What is dermatology?

Dermatology is an area of medicine concerned with the health of the skin, as well as diseases of the hair, nails and mucous membranes.The skin is the largest organ of the body, covering a total area or around 20 square feet in the average adult. It is the first line of defense against bacteria and injury, and often reflects the overall health of the body.A study conducted by the Mayo Clinic, published in 2013, reported that 42.7% of patients visited their doctors at some point due to a skin disorder. Disorders of the skin, hair, nails and mucous membranes are managed through investigations and therapies that include histopathology, immunotherapy, laser therapy, medication, phototherapy, radiotherapy and surgery (including cosmetic procedures).
Dermatologist qualifications
There are at minimum four stages of training required to become a dermatologist in the US. Firstly, anyone wishing to become a dermatologist must earn a college degree. Secondly, they must graduate from medical school, either becoming a medical doctor (MD) or doctor of osteopathic medicine (DO).Following this, the doctor must complete a one-year internship in a hospital or clinic to get hands-on medical experience. For trainee dermatologists, this internship is often carried out in an associated field, such as general surgery, internal medicine, family medicine, emergency medicine or pediatrics.Once the internship is complete, the trainee dermatologist can enter into a dermatology residency program. They are then known as a dermatology resident and receive training in surgical procedures, diagnosis and treatment for the vast array of conditions that they will go on to face, all while seeing patients. Residency programs run for at least 3 years.After successfully completing a dermatology residency, the resident can take their dermatology board exams to become a board-certified dermatologist. Board exams have to be retaken every 10 years to
ensure that dermatologists stay up to date with the advances made within the specialty over time.If a dermatologist wishes to specialize in a particular subspecialty of dermatology, such as cosmetic dermatology or Mohs surgery (a form of skin cancer treatment), they can continue their studies and take a fellowship that allows them to engage in extensive medical study in one particular area.Some dermatologists have the initials FAAD after their name, which stands for “Fellow of the American Academy of Dermatology.” These initials indicate that the dermatologist:

Is licensed to practice medicine


Has passed exams given by either the American Board of Dermatology or the
Royal College of Physicians and Surgeons of Canada

Is a member of the American Academy of Dermatology.
Common conditions treated
5
Dermatologists need to have a great depth of clinical knowledge, including knowledge of the basic
sciences and all other medical specialties. This is because they need to be aware of the numerous internal
conditions that can cause skin manifestations.
Even within their own speciality dermatologists have a great deal to contend with. Here are some
examples of the more common conditions dermatologists treat:

Vitiligo is a condition in which the skin loses melanin, leading to the development of
patches of lighter colored skin.

Acne:
a disease affecting the skin’s oil glands, acne is the most common skin
condition in the US. It has a number of possible underlying causes that lead to
the formation of many different kinds of
pimples. Acne can result in
depression,
low self-esteem, and scarring.
9,10

Dermatitis and eczema:
inflammation
of the skin, typically involving
swelling with an itchy rash. Dermatitis comes in many different forms, including
atopic dermatitis (often referred to as
eczema
), contact dermatitis and seborrheic
dermatitis.
11,12

Fungal infections:
affecting the skin, nails, and hair, these infections are
common and symptoms are normally mild. However, in people with weakened

immune systems they can be more serious. A group of yeasts called
Candida
can
cause a wide range of infections, including
oral thrush
and
balanitis
.
13,14

Hair disorders:
people of all genders can experience
hair loss, which may
be a result of an underlying condition, alopecia or an isolated issue.
Hereditary
hair loss
affects 80 million men and women in the US. The hair can
also be affected by head lice – around 6-12 million children aged 3-12 get head
lice in the US every year.
15-17

Nail problems:
conditions affecting the nails make up around 10% of all
dermatological conditions. Approximately half of these are fungal infections, with
ingrown nails also quite common. Nail problems can be indicative of other
underlying conditions, with the nails often reflecting overall health.
18,19

Psoriasis:
a chronic, autoimmune skin disorder that speeds up the growth of
skin cells, resulting in thick red skin and silvery scales. There are several different
types of
psoriasis, which can sometimes have a similar appearance to eczema,
meaning that it is important for a dermatologist to make a proper diagnosis.
20,21

Rosacea:
a skin condition that causes redness in the face, akin to blushing or
flushing. It often causes small, pus-filled bumps to appear, and can also lead to
visible blood vessels and swollen eyelids.
Rosacea
can spread from the nose—-

