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Dermatology is a branch of medicine dealing with the skin, its structure, functions, and diseases (from Greek derma, "skin"), as well as its appendages (nails, hair, sweat glands). A doctor who practices dermatology is a dermatologist. A dermatologist must be degreed in medicine, either as a Medical Doctor or a Doctor of Osteopathic Medicine. Many dermatologists have both a Medical Doctorate and a Doctorate in Philosophy.
Scope of the field
The skin is the largest organ of the body and certainly the most visible. Although many skin diseases are isolated, a significant portion of skin symptoms reflects a more generalised disease that affects other organs. Hence, a dermatologist is required to have a working knowledge of basic surgery, rheumatology (many rheumatic diseases can feature skin symptoms), neurology (the "neurocuteaneous syndromes", such as neurofibromatosis and tuberous sclerosis) and endocrinology.
Dermatology is often practiced in tandem with venereology, the specialism that diagnoses and treats sexually transmitted diseases, and phlebology, the specialism that deals with problems of the superficial venous system.
Diagnosis The first step of any contact with a doctor is the medical history. In order to classify a cuteous eruption, a dermatologist will ask detailed questions on the duration and temporal pattern of skin problems, itching or pain, relations to food intake, sunlight, over-the-counter creams and clothing. When an underlying disease is suspected, a more detailed history of related symptoms might be elicited (such as arthritis in a suspected case of lupus erythematosus).
Physical examination is generally under bright light and involves the whole body. At this stage, the doctor may apply Wood's light, which may aid in diagnosing types of mycosis, or a dermatoscope, which enlarges a suspected lesion and may help differentiating lesions, e.g. between a naevus from melanoma. A morphological classification of dermatological lesions is critical to being able to diagnosis dermatological disorders.
Dermatology has the benefit of having easy access to tissue for diagnosis. Culture or Gram staining of suspected infectious lesions may identify a pathogen and help direct therapy.
If the diagnosis is uncertain, or cutaneous malignancy is suspected, a small punch-hole biopsy can be taken under local anesthetic, to be examined by a specialist of histopathology.
Therapy Again, the skin is immediately accessible to local therapy, often in the form of creams. Antibiotic creams can help eliminate infections, while inflammatory skin diseases (such as eczema and psoriasis) often respond to steroid creams. Apart from pharmacological ingredients, the base of the cream itself can be often be of benefit, e.g. a fatty cream in diseases that causes dry skin.
Dermatologists relatively rarely have to resort to oral medications. These are reserved for diseases that cannot be treated with local applications. Antibiotics and immune suppressants are most often prescribed for dermatological problems.
Surgical intervention may be necessary, e.g. in varicose veins or skin cancer. Varicose veins can also be treated with sclerotherapy (injecting an agent that obliterates the vein).
Research Due to the disease burden of many skin diseases, there is a large amount of medical research taking place in the field of dermatology, ranging from skin biology and immune response in the skin to the optimal therapy for psoriasis.
Dermatological diseases
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