Dermatology Explained

Dermatology
Caption:Dermatology
System:Skin
Diseases:Skin cancer, skin infections, eczemas, burn
Tests:Skin biopsy
Specialist:Dermatologist

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 medical doctor who manages diseases related to skin, hair, nails, and some cosmetic problems.[6]

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. Neo-Latin dermatologia was coined in 1630, an anatomical term with various French and German uses attested from the 1730s.[9]

History

See main article: History of dermatology. In 1708, 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, 1806–1816) appeared in print around the same time.[10]

Training

Dermatologist
Official Names:Doctor, Medical Specialist
Type:Specialty
Activity Sector:Medicine, surgery
Formation:Doctor of Medicine (M.D.) or
or
Employment Field: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 American Osteopathic Board of Dermatology is four years.[11] This training consists of an initial medical, transitional, surgical, or pediatric intern year followed by a three-year dermatology residency.[12] [13] 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. While these dermatology fellowships offer additional subspecialty training, many dermatologists proficiently provide these services without subspecialty fellowship training. For the past several years, dermatology residency positions in the United States have been one of the most competitive to obtain.[14] [15] [16]

According to the American Academy of Dermatology, dermatologists are trained to diagnose and manage over 3,000 distinct skin, hair, and nail conditions across patients spanning various age groups.[17]

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.[18]

United Kingdom

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

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.[19]

Fields

Cosmetic dermatology

Dermatologists have been leaders in the field of cosmetic surgery.[20] 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.[21] [22] 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.[23]

Dermatopathology

See main article: Dermatopathology. A dermatopathologist is a pathologist or dermatologist who specializes in the pathology of the skin.[24] This field is shared by dermatologists and pathologists. Usually, a dermatologist or pathologist completes one year of dermatopathology fellowship. In 2022, the market size was valued at a substantial $0.6 billion,[25] and according to market projections, it is estimated to expand at a compound annual growth rate (CAGR) of 11.4% from 2022 to 2030. This usually includes six months of general pathology and six months of dermatopathology.[26] 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

See main article: Trichology. Trichology specializes in diseases, which manifest with hair loss, hair abnormalities, hypertrichosis and scalp changes. Trichoscopy is a medical diagnostic method that is used by dermatologists with a special interest in trichology.[27]

Immunodermatology

See main article: 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.[28] 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.[29]

Mohs surgery

See 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 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 seek additional training either through formal preceptorships to become fellows of the American Society for Mohs Surgery[30] or through one-year Mohs surgery fellowship training programs administered by the American College of Mohs Surgery.[31] In 2020, the American Board of Dermatology (ABD) received approval from the American Board of Medical Specialties (ABMS) to establish a board-certification exam in the subspecialty of Micrographic Dermatologic Surgery (Mohs Surgery). The exam was first offered in October 2021 to any US board-certified dermatologist who practices Mohs surgery, regardless of whether they received their training in dermatology residency or as part of a fellowship.[32]

This technique requires the integration of the same doctor in two different capacities - surgeon and pathologist. In case either of the two responsibilities is assigned to another doctor or qualified health-care professional, it is not 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.[33] This field encompasses the complex diseases of the neonates, hereditary skin diseases or genodermatoses, and the many difficulties of working with the pediatric population.[34]

Teledermatology

See main article: Teledermatology. Teledermatology is a form of dermatological practice in which telecommunication technologies are used to exchange medical information and treatment through audio, visual, and data communication, including photos of dermatologic conditions, between dermatologists and nondermatologists who are evaluating patients, along with dermatologists directly with patients via distance.[35] [36] [37] In India, during the severe coronavirus situations, some dermatologists have initiated online consultation with their patients using some of popular apps, such as Practo, Apollo Pharmacy, Skin Beauty Pal, Lybrate, etc. This subspecialty deals with options to view skin conditions over a large distance to provide knowledge exchange,[38] to establish second-opinion services for experts,[39] or to use this for follow-up of individuals with chronic skin conditions.[40] [41] Teledermatology can reduce wait times by allowing dermatologists to treat minor conditions online while serious conditions requiring immediate care are given priority for appointments.[42]

Dermatoepidemiology

Dermatoepidemiology is the study of skin disease at the population level.[43] One of its aspects is the determination of the global burden of skin diseases.[44] [45] From 1990 to 2013, skin disease constituted about 2% of total global disease disability [46] as measured in disability-adjusted life-years.[47]

Therapies

Therapies provided by dermatologists include:

Most dermatologic pharmacology can be categorized based on the Anatomical Therapeutic Chemical (ATC) classification system, specifically the ATC code D.

