INTRODUCTION
The aging of our largest organ, the integument, results
from both intrinsic and extrinsic factors. This proposed
terminology Generational Dermatology encompasses
prevention and involves medical, cosmetic, surgical and oncologic
strategies over the decades to optimize skin performance
throughout the course of a lifetime.1 Generational Dermatology
also coined “GDerm” and “Gendermatology” was a term
the author developed in 2009, introduced in 2011 as Founder of
the Generational Dermatology (GDerm) Summit held in NYC,
presented internationally at the 2011 World Congress of Dermatology
in Seoul and most recently presented at the American
Dermatological Association annual meeting in Scottsdale
Arizona 2013. It is based upon observations over an almost 20
year practice period in a stable southern California community
where I was able to clinically follow my aging patients.
Establishing a private practice in 1994, I had patients who became
50 years old in 2004. I observed that the skin of these
patients had changed in ten years. The sixth decade brought on
more skin problems, and it continues. I saw a pattern in the skin
aging, many related to skin barrier breakdown and started to intervene
where I could. I began to tease out the idea of looking at
the aging process as an evolving process. My 65 plus Geriatric
patients did not turn 65 overnight. It happened one day at a time
and one decade at a time. We are, and specifically our skin is,
the sum of all of our decades of health or disease. For example,
extensive unprotected sun exposure on a child eventuates in
adult skin with clinical signs of photodamage. While the original
intention of this concept was targeted to interrupt the extrinsic
and intrinsic aging process to “turn back the clock”; I soon discovered
that by understanding evolving process of aging I could
begin intervening in the aging process in hopes of prevention.
I began injecting fillers and neurotoxins a little earlier based
on evolving rhytids that could be seen on the horizon, peeling
slightly photodamaged skin hoping to reduce future pathology
and skin cancers; advocating for pedicures and foot massage for
my elderly male patients who seemed to have a lot of dry foot,
nail disorders and foot rigidity related to aging.
In one lecture at CosdermIndia I gave on generational dermatoIogy
I analogized it to the popular 80’s movie “Back to the
Future™” The analogy is knowing what course the patient’s skin
is going in via genetic predisposition, indicators and environment;
we can begin preventive medicine strategies early on to
effect a different outcome than they would experience with no
skin care intervention. The goal being to optimize skin health
over the course of a lifetime and decade by decade, which defines
it as a generational approach to prevention.
Generational Preventive Approach
Organ failure is the inability of the organ to perform its determined
function as a part of normal physiology and it may be
