Today, technology has a major impact on almost every aspect of our life. Entire industries have collapsed, and new ones have emerged. Dermatology will still be around in 2029, but its emphasis will likely be very different from where it is today. We look at past and present and speculate on where the science of skin is heading in the next decade.
What’s New Today
Predictions are often a reflection of the past and present. Although physicians have always treated skin ailments, dermatology is a relatively new specialty with little more than 100 years of history. It is also a very fast-moving area of medicine. It wasn’t long ago that the skin was viewed largely as a glorified border wall, and cosmetic dermatology was a niche subspecialty that treated Hollywood Stars almost exclusively. Who could have predicted that Botox, once a little-known toxin used to treat specific eye spasms, would become used by over 6 million Americans a year?1 On the medical side, many skin conditions with few effective treatments (including the common acne) can now be easily controlled. The target for many of the latest psoriasis treatments today is 90% to 100% clearance, an achievement that would be hard to imagine even in the relatively recent past. Dermatology is an exciting space to be in and will likely see major transformations over the next 10 years.
The Skin is Part of the System
One of the big shifts in dermatology is in the way that we understand the skin. In the early days of dermatology, the skin was viewed as a physical wall. Today, the skin is recognized as a complex organ that regulates temperature, has its own microbiome, and plays an important role in immune signaling. Dermatology is becoming more sophisticated in its approach and going deeper than what’s visible on the skin’s surface.
Immunology and the skin microbiome are increasingly becoming an important area of interest in dermatology. Human skin, like the gut, is host to thousands of species of bacteria. Moreover, they play an important role in our immune response. Dermatologists look deeper into how many skin conditions like atopic dermatitis may be affected by disrupted bacterial balance (dysbiosis).
From General to Specific
The 20th Century saw the greatest medical breakthroughs in history: Vaccines and antibiotics.2 These breakthroughs were game-changing because of their efficacy but also because of their universality. Vaccines and antibiotics have a predictable effect and interact with the whole body. It’s a mass effect. Today, the cutting-edge treatment in dermatology are biologics, proteins made from humans or animals. They target a tiny and specific part of the immune system, allowing them to be more effective while reducing unwanted side-effects. In dermatology, we often target interleukins.3 Specifically, many biologics used in dermatology target IL17 and IL23, which loosely control the inflammatory response. These drugs allow dermatologists to tweak more specific parts of the immune system while leaving other parts untouched.
As an overall trend, dermatology is moving from the general to the individual and specific. Precision medicine takes population and environmental tendencies into account, and personalized medicine goes even further to the individual level. Medicine, in general, is seeking to be more precise, accurate, and individually tailored. This trend also comes at a cost. Rising health care costs are an issue globally with an aging population, which means more chronic illnesses. This is before adding in a host of complex political issues like health insurance and patents for medications. While extremely powerful, biologics can cost up to $45000 a year.4 While part of the cost has to do with the politics involving patents and how high drug development costs are paid for and by whom, these medications are also naturally more costly to produce compared to 20th Century generics that are mass-produced, and the overall trend towards individualization is likely to increase the cost of medicine even higher.4
Teledermatology and Machine Learning
Technology has affected dermatology in other ways as well. The first trend is teledermatology, which we’ve written about, allowing dermatologists to communicate with patients remotely, greatly expanding access.
Machine learning is also likely to play an increasingly important role in medicine, especially in radiology and diagnosis. Dermatology will also benefit from this advancement. Already have cases where machine learning can outperform dermatologists in hyper-specific tasks like identifying melanoma from dermoscopic images.5
Soft Cosmetic Procedures
Cosmetic dermatology has exploded, and with increased interest, there is accelerated medical advancement as well. As a general trend, cosmetic treatments have tended toward moderation and more “natural” outcomes. Cosmetic surgery, while still relevant and providing patients with a powerful option, has been outgrown in popularity by softer cosmetic treatments like fillers and neuromodulators. Convenience (most of these treatments can be performed during a lunch break), the low immediate cost, low risk, and conservative or “natural” outcomes make it appealing to a wider audience. The trend towards convenience will likely continue, and prices of these procedures will likely continue to drop.
1 https://dermletter.com/cosmetic-dermatology/early-history-of-botox/
2 The most numerous significant breakthroughs as well.
3 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3178996/
4 https://health.usnews.com/health-news/health-wellness/articles/2015/02/06/why-are-biologic-drugs-so-costly
5 https://www.ejcancer.com/article/S0959-8049(19)30221-7/fulltext