See also

Notes and References

  1. Random House Webster's Unabridged Dictionary. Random House, Inc. 2001. Page 537. .
  2. Web site: What is a dermatologist? . 2008-11-27 . https://web.archive.org/web/20081216054753/http://www.aad.org/public/specialty/what.html . 2008-12-16.
  3. Web site: Dermatology Procedures - American Osteopathic College of Dermatology (AOCD). www.aocd.org.
  4. Web site: What is a dermatologist; what is dermatology. DermNet NZ . Dermnetnz.org . 2009-06-15 . 2012-10-28.
  5. Web site: What is a Dermatologist . Dermcoll.asn.au . 2012-10-28 . dead . https://archive.today/20120525085929/http://www.dermcoll.asn.au/public/what_is_a_dermatologist.asp . 2012-05-25 .
  6. Web site: Welcome to the American Academy of Dermatology . American Academy of Dermatology. www.aad.org.
  7. https://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.04.0057%3Aentry%3Dde%2Frma δέρμα
  8. https://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.04.0057%3Aentry%3Dde%2Frw δέρω
  9. Janssen. Diederik F.. 2021-04-04. Dermatology: coinage of the term by Johann Heinrich Alsted (1630). International Journal of Dermatology. 60. 7. en. 877–878. 10.1111/ijd.15551. 33817784. 233026849. 0011-9059.
  10. Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill Professional. Page 3. .
  11. Web site: What is a dermatologist? . 2022-03-23 . www.aad.org . en.
  12. Web site: American Board of Dermatology . Abderm.org . 2012-10-28 . https://web.archive.org/web/20130610234130/http://www.abderm.org/residency.html . 2013-06-10 . dead .
  13. Web site: American Osteopathic College of Dermatology - Qualifications Overview . Aocd.org . 2012-10-28 . dead . 2012-10-15 . https://web.archive.org/web/20121015061926/http://www.aocd.org/qualify/board_certification.html.
  14. The academic strength of current dermatology residency applicants. ...has been the most competitive of all specialties for at least the last 5-6 years as seen by results published by the Electronic Residency Application Service (ERAS).. Wu JJ, Tyring SK . Dermatology Online Journal . 2003 . 9. 3. 22. 10.5070/D340v593q5. 12952769 .
  15. Dermatology Residency Program Characteristics That Correlate With Graduates Selecting an Academic Dermatology Career. Dermatology continues to be the most competitive residency to enter... . Wu JJ, Ramirez CC, Alonso CA, Mendoza N, Berman B, Tyring SK . Archives of Dermatology. July 2006. 142. 7. 845–850 . 10.1001/archderm.142.7.845. 16847199 .
  16. News: For Top Medical Students, an Attractive Field . The New York Times . Natasha . Singer . 2008-03-19 . 2010-05-01.
  17. Web site: 2019-12-10 . What Is Dermatology? . 2023-05-26 . Castle Connolly . en.
  18. Analysis of Trends in Geographic Distribution and Density of US Dermatologists. American Medical Association. 2017-04-01. 10.1001/jamadermatol.2016.5411. Glazer. Alex M. . Farberg. Aaron S. . Winkelmann. Richard R.. Rigel. Darrell S.. JAMA Dermatology. 153 . 4. 322–325. 28146246. 9283682.
  19. Web site: 2015-04-07 . Dermatology . 2023-05-26 . healthcareers.nhs.uk . en.
  20. James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology (10th ed.). Saunders. Page 895. .
  21. Web site: Dayton Skin Care Specialists: Fellowship Information . Daytonskinsurgery.org . 2012-10-28 . https://web.archive.org/web/20120928023900/http://www.daytonskinsurgery.org/fellowship.html . 2012-09-28 . dead.
  22. Web site: UC Davis Health System, Department of Dermatology . ACGME Micrographic Surgery and Dermatologic Oncology Fellowship . Ucdmc.ucdavis.edu . 2010-04-21 . 2012-10-28.
  23. Web site: Dermatology . 2023-05-26 . medicalexpert.com . en.
  24. Web site: What is dermatopathology? Diagnosing disorders of the skin - David Geffen School of Medicine - Los Angeles, CA. medschool.ucla.edu. 2 December 2016 . 2018-09-06.
