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It's inevitable. The calendar year draws to a close and we begin to weigh the accomplishments, omissions, challenges, and failures of the past 12 months. New Year's Resolutions. The Top 10 Movies of the Year. The Time Magazine Person of the Year. All are products of our impulse to look back, assess, and catalog.
Here at Medscape Dermatology we're not immune to this urge. Recently I asked several board members and contributors to tell me what they thought were the most important developments in dermatology over the past year. The result is an emphatically subjective list that helps us think about the year in dermatology -- and the year at Medscape Dermatology:
Biologic therapies
Topical immunomodulators
Botox
Regulation of office surgery
Bioterror and the dermatologist
Nonablative dermal remodeling
Everyone I talked to cited the use of new biologic therapies to treat inflammatory skin disease, especially psoriasis, as a huge breakthrough. As Steven R. Feldman, MD, PhD, said, "Drugs already on the market (Enbrel, Remicade) and drugs soon to be available (Amevive, Raptiva) hold tremendous promise not only to treat patients whose inflammatory skin diseases have been resistant to therapy but also to offer safer approaches to treat patients whose only hope so far has been methotrexate and cyclosporine." Thomas Stasko, MD, added that "these therapies have changed not only treatment but also how we view the pathogenesis of the diseases these drugs treat."
For a review of the new biologic therapies in psoriasis, read Dr. Feldman's Conference Report from the 60th Annual Meeting of the American Academy of Dermatology. For a discussion of these drugs from a pediatric perspective, read Dr. Sheila Fallon Friedlander's report from the recent Society for Pediatric Dermatology meeting.
The topical immunomodulators tacrolimus and pimecrolimus are no longer brand-new drugs, but "the further experience with and continued excellent safety profile of these drugs ranks right up there," among the top dermatology developments in 2002, according to Dr. Fallon Friedlander. For a review of these drugs, read her Conference Report Pediatric Dermatology: New Therapeutic Options.
Botox
Graeme Lipper, MD, noted that the US Food and Drug Administration (FDA) approval of Botox for facial rhytides -- coupled with consumer marketing efforts -- has led to "unprecedented demand, despite a soft economy" for Botox treatment. Of course the FDA approval of Botox has also highlighted philosophical practice issues about the balance between cosmetic and medical dermatology, as well as larger social questions about beauty and aging.
Medscape covered another aspect of Botox in our Clinical Update Hyperhidrosis: Current Understanding, Current Therapy., which is still available online for free CME credit.
According to Dr. Feldman, "The issue that may affect our specialty more than any other is the potential for regulation of surgical procedures performed in dermatologists' offices." Dr. Stasko agreed, and pointed out that the data support office-based surgery as "safer for the patient and also cost-effective." Dr. Feldman believes that "it is essential that we work with other specialties to assure rational regulation that improves rather than hinders the provision of quality care. Other physicians know very little about what dermatologists do in our offices. We need to make sure they know the experience, quality, and cost-effectiveness of the care that we provide."
Dr. Fallon Friedlander cited the risk of bioterrorism and the important role that dermatologists play in the diagnosis of bioterror-related illness. As Thomas W. McGovern points out in his Expert Column Can Derm Warfare Fight Germ Warfare?, "Out of the 12 Category A high-priority agents posing a risk to national security, only botulism toxin and Lassa fever virus do not elicit any cutaneous manifestations. The agents causing anthrax, smallpox, plague, tularemia, Ebola fever, Marburg fever, and the 4 South American viral hemorrhagic fevers...cause specific cutaneous findings." Indeed, dermatologists made the first diagnoses of cutaneous anthrax in New York City during the bioterror scare. For an account of the diagnosis and treatment of one of those cases, read Dr. Fallon Friedlander's report from the SPD.
The concept and practice of nonablative dermal remodeling has, according to Dr. Lipper, "drastically changed the way dermatologists approach common cosmetic concerns such as acne scarring and photoaging." Dermal remodeling is based on the concept that lasers and radiofrequency devices can induce collagen remodeling by selectively heating the dermis while sparing the epidermis. Dr. Lipper cautions, however, that "whether these technologies in practice will justify the early hype remains to be seen." For more detail on nonablative dermal remodeling, see the Conference Report from the 2002 Meeting of the American Society for Laser Surgery and Medicine.
The year 2002 also saw significant changes at Medscape Dermatology. We redesigned the home page for a cleaner, crisper look, and made adjustments to our platform to make the site easier to use. If you have suggestions for ways to improve Medscape Dermatology -- or if you would like to add to the Significant Developments in Dermatology List -- write me directly at Dermatologyeditor@webmd.net.
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