The scientific study of the structure and function of the skin and of its diseases. It is a specialized branch of medical practice.
Dermatology (from Greek derma, "skin") is a branch of medicine dealing with the skin and its appendages (hair, nails, sweat glands etc).
Scope of the field
Dermatologists are physicians (medical doctors) specializing in the diagnosis and treatment of diseases and tumors of the skin and its appendages. Dermatologic surgeons practice skin cancer surgery (including Mohs' micrographic surgery), laser surgery, photodynamic therapy (PDT) and cosmetic procedures using botulinum toxin ('Botox'), soft tissue fillers, sclerotherapy and liposuction. Immunodermatologists specialize in the diagnosis and management of skin diseases driven by an altered immune system including blistering (bullous) diseases like pemphigus.
Training Program
Residency training program in North America
A minimum of 12 years of college and post graduate training is required to become a dermatologist in the United States and Canada. This includes graduation from a 4-year college, a 4-year medical school followed by a year of post graduate training in medicine, surgery or pediatrics (called an internship) after which a physician may apply for admission to graduate dermatology residency training. Following the successful completion of formal residency training in dermatology (3 years) the physician is qualified to take certifying board examinations (written and oral) by the American Board of Dermatology or the American Osteopathic College of Dermatology. Once board certified, dermatologists become Diplomates of the American Board of Dermatology or the American Osteopathic College of Dermatology AOCD. Fellowships in dermatology include pediatric dermatology, surgical dermatology including MOHS micrographic surgery, dermatopathology (pathology of skin diseases) and dermatological immunology.
Training program in Australia
An Australian specialist dermatologist will have completed 6 years of medical school, one internship year and at least one year of general medical or surgical service in the public hospital system, prior to becoming eligible for specialist training in dermatology. candidates must pass science and pharmacology exams and engage in monitored and assessed practical training in medical and surgical dermatology.
Training program in India
To be a dermatologist in India, a minimum of 2 or 3 years of training is required after graduation from medical school and internship. The period involves rigorous training in all aspects of general dermatology, cosmetic dermatology,dermatoptahology, dermatosurgery, venereal diseases (including HIV) and leprosy. The postgraduate qualification awarded is DVD(Diploma in Venereology and Dermatology) and MD (dermatology, venereology and leprosy). Hence, a dermatologist is schooled in aspects of surgery, rheumatology (many rheumatic diseases can feature skin symptoms and signs), immunology, neurology (the "neurocuteaneous syndromes", such as neurofibromatosis and tuberous sclerosis), infectious diseases and endocrinology.
Venereology and Phlebology
Venereology, the subspecialty that diagnoses and treats sexually transmitted diseases, and phlebology, the specialty that deals with problems of the superficial venous system, are both part of a dermatologist's expertise.
Cosmetic Dermatology
Cosmetic dermatology has long been an important part of the field, and dermatologists have been the primary innovators in this area.
Dermatologic Surgery
Dermatologic surgery (sometimes referred to as "Dermasurgery") is surgery performed by a dermatologipt physician. A dermatologic surgeon (sometimes known as a "Dermasurgeon") is a dermatologist with a special interest in this field who has applied for fellowship status in the American Society for Dermatologic Surgery, a professional organization dedicated to supporting and educating these physicians.
Techniques available to a dermatologic surgeon include lasers, traditional scalpel surgery, electrosurgery, cryosurgery, photodynamic therapy, liposuction, blepharoplasty (cosmetic eyelid surgery), minimally-invasive facelift surgery (e.g., the S-lift), and a variety of topical and injectable agents such as dermal fillers including fat transfer and hyaluronic acid.
Some specially trained dermatologic surgeons perform Mohs cancer surgery, which can be an effective method for the treatment of recurrent, indistinct, or difficult skin cancers.
Diagnosis
Any mole that is irregular in color or shape should be examined by a dermatologist to determine if it is a malignant melanoma, the most serious and life-threatening form of skin cancer.
Medical history
The first step of any contact with a physician is the medical history.
Physical examination
Dermatology has the obvious benefit of having easy access to tissue for diagnosis.
Biopsy
If the diagnosis is uncertain or a cutaneous malignancy is suspected, the dermatologic surgeon may perform a small punch biopsy (using a local anesthetic) for examination under the microscope by the dermatologist who is a trained dermatopathologist.
Therapy
The skin is obviously accessible to topical local therapy.
Topical medications
Topical medications treat many dermatological diseases, but dermatologists also use oral medications.
Photomedicine
Photomedicine involves the use of ultraviolet light, often in combination with oral or topical agents, to treat skin disease (eg.
Surgical therapies
Surgical intervention by a dermatologic surgeon may be necessary, for example, to treat varicose veins or skin cancer. (See above section on "Dermatologic Surgery" for more details.)
Research
From the basic science of cutaneous genetics and immunology, to the practical application of new knowledge and technology in the diagnosis and management of skin disease (like psoriasis) and surgical treatment of skin cancer, dermatologists have been among the leaders in the field. The annual meeting of the American Academy of Dermatology is one of the keys for rapid dissemination of new knowledge to the practicing dermatologist and dermatologic surgeon.
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