? What should I take? Should I take this? I read online that I have this and I should take this herb, what do you think?” And I am very reluctant to ever make those types of recommendations because, well, herbs, there's pros and cons, so I want you to talk a little bit about that. But also there, there, there can be downsides to things, right? So can, can you give us some guardrails here? Some like, I don't know, talk straight with us about herbs are wonderful but…

Dr. Quave: I'll definitely, I can definitely give you the straight talk. So herbs are amazing, but you know, out of those nearly 400,000 species of plants, there are many medicines, but there are also also many poisons. And in fact, really the main difference between a medicine and a poison comes down to just dose and intent, right? Anything that has medicinal properties can be a poison if taken in the wrong way or the wrong context. A good example I like to give to my students is, you know, caffeine. Caffeine is a natural substance produced by certain plants, including coffee and yerba mate, right? We all love our coffee. However, if you take high doses of caffeine, your body will react very poorly. You will develop hives, your heart will start racing, you'll get insomnia, maybe a little paranoia. There's, there's a, you know, so getting to this understanding of yes dose is very important and the way that you consume a botanical is also important.

I think one other area of confusion people have is they assume that if something is applied topically, it's even safer, right? It's natural. I'm not drinking it, I'm not eating it, I'm just putting it on my skin. That's surely the safest way to use a plant. And that's also not necessarily true. One common remedy, for example, for fungal skin infections is the use of raw crushed garlic. Now I've seen examples where people have put garlic between their toes to treat athlete's foot and put a sock on it overnight, and they wake up with what looks like third degree burns because they have severe, you know, dermatitis, contact dermatitis reactions to that. So your body, whether it's something applied topically or something taken internally, we have to be really careful because there are issues with toxicity and allergenicity as well.

Also the way your herbs are prepared is actually really important. And that can be a bit confusing when you're looking at, um, products on the marketplace. So you may see for example pills of herbs or kind of supplements. Some of those supplements might just be ground up plant. And in most cases though, it's going to be an extract of the plant. And you may be wondering what is an extract? I'm gonna go back to that simple example of coffee. When we start making coffee in the morning, you have your clear solvent, your water crystal clear, right? You pour that hot water through your plant material, your ground coffee beans, an outcome, something kind of black colored within that coffee pot. You don't have just a single compound. It's not just caffeine. There are thousands of unique molecules present there that give coffee its overall taste and flavor.

An extract basically takes that liquid and evaporates it down into like a powder. And that's what's included in a lot of supplements. Um, you can also make extracts of plants by producing essential oils. Now essential oils also this bit confusing in the name. Some people might think, oh, it's essential for my life or my wellness. But actually no. An essential oil is again, just a distilled, super concentrated liquid form of what are known as volatile compounds, so smelly compounds, terpenes, and things like that, that are, that are found in the plant material that are very, very potently concentrated. I'm sure you've talked about this before with your patients and on the show, we never ever wanna put straight essential oils directly on the skin. You always wanna dilute that with another base like an oil or base cream, because again, you can cause some pretty severe skin reactions.

Jennifer: Yeah. Um, and I've actually heard from clients who have developed some sort of dermatitis or reaction and then like a hypersensitivity to that particular Oil. Then you know, unfortunately I'm in a lot of Facebook groups for skin issues and I will see people say, oh, you have, I looked at your photos. Cuz people are post photos and I understand I'm not no judgment there, but you know, someone will say, oh, you know what, you should, you should use X essential oil and apply that topically to those rashes. And I'm like, oh, that's compromised skin. That's a compromised skin barrier. I don't like talk about why that might not be safe. I mean obviously if you're saying don't apply an essential oil straight to your skin, what you're talking about is literally like healthy skin barrier. Is it worse and more problematic if it's a compromised skin barrier?

Dr. Quave: Absolutely. I mean, if you have a compromised skin barrier and you're putting some very, you know, concentrated plant chemicals into that, you're number one opening yourself up for development of allergies to that product that you're applying to that disruptive skin barrier. And you might have like even a burning sensation or other bad reactions immediately upon contact. So yeah, we don't wanna do that.

