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20-September-2008 10:21:22 - Dermatology This article or section includes a list of references or external links, but its sources remain unclear because it lacks in-text citations. You can improve this article by introducing more precise citations where appropriate. February 2008 Dermatology Greek δεÏ?μα, skin and λόγος, word, science is a branch of medicine dealing with the skin and its appendages hair, sweat glands, etc. Contents 1 Subspecialties 1.1 Venereology and phlebology 1.2 Cosmetic dermatology 1.3 Dermatologic surgery 2 Diagnosis 2.1 Medical history 2.2 Physical examination 2.3 Microbiology 2.4 Biopsy 3 Therapy 3.1 Topical medications 3.2 Photomedicine 3.3 Surgical therapies 3.4 Psychodermatology and hypnodermatology 4 Training programs 4.1 Residency training program in North America 4.2 Training programme in Australia 4.3 Training program in India 5 Research 6 Dermatological diseases 7 History 8 Notes 9 Further reading 10 See also 11 External links Subspecialties The skin is the largest organ of the body and is the most visible. Although many skin diseases are isolated, some are manifestations of internal disease. 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. The study of genetics is also becoming increasingly important. 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 in some countries 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. In the 1900's dermatologists employed dermabrasion to improve acne scarring and fat microtransfer was used to fill in cutaneous defects. Dermatologists specializing in cosmetic dermatology typically use non-invasive procedures to reverse the signs of aging. Botox has been used since it was FDA approved for the treatment of wrinkles. It is used to minimize wrinkles such as frown lines and crow's feet. Fillers are used to fill in lines on the face and to minimize the appearance of wrinkles. Brand names of fillers include Restylane, Perlane, Juvederm, Radiesse and Cosmoplast among many others. Dermatologists are also the pioneers of energy based treatments for the skin and these include lasers, intense pulsed light, radiofrequency, infrared light and photodynamic treatments. Dermatologic surgery Dermatologic surgery dermasurgery is performed by all dermatologists. Surgery is an integral part of dermatology residency training; thus all dermatologists are well trained in cutaneous surgery. In North America specialized training through a 1 year dermatologic surgery fellowship is available upon completion of the dermatology residency, and usually focuses on training in Mohs' micrographic surgery. Most dermatologic surgeons who have a special interest in this field apply for fellowship status with the American College of Mohs Surgery1; or the American Society for Dermatologic Surgery. 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 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. Following a visual examination and a dermatoscopic exam an invaluable new instrument that illuminates a mole without reflected light, a dermatologist may biopsy a suspicious mole. If it is malignant, it will be excised in the dermatologist's office. Medical history The first step of any contact with a physician is the medical history. In order to classify a cutaneous eruption, the dermatologist will ask detailed questions on the duration and temporal pattern of skin problems, itching or pain, relation to food intake, sunlight, over-the-counter creams and clothing. When an underlying disease is suspected, an additional detailed history of related symptoms will be elicited such as arthritis in a suspected case of lupus erythematosus. Physical examination Dermatology has the obvious benefit of having easy access to tissue for diagnosis. Physical examination is generally done under bright light and preferably involves the whole body. At this stage, the doctor may apply Wood's light, which may aid in diagnosing types of mycosis or demonstrate the extent of pigmented lesions, or use a dermatoscope which enlarges a suspected lesion and visualizes it without reflected light. The dermatoscope is helpful in differentiating a benign naevus from melanoma or a seborrheic keratosis from a mole. A morphological classification of dermatological lesions is important in the diagnosis of dermatological disorders. Dermatologic diagnosis is often dependent upon pattern recognition of lesions and symptoms. Microbiology Culture or Gram staining of suspected infectious lesions may identify a pathogen and help direct therapy. 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. Antibiotic creams can help eliminate infections, while inflammatory skin diseases such as eczema and psoriasis often respond to steroid creams or topical anthralin. Dermatologists are innovators of new immune enhancing treatments, like topical imiquimod for superficial cancers and injection immunotherapy for warts as discussed below. Topical medications Topical medications treat many dermatological diseases, but dermatologists also use oral medications. Antibiotics and immune suppressants or immune enhancing agents injection immunotherapy or topical imiquimod for dermatological diseases or tumors. Isotretinoin Accutane is used for severe cystic acne vulgaris and often produces a lifetime remission of this disfiguring disease. Isotretinoin prescribing in the U.S. is now controlled by a cumbersome FDA governmental website called iPLEDGE. Various new modalities of treatment are in the foray; with the advent of laser technology things are quite promising. Photomedicine Photomedicine involves the use of ultraviolet light, often in combination with oral or topical agents, to treat skin disease e.g., psoriasis or mycosis fungoides. Surgical therapies Surgical intervention by a dermatologic surgeon may be necessary, for example, to treat varicose veins or skin cancer. Varicose veins can be treated with sclerotherapy injecting an agent that obliterates the vein or the long-pulsed Nd:YAG laser. Skin cancers can be managed with excision including Mohs cancer surgery, cryosurgery, x-ray, or with the recent topical immune enhancing agent imiquimod. See above section on Dermatologic Surgery for more details. Psychodermatology and hypnodermatology Main articles: Psychodermatology and Hypnodermatology Psychodermatology and hypnodermatology involve using hypnosis in combination with other pseudo-psychological therapies to treat skin disorders. Training programs 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 where they will take Pre-Medicine, then 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. Dermatology residencies are the most competitive in terms of admission123. The