A dermatologist is a doctor who specializes in the prevention, diagnosis, and treatment of conditions affecting skin, hair, nails, sweat and oil glands, mucus membranes (inside the mouth, nose, and eyelids) which can include cancer. The skin is the largest and most visible organ of the body, and reflects the health of the body. It acts as a barrier to injury and bacteria.
Dermatology patients can be of any age, from babies to people who are more than 100 years old. Out of 3,000 different dermatology conditions that might be treated, 20 of these account for around 80 percent of a dermatologist's workload.
In certain parts of the world, like Australia, dermatologists spend much of their time treating conditions resulting from exposure to the sun, such as malignant melanoma, squamous cell carcinoma, and basal cell carcinoma. In other regions, dermatologists are more likely to encounter cosmetic problems; moles, hair and nail disorders, occupational dermatitis, psoriasis, skin infections, eczema, acne, rosacea, and hand dermatitis. Rosacea is a common skin condition that can cause redness and swelling. Hand dermatitis results from contact with household chemical and affects most women with children. The cosmetic problems for which dermatologists can provide assistance include wrinkles, age spots and other signs of aging, hair loss, and scars. Some dermatologists perform minor cosmetic procedures such as face lifts, liposuction, and blepharoplasty, a surgical modification of the eyelid.
Cosmetics, industrial compounds, and pesticides continually present new dermatological problems. The increased outdoor work and leisure time of people today have increased their exposure to the sun and other hazards that can cause skin problems. It takes years of training and experience to learn how to distinguish the subtle differences in skin problems. Different conditions often share similar symptoms. There is therefore a growing need for more doctors to understand dermatology.
Family doctors might refer a patient to a dermatologist only after their treatment has failed, or if an unsuccessful treatment has caused complications. Because of this, it is often cost-effective to see a dermatologist in the first instance. Dermatologists are also better able to make an early diagnosis. Dermatology was once considered a "lightweight" specialty, but is now recognized as being critical to people's well-being.
Most skin conditions can be treated with topical therapy such as lotions and creams. The surgical procedures dermatologists must learn include the injection of fillers and botulinum toxin (botox) to give a patient a more youthful appearance at the expense of facial mobility, cryotherapy and other procedures to remove common skin growths such as warts, excision, and skin and nail biopsies where the patient is awake and small amounts of tissue are removed to facilitate diagnosis.
Because of the increasing rate of skin-related diseases in recent years, dermatological therapies have been revolutionized by new drugs, laser treatment, photodynamic therapy, and ultraviolet light therapy. That notwithstanding, dermatologists are still in high demand and their work environment can be very busy. At the hospital, they offer general consultation and treat in-patients who have various skin-related diseases.
Dermatologists can decide to work in private practice or public hospitals. They can also provide training for general medical practitioners, teach at a university or run clinical trials in a research lab. Dermatologists can decide to lead campaigns aimed at the community and even offer their services to spas and other beauty therapy institutions.
As is true for most medical disciplines, there are several subspecialties within dermatology:
This aspect of dermatology which focuses on the patient's appearance is sometimes defined as the one which emphasizes 'looking good.' Cosmetic dermatologists are trained in the use of fillers, botox, and laser surgery. Their practice is generally limited to minimally invasive procedures such as facelifts, surgery to diminish scars, liposuction, and blepharoplasty (surgical repair or reconstruction of an eyelid).
A dermatopathologist is a pathologist or dermatologist who specializes in the science of the causes and effects of diseases of the skin. A dermatopathology fellowship includes six months of general pathology and six months of dermatopathology.
The focus of immunodermatology is the diagnosis and treatment of skin disorders distinguished by defective responses of the body's immune system. In other words, the goal of an immunodermatologist is to understand how the body's immune system works with the skin. Because the skin is the most exterior part of the body it is constantly assaulted by chemicals, micro-organisms, and other foreign materials. The Immunodermatology Laboratory is dedicated to understanding how the immune system in the skin protects us.
Developed in 1938 by general surgeon Frederic E. Mohs and also known as Mohs micrographic surgery, Mohs surgery is an extremely precise procedure which involves the progressive removal of layers of cancerous skin until only cancer-free tissue remains.