Jennifer: No, no, no, no.

Dr. Quave: And it's tricky. You know, not everyone's skin is the same. I mean, I love making some, you know, face masks at home. I do that sometimes for the holidays for gifts, but my daughter, um, has extremely sensitive skin. Like there are certain botanicals I put it on, you know, if I try a little bit on her before I put it on her whole face, she just turns bright red. Like she, so people react differently to herbs too. And so I think anytime that you're trying a new botanical product, it's good to do a very small test treatment to see if you do have any skin reactions before you slather it all over your intact skin barrier.

Jennifer: Um, okay, so just to recap, number one, you can have reactions to herbs. It can happen and what might work for me might not work for you. And that's just how it goes. So natural does not mean so safe that you could never react to it. That's number one what we have learned. Number two, do not apply undiluted essential oils to your skin. We've talked about this once or twice, but I think it always bears repeating because there's so much information out there about using essential oils topically that we have to, I think providing that reminder is really, really crucial. Iin terms of the use of supplements. Um, and so we'll talk about like oral supplements as an example, whether it's a tincture versus a tea versus, uh, those capsules you mentioned… For someone who is pregnant. I feel like that's where it gets really gray and this is where I feel I really feel for women in this during this period. Um, they wanna do things or their skin has horribly flared up and I am, I err on the side of great caution. What's your take on herbs in pregnancy?

Dr. Quave: And this, this is such a great question. I mean, and I've I've had three pregnancies of my own, so I have been through this. I know exactly what you're going through when you're experiencing these symptoms. You know, I think my go-to safety whenever I was pregnant was really to rely on culinary herbs that I grew in my garden. So these, I was not taking supplements other than my prenatal vitamins and things like that. But there are a lot of benefits that you can get from just having fresh teas out of mint or lemongrass or chamomile. I mean, these are all things that you can grow on a balcony and an apartment. You don't have to have, an extensive garden in your backyard. But, um, some of my favorite medicinal mints are things like lemon balm and, and, and mint, um, uh, tulsi, which is, um, a kind of a, a relative of basil, right? So those I feel are, you know, have good safety profiles, according to what we know in the literature. And again, you know exactly what you're getting and you know what dose you're getting because you yourself are putting the leaves into your cup of hot water. Right? So I tend to veer that way when, when thinking about, you know, for either for, you know, medicinal teas for children or for pregnant women.

Jennifer: Yeah. I mean cuz I, my understanding is that there's not a lot of research done with herbs in pregnancy and some can be contraindicated, some have historical contraindications for pregnancy especially in the first trimester.

Dr. Quave: Yeah. Some can have uterine contractility, like basically they cause your uterus to kind of contract, which can be helpful following childbirth, maybe helpful during menstruation, but not something you wanna take when you're pregnant. So I think it's, it's really important to, to, you know, talk to your doctor about it, inform yourself. But I think again, in most cases if you stick to some of these basics, especially the medicinal mints, you're gonna be okay. Like, you know, there's a lot of benefit you can get from a simple cup of tea with a slice of lemon and some fresh ginger. I mean, there's a lot of ways that you can use herbal medicine in a safe way, whatever your stage of life.

Jennifer: Yeah. Uh, for you and, and especially cuz you work in a dermatology department, are there certain herbs that you just have come to love? And again, these are not suggestions by any means for everyone out there, but are there some herbs that you find that just seem to be like fascinating having, um, applications for those who have skin issues?

Dr. Quave: Yeah, I mean, I am, I am always, I draw a lot of my inspiration from kind of two places. One is working with indigenous healers around the world and, you know, midwives and healers that practice their own form of medicine in different traditional systems of medicine. So outside the Western medical construct. Then there's also, I'm inspired by what we find and discover in the laboratory. So I can give a few examples of things that definitely interest me from things that I've observed in fieldwork. I think that calendula is really great for wound healing. There's been a lot of research to support this too by various groups showing that it has, you know, good barrier restorative activities. It's commonly prepared in, for example, the Balkans by having the flowers basically imbued into a kind of fat or oil.

