Expect exciting trends in dermatology care

Lasers, targeted therapies, and biologics. These were great advancements in dermatology in the past several decades. They changed clinical practice and re-defined patient care. And, they also laid the groundwork for the next generation of accomplishments.

Looking into the future, dermatologists can anticipate new technologies and treatments to, again, enhance services. Some things will directly impact daily workflow. 

“Overall, the future of the specialty is bright,” said Brett Coldiron, M.D., president of the Ohio Dermatological Foundation and clinical associate professor at the University of Cincinnati, noting the next decades will be an exciting time.

NEW TECHNOLOGIES

Many new technologies will focus on improving care for skin cancer, particularly melanoma, said Eric Tkaczyk, M.D., Ph.D., director of the Cutaneous Imaging Clinic and assistant professor of medicine in the dermatology division at Vanderbilt University Medical Center.

“It’s a common daily routine to look at hundreds of pigmented lesions to determine if patients can go home, need follow-up, or require an excision,” he said. “‘We’re pretty good with visual analysis, but even top dermatologists with extensive experience usually have to cut out dozens of pigmented lesions from many patients to remove one melanoma.”

These technologies could better facilitate care:

Confocal microscopy: Although it’s existed for 20 years, confocal microscopy was approved for reimbursement in the United States approximately two years ago. It provides high-resolution microscopy lesion images at the beside. Although it cannot penetrate into deeper dermis layers, several large clinical studies have shown it reduces benign lesion excisions by more than a factor of two.

Photo-acoustic tomography (PAT): The Food & Drug Administration (FDA) hasn’t approved PAT yet, and there are no existing multi-center studies, but this 3D imaging is based on the principle “light-in, sound-out.” Biological tissues absorb light and convert it to transient heating, creating an ultrasonic wave. Broadband ultrasonic transducers detect ultrasound waves and convert them to a tomographic image. This reveals a lesion’s depth, facilitating prognosis or staging.

One less than 50-participant study also indicated PAT can identify melanin in lymph nodes. Results revealed PAT pinpoints instances where lymph node excision is not necessary.

Raman spectroscopy (RS): RS uses vibrational spectra of molecules at optical wavelengths to identify chemical and biological compounds in the outermost skin layers. It monitors conformational changes in the skin’s lipids and proteins and can measure skin hydration, retinol, lactate, and other molecules. RS is a burgeoning technology in engineering, Tkaczyk said, with moderate clinical impact to-date.

NEW THERAPEUTICS

Alongside technology advancements, the future also holds new medications and therapies, said Seemal Desai, M.D., president of the Skin of Color Society and president and medical director for Innovative Dermatology, PA, in Texas.
“There are a couple of things in development that will be used for diseases we haven’t had FDA-approved treatments for,” he said. “It’s really new and exciting that these things are being done.”

JAK inhibitors: This class of drug, including tofacitinib (Xeljanz, Pfizer) and ruxolitinib (Jakafi, Incyte Corp.) is already used to treat rheumatoid arthritis, Dr. Desai said, but current research is investigating its utility for treating vitiligo, alopecia areata, and psoriasis. Phase 1 trials are also underway for additional JAK inhibitors.

Gene & stem cell therapy: The National Institutes of Health is also beginning to invest more research funding into genetic and rare skin conditions with no existing treatments, he said.

WORKFLOW

The coming years are also likely to change how dermatologists manage their daily activities.

Physician extenders: Physician assistants and nurse practitioners will likely provide more dermatology care, Dr. Coldiron said, as aging dermatologists retire and patient volumes continue to rise. He cautioned dermatologists to closely supervise these extenders and to have them provide care during follow-up visits for existing patients, never for an initial appointment.

Ultimately, he said, dermatology can look forward to many positive developments.

“It’s the most attractive specialty in all of medicine,” Coldiron said. “It’s been rewarding to watch dermatology develop treatments for things we once couldn’t help. And, there’s more promising areas like that on the way.”ƒ