  25. Web site: Third Party Derma Manufacturer India - GaryPharma. 18 December 2023 .
  26. Web site: Dermatopathology Fellowship Goals and Objectives with General Competencies . 2005-06-17 . 2012-10-28.
  27. Wang EH, Monga I, Sallee BN, Chen JC, Abdelaziz AR, Perez-Lorenzo R, Bordone LA, Christiano AM. Primary cicatricial alopecias are characterized by dysregulation of shared gene expression pathways . PNAS Nexus . 1 . 3 . pgac111 . Jul 2022 . 35899069 . 10.1093/pnasnexus/pgac111. 9308563 .
  28. Web site: Disease List - U of U School of Medicine - University of Utah. medicine.utah.edu. en. 2017-02-05. 2022-01-26. https://web.archive.org/web/20220126044148/https://medicine.utah.edu/dermatology/labservices/immunodermatology/services/disease-list.php. dead.
  29. Web site: 2022-11-01 . Immunodermatology Laboratory . 2023-05-26 . Dermatology U of U School of Medicine . en-US.
  30. Web site: About ASMS. American Society for Mohs Surgery.
  31. Web site: The Mohs College Difference . Mohscollege.org . 2012-10-28 . 2011-05-12 . https://web.archive.org/web/20110512214738/http://www.mohscollege.org/acms/difference.php . dead .
  32. Web site: MDS Exam . abderm.org . 2021-10-30 . 2021-12-02 . https://web.archive.org/web/20211202210214/https://www.abderm.org/public/announcements/mds-subspecialty-certification-exam-study-guide-and-faqs.aspx . dead .
  33. Web site: Subspecialty Certification in Pediatric Dermatology . . The American Board of Dermatology . October 30, 2014.
  34. Web site: Pediatric Dermatology . . Medscape . June 22, 2018.
  35. Burg G, Soyer H.P, Chimenti S. (2005): Teledermatology In: Frisch P, Burgdorf W.: EDF White Book, Skin Diseases in Europe. Berlin, 130-133
  36. Douglas A. Perednia, M.D., Nancy A. Brown, M.L.S., OregonHealthSciencesUniversity Teledermatology: one application of telemedicine
  37. Ford. Adam R.. Gibbons. Caitlin M.. Torres. Josefina. Kornmehl. Heather A.. Singh. Sanminder. Young. Paulina M.. Chambers. Cindy J.. Maverakis. Emanual. Dunnick. Cory A.. Armstrong. April W.. 2019. Access to Dermatological Care with an Innovative Online Model for Psoriasis Management: Results from a Randomized Controlled Trial. Telemedicine and e-Health. en. 25. 7. 619–627. 10.1089/tmj.2018.0160. 1530-5627. 6417973. 30222518.
  38. Web site: DermNet NZ – All about the skin - DermNet NZ. www.dermnetnz.org.
  39. Web site: telederm.org - dermatological advice on a click!. www.telederm.org.
  40. Ebner et al. 2006 e&i
  41. H. Peter Soyer, Rainer Hofmann-Wellenhof, Cesare Massone, Gerald Gabler, Huiting Dong, Fezal Ozdemir, Giuseppe Argenziano telederm.org: Freely Available Online Consultations in Dermatology
  42. Web site: Agency for Healthcare Research and Quality . Online Visits With Dermatologists Enhance Access to Care for Patients With Minor and Serious Skin Conditions, Boost Physician Productivity . 2013-11-06 . 2013-11-06.
  43. Barzilai. DA. Freiman. A. Dellavalle. RP. Weinstock. MA. Mostow. EN. Dermatoepidemiology.. Journal of the American Academy of Dermatology. Apr 2005. 52. 4. 559–73; quiz 574–8. 15793504. 10.1016/j.jaad.2004.09.019.
  44. Web site: The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions . . 1 November 2013 . IHME. 31 January 2017 .
  45. Web site: Global Burden of Disease. W.H.O. Global Burden of Disease/en/. 7 October 2015.
  46. Web site: IHME Data Visualization: Compare. 22 April 2014. 7 October 2015.
  47. Murray. CJ. Quantifying the burden of disease: the technical basis for disability-adjusted life years.. Bulletin of the World Health Organization. 1994. 72. 3. 429–45. 8062401. 2486718.
  48. Web site: Liposuction - Who Invented Liposuction? . http://webarchive.loc.gov/all/20081107040140/http://inventors.about.com/od/lstartinventions/a/liposuction.htm . dead . 2008-11-07 . Inventors.about.com . 2012-04-09 . 2012-10-28 .

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