Dermatologists are specially trained doctors who diagnose and treat conditions of the skin, hair, nails and mucous membranes (such as those lining the eyelids, mouth and nose). They see patients at every stage of life, from newborn infants to the elderly.
According to the American Academy of Dermatology (AAD), dermatologists deal with more than 3,000 different diseases, ranging from acne to skin cancer. They can also provide support for cosmetic issues, helping patients to revitalize the appearance of their skin, hair and nails.1
The Centers for Disease Control and Prevention (CDC), report that in 2010, there were an estimated 39 million visits to non-federally employed, office-based dermatologists in the US.2 Of the 700,000 or so practicing physicians in the US, an estimated 8,050-8,500 (1.2%) are dermatologists.3
In a 2012 survey of 29,025 physicians representing 25 different medical specialties, dermatologists were found to be the second happiest with their lives outside of work, behind physicians practicing rheumatology. Dermatologists reported an average happiness rating of 4.05 on a scale of 1-5, with 1 meaning "very unhappy" and 5 meaning "very happy."4
Contents of article:
What is dermatology?5
Dermatology is an area of medicine concerned with the health of the skin, as well as diseases of the hair, nails and mucous membranes.
Dermatologists specialize in treating disorders of the skin, nails, hair and mucous membranes.
The skin is the largest organ of the body, covering a total area or around 20 square feet in the average adult.6 It is the first line of defense against bacteria and injury, and often reflects the overall health of the body.
A study conducted by the Mayo Clinic, published in 2013, reported that 42.7% of patients visited their doctors at some point due to a skin disorder.7
Disorders of the skin, hair, nails and mucous membranes are managed through investigations and therapies that include histopathology, immunotherapy, laser therapy, medication, phototherapy, radiotherapy and surgery (including cosmetic procedures).
There are at minimum four stages of training required to become a dermatologist in the US. Firstly, anyone wishing to become a dermatologist must earn a college degree. Secondly, they must graduate from medical school, either becoming a medical doctor (MD) or doctor of osteopathic medicine (DO).
Following this, the doctor must complete a one-year internship in a hospital or clinic to get hands-on medical experience. For trainee dermatologists, this internship is often carried out in an associated field, such as general surgery, internal medicine, family medicine, emergency medicine or pediatrics.
Once the internship is complete, the trainee dermatologist can enter into a dermatology residency program. They are then known as a dermatology resident and receive training in surgical procedures, diagnosis and treatment for the vast array of conditions that they will go on to face, all while seeing patients. Residency programs run for at least 3 years.
After successfully completing a dermatology residency, the resident can take their dermatology board exams to become a board-certified dermatologist. Board exams have to be retaken every 10 years to ensure that dermatologists stay up to date with the advances made within the specialty over time.
If a dermatologist wishes to specialize in a particular subspecialty of dermatology, such as cosmetic dermatology or Mohs surgery (a form of skin cancer treatment), they can continue their studies and take a fellowship that allows them to engage in extensive medical study in one particular area.
Some dermatologists have the initials FAAD after their name, which stands for "Fellow of the American Academy of Dermatology." These initials indicate that the dermatologist:
- Is licensed to practice medicine
- Has passed exams given by either the American Board of Dermatology or the Royal College of Physicians and Surgeons of Canada
- Is a member of the American Academy of Dermatology.
Common conditions treated5
Dermatologists need to have a great depth of clinical knowledge, including knowledge of the basic sciences and all other medical specialties. This is because they need to be aware of the numerous internal conditions that can cause skin manifestations.
Even within their own speciality dermatologists have a great deal to contend with. Here are some examples of the more common conditions dermatologists treat:
Vitiligo is a condition in which the skin loses melanin, leading to the development of patches of lighter colored skin.
