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] The name of this specialty originated in the form of the (semantically wrong) words dermologie (in French, 1764) and, a little later, dermatologia (in Latin, 1777).^[5] A dermatologist takes care of diseases, in the widest sense, and some cosmetic problems of the skin, scalp, hair, and nails.^[3]

History

Readily visible alterations of the skin surface have been recognized since the dawn of history, with some being treated, and some not. 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]

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][6][7] However, following this training, one or two year post-residency fellowships are available in immunodermatology, phototherapy, laser medicine, Mohs micrographic surgery, cosmetic surgery or dermatopathology. Within the past several years, dermatology residencies in the United States have been the most competitive in terms of admission.^[8][9][10] Dermatology Times identified the following dermatology clinics as Clinical Centers of Excellence for 2009, Harvard, Mayo Clinic, Mount Sinai, NYU, UCSF, University of Michigan, UT Houston, and Wake Forest.^[11]. These clinics are similarly ranked in peer-reviewed publications.^[12]

Subspecialties

Cosmetic dermatology

Dermatologists have been leaders in the field of cosmetic surgery.^[13] 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 cosmetic procedures including liposuction, blepharoplasty, and face lifts.^[14][15][16] 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

This is a pathologist who specializes in the pathology of the skin. This field is shared by dermatologists and pathologists. Usually a dermatologist will complete 1 year of dermatopathology fellowship. This usually includes 6 months of general pathology, and 6 months of dermatopathology.^[17] A similar fellowship can be completed by a pathologist. Alumni of both specialties can qualify as a dermatopathologist. At the completion of a standard residency in dermatology, many dermatologist are also competent at dermatopathology. Some dermatopathologists qualify to sit for their examination by completing both a dermatology and a pathology residency.^[18]

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

Mohs Surgery

This dermatologic subspecialty 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. 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^[20] or through formal one to two-year Mohs surgery fellowship training programs administered by the American College of Mohs Surgery^[21].

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.^[22] This field encompasses the complex diseases of the neonates, hereditary skin diseases or genodermatoses, and the many difficulty working with the pediatric population.^{[citation needed]}

Teledermatology

Teledermatology is a form of dermatology where telecommunication technologies are used to exchange medical information using 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).^[23][24] This subspecialty deals with options to view skin conditions over a large distance to provide knowledge exchange^[25], to establish second opinion services for experts^[26] or to use this for follow-up of individuals with chronic skin conditions^[27][28].

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.^[29]

• 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.
• 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 skin diseases
• Skin disease
• Skin lesion

Notes

External links

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