Dermatology
Overview
 
Dermatology is the branch of medicine dealing with the skin
Skin
-Dermis:The dermis is the layer of skin beneath the epidermis that consists of connective tissue and cushions the body from stress and strain. The dermis is tightly connected to the epidermis by a basement membrane. It also harbors many Mechanoreceptors that provide the sense of touch and heat...

 and its diseases, a unique specialty with both medical and surgical aspects. A dermatologist takes care of diseases, in the widest sense, and some cosmetic problems of the skin, scalp, hair, and nails.
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).
Encyclopedia
Dermatology is the branch of medicine dealing with the skin
Skin
-Dermis:The dermis is the layer of skin beneath the epidermis that consists of connective tissue and cushions the body from stress and strain. The dermis is tightly connected to the epidermis by a basement membrane. It also harbors many Mechanoreceptors that provide the sense of touch and heat...

 and its diseases, a unique specialty with both medical and surgical aspects. A dermatologist takes care of diseases, in the widest sense, and some cosmetic problems of the skin, scalp, hair, and nails.

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). The term derives from the Greek
Greek language
Greek is an independent branch of the Indo-European family of languages. Native to the southern Balkans, it has the longest documented history of any Indo-European language, spanning 34 centuries of written records. Its writing system has been the Greek alphabet for the majority of its history;...

 "δέρματος" (dermatos), genitive of "δέρμα" (derma), "skin" (from "δέρω" – dero, "to flay") + "-logy
-logy
-logy is a suffix in the English language, used with words originally adapted from Ancient Greek language ending in -λογία...

, "the study of", a suffix derived from "λόγος" (logos
Logos
' is an important term in philosophy, psychology, rhetoric and religion. Originally a word meaning "a ground", "a plea", "an opinion", "an expectation", "word," "speech," "account," "reason," it became a technical term in philosophy, beginning with Heraclitus ' is an important term in...

), amongst others meaning "speech, oration, discourse, quote, study, calculation, reason", in turn from "λέγω" – lego, "to say", "to speak".

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
Hôpital Saint-Louis
Hôpital Saint-Louis is a hospital in Paris, France. It is part of the Assistance publique - Hôpitaux de Paris hospital system, and it is located at 1 avenue Claude-Vellefaux, in the 10th arrondissement, near the metro station: Goncourt.-External links:*...

 in Paris, while the first textbooks (Willan's, 1798–1808) and atlases (Alibert's
Jean-Louis-Marc Alibert
Jean-Louis-Marc Alibert was a French dermatologist born in Villefranche-de-Rouergue, Aveyron. He was a pioneer of French dermatology....

, 1806–1814) appeared in print during the same period of time. In 1952, Dermatology was greatly advanced by Dr. Norman Orentreich
Norman Orentreich
Norman Orentreich is a pioneering New York dermatologist and the father of modern hair transplantation. Orentreich created Estee Lauder Inc.'s Clinique line of skin care products, invented numerous dermatologic procedures and was the first president of the American Society for Dermatologic Surgery...

'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.
Following this training, one- or two- year post-residency fellowships are available in immunodermatology
Immunodermatology
Immunodermatology studies skin as an organ of immunity in health and disease. Several areas have special attention, such as photo-immunology , inflammatory diseases such as allergic contact dermatitis and atopic eczema, presumably autoimmune skin diseases such as vitiligo and psoriasis, and finally...

, phototherapy, laser medicine
Laser medicine
Laser medicine is the use of various types of lasers in medical diagnosis, treatment, or therapy. Types of lasers used in medicine include in principle any laser design, especially:* CO2 lasers* diode lasers* dye lasers* excimer lasers* fiber lasers...

, Mohs micrographic surgery, cosmetic surgery or dermatopathology
Dermatopathology
Dermatopathology is a subspecialty of both dermatology and surgical pathology that focuses on the study of cutaneous diseases at a microscopic level. It also encompasses analyses of the potential causes of skin diseases at a cellular level. Dermatopathologists work in close association with...

