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Volume 5, Number 1 Winter 2005
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Pathways
Editor’s Message
James Q. Del Rosso, DO, FAOCD
Dear Readers:
This edition of PATHWAYS begins
with an article on selling skin care
products in the office setting. Selling
these products, also known as cosmeceuticals,
can be beneficial to both
dermatologist and patient if conducted
in the proper way. Dispensing
appropriately and ethically, whether
you choose to sell your own product
line or a commercially available one, is
key. Here, several dermatologists
share their experiences with dispensing
cosmeceuticals in their offices.
Next, we present an article on
getting published. While publishing
one’s work can launch a new dermatologist
into the ongoing clinical
discussion of dermatologic practice,
this process can be challenging for
the new physician-author. This article
explores the different avenues of
publishing—poster presentation,
journal article, or book—and
describes what one can expect
along the way. The author discusses
the importance of deciding on a
topic, determining the audience,
and selecting an appropriate
avenue. As the author suggests,
most dermatologists who publish
find the experience rewarding. It is
our hope that this process of sharing
the latest in dermatologic treatment
will improve care of the patient.
Please e-mail any comments or
suggestions for PATHWAYS to me
through stuleya@hmpcommunications.com.
As always, I hope you find
PATHWAYS valuable and enjoyable.
Sincerely,
James Q. Del Rosso,
DO, FAOCD
Editor, PATHWAYS
Private Dermatology
Practice, Las Vegas Skin
& Cancer Clinics and
Clinical Assistant Professor, Department of
Dermatology, University of Nevada School of
Medicine, Las Vegas, Nevada
Practical career advice for dermatology residents
Selling Cosmeceuticals
in Your Practice
Several dermatologists share their
thoughts on dispensing skin care products.
By Adam Marcus
Walk into many dermatologists’ offices these days,
and alongside the stacks of medical pamphlets,
popular magazines, and other standard accouterments
is new scenery: stacks and rows of precious—and
preciously packaged—balms, ointments, and salves
promising more youth and vitality than the mere skin cream
could ever dare to dream.
WHAT ARE COSMECEUTICALS?
These so-called “cosmeceuticals,” cosmetics that boast medicinal powers,
are becoming an increasingly common fixture in dermatology.
The US Food and Drug Administration (FDA) does not consider the term
“cosmeceutical” a legal definition. Products marketed as cosmeceuticals are treated
as cosmetics, meaning they do not have to gain FDA approval prior to being sold.
Cosmeceuticals are a booming business. Revenues for the industry were
expected to reach $6.4 billion in 2004, up 7.3 percent from the prior year,
according to a recent article in BusinessWeek’s online edition. 1 Several cosmetic
“giants,” from Estee Lauder to Revlon, make cosmeceutical lines, as do a
Photo courtesy of Evelyn Jones, MD, Paducah, KY.
continued on page 2
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• The Inside Track to Getting Published

Pathways: Winter 2005
continued from page 1
handful of pharmaceutical companies,
including Johnson & Johnson.
COSMECEUTICALS IN
THE OFFICE SETTING
Dr. Mary Lupo, a New Orleans
dermatologist who has her own line of
skin care products, said she first considered
embarking on the project in
1989.“I liked [alphahydroxy acids] and
couldn’t get information from companies
on acid concentrations, etc.,” said
Lupo, a clinical assistant professor of
dermatology at Tulane University
Medical School. “It took me until
1994 to find a biochemist I thought I
could work with.” Her product line
came out the next year and now
includes 10 items.
Lupo displays her skin care products
in a pedestal case that takes up
“no more [space] than a chair.” She
also has another case where patients
check out of the office, from which
staff can retrieve products. “The case
has storage underneath, and we have
more products down in our laser
area,” she said.
Lupo estimates that dispensing
products takes “a few hours” a month to
educate patients, monitor inventory,
and otherwise handle the items. In
addition to her own line, Lupo dispenses
two others, Procyte and Kinerase,
and will soon carry a third, Prevage.
