Dermatology

Dermatology is the branch of medicine dealing with the skin.[1][2] It is a speciality with both medical and surgical aspects.[3][4][5] A dermatologist is a specialist doctor who manages diseases related to skin, hair and nails and some cosmetic problems.[2][6]

For the journal, see Dermatology (journal).
"Dermatologic surgery" redirects here. For the journal, see Dermatologic Surgery (journal).
Dermatology
SystemSkin
Significant diseasesSkin cancer, Skin infections, eczemas
Significant testsSkin biopsy
SpecialistDermatologist

Etymology

Attested in English in 1819, the word dermatology derives from the Greek δέρματος (dermatos), genitive of δέρμα (derma), "skin"[7] (itself from δέρω dero, "to flay"[8]) and -λογία -logia.

History
Main article: History of dermatology

In 1801 the first great school of dermatology became a reality at the famous Hôpital Saint-Louis in Paris, and the first textbooks (Willan's, 1798–1808) and atlases (Alibert's, 1806–1814) appeared in print around the same time.[9]

Training
Dermatologist
Occupation
NamesDoctor, Medical Specialist
Occupation type
Specialty
Activity sectors
Medicine
Description
Education required
Doctor of Medicine (M.D.) or
Doctor of Osteopathic Medicine (D.O.) or
Bachelor of Medicine, Bachelor of Surgery
Fields of
employment
Hospitals, Clinics

United States

After earning a medical degree (M.D. or D.O.), the length of training in the United States for a general dermatologist to be eligible for Board Certification by the American Academy of Dermatology, American Board of Dermatology or the American Osteopathic Board of Dermatology is a total of four years. This training consists of an initial medical, transitional, surgical, or pediatric intern year followed by a three-year dermatology residency.[2][10][11] Following this training, one- or two- year post-residency fellowships are available in immunodermatology, phototherapy, laser medicine, Mohs micrographic surgery, cosmetic surgery, dermatopathology, or pediatric dermatology. For the past several years, dermatology residency positions in the United States have been one of the most competitive to obtain.[12][13][14]

The United States has been experiencing a national shortage of dermatologists for more than a decade. A study published by the Journal of the American Medical Association reported fewer than 3.4 dermatologists for every 100,000 people.[15]

United Kingdom

In the UK, a dermatologist is a medically qualified practitioner who has gone on to specialize in medicine and then sub-specialize in dermatology. This involves:

  • Medical school for five years to obtain an MBBS, MBBCh or MB, BChir degree
  • One year of house jobs before becoming fully registered as a medical practitioner
  • Two to three years training in general medicine to obtain a higher degree in medicine and become a member of the Royal College of Physicians
  • Having obtained the MRCP examination, applying to become a Specialty Registrar (StR) in Dermatology and training for four years in dermatology
  • Passing the Specialty Certificate Examination (SCE) in Dermatology before the end of training

Upon successful completion of the four-year training period, the doctor becomes an accredited dermatologist and is able to apply for a consultant hospital post as a consultant dermatologist.

Fields

Cosmetic dermatology
A Cosmetic dermatology unit in SM City North Edsa, Philippines

Dermatologists have been leaders in the field of cosmetic surgery.[16] Some dermatologists complete fellowships in surgical dermatology. Many are trained in their residency on the use of botulinum toxin, fillers, and laser surgery. Some dermatologists perform cosmetic procedures including liposuction, blepharoplasty, and face lifts.[17][18] Most dermatologists limit their cosmetic practice to minimally invasive procedures. Despite an absence of formal guidelines from the American Board of Dermatology, many cosmetic fellowships are offered in both surgery and laser medicine.[19]

Dermatopathology

A dermatolopathologist is a pathologist or dermatologist who specializes in the pathology of the skin.[20] This field is shared by dermatologists and pathologists. Usually a dermatologist or pathologist will complete one year of dermatopathology fellowship. This usually includes six months of general pathology, and six months of dermatopathology.[21] Alumni of both specialties can qualify as dermatopathologists. At the completion of a standard residency in dermatology, many dermatologists are also competent at dermatopathology. Some dermatopathologists qualify to sit for their examinations by completing a residency in dermatology and one in pathology.

Trichology

Trichology specializes in diseases, which manifest with hair loss, hair abnormalities, hypertrichosis and scalp changes. Trichoscopy is a medical diagnostic method, which is used by dermatologists with a special interest in trichology.

Immunodermatology

This field specializes in the treatment of immune-mediated skin diseases such as lupus, bullous pemphigoid, pemphigus vulgaris, and other immune-mediated skin disorders.[22] Specialists in this field often run their own immunopathology labs.Immunodermatology testing is essential for the correct diagnosis and treatment of many diseases affecting epithelial organs including skin, mucous membranes, gastrointestinal and respiratory tracts.The various diseases often overlap in clinical and histological presentation and, although the diseases themselves are not common, may present with features of common skin disorders such as urticaria, eczema and chronic itch. Therefore, the diagnosis of an immunodermatological disease is often delayed. Tests are performed on blood and tissues that are sent to various laboratories from medical facilities and referring physicians across the United States.