. For the past several years, dermatology residency positions in the United States have been one of the most competitive to obtain.

Cosmetic dermatology

Dermatologists have been leaders in the field of cosmetic surgery. 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
Liposuction
Liposuction, also known as lipoplasty , liposculpture suction lipectomy or simply lipo is a cosmetic surgery operation that removes fat from many different sites on the human body...

, blepharoplasty
Blepharoplasty
Blepharoplasty is surgical modification of the eyelid. Excess tissue such as skin and fat are removed or repositioned, and surrounding muscles and tendons may be reinforced. It can be both a functional and cosmetic surgery.-Indications:...

, and face lifts. Most dermatologists limit their cosmetic practice to minimally invasive procedures. Despite an absence of formal guidelines from the American Board of Dermatology
American Board of Dermatology
The American Board of Dermatology , located in Detroit, MI, certifies physicians in dermatology, dermatopathology and pediatric dermatology. Certified physicians are known as diplomates and may represent themselves to the public as “board-certified”. Since its inception in 1932, the ABD has...

, many cosmetic fellowships are offered in both surgery and laser medicine.

Dermatopathology

A dermatolopathologist is a pathologist or dermatologist who specializes in the pathology
Pathology
Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....

 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. 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.

Immunodermatology

This field specializes in the treatment of immune-mediated skin diseases such as lupus
Lupus
Lupus most commonly refers to the disease systemic lupus erythematosus.Lupus may also refer to:-Medicine:* Lupus erythematosus, a chronic autoimmune disease with several different forms...

, bullous pemphigoid
Bullous pemphigoid
Bullous pemphigoid, also referred to as BP, is an acute or chronic autoimmune skin disease, involving the formation of blisters, more appropriately known as bullae, at the space between the skin layers epidermis and dermis.-Signs and symptoms:...

, pemphigus vulgaris
Pemphigus vulgaris
Pemphigus vulgaris is a chronic blistering skin disease with skin lesions that are rarely pruritic, but which are often painful.-Pathophysiology:...

, and other immune-mediated skin disorders. Specialists in this field often run their own immunopathology labs.

Mohs surgery

The dermatologic subspecialty called Mohs surgery
Mohs surgery
Mohs surgery, also known as chemosurgery, created by a general surgeon, Dr. Frederic E. Mohs, is microscopically controlled surgery used to treat common types of skin cancer. It is one of the many methods of obtaining complete margin control during removal of a skin cancer using frozen section...

 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
Frederic E. Mohs
Frederic Edward Mohs , a physician and general surgeon, developed the Mohs micrographic surgery technique in 1938 to remove skin cancer lesions while still a medical student at the University of Wisconsin–Madison...

. The procedure is defined as a type of CCPDMA
CCPDMA
CCPDMA is the acronym for "complete circumferential peripheral and deep margin assessment". It is the preferred method for the removal of certain cancers, especially skin cancers.A classical example of CCPDMA is Mohs surgery...

 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 or through formal one- to two-year Mohs surgery fellowship training programs administered by the American College of 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. This field encompasses the complex diseases of the neonates, hereditary skin diseases or genodermatoses
Genodermatosis
Genodermatoses are inherited genetic skin conditions often grouped into three categories: chromosomal, single gene, and polygenetic....

, and the many difficulties of working with the pediatric population.

Teledermatology

Teledermatology
Teledermatology
Teledermatology is a subspecialty in the medical field of dermatology and probably one of the most common applications of telemedicine and e-health. In teledermatology, telecommunication technologies are used to exchange medical information over a distance using audio, visual and data communication...

 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).
This subspecialty deals with options to view skin conditions over a large distance to provide knowledge exchange, to establish second-opinion services for experts or to use this for follow-up of individuals with chronic skin conditions.