How does she choose which
products to offer? “The most important
element in deciding is to believe
in the products you sell and understand
how to recommend them to
patients. It should not be about
money but rather good patient care. If
they are doing well and like their
existing products, I don’t push mine
just to make a sale.”
Dr. Patricia Farris, a clinical assistant
professor of dermatology at
Tulane University Medical Center, in
New Orleans, said she uses herself as
her own guinea pig.“I never buy anything
that I don’t try myself. Personally,
I can’t sell anything I don’t love.
My motto is ‘great products at a great
price point.’”
Farris said most of the fun dispensing
products comes when she
talks with patients about what works
and what doesn’t, “and saving them
money on expensive brands that are
not worth the money” is also pretty
enjoyable. “Patients really appreciate
this and find it a value-added service.”
As for the business end, how
much doctors make depends on how
committed they are to dispensing, she
said. Many dermatologists sell products
in the office. Fewer take the time
to talk with patients about what they
should be using. More often, those
recommendations come from office
staff instead of the physicians themselves,
a practice that should be
reversed, she said.
What happens if a product doctors
sell is no longer produced or for some
reason loses luster—leaving patients on
a limb? That’s a risk, admits Farris.“We
have had problems with products that
are discontinued, but I try to find
something to replace it with that is
comparable.”
While a growing
number of
dermatologists
dispense
cosmeceuticals,
they’re now
competing, often
unsuccessfully,
with the Internet.
Dr. Mark Nestor, director of the
Center for Cosmetic Enhancement, in
Aventura, FL, sells his own line of cosmetic
products, as well as selects others
that he likes.
“If you dispense appropriately and
ethically, we’re essentially giving benefit
to patients that they don’t have otherwise,”
said Nestor, who is also an
associate professor of dermatology and
cutaneous surgery at the University of
Miami School of Medicine.“You can’t
get these cosmeceuticals most are dispensing
elsewhere.”
Nestor’s practice has offered
patients several product lines in recent
years. He also has developed a touchscreen
computer system, called Dermassist,
that guides patients to the
products right for their particular skin
types. Patients who want to buy
something are given a one-month
supply of the item, which they must
pay for out of pocket, since health
insurance doesn’t cover the items. If
the product doesn’t help, Nestor
added, he will work with the patient
to find something better.
While a growing number of dermatologists
dispense cosmeceuticals—
surveys show about 40 percent, Nestor
said—they’re now competing, often
unsuccessfully, with the Internet.
“Some companies and doctors are
looking at this as a quick revenue
source, and that undercuts doctors
who sell them in the office” where
overhead is higher than in cyberspace.
“Patients are coming in saying,
‘You charge me more than what I can
get on the Internet.’”That’s friction no
one wants, he said. As a result, doctors
are increasingly turning to proprietary
product lines that offer brand distinction.
“They make sure it’s a private
label,” he said.
Dr. Kenneth Beer, founder of
Palm Beach Esthetic Center, in West
Palm Beach, FL, has been selling his
own label of skin care products for a
decade. But the label has changed several
times over the years, as Beer struggled
to find a producer with which he
felt comfortable. Usually, the rifts that
forced breakups involved poor packaging
or, more often, weak product and
sales support.“If a company sells you a
product and that’s the last time you
hear from them, and they never come
in to see how things are going, you sit
with inventory, your staff doesn’t want
to sell it, and patients don’t want to
buy it,” he said.
Beer has been buying his current
product line, Palm Beach Esthetic,
from the same New York-based supplier
for the last five years, a relationship
he considers successful. However,
he is about to make a significant shift
away from office-based dispensing by
opening a day spa dedicated to skin
care procedures. The move will free
up his office staff members, who
already are swamped with cosmetic
patients and “don’t have the time or
the desire to deal with products,” he
PAGE 2

Dispensing Cosmeceuticals
Photo courtesy of Evelyn Jones, MD, Paducah, KY.
