Learn what experts discussed about the innovations, the dermatology field is experiencing, and how these revolutions are game-changing.
“The Future of Dermatology: Breakthroughs in 2021 and Beyond,” a panel of industry dermatology leaders, shared their predictions and most significant developments for the dermatology specialty, in both the present and the future. As Mary Scoviak writes in the Dermatology Times this was in part a tribute, to a “December 2020 virtual gala celebrating the Dermatology Times® 2020 Giants of Dermatology®. The awards program recognizing leading physicians and investigators for their landmark successes in dermatology and dedication to the field1”. The roundtable consisted of 3 participants, Jill S. Waibel, MD, medical director and owner of Miami Dermatology and Laser Institute in Florida. Wendy E. Roberts, MD, founding director of dermatopathology at Loma Linda University Medical Center in California, and Tiffany Alexander, MD, chief resident in the Department of Dermatology at Duke University Medical Center in Durham, North Carolina.
Where will be the most innovation in dermatology?
ROBERTS: “The next big breakthroughs will be in skin cancer. We already use biologics to treat some skin cancers instead of relying only on surgery. We’ve moved from topical chemotherapy and oral chemotherapy injection to superficial radiation therapy. I’m excited about that imaging component, especially using imaging and ultrasound in combination with microscopy because we can image and treat. We’re going into the realm of multi-photon excitation1”.
ALEXANDER: Claims to have seen more extensive research being conducted on hair disorders, and more specifically scarring hair disorders. These researches Alexander says focus on the overall number of women and the number of women with skin color affected by these conditions. Genetic-related causes are now peak areas of interests for researchers and dermatologists alike.
WAIBEL: Expects a huge step in the role laser technology will play, in scenarios that extend past cosmetic situations, and into the field of cancer, and laser-assisted drug delivery. But probably the biggest piece of news Waibel is most excited for, is the innovation in other energy-based solutions. “Artificial intelligence will contribute significantly to our understanding of our specialty and provide an assistive tool for diagnostic accuracy1”.
What are the challenges ahead for dermatology?
ALEXANDER: “Getting insurance companies to approve some of the specialty treatments that benefit our patients is a major challenge”. Biologics is a prime example; results have been phenomenal, and they receive rave reviews by patients. But physicians have to go through numerous protocols to get an insurance companies’ approvals, which can significantly slow down the patient’s access to these treatments. “Off-label use of medications is another concern. It can be difficult to get these treatments, so we may have to use compounding pharmacies”. Teledermatology’s life span, is also another critical obstacle in 2021. Many patients were forced to seek consultations from the safety of their home, due to COVID-19. But eventually when the majority of the population gets vaccinated and people start to feel safer leaving the house, will teledermatology be just as effective? Ideally it should, it helps provide access for all patients, but insurance companies may decide against including it in their coverage.
ROBERTS: Believes telemedicine has some challenging road bumbs in its future. “Telemedicine is great for providing accessible, affordable care. I love it for medication refills, among other things. But there are numerous problems that need addressing. The toughest part is that it doesn’t replace a physical exam, which may mean that the patient has to schedule a second visit to come into the office if the condition warrants a physical exam or testing1”.
Roberts goes on to say how she agrees with Dr. Alexander about the prescribing and delivery of medications, to patients. “Our specialty is looped out. We get medications after development. We need to be more involved in how these agents are bought to market”.
Another pressing challenge Roberts brought to the discussion, was the fact that much of the nation’s population struggles with access to dermatology. Being in a more preventative mode, could potentially lower the cost of medicine, since there is a wide perception that skin disorders drive up the price of medicine nationally. Part of the reason access to dermatology is so hard to come by, is because of the price. Most patients don’t have access to the best medicines and physicians because they simply can’t afford it. Dermatologists themselves also suffer from a lack of access to the necessary tools to treat extreme forms of skin impairment. Devices such as lasers, and other surgery tools. Having access to all the devices, gives dermatologists choices, and better equips them to handle even the more serious of skin conditions1.
WAIBEL: Believes access is also a problem. “In parts of the country such as Indiana, where I grew up, there’s definitely an access problem. There are so few dermatologists that it may take a patient with skin cancer 8 months to get an appointment. By then, they may have stage III melanoma”.
Waibel continues to say that she too believes that costs ultimately lead to a lack of access for dermatology care. “I share Dr. Roberts and Alexander’s concerns about costs. I practice in-patient hospital medical and medical dermatology. Reimbursements continue to go lower for a lot of our medical-only colleagues; it’s getting to be very challenging”. Waibel claims that it has gotten so bad, that their colleagues can work with a patient for a year, and deductibles will still not have even been met.
What product or opportunity has the most potential in 2021?
ALEXANDER: “Biologics, particularly ones that may not have any adverse effects and may not require lab monitoring—there are so many for psoriasis. More are being developed to treat atopic dermatitis”.
ROBERTS: Roberts says that nano-pulse stimulation for the removal of benign lesions has the potential to be a game-changer in 2021. Roberts claims to have seen numerous patients with sebaceous hyperplasia and seborrheic keratoses. Up until 2020, only liquid nitrogen had been capable of treating certain lesions. Using nano pulse, would give the public a much more cost-effective treatment.
WAIBEL: Stem cell research—researchers across the nation, are growing new kidneys and bladders from their patient’s own cells in vivo and implanting them into the patient.
Dermatologists are also working on developing a combination of the punch biopsy and the fractional laser, with the aim is to tighten the skin and soften wrinkles. However, many dermatologists believe it can be used for more than that, as there is a common perception among many colleagues, that it can be used it for acne scars, stretch marks, tattoos, and much more.
JAK inhibitors also seem to be another focal point in dermatology field. As an example of just how powerful these inhibitors are, patients with atopic dermatitis affecting 80% of the body surface area, can see their condition clear in 2 weeks. “I see potential use for vitiligo and alopecia. I think it’s going to help heart disease, lupus, and autoimmune diseases, among others1”.
If any dermatologist would like to continue learning about the future of their field, they can do so here.
- Mary Scoviak; A Wave of Change Approaching for the Future Dermatology; February 2021, Dermatology Times