Dermatology

Dermatologist

Occupation
Names	Doctor, Medical Specialist
Activity sectors	Medicine
Description
Education required	Doctor of Medicine, Doctor of Osteopathic Medicine

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] A dermatologist takes care of diseases, in the widest sense, and some cosmetic problems of the skin, scalp, hair, and nails.^[3]

Etymology

Coined in English 1819, the word dermatology originated in the form of the words dermologie (in French, 1764) and, a little later, dermatologia (in Latin, 1777).^[5] The term derives from the Greek "δέρματος" (dermatos), genitive of "δέρμα" (derma), "skin"^[6] (from "δέρω" – dero, "to flay"^[7]) + "-logy, "the study of", a suffix derived from "λόγος" (logos), amongst others meaning "speech, oration, discourse, quote, study, calculation, reason",^[8] in turn from "λέγω" – lego, "to say", "to speak".^[9]

History

Main article: History of dermatology

Readily visible alterations of the skin surface have been recognized since the dawn of history, with some being treated, and some not.^{[citation needed]} In 1801 the first great school of dermatology became a reality at the famous Hôpital Saint-Louis in Paris, while the first textbooks (Willan's, 1798–1808) and atlases (Alibert's, 1806–1814) appeared in print during the same period of time.^[5] In 1952, Dermatology was greatly advanced by Dr. Norman Orentreich's pioneering work in hair transplantation.

Training

After earning a medical degree (M.D. or D.O.), the length of training for a general dermatologist in the United States is a total of four years. This training consists of an initial medical or surgical intern year followed by a three-year dermatology residency.^[3][10][11] Following this training, one- or two- year post-residency fellowships are available in immunodermatology, phototherapy, laser medicine, Mohs micrographic surgery, cosmetic surgery or dermatopathology. For the past several years, dermatology residency positions in the United States have been one of the most competitive to obtain.^[12][13][14]

Subspecialties

Cosmetic dermatology

Dermatologists have been leaders in the field of cosmetic surgery.^[15] Some dermatologists complete fellowships in surgical dermatology. Many are trained in their residency on the use of botox, fillers, and laser surgery. Some dermatologists perform cosmetic procedures including liposuction, blepharoplasty, and face lifts.^[16][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.^{[citation needed]}

Dermatopathology

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.^[19] 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.^[20]

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.^[20][21] Specialists in this field often run their own immunopathology labs.^{[citation needed]}

Mohs surgery

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 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^[22] or through formal one- to two-year Mohs surgery fellowship training programs administered by the American College of Mohs Surgery.^[23]

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.^[24] This field encompasses the complex diseases of the neonates, hereditary skin diseases or genodermatoses, and the many difficulties of working with the pediatric population.^{[citation needed]}

Teledermatology

Teledermatology is a form of dermatology where telecommunication technologies are used to exchange medical information via 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).^[25][26] This subspecialty deals with options to view skin conditions over a large distance to provide knowledge exchange,^[27] to establish second-opinion services for experts^[28] or to use this for follow-up of individuals with chronic skin conditions.^[29][30]

Therapies

Therapies provided by dermatologists include, but not restricted to:

• Cosmetic filler injections
• Hair removal with laser or other modalities
• Hair transplantation – a cosmetic procedure practiced by many dermatologists.
• 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.
• 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.^[31]
• Cryosurgery – for the treatment of warts, skin cancers, and other dermatosis.
• 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.

See also

• History of dermatology
• List of dermatologists
• List of cutaneous conditions
• Skin disease
• Skin lesion

Notes

1. ^ Random House Webster's Unabridged Dictionary. Random House, Inc. 2001. Page 537. ISBN 037572026.
2. ^ http://dermnetnz.org/dermatologist.html
3. ^ ^{a b c} http://www.aad.org/public/specialty/what.html
4. ^ http://www.dermcoll.asn.au/public/what_is_a_dermatologist.asp
5. ^ ^{a b} Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill Professional. Page 3. ISBN 0071380760.
6. ^ δέρμα, Henry George Liddell, Robert Scott, A Greek-English Lexicon, on Perseus Digital Library
7. ^ δέρω, Henry George Liddell, Robert Scott, A Greek-English Lexicon, on Perseus Digital Library
8. ^ λόγος, Henry George Liddell, Robert Scott, A Greek-English Lexicon, on Perseus Digital Library
9. ^ λέγω, Henry George Liddell, Robert Scott, An Intermediate Greek-English Lexicon, on Perseus Digital Library
10. ^ http://www.abderm.org/residency.html
11. ^ http://www.aocd.org/qualify/board_certification.html
12. ^ Wu JJ, Tyring SK. ""...has been the most competitive of all specialties for at least the last 5-6 years." This is confirmed by data from the electronic residency application service (ERAS).". http://dermatology.cdlib.org/93/editorial/residency/wu2.html. Retrieved 2007-06-23. 
13. ^ Wu JJ, Ramirez CC, Alonso CA, et al.. ""Dermatology continues to be the most competitive residency to enter..." Arch Dermatol. 2006;142:845-850.". http://archderm.ama-assn.org/cgi/content/full/142/7/845. Retrieved 2007-06-25. 
14. ^ Singer, Natasha (2008-03-19). "For Top Medical Students, an Attractive Field". The New York Times. http://www.nytimes.com/2008/03/19/fashion/19beauty.html?_r=1&hp=&pagewanted=print&oref=slogin. Retrieved 2010-05-01. 
15. ^ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology (10th ed.). Saunders. Page 895. ISBN 0721629210.
16. ^ http://www.derm.net/sv_cosmetic_surgery.shtml
17. ^ http://www.daytonskinsurgery.org/fellowship.html
18. ^ http://www.ucdmc.ucdavis.edu/dermatology/education/fellowship.html
19. ^ uwpathology.org/academics/residency/fellowship/DermGoals.pdf
20. ^ ^{a b} http://www.abderm.org/qualification.html
21. ^ http://www.mayo.edu/msgme/immunderm-rch.html
22. ^ http://www.mohssurgery.org/New/Patient_publicResources/PhysicianTraining.html
23. ^ http://www.mohscollege.org/acms/difference.php
24. ^ http://www.abderm.org/subspecialties/pediatric.htm
25. ^ Burg G, Soyer H.P, Chimenti S. (2005): Teledermatology In: Frisch P, Burgdorf W.: EDF White Book, Skin Diseases in Europe. Berlin, 130-133
26. ^ Douglas A. Perednia, M.D., Nancy A. Brown, M.L.S., OregonHealthSciencesUniversity Teledermatology: one application of telemedicine
27. ^ DermNet NZ: the dermatology resource
28. ^ The Community for Dermatology | Teledermatology
29. ^ Ebner et al. 2006 e&i
30. ^ H. Peter Soyer, Rainer Hofmann-Wellenhof, Cesare Massone, Gerald Gabler, Huiting Dong, Fezal Ozdemir, Giuseppe Argenziano telederm.org: Freely Available Online Consultations in Dermatology
31. ^ http://inventors.about.com/od/lstartinventions/a/liposuction.htm

External links

• American History of Dermatology Society
• French Society for the History of Dermatology
• American Academy of Dermatology
• Society of Investigative Dermatology