Opening a day spa
that focuses
exclusively on skin
care could spur
sales of creams
and lotions that
languish on the
shelves of a
dermatology suite.
said. It will also vacate much needed
real estate in his office, which can’t
handle any more display cases.
Financial considerations also play
a role in the decision, Beer said. He
typically turns over product inventory
every 30 to 45 days. “It’s less than
I’d hoped for, and we’d like to turn it
faster,” he said. Opening a day spa
that focuses exclusively on skin care
could spur sales of creams and lotions
that languish on the shelves of a dermatology
suite.
Like many of his colleagues, Beer
was attracted to dermatology because
of the entrepreneurial prospects it
promised. “You have the opportunity
to do a few very interesting business
things,” he said, including creating
individualized product lines—something
he said he wanted to do from the
start of his medical career. New dermatologists,
he advises, should start
thinking about that side of their practices
immediately. “I would start it
early. It’s a lot easier to set the stage
early and build your own brand as
you’re building your practice then to
have your brand built and say, ‘Hey, I
want to modify it.’” ■
REFERENCE
1. Tsao A.The changing face of skin care. BusinessWeek
online. November 30, 2004. Available
at: http://www.businessweek.com/
bwdaily/dnflash/nov2004/nf20041130_096
2_db035.htm. Accessed December 29, 2004.
Adam Marcus is a contributing editor
for Skin & Aging magazine. Send correspondence
to Adam by e-mail at amarcus3@nyc.rr.com.
PAGE 3

Pathways: Winter 2005
The Inside Track
to Getting Published
Publishing is a great way to immerse oneself in the ongoing clinical discussion of
dermatologic practice, but many new authors may not know how to tackle this endeavor.
By Jo Ann Le Quang
Publishing your work is more than just getting your
name in print or having one more thing to add to your
curriculum vitae.As most authors have come to realize,
getting published means participating in the ongoing
clinical discussion of dermatologic practice. Never before in history
has the conversation among the learned men and women
of dermatology been so exciting. Breakthrough drugs, new treatment
options, and more complete understanding of disease
processes continue to emerge.
WHERE TO BEGIN
“Getting started as an author can
be daunting,” said Stacey Moore, owner
of Physician Resources, an organization
focused on consulting in dermatologic
medical education and dedicated to
helping dermatologists publish their
work. “But there are many ways that
physician-authors can improve their
chances of getting published.”
The first strategy behind getting
published involves having a plan.
“Physicians need a strategy first,”
Moore explained. “Selecting a topic
can be challenging. They need to
define their area of interest and/or
expertise within their field.”
Moore recommends that new
authors start from their comfort zone.
“The writing process becomes easier
once you are comfortable with your
subject matter. Some ways to select a
topic include identifying problems
solved or interventions implemented
for particular diagnoses, including new
information or treatment approaches,
patient interactions, and research studies
or quality improvement projects.
Once you gather resources for
researching your topic, this should also
help to determine which journal to
target for publication of your article.
Some journals want a clinical perspec-
PAGE 4

Getting Published
tive, and others focus on researchbased
articles.
“While journals are one choice,
the opportunity to present at a national
society meeting or publish a scientific
poster presentation is an ideal option
for some potential authors. The first
step is to decide what you have to
communicate and to what audience
and explore the options,” she adds.
Some publishers and organizations
field inquiries about possible future topics
and often publish on their websites
or in their journals a “call for abstracts.”
It is not out of place for a prospective
author to contact a journal, publisher, or
organization and express interest in
developing material on specific content.
If the publisher thinks the material
might be suitable, the author is advised
to develop the idea more formally.
“Preparation, submission, and presentation
of an abstract are important
steps in the research process that can
benefit the investigator/author. The
abstract typically describes a study and
its results, but the first step in writing
an abstract includes reading the
instructions or guidelines given from
the journal, society, or organization.
