HOWARD EPSTEIN, Ph.D.
Director Technical Services, Cosmetic Functional Ingredients, Surface Solutions, EMD Electronics

Over 20,2878 physicians, research scientists and others involved in dermatological related interests attended the meeting March 7-11, 2025, in Orlando, Florida.

Introduction

Physicians practicing dermatology treat skin and hair often specialize in various subspecialties, including medical, cosmetic, surgical, and pediatric dermatology, as well as dermatopathology and Mohs surgery. Medical dermatology primarily focuses on diagnosing and treating conditions affecting skin, hair and nails. Cosmetic dermatology also known as aesthetic medicine has a focus on improving skin appearance through non-surgical procedures and treatments, typically addressing wrinkles, skin tone and texture, removing hair on the face and body, tightening skin, treating cellulite, acne and acne scars. Aesthetic medicine appears to be moving more aligned with consumers who wish to avoid invasive procedures and desire a more “natural” approach to fighting the appearance of aging.

Current and Future Trends

Current and future skin/hair care trends were addressed in several presentations at the recent AAD meeting. Presentations relevant for skin and hair care with the theme of the changing view of skin care-new perspectives included:

A session entitled “The Future of Cosmetic Dermatology,” directed by Neil S. Sadic, MD, Clinical Professor Dermatology, Weill Cornell Medical College, Cornell University, New York, USA, and Suleima Arruda, MD Research Director, Sadick Research Group, New York, USA, explored the cutting edge of cosmetic dermatology describing technologies, treatments, and patient preferences that will shape the future of this field. Technology discussed includes use of lasers, radiofrequency and ultrasound for skin rejuvenation, body contouring, and hair restoration. Dr. Sadick mentioned that in the US the Food and Drug Administration (FDA) cleared the fractional laser for hair loss for both men and women, the first approval of this application (1). For facial rejuvenation devices including TriLift and EMFACE combine radiofrequency with muscle stimulation to tone facial muscles and improve skin quality. Dr. Sadick went on to say these types of therapies offer alternatives to traditional injectables and surgery. Dr. Arruda discussed the current state of the art for biologics including stem cell-based therapies, and extracellular vesicles. Exosomes are extracellular vesicles that have emerged as promising alternatives to traditional cell-based treatments for skin rejuvenation and aid wound healing, advancing more personalized skin care. Dr. Ronda Farah, Associate Professor, Department of Dermatology, University of Minnesota, USA, presented the latest update regarding stem cells and exosomes for hair growth. Stem cells can be removed from existing hair follicles and placed into exosomes and then transplanted into scalp to potentially grow new hair. Dr. Farah cautioned that the FDA has not yet approved this treatment for hair and general patient treatment. Human studies of stem cell loaded exosomes currently in process show potential for increased hair follicle counts, induction of hair growth proteins and growth factors, prolongation of the anagen phase of hair growth and increased hair regrowth (2). Dr. Farah concluded with the comments that stem cell and exosome human data exists and initial studies are promising, but not without risk. Human data on exosome product injection is lacking and not FDA approved. Manufacturing requires stringent patient safety mechanisms and standards to ensure safety. Monitor FDA and CDC (Center for Disease Control) websites for updates.

Dr. Zoe Draelos, Consulting Professor Dermatology, Duke University, North Carolina, USA, presented “CBD (cannabidiol) and New Generation Nutraceuticals for Hair and Skin.” Products sold in the US market contain CBD derived from hemp leaves and its flowers, unlike marijuana does not contain tetrahydrocannabinol (THC). A 2018 federal Farm Bill removed hemp from the legal definition of marijuana, CBD products with less than 0.3% THD are federally legal in the US (3). CBD products are anticipated to reach US $1.7 billion in sales, benefits include sebum regulation, a decrease in sebum related to an anti-inflammatory effect of sebocytes. The anti-inflammatory property may benefit people with eczema and psoriasis. Products in the marketplace contain CBD in various forms, typically a CBD isolate that contains a purified crystal CBD precipitate with no THC, that can be sold across state lines, a full-spectrum CBD with other cannabinoids containing 1.0% or less THC is not believed to be psychoactive. Dr. Draelos advised that one approach for evaluating product safety is to look for testing of manufactured products that verifies no more than 0.3% THC in the product. Products should have third party testing for potency and safety, certificates of analysis indicating absence of heavy metals, pesticides and microbes should be available and confirm that the manufacturer has not received an FDA warning letter.