Mohs surgery
Main article: Mohs surgery

The dermatologic subspecialty called Mohs surgery focuses on the excision of skin cancers using a technique that allows intraoperative assessment of most of the peripheral and deep tumor margins developed in the 1930s by Dr. Frederic E. Mohs. The procedure is defined as a type of CCPDMA processing. Physicians trained in this technique must be comfortable with both pathology and surgery, and dermatologists receive extensive training in both during their residency. Physicians who perform Mohs surgery can receive training in this specialized technique during their dermatology residency, but many will seek additional training either through preceptorships to join the American Society for Mohs Surgery[23] or through formal one to two years Mohs surgery fellowship training programs administered by the American College of Mohs Surgery.[24]

This technique requires the integration of the same doctor in two different capacities: surgeon as well as pathologist. In case either of the two responsibilities is assigned to another doctor or qualified health care professional, it will not be considered to be Mohs surgery.

Pediatric dermatology

Physicians can qualify for this specialization by completing both a pediatric residency and a dermatology residency. Or they might elect to complete a post-residency fellowship.[25] This field encompasses the complex diseases of the neonates, hereditary skin diseases or genodermatoses, and the many difficulties of working with the pediatric population.[26]

Teledermatology
Main article: Teledermatology

Teledermatology is a form of dermatological practice where telecommunication technologies are used to exchange medical information and treatment through audio, visual, and data communication, including photos of dermatologic conditions, between dermatologists and non-dermatologists who are evaluating patients, along with dermatologists directly with patients via distance.[27][28][29] This subspecialty deals with options to view skin conditions over a large distance to provide knowledge exchange,[30] to establish second-opinion services for experts,[31] or to use this for follow-up of individuals with chronic skin conditions.[32][33] Teledermatology can reduce wait times by allowing dermatologists to treat minor conditions online while serious conditions requiring immediate care are given priority for appointments.[34]

Dermatoepidemiology

Dermatoepidemiology is the study of skin disease at the population level.[35] One aspect of dermatoepidemiology is the determination of the global burden of skin diseases [36][37] From 1990 to 2013, skin disease constituted approximately 2% of total global disease disability [38] as measured in disability adjusted life years (DALYS).[39]

Therapies
Facial cleansing pores in Meditec at ITESM CCM(2012)

Therapies provided by dermatologists include, but are not restricted to the following:

  • Excision and treatment of skin cancer
  • Cryosurgery – for the treatment of warts, skin cancers, and other dermatoses.
  • Cosmetic filler injections
  • Intralesional treatment – with steroid or chemotherapy.
  • Laser therapy – for both the management of birth marks, skin disorders (like vitiligo), tattoo removal, and cosmetic resurfacing and rejuvenation.
  • Chemical peels for the treatment of acne, melasma, and sun damage
  • Photodynamic therapy – for the treatment of skin cancer and precancerous growths.
  • Phototherapy – including the use of narrowband UVB, broadband UVB, psoralen and UVB.
  • Tattoo removal with laser.
  • Tumescent liposuction – liposuction was invented by a gynecologist. A dermatologist (Dr. Jeffrey A. Klein) adapted the procedure to local infusion of dilute anesthetic called tumescent liposuction. This method is now widely practiced by dermatologists, plastic surgeons and gynecologists.[40]
  • Radiation therapy – although rarely practiced by dermatologists, many dermatologist continue to provide radiation therapy in their office.
  • Vitiligo surgery – Including procedures like autologous melanocyte transplant, suction blister grafting and punch grafting.
  • Allergy testing – 'Patch testing' for contact dermatitis.
  • Systemic therapies – including antibiotics, immunomodulators, and novel injectable products.
  • Topical therapies – dermatologists have the best understanding of the numerous products and compounds used topically in medicine.

Most dermatologic pharmacology can be categorized based on the Anatomical Therapeutic Chemical Classification System, specifically the ATC code D.

gollark: Biotech? To some extent, sure.
gollark: DNA is basically horrible spaghetti code with absolutely no comments and which seems like it may be partly self-modifying.
gollark: If you tweak them at all, they probably stop working properly for unfathomable chemistry/physics reasons.
gollark: I mean, consider enzymes. They can do things which regular non-biochemist chemists could only dream of, and often do multiple functions at once and interact with each other in bizarre ways.
gollark: Much of the foolish human body is like this, because it's hyperoptimized in some ways by a design process which doesn't care if our brains can actually make sense of it.

See also

References
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