Dermatology:
Dermatology is the branch of medicine dealing with the skin and its diseases.[1], a unique specialty with both medical and surgical aspects.[2][3][4]
[edit] What Do Dermatologists Offer?
Most often, a deeper insight into the diagnosis of systemic diseases with skin manifestation. A dermatologist can offer non-invasive testing such as patch testing for contact allergens, skin scrapings for parasites and fungus, cytologic preps for Tzanck test, and simple diagnostics such as hair exam and hair count. The most significant contribution dermatologist makes to medicine is the ability to perform a skin biopsy with the proper pre-surgical history, clinical exam, and post-surgical evaluation of the pathologic report. While many internists and family doctors perform skin biopsy, without the proper documentation and communication - a pathologist often can not come to the correct diagnosis with the same piece of skin.
For the patient, a dermatologist can provide skin cancer screening[5], often utilizing a method called dermatoscopy. He or she can guide the patient on proper skin care in the management of skin disorders from childhood until senescence.
From the cosmetic surgical standpoint - dermatologists are often at the frontier in the field of laser medicine, laser skin resurfacing, liposuction, and skin fillers. From the surgical oncologic standpoint - dermatologists continue to provide outstanding surgical care of skin cancers through Mohs surgery and surgical reconstruction.
[edit] Training
The usual length of training for a dermatologist in the USA is 1 year of rotating medical or surgical internship, followed by 3 years of dermatology residencies.[6][7][8] One to 2 year post-residency fellowships are available in immunodermatology, phototherapy, laser medicine, Mohs micrographic surgery, cosmetic surgery, dermatopathology, or cutanous surgery. More recently, dermatology residencies in the United States are the most competitive in terms of admission.[9][10][11] Because of its unique position in medicine, dermatology continues to attract some of the best and brightest among students. In some countries, dermatologists limit their surgical practice to minor punch biopsies and incisional biopsies. In other countries, dermatologists are fully trained in most aspects of cutanous surgery.
[edit] Subspecialties
[edit] Cosmetic dermatology
Dermatologists have been leaders in the field of cosmetic surgery.[12] Some dermatologist complete fellowships in surgical dermatology. Many are trained in their residency on the use of botox, fillers, and laser surgery. Some dermatologists perform minor cosmetic procedures including liposuction, blepharoplasty, and face lifts.[13][14] [15] Most dermatologists limit their cosmetic practice to minimally invasive procedures. Despite not having any formal guidelines from the American Board of Dermatology, many cosmetic fellowships are offered in both surgery and laser medicine.
[edit] Dermatopathology
This is a pathlogist who specializes in the pathology of the skin. This field is shared by both dermatologists and pathologists. The usual dermatologist will complete 1 year of dermatopathology fellowship. This usually include 6 months of general pathology, and 6 months of dermatopathology.[16] A similar fellowship can be completed by a pathologist. Both specialties can be qualified as a dermatopathologist. At the completion of a standard residency in dermatology, many dermatologist are also competent at dermatopathology. Some dermatopathogists qualify to sit for their examination by completing both a dermatology and a pathlogy residency.[17]
[edit] Immunodermatology
This is a specialist who specializes in the treatment of immune mediated skin diseases such as lupus, bullous pemphigoid, pemphigus vulgaris, and other immune mediated skin disorders.[18][19]
[edit] Mohs Surgery
This specialty owes it origin in the invention of a general surgeon, Dr. Frederick Mohs. Dr. Mohs intended his procedure to be practiced by all surgeons. Unfortunately, his enthusiasm for the Mohs surgery method only attracted physicians comfortable in both pathology and surgery - the dermatologists. Some Mohs surgery receive their training during their residency. Others complete preceptorship through the American Society for Mohs Surgery[20]. Many completed a 1 year fellowship in Mohs surgery after residency. [21] Many physicians perform Mohs surgery through extensive training in their residency or by mentorship.[22] Before formal preceptorship and fellowships were established, Mohs surgeon were trained by spending a week or more with Dr. Frederick Mohs in Mandison, Wisconsin. Established Mohs surgeons are often regarded by their peers as the best reconstructive surgeons in the field. However, many Mohs surgeons do not perform significant reconstructive procedures, preferring to have another surgeon completing the plastic repair and reconstruction.
[edit] 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. [23] This field encompasses the complex diseases of the neonates, hereditary skin diseases or genodermatoses, and the many difficulty working with the pediatric population.
[edit] Therapies
Therapies provided by dermatologists include, but not restricted to:
Phototherapy - including the use of narrowband UVB, broadband UVB, psoralen and UVB.
Photodynamic therapy - for the treatment of skin cancer and precancerous growths.
Laser therapy - for both the management of birth marks, skin disorders (like vitiligo), tattoo removal, and cosmetic resurfacing and rejuvenation.
Hair transplantation - a cosmetic procedure practiced by many dermatologists.
Intralesional treatment - with steroid or chemotherapy.
Cryosurgery - for the treatment of warts, skin cancers, and other dermatosis.
Topical therapies - dermatologists have the best understanding of the numerous products and compounds used topically in medicine.
Radiation therapy - although rarely practiced by dermatologists, many dermatologist continue to provide radiation therapy in their office.
Systemic therapies - including antibiotics, immunomodulators, and novel injectable products.
Most dermatologic pharmacology can be categorized based on the Anatomical Therapeutic Chemical Classification System, specifically the ATC code D.
[edit] See also
[edit] References
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