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Dermatology

[ Learn about the scope of the field, training and qualifications defined. ]

It is a branch of medicine dealing with the skin and its appendages (hair, nails, sweat glands etc). A medical doctor who specializes in dermatology is a dermatologist. The surgical practice of dermatology is dermasurgery.

Scope of the field

Dermatologists are physicians (medical doctors) specializing in the diagnosis and treatment of diseases and tumors of the skin and its appendages. There are medical and surgical sides to the specialty. Dermasurgeons practice skin cancer surgery (including Mohs' micrographic surgery), laser surgery, photodynamic therapy (PDT) and cosmetic procedures using botulinum toxin ('Botox'), soft tissue fillers, sclerotherapy and liposuction. Dermatopathologists interpret tissue under the microscope (histopathology). Pediatric dermatologists specialize in the diagnoses and treatment of skin disease in children. Immunodermatologists specialize in the diagnosis and management of skin diseases driven by an altered immune system including blistering (bullous) diseases like pemphigus. In addition, there are a wide range of congenital syndromes managed by dermatologists.

North American training program: After graduation from a 4-year college, a 4-year medical school and a year of post graduate training in medicine, surgery or pediatrics, a physician may apply for the competitive graduate dermatology residency training. Following the successful completion of formal residency training (3-4 additional years) and a certifying board examination, dermatologists become Diplomates of the American Board of Dermatology. They are then eligible to apply for fellowship status in the American Academy of Dermatology and the American Society of Dermatologic Surgery. Other certifying organizations for those with additional advanced training include the American College of Mohs Micrographic Surgery and Cutaneous Surgery; the American Society for Mohs Surgery; the American Board of Dermatopathology and a similar pediatric organization.

The skin is the largest organ of the body and obviously the most visible. Although many skin diseases are isolated, some are manestations of internal disease. Hence, a dermatologist is schooled in surgery, rheumatology (many rheumatic diseases can feature skin symptoms and signs), immunology, neurology (the "neurocuteaneous syndromes", such as neurofibromatosis and tuberous sclerosis), infectious diseases and endocrinology. The study of genetics is also becoming increasingly important.

Venereology, the subspecialty that diagnoses and treats sexually transmitted diseases, and phlebology, the specialty that deals with problems of the superficial venous system, are both part of a dermatologist's expertise.

Cosmetic dermatology has long been an important part of the field, and dermatologists have been the primary innovators in this area. In the 1900's dermatologists employed dermabrasion to improve acne scarring and fat microtransfer was used to fill in cutaneous defects. More recently, dermatologists have been the driving force behind the development and safe and effective employment of lasers, new dermal filling agents (collagen and hyaluronic acid), botulinum toxin ("Botox"), nonablative laser rejuvenation procedures, intense pulsed light systems, photodynamic therapy, and chemical peeling.

Diagnosis

Any mole that is irregular in color or shape should be examined by a dermatologist to determine if it is a malignant melanoma, the most serious and life-threatening form of skin cancer. Following a visual examination and a dermatoscopic exam (an invaluable new instrument that illuminates a mole without reflected light), a dermatologist may biopsy a suspicious mole. If it is malignant, it will be excised in the dermatologist's office.

The first step of any contact with a physician is the medical history. In order to classify a cutaneous eruption, the dermatologist will ask detailed questions on the duration and temporal pattern of skin problems, itching or pain, relation to food intake, sunlight, over-the-counter creams and clothing. When an underlying disease is suspected, an additional detailed history of related symptoms will be elicited (such as arthritis in a suspected case of lupus erythematosus).
Physical examination is generally done under bright light and preferably involves the whole body. At this stage, the doctor may apply Wood's light, which may aid in diagnosing types of mycosis or demonstrate the extent of pigmented lesions, or use a dermatoscope which enlarges a suspected lesion and visualizes it without reflected light. The dermatoscope is helpful in differentiating a benign naevus from melanoma or a seborrheic keratosis from a mole. A morphological classification of dermatological lesions is important in the diagnosis of dermatological disorders. Dermatologic diagnosis is often dependent upon pattern recognition of lesions and symptoms.

Dermatology has the obvious benefit of having easy access to tissue for diagnosis. Culture or Gram staining of suspected infectious lesions may identify a pathogen and help direct therapy.

If the diagnosis is uncertain or a cutaneous malignancy is suspected, the dermasurgeon may perform a small punch biopsy (using a local anesthetic) for examination under the microscope by the dermatologist who is a trained dermatopathologist.

Therapy

The skin is obviously accessible to topical local therapy. Antibiotic creams can help eliminate infections, while inflammatory skin diseases (such as eczema and psoriasis) often respond to steroid creams or topical anthralin. Dermatologists are innovators of new immune enhancing treatments, like topical imiquimod for superficial cancers and injection immunotherapy for warts as discussed below.

Topical medications treat many dermatological diseases, but dermatologists also use oral medications. Antibiotics and immune suppressants or immune enhanancing agents (injection immunotherapy or topical imiquimod) for dermatological diseases or tumors. Isotretinoin ("Accutane") is used for severe cystic acne vulgaris and often produces a life-time remission of this disfiguring disease. Isotretinoin prescribing in the U.S. is now controlled by a cumbersome FDA governmental website called iPLEDGE.

Photomedicine involves the use of ultraviolet light, often in combination with oral or topical agents, to treat skin disease (eg. psoriasis or mycosis fungoides).

Surgical intervention by dermasurgeons may be necessary, for example, to treat varicose veins or skin cancer. Varicose veins can be treated with sclerotherapy (injecting an agent that obliterates the vein) or the long-pulsed Nd:YAG laser. Skin cancers can be managed with excision (including Mohs micrographic surgery), cryosurgery, x-ray, or, more recently, with the topical immune enhancing agent, imiquimod ("Aldara"). The American Society for Dermatologic Surgery is the dermatologists's professional organization representing the dermasurgery side of this specialty. Dermasurgeons are the expert skin surgeons, having spent a significant part of their residency training years learning this subject.

Also:
• About Acne
• adult acne
• Causes of Acne
• Acne Treatments
• Acne Scars
• Chloracne
• Microdermabrasion

• Basal cell carcinoma
• Skin Cancer

• List of Dermatological Diseases
• Angioma
• Aquagenic pruritus
• Athlete's foot
dermatopathology
skin

• Dermatology
• Dermasurgery - Dermasurgeon
• List of Dermatological Diseases

• Florida Dermatologists
• Miami Dermatologists
• Tampa Dermatologists
• Cape Coral Dermatologists
• Chicago Dermatologists
• Washington DC dermatologists

This article is licensed under the GNU Free Documentation License.
It uses material from the Wikipedia article "Dermatology".