Dermatologists qualify for this specialization by completing dual residencies in pediatrics and dermatology or by completing a post-residency fellowship. This specialization focuses on the diagnosis and treatment of skin diseases affecting infants, children, and adolescents. In pediatric dermatology particular attention is paid to the specific physiological and developmental issues of the pediatric population. Among these issues are acne, birthmarks, warts, and genetic skin diseases.
In the field of teledermatology, audio, visual, and data telecommunication technologies are used to exchange medical information. This allows non-dermatologists to obtain evaluations by off-site dermatologists. The subspecialty provides for the viewing of skin conditions over large distances and establishes second opinion networks for patients with chronic skin conditions.
Allaying patient anxiety and managing patient fears and expectations are critical aspects of practicing dermatological medicine. While physicians logically focus on long-term results, it is not uncommon for patients to be concerned about, even preoccupied, by the immediate post-treatment or postoperative appearance of a wound or reconstruction. Patients with severe acne, psoriasis, or melanoma can be particularly impacted by the social stigma that their conditions can cause. Such factors require that dermatologists remain sensitive to the emotional, non-physical concerns of their patients.
Managing the expectations of cosmetic patients, in particular, is a familiar topic within the dermatologist community. Expectations of immediate or unrealistic results following facelifts, laser treatments, or botox injections must be addressed early in the physician/patient consultation. In some cases, dermatologists may suspect that psychological problems – such as an inability to emotionally deal with aging – are at the root of patient expectations. Under these circumstances it may be necessary to involve mental health services before conducting the physical procedure requested. With patient education and expectations managed properly, the dermatologist is far more likely to have satisfied patients.
It is not uncommon for cosmetic dermatologists to complement their practice with either a medical spa or in-office sales of spa products.Medical spas generally offer facials, manicures, pedicures, and body wraps. The decision around the selling of spa products is often more delicate, considering the vast array of available products and the potential claims made by their marketers. To uphold their fiduciary duties toward their patients and to avoid any conflict of interest, it is generally recommended that physicians set up their clinics in such a way that separates the dermatology aspect of their practice from any onsite peripheral services and sales.
Dermatologists and plastic surgeons do, in fact, treat many of the same disorders. However, while both practitioners perform liposuction and cosmetic repairs on skin damaged by age, disease, or overexposure to the sun’s ultraviolet rays, the disciplines are different in their focus.
Doctors of dermatology deal with non-life-threatening illnesses such as chronic acne and also with cancers, autoimmune disorders, and sexually transmitted diseases. They focus primarily on conditions of the skin, hair, nails, and mucous membranes. While they frequently perform surgeries, they treat many patients by means of drugs, medications, and other non-surgical therapies.
Plastic surgeons offer optional cosmetic procedures including breast enlargement and liposuction, but they are more likely to perform significant restorative and reconstructive surgeries to treat burns, correct birth defects, or repair injuries to the face or extremities.
Skin cancer is diagnosed by physical exam and removal of skin tissue for examination by a laboratory. A dermatologist can perform this procedure during an office visit.
Treatment for skin cancer is determined by the patient's age and health; the type and size of cancer; where on the body it is located; and whether the skin cancer has spread elsewhere in the body.
Types of treatment include surgery, freezing, scraping, radiotherapy, and chemotherapy. Each individual patient will have a team of different types of doctors, depending on the specific case. Working with the dermatologist may be a surgical oncologist who performs surgery to treat cancer; a medical oncologist who treats cancer with medicines and targeted therapies such as chemotherapy or immunotherapy; and a radiation oncologist who treats cancer with radiation therapy.
Consultations by a dermatologist which are considered medically necessary are generally covered by health plans. These include visits for non-cosmetic reasons such as:
Removal of tattoos, botox injections, microdermabrasion (skin 'sanding' to reveal an undamaged, smoother layer of skin), and chemical peels fall into the elective or nonessential category and are therefore typically pay-on-your-own services.
While these distinctions between covered and elective procedures are a guideline based on common practice, different insurance companies offer different plans and policies with varying benefits and degrees of coverage. Most dermatologists are knowledgeable about which health plans cover their various services.
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