Dermatology

Dermatology is the branch of medicine that specializes in the diagnosis, treatment, and management of diseases and disorders of the skin. The doctor specializing in this discipline is called a "dermatologist." and his work focuses on the clinical, surgical, preventive and therapeutic aspects of the cutaneous organ.

Etymology

The term "dermatology" derives from the Greek δέρματος (dermatos), genitive of δέρμα (derma), "skin"[7] (in turn from δέρω dero, "skin") and -λογία -logia. In 1630 the Neo-Latin dermatology was coined, an anatomical term with various uses in French and German attested from the 1730s.

History

In 1708, the first major school of dermatology came into being at the famous Hôpital Saint-Louis in Paris, and the first textbooks (Willan, 1798–1808) and atlases (Alibert, 1806–1816) appeared in print almost at the same time.

Training

The skin is the largest organ in the body, its large surface area ranging from 1.6 to 2 square meters in adults. Many diseases of this organ appear isolated, however others are externalizations of internal ailments. A doctor who is already a specialist in dermatology is called a dermatologist. To obtain a degree, it is necessary to complete a medical degree and then carry out specialized training in dermatology, which varies in length depending on the country, generally in the European Union it's 4 years. The dermatologist, in addition to knowing how to diagnose and treat skin diseases, has knowledge of surgery and other medical specialties, including rheumatology, immunology, neurology, infectious diseases and endocrinology.

Subspecialties

Cosmetic Dermatology

A Cosmetic Dermatology Unit in SM City North Edsa, Philippines

It is an important field within the specialty. Dermabrasion has been used for several decades to alleviate scars left by acne and microtransfer of fat to fill skin defects, lasers are also used, new dermatological fillers such as collagen and hyaluronic acid, botulinum toxin, intense pulsating light systems, photodynamic therapy and chemical peeling. Some dermatologists perform cosmetic procedures including liposuction, blepharoplasty, and facelift. Most dermatologists limit their cosmetic practice to minimally invasive procedures. In America, despite the absence of formal guidelines from the American Board of Dermatology, many cosmetic fellowships are offered in both surgery and laser medicine.

Dermatopathology

A dermatopathologist is a pathologist or dermatologist who specializes in the pathology of the skin. This field is shared by dermatologists and pathologists. Typically, a dermatologist or pathologist completes one year of a dermatopathology fellowship. This typically includes six months of general pathology and six months of dermatopathology. Trainees in both specialties can qualify as dermatopathologists. Upon completion of a standard dermatology residency, many dermatologists are also proficient in dermatopathology. Some dermatologists qualify to sit for their exams by completing a dermatology residency and a pathology residency.

Trichology

Trichology specializes in conditions manifesting with hair loss, hair abnormalities, hypertrichosis, and scalp changes. Trichoscopy is a medical diagnostic method used by dermatologists with a special interest in trichology.

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. Specialists in this field often direct their own immunopathology laboratories. Immunodermatology tests are essential for the correct diagnosis and treatment of many diseases that affect epithelial organs, such as the 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, they may present with features of common skin disorders, such as urticaria, eczema, and chronic itching. Therefore, the diagnosis of an immunodermatological disease is often delayed. The tests are performed on blood and tissues that are sent to various laboratories from medical centers and referring physicians throughout the United States.