First-time authors might find it helpful
to read through published abstracts
from the most recent annual meeting
to help illustrate the concepts discussed
in that article, poster, or presentation
and develop a feel for what a good and
accepted abstract looks like,” says
Moore.
Even scholarly publishers and
meeting planners have to “market”
their materials, so they are looking for
content that is timely, of great interest
to the target audience, and—ideally—
not presented as well or as thoroughly
in other places. Identifying the channels
and their respective target audiences
is an easy but often overlooked
step by new authors.
Most publications have authors’
guidelines, which specify how they wish
to receive materials. Conventions and
society meetings may have regulations—and
deadlines—as to what sort
of materials to submit. Adherence to
these guidelines and their deadlines
greatly enhances the chance that the
material will be published. Publishers—
no matter how interested in a specific
topic—may not be able to work with
material that is submitted past deadline
or not in the proper format.
One general rule in publishing: it
never hurts to ask. Provided queries are
brief and on-point, most publishers
prefer getting them to full-blown
materials that may not be exactly what
they seek. But once an author and a
publisher have established that they
want to work together, a very different
phase of the project commences.
It is not out of
place for a
prospective author
to contact a
journal, publisher,
or organization
and express
interest in
developing
material on
specific content.
PREPARING YOUR MATERIALS
Developing the material can be the
most exciting—or the most bothersome—part
of the project.
“I don’t recommend spending
serious time developing the final manuscript
until it has found a potential
‘home,’” added Moore. “It is wise to
work with the editor to define the
material and be sure there is interest
and a need for the content. Even before
the first word of an article is written, a
good editor is already helping to shape
the final product.”
In terms of writing, most writer’s
guidelines help define the format and
scope of the article. For physicians
comfortable with organizing their
thoughts on paper, writing can go
quickly. Others may rely on assistants,
support staff, or even freelance writers
to produce the material.
“When you write a manuscript or
even construct a presentation, there are
really three phases involved,” Moore
explained. “The first is writing, the act
of getting the thoughts down on paper
or typed in the computer. The second
phase is gathering resources or
researching your topic, including
obtaining references. Unless your manuscript
is historical in nature, references
that are over 10 years old should be
scrutinized to account for new information
that may have been published.
The third phase is editing, which
means going through that material
meticulously to make sure it has good
structure, inherent logic, and clarity.
Rarely is anybody good at both writing
and editing, so don’t be afraid to go
to a peer or professional for his or her
opinion prior to submission.Try not to
be afraid of criticism or suggestions
that might enhance your manuscript.
Most of us—even professionals in publishing—tend
to be either more in the
writing camp or more in the editing
camp. Find out which strength is yours
and get help with the other part.”
For some physician-authors, this
may mean submitting data, notes, and
ideas to a ghostwriter to get the first
draft put together. For other physicianauthors,
it may mean contracting with
a freelance editor to review the article
and suggest ways to improve it. Most
journals offer editorial support as well,
but the more finalized material is when
it arrives at the journal, the better the
chance it will get printed. “It can be
very competitive out there,” Moore
remarked. “Journals are extending the
amount of review time for manuscripts,
and editors are more inclined to
favor finalized material over manuscripts
that they have to help organize
or create. Use spell-check, follow the
instructions or guidelines for authors,
and organize your thoughts within the
manuscript.”
Illustrations can be a crucial component
in creating a powerful publication,
but few dermatologists have the
skills necessary to produce professional-level
art work.
“Most publishers know this and
have access to artists who can develop
charts, graphs, diagrams, and drawings.
There are also agencies or freelance
designers or artists who can help doctors
develop animations for presentations,”
Moore stated.“When a publish-
PAGE 5

Pathways: Winter 2005
er develops the art work, you should
clarify who owns it, in case you want
to use it later. I advise all of the doctors
I work with to copyright their
original work.”
For dermatologists, photography
can also be a necessary component of a
publication.
