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] The dermatologist takes care of diseases and cancers of the skin, scalp, hair, and nails.[6]
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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]
The length of training for a general dermatologist in the United States is a total of four years, training composed of an initial medical or surgical intern year, then followed by a three year dermatology residency.[7][8][9] However, following this training, one or two year post-residency fellowships are available in immunodermatology, phototherapy, laser medicine, Mohs micrographic surgery, cosmetic surgery, dermatopathology, or cutanous surgery. Within the past several years, dermatology residencies in the United States have been the most competitive in terms of admission.[10][11][12]
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 minor cosmetic procedures including liposuction, blepharoplasty, and face lifts.[14][15][16] Most dermatologists limit their cosmetic practice to minimally invasive procedures. Despite not having any formal guidelines from the American Board of Dermatology, many cosmetic fellowships are offered in both surgery and laser medicine.
This is a pathlogist who specializes in the pathology of the skin. This field is shared by both dermatologists and pathologists. The usual dermatologist will complete 1 year of dermatopathology fellowship. This usually include 6 months of general pathology, and 6 months of dermatopathology.[17] A similar fellowship can be completed by a pathologist. Both specialties can be qualified as a dermatopathologist. At the completion of a standard residency in dermatology, many dermatologist are also competent at dermatopathology. Some dermatopathogists qualify to sit for their examination by completing both a dermatology and a pathlogy residency.[18]
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.[19][20] Specialists in this field often run their own immunopathology labs.
This specialty owes it origin in the invention of a general surgeon, Dr. Frederick Mohs. Dr. Mohs intended his procedure to be practiced by all surgeons. Unfortunately, his enthusiasm for the Mohs surgery method only attracted physicians comfortable in both pathology and surgery - the dermatologists. Some Mohs surgery receive their training during their residency. Others complete preceptorship through the American Society for Mohs Surgery[21]. Many completed a 1 year fellowship in Mohs surgery after residency. [22] Many physicians perform Mohs surgery through extensive training in their residency or by mentorship.[23] Before formal preceptorship and fellowships were established, Mohs surgeon were trained by spending a week or more with Dr. Frederick Mohs in Mandison, Wisconsin. Established Mohs surgeons are often regarded by their peers as the best reconstructive surgeons in the field. However, many Mohs surgeons do not perform significant reconstructive procedures, preferring to have another surgeon completing the plastic repair and reconstruction.
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 difficulty working with the pediatric population.
Therapies provided by dermatologists include, but not restricted to:
Phototherapy - including the use of narrowband UVB, broadband UVB, psoralen and UVB.
Photodynamic therapy - for the treatment of skin cancer and precancerous growths.
Laser therapy - for both the management of birth marks, skin disorders (like vitiligo), tattoo removal, and cosmetic resurfacing and rejuvenation.
Hair transplantation - a cosmetic procedure practiced by many dermatologists.
Hair removal with laser or other modalities
Tattoo removal with laser
Cosmetic filler injections
Intralesional treatment - with steroid or chemotherapy.
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.[25]
Cryosurgery - for the treatment of warts, skin cancers, and other dermatosis.
Topical therapies - dermatologists have the best understanding of the numerous products and compounds used topically in medicine.
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.
Most dermatologic pharmacology can be categorized based on the Anatomical Therapeutic Chemical Classification System, specifically the ATC code D.
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