Having an interest in skin care is often derided as a superficial pursuit, but that's most certainly not the case in the medical world. Studying the surface of the body means that results of new treatments are both visible and easily quantifiable to doctors and patients. "Skin is a particular opportunity for studying genetics because it's like a window to cellular mechanisms that are going on inside the body," says Dr. Sara Brown, professor of molecular and genetic dermatology at the University of Dundee in Scotland.

She explains that many common skin diseases, such as eczema, psoriasis, skin cancer and acne, are controlled in part by genetics and in part by the environment. While environmental choices can be managed to an extent, there are major advantages to figuring out the genetics of a disease. "If you can understand the genetic code and how this gives information to the skin, leading to healthy skin or causing disease, then potentially you can design treatments based on [that], rather than just looking at the final results of the disease and trying to reverse it," she says.

Brown was one of the many skin-care professionals who attended the World Congress of Dermatology in Milan, Italy, in June, where some 12,600 attendees, including dermatologists, skin-care companies and manufacturers of medical equipment, gathered to share their latest research, products and innovations. Held every four years, it's a massive conference, during which around 200 meetings and sessions are held and nearly 6,000 scientific abstracts are presented. The theme this year was "A new era of dermatology."

For Giovanni Pellacani, a professor at the University of Modena and Reggio Emilia in Italy, and the president of the 2019 congress, that new era is defined by addressing issues sooner. That's true when it comes to dangerous growths such as melanomas, as well as for conditions such as psoriasis or eczema, he said in a press release.

Brown's work in genetics and artificial intelligence come together in an emerging field called precision medicine. Its basis is that genetic data and artificial intelligence can be used to predict which diseases you're predisposed to based on your genetic makeup. A visit to the doctor's or dermatologist's office could include a simple test to predict your risk for disease, detect it early on and prescribe a preventive course of actions.

Brown points to progress in the treatments of psoriasis specifically as an example of how genetic research is tailoring treatments to the individual. That's much better than the current approach of trial and error, she says, where dermatologists start with the most readily available treatments then change to another when the first one doesn't work as well as they would like. "That's just in its early days but we're definitely moving in that direction," she says.

At the beauty counter, customized skin-care products offer a peek into the possibilities of more personalized dermatology. Big data is already allowing brands to mix tailor-made formulas from information gathered through customer questionnaires and assessments.

Virginie Couturaud, scientific director of skin-care brand Institut Esthederm, was at the congress to present new studies and products from her brand, which is designed to complement cosmetic treatments. Its parent company Naos also owns Bioderma, a dermatology-focused drugstore brand, and Etat Pur, a new personalized skin-care line that has yet to enter the Canadian market.

"For us, it is very important to understand your skin, to adapt your skin treatment, to use different product on your face and to have the safety with recommendations with dermatologists," she says, explaining that it's a 360-degree approach to skin health.

As with precision medicine, Naos takes a preventative, rather than corrective, approach to skin care. "The skin adapts all the time with the environment. There is self-regulation and self-adaptation," Couturaud says. "For us what is important is to protect the skin and reinforce its defences."

Getting to the root of how skin defends itself begins at the cellular level and nothing is more powerful than the genetic code, something Brown says holds the instructions for the building blocks of our bodies. As such, genetically tailored medical treatments can have a major impact. "Even tiny changes in the code can have quite profound effects in how our body works," Brown says. With artificial intelligence and ongoing research, decoding the road to healthy skin is closer than ever.

At the World Congress of Dermatology, these five trends were front and centre

"When you practise different sports or you have a baby, your skin changes and it is possible to adapt your product to your skin," explains Virginie Couturaud, scientific director of Institut Esthederm. The wider availability of ever-more personalized skin-care formulas tailored to the lifestyle of the user means that more consumers have access to products that can evolve to suit any changes. "The best move for us is to analyze the lifestyle of our consumer."

Facial contouring, where aspects of the face shape are altered using non-surgical means, is an increasingly popular service. "Facial contouring is really where we're going in the future," dermatologist Dr. Susan Weinkle said in her plenary lecture at the congress. According to Weinkle, one option that's growing in popularity is the thread lift, where temporary sutures are inserted to produce a subtle lift in the face that can last between one and three years.

The exposome is the measure of everything an individual is exposed to in their lifetime, such as her or his environment, diet and overall lifestyle. As it grows more complicated, skin-care companies such as Bioderma are developing products to help skin better protect itself. "In a beautiful world, the skin could fight itself against every aggression," brand director Laurencia Musol says. "We try to help the skin to do it correctly and re-stimulate its own power of defence."

Research on the microbiome that was unavailable until 10 or 15 years ago is changing dermatology considerably, with findings linking imbalances in the microbiome to psoriasis and many other skin diseases. Dermatologist Dr. Marco Pignatti of the University of Modena and Reggio Emilia presented his research on the gut-brain-skin connection, explaining the set of mechanisms linking everything introduced to the body with the skin.

New features in non-invasive treatments for body remodelling are increasingly requested by patients as an alternative to surgical treatments. Procedures done without a scalpel such as filler injections can be used to shape body parts such as the thighs and even lift the derrière.

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