It may be an animal or vegetable fat and made into a kind of ointment that can be applied to chapped skin during the winter. And that seems to be really effective according to their reports. Another plant that's fascinating me is St. John's wort, but I'll put this with an asterisk of caution because you can find St. John's wort tinctures in pharmacies. You can find different products with St. John's wort. However, there are chemicals in St. John's wort that can cause really severe skin reactions when you consume them and then are exposed to the sun. These are caused by a phototoxicity, a sunburn kind of reaction. I was really curious though about this practice that we noted in Eastern Europe where they take the flowers of St. John's wort, they stick it into bottles of oil, and leave it in the sun for 40 days until it turns bright blood red.

And they rub this on their skin to treat everything from abrasions to wounds, cuts, lacerations to promote wound healing. And there's been some really nice studies done with animal models in Turkey and other places where this is more popular. From my perspective, I was just fascinated with this idea that here we have a plant that we know has compounds that are phototoxic and yet these people are putting it on their skin all the time. And we're like what's happening? We brought the medicine back to my lab and we evaluated its chemistry and guess what? The traditional preparation of putting it into this oil base and extracting it in that manner resulted in the degradation of the toxic compound. But it left intact the compounds that have antimicrobial and other kind of wound healing properties. The tincture on the other hand has the phototoxic compounds. So this is where it gets so tricky for the everyday consumer. It's like I know that because I'm an expert in medicinal plant chemistry. Right? But how do you know, okay, I'm gonna take St John's wort. Well the way that St. John's wort is prepared and then used can actually have a really big impact on how safe it is and how effective it is for different applications.

Jennifer: Yeah. And I will also add, for anyone listening, just in case you've seen the tincture, you cannot take that with SSRIs and it's one of those things that conflicts with a lot of medications. You have to be really careful. So talk to someone, work with someone if you are interested in doing the St. John's wort tincture or um, some sort of supplement with it in it. Just be very careful.

Dr. Quave: And you can also have, you know, herb, herb interactions, like you said, herb drug interactions where you don't wanna mix certain herbs with your pharmaceuticals. But also just the same, you know, if you have an herb that interferes with the way that your liver enzymes break down different molecules whether they're medicinal molecules from a plant or from a pharmacy company, um, you can still have interactions there too. Yeah. And I mean this is an exciting area of research…

Jennifer: Can I also ask you about that a little bit more? Cuz we have a lot of clients that are on biologic drugs and immunosuppressants like cyclosporine. And one thing I, I'm always careful of, I'm like, well is there any interaction in the liver? And unfortunately with like cyclosporine, which is an immunosuppressant, there is a pretty lengthy list of herbs that we found that could potentially interact with how phase one detox the CYP450 system would actually Detox. So can you just, I, you don't have to list any of that out, we're not gonna necessarily dive into that but, so liver detox, can you just talk a little bit about that a little bit more? That's where your drug, how drugs may be metabolized and herbs can do what in terms of liver detox, what could they do to with a drug that could have a negative side effect for you?

Dr. Quave: Yeah, so I think we have to be careful using this term detox cuz it can also be interpreted different ways by people. Like there are people that that will say, I'm gonna take this tea to detoxify my body. That's something else that we're talking about. And really you should just drink water… to detox your body. For when it comes to liver enzyme interactions of how your liver breaks down these molecules, it detoxes these molecules. Um, there are, as you said, different types of CYP450 enzymes. So each class of enzyme breaks down different groups of drugs. We know that some, some herbs can inhibit the ability of these enzymes to function properly. And as a result you may get a buildup of too much of a certain drug in your system. Or on the flip side you may have some that, that basically exacerbate the activity and then you break down the drug too quickly. So it's really about making sure you have the right amount of your pharmaceutical or your other herbal products in your body and certain herbs can interfere with that breakdown process.