Biopsies:
skin biopsies are primarily carried out to diagnose or rule out
certain skin conditions. There are three main types of skin biopsy that are
commonly performed: shave biopsies remove small sections of the top layer of
skin, punch biopsies remove small circular section including deeper layers, and
excision biopsies remove entire areas of abnormal-looking skin.
33,34

Chemical peels:
a chemical solution is applied to the skin. It causes a layer
of skin to separate and peel off over the course of up to two weeks, leaving a
layer of regenerated skin underneath that is typically smoother. Dermatologists
can use this procedure to treat sun-damaged skin and some types of acne, as
well as more cosmetic complaints, such as age spots and lines under the
eyes.
35,36

Cosmetic injections:
wrinkles, scarring and lost facial fullness can be
temporarily treated with injections to diminish the signs of aging. Botulinum toxin
therapy or fillers such as
collagen
and fat can be injected by dermatologists
during office visits. Results of this treatment tend to last for a few months, and so
injections need to be repeated periodically, although some people can develop
antibodies to Botox that make repeat treatments ineffectual.
37,38

Cryotherapy:
a quick and common form of treatment for many benign skin
conditions such as warts. Skin lesions are frozen, often using liquid nitrogen, in
order to destroy affected skin cells. Dermatologists can perform cryotherapy in
their offices.
39

Dermabrasion:
another procedure to change the appearance of the skin.
Using a high-speed rotating brush, a dermatologist removes the top layer of skin,
surgically sloughing off scar tissue, fine wrinkles, tattoos and potentially
precancerous skin patches.
40,41

Excisions of lesions:
skin lesions can be excised for several reasons; to
prevent disease from spreading, for cosmetic reasons, to prevent repeat
infection, to alleviate symptoms and for diagnosis. Depending on the size of the
lesion, local or general anesthetic can be used to numb the area.
42

Hair removal and restoration:
Hair loss can be treated with hair
transplantation or surgery to the scalp. Unwanted body hair can be removed with
laser hair epilation or electrolysis to destroy hair follicles.
43,44

Laser surgery:
dermatologists can use special light beams to remove a
variety of skin complaints. These include, but are not limited to, tumors, warts,
moles, tattoos, birthmarks, scars, wrinkles and unwanted hair.
45

Mohs surgery:
a specific type of surgery for the treatment of skin cancer.
Layers of skin are removed and examined under microscope in order to get rid of
cancerous cells. Successive layers are removed until the surgeon is unable to find
any
cancer
cells. Mohs surgery is only performed by Mohs surgeons –
dermatologists who have completed specific additional medical training.
46

PUVA:
an initialism that stands for “psoralen combined with ultraviolet A
(UVA)” treatment. Psoralen is a drug that sensitizes the skin to radiation
treatment. PUVA is used to treat severe skin diseases such as
psoriasis
,
dermatitis, and
vitiligo
.
3,47

Skin grafts and flaps:
dermatologists can repair parts of the body where
skin is missing, possibly due to other surgery or an injury, using skin from
elsewhere on the body. Skin can either be grafted, using a free piece of tissue
without its own blood supply, or a skin flap can be created from skin tissue
adjacent to the area of skin loss.
48


Tumescent liposuction:
Liposuction is the removal of excess fat from the
body. Dermatologists typically use a process called tumescent liposuction to do
this, whereby large volumes of local anesthetic are injected into the fatty tissue
being removed. The tissue is then sucked out of the body. Tumescent liposuction
should not be considered a treatment for
obesity
, rather a procedure for body
contouring. The process can be aided further with the use of lasers to selectively
burst fat cells and help remove tumescent fluid.
49,50

Vein therapy:
superficial leg veins – also known as spider veins – are small,
dilated surface veins that may look unsightly. Sclerotherapy is a minimally
invasive procedure that is usually the preferred treatment for spider veins.
Dermatologists insert either foam or a solution into the vein which irritates the
lining and causes it to shut. The vein becomes less distinct or disappears
completely.
51,52
When to see a dermatologist
1
A dermatologist should be consulted by anyone with symptoms of a disease affecting the skin, hair, nails
or mucous membranes. A dermatologist can also be consulted by anyone with more cosmetic concerns
about the appearance of their skin, hair and nails – in this instance, a specialized cosmetic dermatologist
may be preferable.
Particular conditions or concerns warrant referral to or consultation with specific types of dermatologist,
such as: Cosmetic dermatologists, who specialize in treatments designed to enhance a person’s
appearance; dermatopathologists, who specialize in diagnosing diseases of the skin, hair, and nails by
examining samples under a microscope; and Mohs surgeons, who specialize in treating skin cancer with
Mohs surgery.

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