nation's most prestigious residency training programs include New York University, the University of Pennsylvania, Harvard, Northwestern and UT Southwestern known colloquially as the Big Five. Following the successful completion of formal residency training in dermatology 3 years the physician is qualified to take certifying board examinations written by the American Board of Dermatology. Once board certified, dermatologists become Diplomates of the American Board of Dermatology. They are then eligible to apply for fellowship status in the American Academy of Dermatology. Some dermatologists undertake advanced subspecialty training in programs known as fellowships after completion of their residency training. These fellowships are either one or two years in duration. Fellowships in dermatology include pediatric dermatology, surgical dermatology including Mohs micrographic surgery, dermatopathology pathology of skin diseases and dermatological immunology. Training programme in Australia An Australian specialist dermatologist will have completed 4-6 years of medical school depending on institution, 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. The selection process is rigorous and transparent; candidates must pass science and pharmacology exams and engage in monitored and assessed practical training in all aspects of medical and surgical dermatology. At the completion of the 5 year training programme, trainees sit a national written examination held over two days. Successful candidates may then proceed to the practical viva examination, similarly held over 2 days. Successful candidates may then apply for Fellowship status with the Australasian College of Dermatologists. Training program in India To be a dermatologist in India, a minimum of 2 years for diploma or 3 years for MD of training is required after graduation from medical school and internship. The period involves rigorous training in all aspects of general dermatology, cosmetic dermatology, dermatopathology, dermatosurgery, venereal diseases including HIV and leprosy. At the end of the training period the resident has to go through written tests and clinical exams. The postgraduate qualification awarded is DVD Diploma in Venereology and Dermatology and MD dermatology, venereology and leprosy. Many specialists also go for certification by the national board for the award of 'diplomate of national board'. The Indian Association of Dermatologists, Venereologists and LeprologistsIADVLis one of the largest dermatolological associations in the world. 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. Dermatological diseases Further information: List of dermatological diseases Comparison of dermatological diseases Disease or condition Location Causes Treatment Impetigo superficial Group A streptococcus Folliculitis one or more hair follicles Staphylococcus aureus for most carbuncles and furuncles Hidradenitis apocrine sweat glands and hair follicles bacteria, facilitated by shaving surgery Erysipelas dermis streptococcus bacteria Cellulitis connective tissue underlying the skin Group A streptococcus Phlegmon spreading diffuse staphylococci, streptococci, pneumococci, spore and non-spore forming anaerobes, etc History The work De morbis cutaneis On the diseases of the skin - 1572 by Geronimo Mercuriali from Forlì Italy is known as the first scientific tractation about Dermatology. Early photographic documentation of skin diseases was produced by Balmanno Squire, Dr. Alfred Hardy, Dr. A. de Montméja, Dr. Howard Franklin Damon, Dr. George Henry Fox and Dr. Oscar G. Mason in the latter 1800s. Notes ^ ...has been the most competitive of all specialties for at least the last 5-6 years. This is confirmed by data from the electronic residency application service ERAS.. Retrieved on 2007-06-23. ^ Dermatology continues to be the most competitive residency to enter... Arch Dermatol. 2006;142:845-850.. Retrieved on 2007-06-25. ^ For Top Medical Students, an Attractive Field. Further reading Dermatology Times - a newsmagazine See also Dermatopathology Rash Immunodermatology Skin Hair Dermasurgery External links American Academy of Dermatology Canadian Dermatology Association American Society for Cosmetic Dermatology and Aesthetic Surgery DMOZ - Skin Conditions, Diseases, Disorders DERMWEB - Dermatology Links and Resources by the University of British Columbia Skin diseases and disorders - dermatology atlas American Society for Dermatologic Surgery American Society for Mohs Surgery American Society for Laser Medicine and Surgery Australasian College of Dermatologists v d e Health science Medicine Specialties and subspecialties Surgery Anesthesiology · Cardiac surgery · Cardiothoracic surgery · General surgery · Neurosurgery · Oral and maxillofacial surgery · Orthopedic surgery Hand surgery · Otolaryngology ENT · Pediatric surgery · Plastic surgery · Surgical oncology · Thoracic surgery · Transplant surgery · Trauma surgery · Urology · Vascular surgery Internal medicine Cardiology · Endocrinology · Gastroenterology · Hematology · Hepatology · Infectious diseases · Intensive care medicine · Nephrology · Oncology · Proctology · Pulmonology · Rheumatology Diagnostic Clinical laboratory sciences Cellular pathology, Clinical chemistry, Hematology, Clinical microbiology, Clinical immunology, Transfusion medicine · Radiology Interventional radiology, Nuclear Medicine · Pathology Anatomical, Clinical · Clinical neurophysiology Other specialties Allergy and immunology · Dermatology · Disaster medicine · Emergency medicine · General practice · Geriatrics · Neurology · Obstetrics and gynaecology Fertility medicine, Reproductive medicine · Andrology · Occupational medicine · Ophthalmology · Palliative care · Pediatrics · Physical medicine and rehabilitation Physiatry · Preventive medicine Public health · Psychiatry · Sleep medicine Other Epidemiology · History of medicine · Hospital medicine · Medical education · Medical genetics · Medical school · Osteopathic medicine · Pharmacy · Physician MD and DO · Physician Assistant · Sports medicine · Medical fiction Retrieved from http://en..org/wiki/Dermatology Categories: Dermatology | Subjects taught in medical schoolHidden category: Articles lacking in-text citations Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages বাংলা БългарÑ?ки Català Česky Dansk Deutsch Eesti Español Esperanto Euskara Français Frysk í•œêµì–´ Bahasa Indonesia Italiano עברית Latina Nederlands नेपाली 日本語 ‪Norsk bokmÃ¥l‬ Polski Português Runa Simi РуÑ?Ñ?кий Shqip Simple English SlovenÄ?ina SlovenÅ¡Ä?ina Svenska Türkçe УкраїнÑ?ька This page was last modified on 15 August 2008, at 16:32
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