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