Public health

Professor John McGrath predicts the future of dermatology


Robot dermatologists, cross-specialisation, gene sequencing-directed diagnosis and treatment and a dash of serendipity are set to colour the next few decades of dermatology, international speaker Professor John McGrath told ICD 2021.

The speculation comes as part of the King’s College London dermatologist clinician researcher and “honorary Australian‘s” keynote speech at this year’s virtual conference, outlining the future of dermatology.

While he admitted RoboDerm — a robot that uses artificial intelligence (AI) and biosensors to remotely diagnose patients and deploys treatments via drone — may be a little far-fetched, Professor McGrath said AI, biosensors, new medical partnerships, next-generation sequencing, disease reclassification and some luck would be key to improving patient care.

AI and machine learning

AI and machine learning have already got skin in dermatology, with some patients uploading rash photos to Google AI to aid self-diagnosis or streamline access to secondary care. Appropriate AI use in practice could help optimise diagnosis and prevent unnecessary misdiagnosis, Professor McGrath said.

Additionally, Niigata University Professor Riichiro Abe has developed some “extraordinary programs that show how machine learning is better than trainees and consultant dermatologists in predicting drug [rash] eruption progression”.

While these technologies are expected to support diagnosis, they aren’t ready to replace human dermatologists yet, with recent studies showing “really experienced” dermatologists are better at differentiating benign and malignant lesions than machine learning, Professor McGrath said.

Biosensors

While clinicians await further computing advancements, Professor McGrath predicted biosensors would take off in the next few years, with the emergence of printed, graphene-based electronics and other sensors allowing dermatologists to remotely monitor local and international patients and collaborate with a community of sub-specialists, including medical, skin cancer and cosmetic dermatologists.

Medical partnerships

Speaking of collaboration, Professor McGrath predicted clinicians would develop new medical partnerships for a cross-disciplinary approach to care.

“Some colleagues will be looking after chronic inflammatory diseases, and that may not just be affecting the skin. It may involve, for example, patients with psoriasis, rheumatoid arthritis or inflammatory bowel disease, where the commonality is the way we approach the pathology and treat the inflammation. So maybe there will be some cross-specialisation of colleagues,” he said.

Disease reclassification

This pathology-based treatment approach may also allow a much-needed overhaul of disease classification, he suggested.

Currently, dermatologists have a surplus of old terms, letters and words to describe diseases that they think a colleague will recognise but may be “no better than stamp collecting, he said.

Instead, Professor McGrath advocated for a reductionist approach, defining conditions by a signature, inflammatory footprint, common signalling pathway or shared biological impact that could direct clinicians to appropriate therapies.

“We’re seeing it in this particular decade with biologics,” he said, citing some genodermatoses (SAM syndrome [DSG1], Hailey-Hailey disease [ATP2C1] and ARCI [NIPAL4] and PRP [CARD14])  “not traditionally thought of as biologic-relevant dermatoses”, that showed a shared inflammatory footprint and responded to secukinumab, dupilumab and ustekinumab, respectively.

Gene sequencing

Next-generation sequencing has already gone a long way to improving disease diagnosis and treatment.

For example, the technology helped clinicians identify “autosomal recessive mutations in a gene [SC4MOL], causing a cholesterol pathway abnormality” and arrange treatment with cholesterol and statin in a patient with previously unknown genodermatosis, Professor McGrath said.

However, genetics “is still in its infancy” and has yet to reach a “ripe enough stage to be delivered to our patients to change their lives”.

“We told our genodermatosis patients 30 years ago that finding ‘the gene’ would give us ‘the cure’, but it hasn’t,” he said.

“We hope that the delivery will be for these patients, gene therapy and cell therapy, and this may be where dermatology is heading for these patients.”

Serendipity

Even with all these technological and clinical advancements, “serendipity, good fortune, is also important”, Professor McGrath said.

“One of the most serendipitous discoveries in paediatric dermatology had nothing to do with pure science. It was just luck — the discovery that B blockers are useful for infantile capillary haemangiomas”, he said.

He also cited a case where a severe alopecia areata patient’s hair grew back after receiving a faecal microbiota transplant for C. difficile and a case of revertant mosaicism or ‘natural gene therapy’ “being something that we can use our skills to discover and exploit for clinical benefit”.

Finally…

Unsurprisingly, Professor McGrath noted that biomarker, pharmacogenomics, stratified and personalised medicine and drug discovery and repurposing advancements will “shape the way we practice dermatology over the next decade”.

Time will tell how all of these developments and new trends in health, technology, governance and other influences will change the profession, he concluded.

The full presentation is available via ICD 2021’s website.

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