Recent medical, technology advances impact derm practices

January 1, 2007

The advent of laser technology, botulinum toxin type A, Accutane (Roche) and Mohs Surgery are just a few of the areas of advancement in dermatology - major steps that have, in some ways, revolutionized the medical specialty.

But those advances came along over a period of perhaps 50 to 70 years. Medical, scientific and technological progress is constantly being made, and On Call wondered which of the more recent advances have had the biggest impact on the practice of dermatology today.

We talked to several dermatologists around the country who have a variety of dermatologic interests and asked them what the most important innovations were for their practices and how those innovations have changed the way they practice dermatology. Many of their selections are based on their special interests.

For J. Michael Maloney, M.D., of Denver, the development of biologics tops the list.

"We have a whole group of patients who suffered with psoriasis for years, who can now keep it under control for all practical purposes, and they need to take only one shot every week or two.

"Before the biologics came along, patients would take pills daily or have to go into the office a few times a week for light treatments, or use the salve two to three times a day, and the worst part was, none of it was very effective."

Dr. Maloney, a practitioner for 24 years, says the treatments can have far-reaching effects on the patients.

"People who have been really burdened all of their life with a terrible disfiguring disease now have a whole different self-confidence, they wear different clothing, do different activities and have a better outlook on life," in large part, because treatment is so simple.

"In the past, people would give up treatment because their options were so limited, and they often couldn't even get to the light center three times a week because they live too far away or they had a job they couldn't leave like that."

Dr. Maloney says the biologics may actually have freed him up to see more patients.

"Since psoriasis patients don't need as frequent office visits, it has left time for other patients to get in."

Laser technology

In West Lafayette, Indiana, biologics were a top choice for John K. Randall, R.PH., M.D., too, but for his practice, he had to settle on better laser technology.

"We're very procedure oriented, so that's had a big impact on our practice. The spectrum of procedures we're able to do has greatly expanded from acne scarring to the hair removal to rosacea to spider veins to lentigo to melasma, and you can just go on. Because the results are better now, through word-of-mouth, our practice has grown exponentially."

Although lasers were used to treat many of those conditions earlier, Dr. Randall says there is a difference now.

"Now, we can actually deliver what we promise. Technology has caught up with expectations and it works. Some of the older lasers actually did a fairly good job, but nonablative lasers, even five years ago, just didn't have much to offer."

Dr. Randall also notes a general technology development that has impacted dermatology.

"Simple things like digital photography have really simplified our practice. It's easy to take a picture, print it out and circle a mole before biopsying it; fewer mistakes are made. Everybody knows where the biopsy site is. We have a number of mid-level practitioners in our office and that makes a difference when various people are seeing patients. You can have an accurate idea where something came from when you biopsy it."

General cosmetics

In a similar vein, John DeSpain, M.D., a solo practitioner for 17 years, generalizes to the range of advancements that have occurred in cosmetic dermatology.