Generational Dermatology: Model for Prevention and Multi Decade Approach Toward the Evolving, Aging Patient
December 2013 | Volume 12 | Issue 12 | Original Article | 1396 | Copyright © December 2013
Wendy E. Roberts MD FAAD
Abstract
The 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. Organ failure is the inability of the organ
to perform its determined function as a part of normal physiology and it may be possible to take a Generational preventive approach
toward reducing morbidities associated with the failure of our largest organ, the skin. Outside of skin cancer prevention efforts we
have as a specialty primarily worked on the tertiary prevention realm. I advocate that we can increase our focus on the primary and
secondary tiers where we as Dermatologists have the training and education to identify risk factors and detect early symptoms of skin
disease. I appeal to the house of Dermatology to embrace this concept of Generational Dermatology as preventive medicine for the
evolving aging patient. The practice of Generational Dermatology will decrease patient morbidity and bring down the cost of healthcare.
Our global increased longevity increases the number of elderly worldwide. Longer lifespan means dermatologic needs will increase
as the skin must perform its basic function longer. There are also new unknowns and skin issues which arise from large numbers of
people in the 9th and 10th decades. Generational Dermatology is well suited to be a model for prevention as our patient's age and we can
intervene at any decade. I believe the specialty will increasingly focus on how the skin can optimally perform for a longer period. Lastly,
the practice of Generational Dermatology unifies the house of Dermatology as we need the innovations and input of every subspecialty
to contribute to the health of the people we serve.
J Drugs Dermatol. 2013;12(12):1396-1399.
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