Jennifer: Yeah. So that's why it's also important when you work with someone, whether it's a doctor or an alternative practitioner who's maybe using herbs, they need to know what you're taking. So they need to know what med you're taking and they need to know what herbs and supplements you're taking because this could be an issue.

Dr. Quave: Yeah, absolutely. I mean, so and yeah. Oh, I was just gonna say, you know, one of the other areas of questions I get a lot recently is with this kind of rebirth of interest in psychedelics are a lot of people interested in psychedelic plants and you know, whether it's cylocibin mushrooms or ayahuasca or some of these other kind of mind altering substances, It is crucially important that you're not on any other pharmaceuticals when taking that. Especially any for, um, any kind of drug that has monoamine oxidase, inhibiting activity. Um, you know, there are some combinations where you could take one of these products, for example, with certain cough syrups and it could have fatal outcomes. There are, there are really big concerns around mixing, um, of these. Also with some of these psychedelics, you have to not just stop your medication right before taking it… if you are on SSRIs, it can take up to a month or more for that to clear out of your system before you could take these. So I just wanna mention this because there are a lot of people that are interested, especially people that are dealing with depression and I mean, people are desperate for good treatments. Please, please, please always talk to your doctor if you're considering taking any of these psychedelics because there are some serious, serious health considerations you have to take into, into account. It's not just a safe tea or herbal preparation. You can just take right there. You have your body has to be ready for it.

Jennifer: It sounds like too, with those, you should be under the care of someone who's well versed and has a lot of education and experience in guiding someone through that process and monitoring you. It's not something to necessarily just do on your own.

Dr. Quave: That's absolutely right. That's so important. Does,

Jennifer: Does kratom fall into that category?

Dr. Quave: So, kratom is another plant that's definitely under research now with regards to herb- drug interactions in kratom. I don't know off the top of my head. That doesn't fall really in the psychedelic category. It's more as a kind of alternate to opiates as kind of dealing with pain. These are powerful, powerful medicines, and the things that are sold on the market right now, there are a lot of challenges, especially with kratom, about identity. Do you have the right plant and do you have the right chemotype because you may have the correct species of kratom, but not all kratom produce the same group of molecules at the same levels. Um, so there's a lot of variability in this. And again, um, I think we have to be really, really careful when, when trying to self-medicate with things that are really powerful like this. Um, um, same to be said for cot, you know? Yeah,

Jennifer: Yeah. I wanna ask you just, uh, I think it's a great final question. Um, a lot of people, because of things that have been going around the last two to three years have started taking different antimicrobials like all the time. They read online, that they should take like olive leaf extract every day or they're taking oregano oil every day because it supposedly will keep them healthy and prevent them from getting a virus or a cold or any number of things. What are your thoughts on that? If someone is just taking, especially things that are highly antimicrobial?

Dr. Quave: You know, I think we're all familiar now with this concept of not that taking low dose antibiotics, like if you were to get a little bit of penicillin every day, that that could lead some problems with drug resistance, could lead to problems in your gut. I mean, you have to remember that, you know, essential oils like oregano oil, which is rich in thymol, which does have antimicrobial activities. Um, but what are you exposing to that product? It's not just your body. You're exposing to that product, you're exposing your entire gut microbiome and oral microbiome to that. And, um, I think that there's definitely not enough science to say if that's safe or even effective as a regular treatment. Um, and in fact, I would be concerned that you could be creating some, some issues by basically killing back some of your healthy gut microbiome by having regular intake of that concentrated level of an antimicrobial.

