Rancho Mirage, California-based dermatologist Wendy Roberts, MD, first coined the term “generational dermatology” in a 2011 interview with a top beauty magazine and this concept has taken on a life of its own ever since. The seminal article on the topic, “Generational Dermatology: a multidecade approach to the evolving aging patient,” was published in 2013 and Dr. Roberts went on to start the Generational Dermatology Symposium, which is now in its 10th year. Dr. Roberts sat down with Practical Dermatology® magazine and talked about intergenerational dermatology and what it means to her and her patients.
Tell us about the origins of the Generational Dermatology Symposium.
Wendy Roberts, MD: When I started my private dermatology practice in 1994, I had patients who were in their 30s and 40s, and they looked great! They were stunning and attractive from head to toe. Twenty years later in 2014, they were crumbling from head to toe with thinning hair, facial wrinkles, brown spots on their chests, torso skin growths, bulging leg veins, and tough leathery feet. It was around 2005 and I distinctly remember saying to myself, “I have got to do something about aging skin.” That’s when I had my “aha” moment about the fierce prevention of skin aging as a possible solution—I’m not just talking about encouraging the wearing of sunscreen. I began to study the mechanisms and nuances of aging skin and created a new niche specialty called generational dermatology as a solution for the evolving, aging skin I was treating every day.
In 2010, I noted that all of the dermatology meetings were owned and run by men—with a few women included in the leadership banner. Seeing a need for a woman-owned continuing medical education meeting, I decided to create one. The subject was the evolving, aging patient. In 2011, I became the first woman in dermatology to own my own meeting. I named it the Generational Dermatology Symposium.
What does generational dermatology look like in practice?
Dr. Roberts: Acne is truly an intergenerational disorder. You have a teenager with untreated acne which may result in scarring. And 30 years later, acne scars are looking worse because of the loss of collagen and dermal connective tissue. We as dermatologists are armed with that generational knowledge and should prioritize acne scar treatment in young women.
Cosmeceuticals are paramount for people in their 20s to help reduce accumulating DNA damage and reset injured photodamaged cells. Radiofrequency micro-needling devices with multiple modalities are some of the tools for 30-year-olds with an eye on prevention. For patients in their 40s and 50s, we focus on rejuvenation using injectables and energy-based devices. In the 60s and beyond, combination modalities and layering vary as needed based on skin tone, texture, and extrinsic aging. This may be a restoration process in the extremely old-appearing 70-year-old or maintenance in the younger-looking 70-year-old. What is key is that at whatever age you check in, your generational dermatology expert creates a plan for you.
How can dermatologists better connect the dots between these age groups?
Dr. Roberts: It begins with an intergenerational dermatology history. Ask what skin, hair, or nail disorders run in the patient’s family. Do women have melasma or dermatosis papulosa nigra? Do men have rosacea or male pattern baldness? This way we are utilizing family history and phenotypes to examine our patients through a proactive, preventative aging lens. We are experts in skin, hair, and nails throughout an individual’s lifetime. This can also be applied to the family, creating a multigenerational dermatology model. In this model, we create plans for each member of the family. Additionally, with the multigenerational lens, you anticipate the needs of your adolescent eczema patient’s mother who may be experiencing melasma, rosacea, and other skin disorders common to her generation. Practicing generational dermatology is just good medicine as we work on primary and secondary levels of preventative care for all skin conditions including aesthetic, medical, and oncologic. It also reduces overall national health care costs by reducing costly interventions.
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