Sunlight, Friend or Foe?

Dr. Henry W. Lim, Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA presented on the topic “Sunlight: Friend or Foe? Dr. Lim mentioned that the spectrum of sunlight reaching the Earth’s surface at sea level consists of 2% UV (290-400 nm), 47% visible light (400-700 nm) and 51% infrared (700 nm-1 mm). While there is no standardized method for assessing sunscreen protection against visible light (VL), in vitro and in vivo studies show that VL exposure generates reactive oxygen species (ROS) in all skin types and results in hyperpigmentation in darker skin types. Apparently, the studies indicate that the Opsin 3 receptor (OPN3) is upregulated by the blue light component of VL in darker skin leading to long-lasting hyperpigmentation (4). Dr. Lim discussed studies that found UVB and UVA2 exposure to skin type I-III resulted in erythema and photocarcinogenesis, UVA1 resulted in tanning, photoaging and photocarcinogenesis for skin types IV-VI, visible light resulted in erythema for all skin types (I-VI) and tanning for skin types IV-VI. Exposure of UVR (311nm), the visible portion of blue light (peak 450 nm) and green light (peak 530 nm) to various skin type histocultures resulted in all three stimulating melanogenesis. Blue and green light, but not UV (311 nm) stimulated melanogenesis in skin type I, VL induced melanogenesis not associated with DNA damage or apoptosis, melanogenesis induced by UV was associated with DNA damage and apoptosis. Dr. Lim discussed other studies that show the impact of UVB exposure inducing matrix metalloproteinases impacting extracellular matrix leading to photoaging, and the impact of UVA (UVA1) exposure on dermal fibroblasts resulting in senescence, and mutations of mitochrondrial DNA (mtDNA) because of formation of reactive oxygen species (4, 5). Conclusions from the study included clinical implications that VL and UVA1 have a role on conditions aggravated by sun exposure such as post-inflammatory hyperpigmentation and melasma, particularly in dark-sinned individuals, and VL and UVA1 induces erythema in light-skinned individuals. It was concluded that currently available organic UV filters are not sufficient to protect the skin from the effect of visible light (4, 5). The presentation concluded with a discussion of a review of published articles on the topic of skin microbiome and photoprotection. Current sun protection recommendations do not consider the potential impact of the microbiome on skin with respect to photoprotection. A review of 122 articles on current sun protection methods was conducted by a group of dermatologists and research investigators. The skin microbiome undergoes constant exposure to solar radiation (SR), understanding the influence of SR on the skin’s microbiome is not well understood. SR exposure can alter microbiome composition, possibly resulting in dysbiosis, compromised skin barrier function, and immune system activation. “Tailored sun protection products that prioritize both skin and microbiome health may offer enhanced defense against SR-induced skin conditions. By safeguarding both skin and microbiota, these specialized products could mitigate dysbiosis risks associated with SR exposure, bolstering skin defense mechanisms and reducing the likelihood of SR-mediated skin issues” (4, 5).

Microbiome and Skin

Dr. Sonal Choudhary, Assistant Professor, Department of Dermatology, University of Pittsburgh, Pennsylvania, USA, presented “Gut Microbiome: Inflammatory Diseases,” mentioned that the gut microbiome, gut dysbiosis, exposome are all involved in skin diseases. The human gut and skin microbiome is very complex consisting of bacteria, viruses and fungi and has a role in fighting or negatively influencing inflammation and a variety of skin diseases including atopic dermatitis, psoriasis and rosacea. Diet has an influence on the microbiome which in turn affects human skin health. It is also shown that the western diet can result in a decreased gut microbiome diversity potentially resulting in development of low-grade inflammation (6).

Concluding Comments

Dermatologists have observed changes in patient demographics that continue to evolve. Profiles are changing, driven by social media influence, and beauty standards. Younger patients are increasingly, and more males with diverse cultural and ethnic backgrounds are seeking cosmetic dermatologists. TikTok and YouTube have a significant impact on the patient expectations and interest in cosmetic treatments. Dermatologists are increasingly using an online presence to educate patients on realistic expectations of the available patient treatments.