Who is a Dermatologist?
Dermatology is the branch of medicine dealing with the skin, nails, hair and its diseases. A dermatologist is a qualified medical practitioner who goes on to specialize in treating diseases of the skin, hair, nails and mucous membranes. Dermatologists are also specialized in the treatment of sexually transmitted infections and diseases, including HIV/AIDS. It is a specialty that has both medical and surgical aspects.
Dermatologist treat over 3,000 diseases including eczema, acne, skin and nail infections, and cosmetic problems of the skin, scalp, hair, and nails. The dermatologist is also trained to recognize systemic diseases which may present with skin signs such as diabetes, liver, kidney and thyroid diseases, among others. Hair loss, scars and skin changes associated with diseases and aging are also managed by the dermatologist.
Becoming a dermatologist after medical school requires specialty rotation in internal medicine, plastic surgery, histopathology, and laboratory medicine, and at least two full years in a dermatology/venereology unit. Training , therefore, spans at least five years.
History of Dermatology
Since the beginning of Medicine, skin diseases have been reported in early Egyptian, Grecian, Roman and Arabian medicine. Ancient records of the 17th and 16th century gave emphasis to skin diseases including cosmetics. Until the 18th century, dermatology was part of general medicine. Early dermatological diseases documented in the literature include alopecia (hair loss), leprosy, white skin, herpes, itching, scabies, boils and syphilis. Some of these were attributed to the activity of demons.
By the middle of the 19th century, Hebra was able to classify skin diseases on a pathological basis, thus inaugurating the modern period of dermatology. Dermatology has come a long way since then and at present, boasts of many subspecialties, all aimed at improving dermatological treatment and practices.
Fields in Dermatology
Dermatologists are trained to manage allergic conditions. They conduct allergic tests to confirm the presence of an allergen, and then treat patients via hyposensitization methods. Allergy tests include skin prick tests, patch test and via ELIZA.
Dermatologists have been leaders in the field of cosmetic surgery. Some dermatologists go ahead to do a further training in cosmetic dermatology which involves botulinum toxin and filler injections, laser surgery, liposuction, blepharoplasty, and face lifts.
These are dermatologists who go on to have specialist training in the field of skin surgery. They deal with the diagnosis and treatment of medical and cosmetic skin, hair, nail, veins and mucous membrane conditions and treat such by various surgical (including lasers), reconstructive, cosmetic and non-surgical methods.
A dermatolopathologist is a pathologist or dermatologist who specializes in the pathology of the skin. 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. Alumni of both specialties can qualify as dermatopathologists.
This field specializes in the treatment of immune-mediated skin diseases such as lupus, bullous pemphigoid, pemphigus vulgaris, and other immune-mediated skin disorders. Specialists in this field often run their own immunopathology labs.
The dermatologic subspecialty called Mohs surgery focuses on the excision of skin cancers using a tissue-sparing technique that allows intraoperative assessment of 100% of the peripheral and deep tumor margins. It was developed in the 1930s by Dr. Frederic E. Mohs. Physicians trained in this technique must be comfortable with both pathology and surgery, and dermatologists receive extensive training in these 2 areas during their residency. This technique requires the integration of the same doctor in two different capacities: surgeon as well as pathologist.
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. This field encompasses the complex diseases of the neonates, hereditary skin diseases or genodermatoses, and the many difficulties of working with the pediatric population.
Teledermatology is a form of dermatology where telecommunication technologies are used to exchange medical information through all kinds of media (audio, visual and also data communication, but typically photos of dermatologic conditions) usually made by non-dermatologists for evaluation off-site by dermatologists).
This subspecialty deals with options to view skin conditions over a large distance to provide knowledge exchange, to establish second-opinion services for experts or to use this for follow-up of individuals with chronic skin conditions. Teledermatology can reduce wait times by allowing dermatologists to treat minor conditions online while serious conditions requiring immediate care are given priority for appointments.
Dermatoepidemiology is the study of skin disease at the population level. One aspect of Dermatoepidemiology is the determination of the global burden of skin diseases From 1990 to 2013, skin disease has constituted approximately 2% of total global disease disability as measured in disability adjusted life years (DALYS).
Common Therapies Provided by DermatologistsTherapies provided by dermatologists include, but are not restricted to the following:
- Cosmetic filler injections
- Hair removal with laser or other modalities
- Hair transplantation – a cosmetic procedure practiced by trained dermatologists.
- Intralesional treatment – with steroid or chemotherapy.
- Laser therapy – for the management of birth marks, skin disorders (like vitiligo), tattoo removal, and cosmetic resurfacing and rejuvenation.
- 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.
- Cryosurgery – for the treatment of warts, skin cancers, and other dermatosis.
- Radiation therapy – although rarely practiced by dermatologists, many dermatologists continue to provide radiation therapy in their office.
- Vitiligo surgery – Including procedures like autologous melanocyte transplant, suction blister grafting and punch grafting.
- Allergy treatment – Avoidance technique or hyposensitization
- 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.