“Digital photography is really
changing dermatology publishing,”
Moore commented. “More physicians
are realizing that they can take goodquality
patient photos right in the
office.” Moore advises physicians who
might be photographing their own
patients to develop a standard modelrelease
form to keep on file. The
advent of digital photography now
means dermatologists can include
electronic files of actual case studies
for consideration with the material
they submit.
“The presence of good photographs
or other illustrations makes
whatever material you submit more
powerful,” Moore commented. “It’s
The advent of
digital
photography now
means
dermatologists
can include
electronic files of
actual case
studies for
consideration
with the material
they submit.
always better to provide whatever
images you can—particularly in dermatology.”
While book authors are entitled to
royalties on their work (typically about
10% of the retail price of the book but
subject to negotiation with the publisher),
article authors may not always
be remunerated. Fees for speaking
engagements vary widely. Physicians
who present posters at certain meetings
may discover that not only is there
no honorarium, there may be out-ofpocket
expenses involved in creating
the poster itself.
“Everybody should be paid for
their work,” Moore said, but she admits
that the world of academic medical
publishing can sometimes seem challenging.“Sometimes
it involves finding
sponsors or grantors for the project.
Specialty societies and other organizations
are one option. Corporate support
also comes into play but in the
form of grants that do not restrict the
authors in terms of the content.” She
noted that a majority of scientific
poster presentations have grantors who
may provide an honorarium to the
PAGE 6

Getting Published
author and may pick up the expenses
of producing the poster and of registering
for the meeting itself.
As the written material makes its
transition to final format—article,
book, poster, live presentation—
authors are cautioned to be meticulous
about references. Bibliographic references
are an important component of
many publications.
“References have to be precise.
Use the format specified by the publisher
or let your editorial assistant help
you. Most authors tend to under-reference
rather than over-reference, so
when in doubt, add the citation. You
never know what physician will need
and use that reference later on.” Moore
encourages all dermatologists with an
interest in publication to find a computer
software program that will automatically
format references or convert
citations from one format to another.
Part of the burden of creating adequate
references is the gracious art of
giving credit where credit is due. A
solid bibliography is less an act of
scholarly discipline than an acknowledgement
of others whose work has
influenced the author.
WHAT TO EXPECT
Much material that gets published
in the world of scholarly dermatology
involves a stringent review process,
usually by other experts in the field.
They are free to analyze and critique
anything from the data to the illustrations
to the wording of a particular
sentence.
“You can’t be thin-skinned as an
author,” Moore advised. “Fortunately,
the peer-review process is a great
safety net for us, and most authors
come to respect the process.The most
onerous part of review is the time it
takes. Depending on the publication,
it can take weeks or even months for
a finished article to get through
review. That can be hard on the
author and others who want to see
the material in print.”
Even after an article is accepted
for publication, it can take many
more months before it actually
appears.“That’s why I like poster presentations
so much,” Moore commented.
“It’s a fast-track to get the
ideas published and into discussion.”
Presentations and even continuing
medical education (CME) activities
can also net faster results than the traditional
journal article.
Another trajectory for a physicianauthor
is to initially develop a live presentation
that later becomes a poster or
an article. Most dermatologists who
enter the world of publishing find it
engaging, rewarding, and invigorating,
once they learn the ropes.
“Physician Resources strives to
continue to raise awareness of the
important role of the dermatologist,”
Stacey Moore said about her business,
which opened two years ago and works
only with dermatologists.“We want to
help facilitate the process of communicating
the latest ideas in dermatologic
treatment and prevention. It is my hope
that this will ultimately impact the dermatologic
patient in a positive way to
enhance his or her care.” ■
Jo Ann LeQuang is a freelance medical
writer based in Angleton, Texas. Contact
Jo Ann at LeQ Medical, 1216 N.Velasco
Street, Suite J, Angleton, TX 77515;
telephone 979-864-4479; fax 979-864-
3930; e-mail joann@leqmedical.com.

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