The dermatological industry spent the better part of the last decade developing ground-breaking treatments for some of society’s most common and yet most devastating skin conditions, including acne, psoriasis, and skin cancer. However, as we look towards the new year, the focus is now trending to developing treatments that improve efficacy while also reducing adverse side effects. These are some of the biggest forecasted trends in skincare anticipated in 2020, with commentary by renowned Florida dermatologist Dr. Tim Ioannides.
CBD products for anti-inflammatory skincare
Since its legalization in 2018, cannabinoid extracts from the hemp plant (CBD) have been seen in products for reducing anxiety, promoting sleep, and pain management. In 2020, skincare products containing CBD will see a rise in popularity. Topical application of CBD has shown anti-inflammatory effects, which can be extremely beneficial in reducing the symptoms of skin conditions with inflammatory symptoms such as psoriasis or eczema. CBD could even potentially have an anti-aging effect, as one of the drivers of premature aging is inflammation causing tiny cracks in the outer layers of the skin.
Because of its classification as a schedule 1 drug for decades prior, the amount of studies available to provide concrete evidence of it’s beneficial properties are still limited. However, the anecdotal evidence is strong and 2020 clinical studies have been increasing in volume for the past two years. Ioannides is keen to see the results, stating “I’ll need to see more research, but with the overall popularity of cannabinol growing rapidly I anticipate research will increase even more in the coming year and we’ll see concrete results soon.”
Sunscreen still an important factor in skin cancer prevention
Sunscreen has been regulated by the FDA and commercially used since the 1970’s, but attempts to bring over-the-counter sunscreens up to date with the latest scientific standards brought with it safety concerns in regards to the potential absorption of its active ingredients into the bloodstream. Sunscreen usage has increased in the past 30 years, moving from primarily being used on a seasonal basis to prevent sunburn to daily usage as part of an average skincare regimen today. Technological advances have also allowed for the creation of higher SPFs and greater broad-spectrum protection resulting in more active ingredients combined together in higher concentrations than used previously. This has resulted in potential greater absorption and possible additional risks should these higher levels enter the bloodstream, as sunscreens are formulated to work on the surface of the skin.
2019 saw the mainstream media and grassroots bloggers covering this study with headlines and articles suggesting that sunscreen products may be adversely affecting their health. However, the FDA is recommending the public continue to use sunscreen. “Despite what we know about prevention, we are still seeing a rise in skin cancer incidence rates,” says Ioannides. “It is paramount that in this day and age, we take every step available to us for protection.” Sunscreen with an SPF of at least 15 remains a crucial element in sunburn and UV damage prevention, and as manufacturers compile data on the absorption rates, more clarity on this issue can be anticipated in 2020.
A paradigm shift in acne development and treatment
Up until recently, it was generally believed that acne’s pathophysiology involved the increasing of of circulating androgens in puberty and increasing sebum production, with inflammatory responses in the skin coming later. However, new research indicates that this was incorrect, and inflammation occurs initially during hyperkeratinization, as well as in every stage thereafter.
With this knowledge now available, treatment of acne is expected to shift in 2020 with more focus being put on the reduction of inflammation. Ioannides states of this development “Acne is not curable, but it is controllable, and this improved understanding of acne pathophysiology will pave the way for a better understanding of how existing therapies treat the disease, as well as opening the doors to treatment strategies that are more comprehensive and target multiple facets.”
Prescribing a topical retinoid early in the treatment plan is now recommended as a way to combat inflammation, and while topical treatments have the advantage of being able to treat acne directly at the source, oral antibiotics are still vitally important in the management of acne. With the advent of this new information, drug development has already begun to target inflammation. The new oral antibiotic Sarecycline recently became the first in 40 years to be approved by the U.S. Food and Drug Administration (FDA) to treat acne vulgaris by way of its inflammatory lesions.
Socioeconomics and psoriasis
With the trend of rising overall costs of healthcare, a recent case study showed the socioeconomic obstacles that continue to present themselves in patients, and the need for doctors to take this into account when developing treatment plans in order to optimize results. A 35 year old man with extensive plaque psoriasis reported having been diagnosed with the skin condition at age 21, but limited access to consistent healthcare over the years had prevented his ability to adhere to a treatment plan. By the time he saw the physician, his condition had spread to cover his scalp, face, limbs, and trunk. Topical triamcinolone was prescribed and markedly improved the rash, but this is just one example of a common occurrence of easily treatable diseases going untreated due to barriers of the socioeconomic nature.
One such example of this is the use of ultrasounds to examine joint inflammation in patients with psoriatic arthritis. Persistent inflammation from this type of arthritis brought on by psoriasis can cause lasting joint damage, so the quick and thorough assessment of inflammation is vital to doctors in aiding their diagnosis and ability to devise treatments. A recent study showed that examination via ultrasound resulted in an earlier diagnosis of inflamed joints that previously appeared normal upon clinical examination. “Ultrasounds are safe, non-invasive, and commonly found in most hospitals and clinics, making them an ideal tool for physicians that should be utilized often,” says Ioannides. Indeed, this is an example of a cost-effective measure that can be used towards treating psoriasis patients in the future, and physicians will need to use their creativity and skill in the coming year to continue creating treatment plans and developing methods of diagnosis that are economical as well as effective.
Diet’s effects on skin cancer and psoriasis
A study conducted towards the end of 2019 found that a diet heavy on fruits and vegetables rich in vitamin A may help lower the risk of developing squamous cell carcinoma (SCC). With previous studies indicating the potential role retinol plays in chemoprevention of SCC, vitamin A’s ability to be converted to retinol in the body identifies the importance of vitamin A-rich foods in a patient’s diet, which was found in the study to mostly be derived from plant-based sources.
Similarly, another study found that psoriasis patients who reported eating at least one serving of fresh fruit per day experienced milder symptoms than those who did not. “With fruits and vegetables already associated with numerous other health benefits, this study only emphasizes the importance placed on a well-balanced diet,” says Ioannides.
As we enter into a new decade, the interconnectedness of health in terms of disease prevention will be emphasized even more. Indeed, with socioeconomic factors being a potential obstacle in treatment plans, educating patients on the importance of a healthy diet in relation to disease and cancer prevention is one way dermatologists can optimize outcomes for all.
Tim Ioannides is the founder of founder of Treasure Coast Dermatology, a dermatology practice with five locations in eastern Florida.
Dr. Ioannides earned his medical degree from the University of Miami School of Medicine. He served his medical internship at the University of Florida School of Medicine Health Science Center and completed his residency through the University of Miami School of Medicine in the Department of Dermatology and Cutaneous Surgery at Jackson Memorial Hospital.
Dr. Ioannides is Board Certified in dermatology by the American Board of Dermatology. He is a fellow member of the American Academy of Dermatology, the American Society for Dermatologic Surgery, and the American Society for Mohs Surgery. Dr. Ioannides is also a member of the American Medical Association and the Florida Society of Dermatology and Dermatologic Surgery.
In addition to his commitment to the Treasure Coast as a physician, Dr. Ioannides extends charitable support to many local organizations.
He also plays an important role in educating future dermatologists in dermatologic surgery and reconstructive surgery as a Voluntary Associate Professor at the University of Miami School of Medicine.