Yeah. Um, again, just because it's from nature doesn't make it safe. Antibiotics by the way, are from nature. They're from fungi found in the soil. There are a lot of, you know, a lot of our current medications are from nature, many from plants as well. We have cancer therapies that are from plants, malaria therapies for heart disease. If you've ever looked at Foxglove for example, which is a beautiful, beautiful plant, but will also kill you dead if you just, you know, if you try and take a tea of that. Um, so we have to be really careful in, in how, how you use these plants. Now if you were taking, on the other hand, if you're following the tradition they do in the Balkans, for example, of making a cup of oregano tea that's consumed on a regular basis. It's called chai malit. It's the mountain tea lovely fragrant tea that I think is safe. But again, it's about the dose. It's like, do you drink a cup of coffee or do you pound back a pack of ca of caffeine? Right. Yeah. That's the difference. When you're taking that concentrated oregano oil, you're basically taking that oregano super high dose that may not be good for you.

Jennifer: So in terms of, we'll say dose, you're, it sounds like you're saying that a tea would be the lower concentration of those active constituents. And then what would be the gradation generally speaking? Is it then different types of tinctures or also possibly supplements or, or that…

Dr. Quave: It could be any of the above because tinctures are made at different strengths as are, you know, supplements, you know, essential oils are definitely by nature are going to be very concentrated. Um, you know, I tend to fall back on what has been used successfully for generations in traditional diets and in traditional cuisines. I can tell you no one is making extracts of olive extracts in Italy or in the area where… that's not a thing. That's just a non-existent food tradition. That's kind of a new invention. So I tend to stick with the old ways. Right. So if someone has been within a culture drinking an oregano tea for centuries, and that's part of their cultural heritage and it is a lovely good tasting drink. Yeah. Okay, that's great. Um, same ferment tea, but if I am taking concentrated menthol every day, that's not in line with tradition.

It's not in line with the centuries of practice that people have. Right? Yeah. So, and this is what makes this field so challenging is there is just amazing potential within plants. We have incredible histories, incredible cultures around plants. Yet today we also have kind of the marketing hype and the product development that may push people in the wrong direction. The truth is, herbal medicine should not be inexpensive enterprise. It's very cheap to grow mint in a pot and enjoy that in your tea every day. You don't have to spend $30 on a bottle of some preparation.

Jennifer: Oh, well thank you so much for sharing a lot of these realities of herbal medicine and I hope that this number one, this episode provides us all some guardrails, right? To understand a little bit more about the use of herbs, what may be a good idea, what might not be a good idea, when to talk to your practitioner, making sure too, if you're taking medication, that there's no interaction and that you're clueing everybody in who's on your practitioner team. So hopefully no issues. It's really, really important. Dr. Quave, you have a great website. You've also got the book out, the Plant Hunter. So for anybody who's interested in diving into this a lot deeper, your book is an excellent resource. And you also have the Foodie Pharmacology podcast as well, that way people can learn more. I just think this is so, herbs are so wonderful and plants are so beautiful. Um, any final thoughts you'd love to share with everyone? Um, I know your website, uh, and do you wanna share your website as well? That way everybody can find you?

Dr. Quave: Yeah, sure. It's, um, it's just my name. It's cassandraquave.com. You can find links to the Foodie Pharmacology podcast on the site. You can also find links to my book, the Plant Hunter. The Plant Hunter is now out in hardback paperback, ebook, and audiobook. So you can enjoy it in your favorite format. Um, yeah, and I, I also have a YouTube channel that has some kind of educational videos about medicinal plants that I use in my classes that you can check out. And that's called the Teach Ethnobotany Channel.

Jennifer: That's awesome. Well, thank you so much for joining us and I hope, uh, we can get you back again some time to talk more about herbs.

Dr. Quave: Great. And I look forward to having you soon on Foodie pharmacology!

Jennifer: Awesome. Thanks.

"I think that calendula is really great for wound healing. There's been a lot of research to support this too by various groups showing that it has, you know, good barrier restorative activities." [15:47]

Jennifer Fugo, MS, CNS

Jennifer Fugo, MS, CNS is an integrative Clinical Nutritionist and the founder of Skinterrupt. She works with women who are fed up with chronic gut and skin rash issues discover the root causes and create a plan to get them back to a fuller, richer life.

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