Therapies

Therapies provided by dermatologists include, but not restricted to:
  • Cosmetic filler injections
  • Hair removal
    Hair removal
    Hair removal is the removal of body hair, and describes the methods used to achieve that result.Hair typically grows all over the human body during and after puberty. Men tend to have more body hair than women. Both men and women tend to have hair on the head, eyebrows, eyelashes, armpits, pubic...

     with laser
    Laser
    A laser is a device that emits light through a process of optical amplification based on the stimulated emission of photons. The term "laser" originated as an acronym for Light Amplification by Stimulated Emission of Radiation...

     or other modalities
  • Hair transplantation – a cosmetic procedure practiced by many dermatologists.
  • Intralesional treatment – with steroid or chemotherapy
    Chemotherapy
    Chemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....

    .
  • Laser therapy – for both the management of birth marks, skin disorders (like vitiligo
    Vitiligo
    Vitiligo is a condition that causes depigmentation of sections of skin. It occurs when melanocytes, the cells responsible for skin pigmentation, die or are unable to function. The cause of vitiligo is unknown, but research suggests that it may arise from autoimmune, genetic, oxidative stress,...

    ), Tattoo removal
    Tattoo removal
    Tattoo removal has been performed with various tools during the history of tattooing. While tattoos were once considered permanent, it is now possible to remove them with treatments, fully or partially...

     , and cosmetic resurfacing and rejuvenation.
  • Photodynamic therapy
    Photodynamic therapy
    Photodynamic therapy is used clinically to treat a wide range of medical conditions, including malignant cancers, and is recognised as a treatment strategy which is both minimally invasive and minimally toxic...

     – for the treatment of skin cancer
    Skin cancer
    Skin neoplasms are skin growths with differing causes and varying degrees of malignancy. The three most common malignant skin cancers are basal cell cancer, squamous cell cancer, and melanoma, each of which is named after the type of skin cell from which it arises...

     and precancerous growths.
  • Phototherapy – including the use of narrowband UVB, broadband UVB, psoralen and UVB.
  • Tattoo removal
    Tattoo removal
    Tattoo removal has been performed with various tools during the history of tattooing. While tattoos were once considered permanent, it is now possible to remove them with treatments, fully or partially...

     with laser.
  • Tumescent liposuction – liposuction was invented by a gynecologist. A dermatologist (Dr. Jeffrey A. Klein
    Jeffrey A. Klein
    Jeffrey Alan Klein, is an American dermatologist from Southern California, known for describing the tumescent technique for liposuction surgery. He is the author of Tumescent Technique: Tumescent Anesthesia & Microcannular Liposuction, a text in liposuction safety and effectiveness.- Education and...

    ) adapted the procedure to local infusion of dilute anesthetic called tumescent liposuction. This method is now widely practiced by dermatologists, plastic surgeons and gynecologists.
  • Cryosurgery
    Cryosurgery
    Cryosurgery is the application of extreme cold to destroy abnormal or diseased tissue. The term comes from the Greek words cryo and surgery meaning "hand work" or "handiwork"....

     – for the treatment of warts, skin cancers, and other dermatosis.
  • Radiation therapy
    Radiation therapy
    Radiation therapy , radiation oncology, or radiotherapy , sometimes abbreviated to XRT or DXT, is the medical use of ionizing radiation, generally as part of cancer treatment to control malignant cells.Radiation therapy is commonly applied to the cancerous tumor because of its ability to control...

     – 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
Anatomical Therapeutic Chemical Classification System
The Anatomical Therapeutic Chemical Classification System is used for the classification of drugs. It is controlled by the WHO Collaborating Centre for Drug Statistics Methodology , and was first published in 1976....

, specifically the ATC code D.

See also

  • History of dermatology
    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. Avicenna's The Canon of Medicine described treatments for a variety of skin conditions, including skin cancer. The preferred medication it recommended was zinc oxide...

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

External links

The source of this article is wikipedia, the free encyclopedia.  The text of this article is licensed under the GFDL.
 
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