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    The on/off button comes to dermatology

    Dr. DraelosDr. Draelos says dermatologists will need to understand new device technologies and incorporate them judiciously into disease treatment where appropriate. The on/off button has come to dermatology. At one point in time, dermatology was defined by creams, ointments, lotions, powders, and sprays. No longer. Micro-miniaturization is changing the way we evaluate our skin, perform treatments, and assess efficacy. All of these activities place the consumer in command providing minute-by-minute data for interpretation.

    One of the most interesting concepts is the personal beauty advisor. This a mirror appearing device that hangs on the wall of the bathroom with a camera mounted front and center at the top. In front of the mirror, is a carpet cleverly concealing a scale. Wake up in the morning, stand in front of your beauty advisor, get your first morning weight, evaluate your undereye bags, skin color, facial redness, and acne lesions. How are you doing? Are your acne lesions decreasing?  How do your undereye bags compare internationally with other women your same age? I worked calibrating one of these devices comparing my assessments to the device and the device performed admirably well.  Certainly, this device could encourage compliance as rosacea patients on oral and topical antibiotics see a decrease in the mirror generated inflammatory lesion count and overall facial erythema.  The mirror offers a personal and population-based database comparison providing all types of objective information for consideration in the privacy of your own bathroom.  Now the "mirror, mirror, on the wall" is a miniature computer with wireless Internet connectivity!  Snow White needs to take a look at this one!

    Electrical devices that plug in the wall are also becoming varied and plentiful.  For example, skin rolling using a wheel containing stainless steel spokes has been introduced into the home healthcare market from the Orient.  These rollers are used for skin poration, but can now be electrified, producing deeper skin injury and more robust columns of collagen regeneration.  In many ways, these electrified poration devices are attempting to mimic Fraxel laser treatments, but are designed to be used at-home.  Other variants of in office treatments to reach the consumer market include the electrified acne face masks based on blue light.  These devices mimic blue light treatments that were originally part of photodynamic therapy.  Galvanic current is also finding numerous uses including penetration enhancement and tissue tightening.  Home devices, based on professional treatments, are sweeping the Internet appealing to the do-it-yourself consumer.

    Even professional non-invasive research devices are finding their way into the home.  A hand held corneometer has been developed that can be touched to the skin to assess skin conductivity.  The corneometer produces low grade current transmitted to the skin using water as a conductor.  More conductivity is present with higher skin concentration while lower conductivity is present with lower water skin concentration.  The at home corneometer worked surprising well when compared to my professional device.  This allows consumers to evaluate the efficacy of moisturizers in real time and possibly even the state of their eczema or atopic dermatitis.  Corneometry could be used as an indirect measure of disease activity for variety of dermatologic conditions.  Dermatologists could even have patients text their daily corneometry measurements to the office to evaluate the efficacy of current prescription therapy and determine whether a change is indicated!

    Perhaps the most interesting device is the ever present smart phone that can become an important telemedicine skin assessment device.  Imagine texting a "selfie" to your on-line dermatologist who will text you back a one word diagnosis and a two-line treatment recommendation while texting your prescription to an on-line pharmacy for next day delivery to your home.  At the 2 week follow up, the patient will again text a "selfie" for re-evaluation by the on-line dermatologist to determine if the treatment was successful or requires changes.  Dermatologic advice is as close as the patient's phone in the privacy of their own home!

    The on/off button is becoming more and more important in dermatology.  It is easier to touch the skin with devices than any other organ. Pictures are also more relevant to dermatology than any other medical specialty.  Dermatologists will need to understand new device technologies and incorporate them judiciously into disease treatment where appropriate. 

    Zoe Diana Draelos, M.D.
    Zoe Diana Draelos, M.D., is a consulting professor of dermatology, Duke University School of Medicine, Durham, N.C. She is investigator, ...


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