Surgical Dermatology

Surgical Dermatology is a subspecialty of dermatology that is involved in oncological surgical procedures (Mohs micrographic surgery, local and wide excision) and reparative aesthetics (hair transplantation, blepharoplasty, facelift, liposuction and fat transfer, among others). It also provides solutions to minor interventions of low complexity (cryotherapy, electrotherapy and laser therapy). The latter, being outpatient procedures, do not require prior preparation and a subsequent control is not necessary, since the patient goes home at the end of the procedure. They are performed on superficial tissues, mainly on the skin (epidermis, dermis and subcutaneous tissue) and skin (hair and nails). They do not require sophisticated surgical instruments. They are done under local anesthesia, which further reduces the low risk associated with major surgical techniques. All this translates into the low possibility of the appearance of intra- or postoperative complications. These minor interventions can provide an immediate response to requests for frequent urgent pathologies (melanomas, keratoacanthomas, furunculosis, infected epidermal cysts, systemic pathologies with repercussions on the skin that require rapid diagnosis, etc.) or not (low-risk malignant tumors, epidermal cysts, lipomas, severe dysplastic nevi, etc.). Physicians who perform Mohs surgery can receive training in this specialized technique during their dermatology residency, but many seek additional training through formal preceptories to become members of the American Society for Mohs Surgery or through training programs. of one-year Mohs surgery fellowships administered by the American College of Mohs Surgery. In 2020, the American Board of Dermatology (ABD) received approval from the American Board of Medical Specialties (ABMS) to establish a certification exam of the board in the subspecialty of Micrographic Dermatological Surgery (Mohs Surgery). The exam was first offered in October 2021 to any US board-certified dermatologist practicing Mohs surgery, regardless of whether they received their dermatology residency training or as part of a fellowship.

Pediatric Dermatology

Physicians can qualify for this specialization by completing a residency in pediatrics and a residency in dermatology. Or they may choose to complete a post-residency fellowship. This field encompasses complex neonatal diseases, hereditary skin diseases or genodermatoses, and the multiple difficulties of working with the pediatric population.

Teledermatology

Teledermatology is a form of dermatology practice in which telecommunication technologies are used to exchange medical information and treatment through audio, visual, and data communications, including photographs of dermatologic conditions, between dermatologists and non-dermatologists who they assess patients, along with dermatologists directly with patients remotely. In India, during severe coronavirus situations, some dermatologists have started online consultations with their patients using some of the popular apps, such as Practo, Apollo Pharmacy, Skin Beauty Pal, Lybrate, etc. This subspecialty deals with options for viewing skin conditions at a great distance to provide knowledge sharing, establishing second opinion services for experts, or using this for follow-up of people with chronic skin diseases. Teledermatology can reduce wait times by allowing dermatologists to treat minor conditions online, while serious conditions that require immediate attention get priority appointments.

Dermatoepidemiology

Dermatoepidemiology is the study of skin diseases at the population level. One of its aspects is the determination of the global burden of skin diseases. From 1990 to 2013, skin diseases constituted about 2% of total disease disability globally measured in disability-adjusted life years.

Elementary injuries

Elementary skin lesions are the basis of all dermatological problems. They are divided into primaries and secondaries. The primary ones are: papule, nodule, wheal, vesicle, bulla, pustule, abscess and cyst. The secondary ones are: scab, eschar, ulcer, crack, fissure, atrophy, sclerosis and lichenification.

Diseases

Some of the diseases that dermatology deals with are mentioned in the table below.

Correlation with other specialties

The skin is the largest organ in the body and, at the same time, the most visible. Although some dermatological diseases exclusively affect the skin, many others are the manifestation of a systemic disorder, that is, one that affects various tissues or organs of the body. Therefore, the training of the dermatologist should include rheumatology (many rheumatic disorders can manifest with signs and symptoms on the skin), immunology, neurology (for example, "neurocutaneous syndromes" such as neurofibromatosis and tuberous sclerosis), infectious diseases and endocrinology. Angiology and phlebology are also part of the dermatologist's cultural baggage.

The study of genetics is becoming increasingly important.

Correlations have also been established between skin pathologies (acne, alopecia, psoriasis, dermatitis, etc.) and emotional aspects and/or states of stress (Psychodermatology).

Additional bibliography

• Jeffrey PCallen, Amy S. Paller, Leonard J. Swinyer, Kenneth E. Greer (5 Juin 2009). Atlas diagnostique dermatologie (in French). Editions Med'Com. ISBN 978-2-35403-018-6.
• Bessis, Didier (December 24, 1999). Atlas diagnostique dermatologie (in French). Arnette. ISBN 2-35403-018-5.
• Lebwohl, Mark (1/10/2004). Peau et maladies systémiques (in French). Paris: Elsevier. ISBN 2-84299-638-0.
• Lipsker, Dan Michael. (15 September 2010). Guide de l'examen clinique et du diagnostic en dermatologie (in French). Paris: Elsevier-Masson. ISBN 978-294-71030-8.