Abstract
Dermatology has advanced significantly in knowledge, technology, and treatment. Restoring the skin microbiome has emerged as a promising therapeutic approach, while the role of the gut-skin axis reveals the potential of dietary patterns in reducing skin inflammation and promoting health. Psychodermatology integrates mental health and dermatology, focusing on the psychological impacts of skin conditions and how psychological factors influence skin health. Despite advances, challenges persist, including accessibility to dermatologic care, integrating emerging tools, as well as addressing the rise of unqualified practitioners and the new risks introduced by social trends, such as the increasing popularity of tattoos and synthetic cosmetics. Particularly, the rise of cosmetic dermatology raises ethical concerns, emphasizing the need for evidence-based practices and maintaining rigorous professional standards. A multidisciplinary, patient-centered, and ethical approach is essential for addressing the evolving complexities in preserving skin health and enhancing overall well-being.
The Shifting Landscape of Dermatology
As a remarkably dynamic organ, the skin comprises diverse cellular populations and structural components that synergize to preserve the integrity of the cutaneous barrier, thereby playing a pivotal role in protecting the organism against external challenges and in maintaining overall internal stability [1]. Various decades ago, it was proposed that the future of dermatology relied on excellence in education, technological advancements, unified efforts within the specialty, and the establishment of dermatologists as primary providers of dermatologic care [2]. However, despite these foundational perspectives, challenges persist, such as the difficulty that dermatologists face in balancing new demands with professional priorities, the integration of emerging tools into practice, and the rise of individuals without adequate qualifications engaging in dermatology-related activities [3,4]. In addition, dermatology has been encountering new concerns derived from social trends [5,6], such as the increasing popularity of tattoos, which has been linked to carcinogenic potential and acute local inflammation [7-9], or the widespread use of synthetic cosmetics, which have been associated with chronic health risks, including cancer, endocrine disruption, neurological disorders, allergic processes, and respiratory conditions [10-13]. In light of these issues, there is a need for research aimed at clarifying prevalent practices, products, and treatments that threaten skin health, to better understand their true risks. In turn, there is also a need for research aimed at developing effective preventive strategies that safeguard the skin and preserve overall health.
Recently, the restoration of the skin microbiome has emerged as a promising therapeutic strategy, with studies exploring the potential of probiotics, prebiotics, and postbiotics in topical treatments for various dermatological conditions, as these compounds exhibit anti-inflammatory, immunomodulatory, and moisturizing effects [14]. Furthermore, the bidirectional relationship between gut and skin dysbiosis suggests that imbalances in the gut microbiome can influence the development of inflammatory skin conditions. As a result, future treatments for skin diseases may rely on adjusting both the skin and gut microbiomes through healthy dietary patterns and microbial interventions [15]. Specifically, it has been proposed that consuming a plant-based diet rich in antioxidants, fiber, and phytonutrients promotes a balanced gut microbiome, which can help reduce skin inflammation and improve overall skin health [16]. Ongoing research into these dietary patterns not only highlights their significant contributions to human health and well-being, but also underscores their role in environmental sustainability, further emphasizing their relevance in modern and future nutritional strategies [17].
Diverse adverse skin conditions, such as acne vulgaris and atopic dermatitis, can significantly impact mental health of the affected individuals, potentially leading to several psychological outcomes, including depression, low self-esteem, and social anxiety, which in turn reduce quality of life [15]. Psychodermatology is an interdisciplinary approach involving dermatologists, psychiatrists, and psychologists to address both mental health issues triggered by skin conditions and the skin disorders influenced by psychological factors, offering more effective results than isolated treatments [15,18]. This underscores the need for dermatology to adopt a comprehensive approach, integrating multiple perspectives to better address the complex relationship between skin health and other determinants influencing overall well-being, such as mental health.
Due to the growing interest in skin care, dermatology has made substantial progress in diagnostic techniques, treatment modalities, and in obtaining a deeper understanding of skin pathophysiology, thereby enabling the management of a wide range of conditions, from common dermatologic issues to complex chronic diseases. However, despite the promising increase in available therapies, a gap remains in addressing the diverse needs of various populations, particularly in nonmetropolitan areas [19]. The growing demand for dermatologic care, coupled with a shortage of specialists in certain regions and high treatment costs, underscores the need to improve accessibility and ensure that dermatology remains patient-centered. Moreover, dermatologists face an increasing responsibility to stay informed about emerging advances in science and to critically assess the long-term safety and efficacy of the innovative techniques they apply. In this respect, the rise of cosmetic dermatology, while valuable for improving quality of life, also presents ethical concerns, such as those related to the patient safety and expectations [20]. Additionally, practitioners without formal medical training, yet engaging in skin care practices, may contribute to professional encroachment and the provision of potentially unsafe or inaccurate treatments, further emphasizing the importance of maintaining rigorous standards within the field [4]. Understanding patient motivations for cosmetic dermatological treatments through intrapersonal, social, and behavioral factors could be a crucial approach for ensuring dermatology remains focused on addressing significant health conditions rather than excessive reliance on cosmetic procedures [21]. Thus, fostering a dermatological practice that prioritizes multidisciplinary research, evidence-based interventions, patient-centered care, equitable access, and ethical integrity is essential for addressing the evolving challenges associated with preserving skin health and enhancing the broader well-being of individuals.
