Keep patients 'first and foremost'

August 1, 2005

As an educator, Richard G. Glogau, M.D., a dermatologic surgeon, tries to remind young physicians that they are not operating in a vacuum. They come from a historical tradition of prior medical science and experience, and they have to constantly relate what is new to what has come before them.

Dr. Glogau, a clinical professor of dermatology at the University of California, San Francisco, uses the academic podium to help future generations of physicians maintain a sense of professional standards.

"The field is one which I have grown up with, I have had a hand in creating, and I can see how it is changing very quickly," Dr. Glogau says. "I think the difficulty is for people in the specialty to keep patients first and foremost. Skincare has collided with the aging demographic population and the shift of interest to appearance as a commodity in society. This, I think, is resulting in an intense degree of commercialization because of the introduction of new technology, and I think it is very difficult for people to sort the wheat from the chaff."

He was also one of the first to adopt soft tissue fillers in his practice.

Dr. Glogau's practice offers patients a mix of cosmetic, general and surgical dermatology.

Pitfall

Dr. Glogau, whose San Francisco practice is largely focused on cosmetic dermatology, does not say technology or change is a bad thing; rather, the belief that everything new is good and better is a pitfall.

"I think the older dermatologists can relate to that when they look back at the development of topical corticosteroids, for instance," Dr. Glogau tells Dermatology Times. "It was an industry-driven phenomenon that evolved dozens of topical steroid creams. Today most dermatologists use a small handful and have done so rather consistently over the years.

"Decisions should be made grounded on a very thorough understanding of what the anatomy and physiology of the skin are."

Begins with conservative

His approach to photoaging begins with the conservative. Dr. Glogau says that having a myriad of fillers available for soft tissue augmentation is exciting, but his job is to sift through what is an improvement on the old tried-and-true collagen and what is not.

The key to treating patients with photoaged skin is sunscreen, he says. Otherwise, he uses topical retinoids, as well as topical therapies for premalignant skin changes. Most patients, he says, are well served by a decent topical therapy and the right sunscreen.

"If patients want to branch off and try some of these photorejuvenative technologies, you have to be honest and tell them the results are quite variable and it is not easy to predict who is going to get a great result," he says.

English major turned doctor

Dr. Glogau was an English major at Dartmouth College, Hanover, N.H., before deciding on medicine in his junior year.

"I always did very well in the sciences, and I liked biology very much," he relates. "I sort of got turned off by the academic politics in the English department, which is amusing when I think of medical academic politics. I went to college in the late '60s, graduating in 1969, and I think it was a very different time in terms of social awareness - the contrast between being the ivory-towered academic and what was going on in the real world."

While at Harvard Medical School, Boston, Dr. Glogau gravitated during his clinical series toward dermatology when a professor of dermatology spoke.