Derms, residents look to the future

National report - The future of dermatology is a bright one for those who are willing to embrace ongoing education, mastery of new procedures and a balance of medical and cosmetic services.

This point of view was the consensus among several established dermatologists and residents who were asked to envision and describe the practice world that today's residents will enter upon graduation.

"The main way dermatology practices have changed is that there is an increasing number of dermatologists that are involved in aesthetic procedures," Nicholas Lowe, M.D., tells Dermatology Times. "This is probably driven by our expertise in a variety of procedures, by the public demand, and by the continuously improving technology in cosmetic procedures."

"It is a benefit to practices to have at least part of their profile in the aesthetic area, as it does not rely on third-party reimbursement," he adds. "However, I feel that we should not abandon medical dermatology as a specialty. The ideal practice combines a mix of medical and diagnostic dermatology and dermatologic surgery, including skin cancer and aesthetic dermatology. This mix doesn't require that every dermatologist in the practice be skilled in all areas. A practice can have people who focus on the different aspects of dermatology."

In his practice, Dr. Lowe services diverse dermatology needs by having different units of time devoted to different services. For example, a half day might be devoted to medical dermatology and another half day to aesthetic dermatology.

Breakthrough drugs

The next big thing Dr. Lowe envisions is the increased use of more effective systemic drugs for treating severe disease.

"Biologic agents have transformed psoriasis and psoriatic arthritis," he says. "We will see the same thing for eczema and bullous diseases. We're going to rely on biological pharmaceutical industry to make these breakthroughs, and they (already) are."

On the other hand, some therapies, such as phototherapy for psoriasis, will be used less frequently, he predicts.

Dermatologists will also have available for use more topical treatments for conditions such as actinic keratoses and superficial skin cancers, as well as photodynamic therapy for superficial skin cancers.

Other leading dermatologists offer views that complement Dr. Lowe's, but with different emphases.

"The big diseases of dermatology, such as eczema, psoriasis and acne, will probably have easy and effective therapy that won't require much time from dermatologists," Kenneth Gross, M.D., says.

Dr. Gross is in private practice in San Diego, where he is a clinical professor of dermatology at the University of California, San Diego. Dr. Gross limits his practice to the treatment of skin cancer.

"An older population will get more skin cancer, but these cancers will be more easily cured and therapies will be more specific," he says. "They will involve medical therapies such as immunotherapy and phototherapy, and a lot less surgery. Over the long haul, surgical treatment of skin cancer will be eliminated."

He agrees with Dr. Lowe that cosmetic procedures will be a growth area for some time, and for the same reasons.

"Dermatologists have always been in the forefront of these therapies and will continue to be," he says.

Diagnostic procedures

As with treatments, diagnostic procedures will be less invasive, Dr. Gross speculates, citing computer diagnosis of skin cancer by episcope microscopy as an example.

These innovations, along with increased automation in the workplace and paperless patient records, will transform the monitoring of skin lesions, he says.