- Acne: a disease affecting the skin's oil glands, acne is the most common skin condition in the US. It has a number of possible underlying causes that lead to the formation of many different kinds of pimples. Acne can result in depression, low self-esteem, and scarring.9,10
- Dermatitis and eczema: inflammation of the skin, typically involving swelling with an itchy rash. Dermatitis comes in many different forms, including atopic dermatitis (often referred to as eczema), contact dermatitis and seborrheic dermatitis.11,12
- Fungal infections: affecting the skin, nails, and hair, these infections are common and symptoms are normally mild. However, in people with weakened immune systems they can be more serious. A group of yeasts called Candida can cause a wide range of infections, including oral thrush and balanitis.13,14
- Hair disorders: people of all genders can experience hair loss, which may be a result of an underlying condition, alopecia or an isolated issue. Hereditary hair loss affects 80 million men and women in the US. The hair can also be affected by head lice - around 6-12 million children aged 3-12 get head lice in the US every year.15-17
- Nail problems: conditions affecting the nails make up around 10% of all dermatological conditions. Approximately half of these are fungal infections, with ingrown nails also quite common. Nail problems can be indicative of other underlying conditions, with the nails often reflecting overall health.18,19
- Psoriasis: a chronic, autoimmune skin disorder that speeds up the growth of skin cells, resulting in thick red skin and silvery scales. There are several different types of psoriasis, which can sometimes have a similar appearance to eczema, meaning that it is important for a dermatologist to make a proper diagnosis.20,21
- Rosacea: a skin condition that causes redness in the face, akin to blushing or flushing. It often causes small, pus-filled bumps to appear, and can also lead to visible blood vessels and swollen eyelids. Rosacea can spread from the nose and cheeks to the forehead, chin, ears, chest and back, and is most often experienced by fair-skinned middle-aged women.22,23
- Skin cancer: each year, almost 5 million people receive treatment for skin cancer in the US. One in five Americans will develop a form of this disease at some point in their lifetime. The most common forms of skin cancer are basal cell carcinoma (BCC), melanoma, and squamous cell carcinoma (SCC). Most skin cancers can be treated successfully if they are treated early.24,25
- Shingles (herpes zoster): a viral infection that affects the nerve endings in the skin, causing a painful rash. Although the condition clears without treatment after a few weeks, treatment is recommended to speed up recovery and to prevent long-lasting pain, numbness and itching after the disease has gone. Shingles can also potentially damage the eyes. 26,27
- Vitiligo: a condition whereby the skin loses melanin - the pigment that determines eye, hair and skin color. Vitiligo results in the development of patches of lighter, depigmented skin. Although there is no cure for the condition, treatments are available to address areas of depigmentation, such as mini skin grafts. The condition can have significant social and psychological repercussion for patients.28,29
- Warts: contagious benign skin growths that appear when a virus infects the top layer of skin. Warts may indicate an underlying issue with immunity, but frequently go away without treatment. Dermatologists can use a variety of treatments to remove warts that persist.30,31
Common procedures performed32
Although many of the conditions seen by dermatologists can be treated with medication and non-invasive therapy, some conditions may require surgical intervention or other more aggressive therapy. The list below includes some of the most common procedures performed by dermatologists, either in an outpatient setting or which require a stay in a hospital or clinic:
In dermabrasion, dermatologists use a high-speed rotating brush to surgically remove the very top layer of skin.
- Biopsies: skin biopsies are primarily carried out to diagnose or rule out certain skin conditions. There are three main types of skin biopsy that are commonly performed: shave biopsies remove small sections of the top layer of skin, punch biopsies remove small circular section including deeper layers, and excision biopsies remove entire areas of abnormal-looking skin.33,34
- Chemical peels: a chemical solution is applied to the skin. It causes a layer of skin to separate and peel off over the course of up to two weeks, leaving a layer of regenerated skin underneath that is typically smoother. Dermatologists can use this procedure to treat sun-damaged skin and some types of acne, as well as more cosmetic complaints, such as age spots and lines under the eyes.35,36
- Cosmetic injections: wrinkles, scarring and lost facial fullness can be temporarily treated with injections to diminish the signs of aging. Botulinum toxin therapy or fillers such as collagen and fat can be injected by dermatologists during office visits. Results of this treatment tend to last for a few months, and so injections need to be repeated periodically, although some people can develop antibodies to Botox that make repeat treatments ineffectual.37,38
- Cryotherapy: a quick and common form of treatment for many benign skin conditions such as warts. Skin lesions are frozen, often using liquid nitrogen, in order to destroy affected skin cells. Dermatologists can perform cryotherapy in their offices.39
- Dermabrasion: another procedure to change the appearance of the skin. Using a high-speed rotating brush, a dermatologist removes the top layer of skin, surgically sloughing off scar tissue, fine wrinkles, tattoos and potentially precancerous skin patches.40,41
- Excisions of lesions: skin lesions can be excised for several reasons; to prevent disease from spreading, for cosmetic reasons, to prevent repeat infection, to alleviate symptoms and for diagnosis. Depending on the size of the lesion, local or general anesthetic can be used to numb the area.42
- Hair removal and restoration: Hair loss can be treated with hair transplantation or surgery to the scalp. Unwanted body hair can be removed with laser hair epilation or electrolysis to destroy hair follicles. 43,44
- Laser surgery: dermatologists can use special light beams to remove a variety of skin complaints. These include, but are not limited to, tumors, warts, moles, tattoos, birthmarks, scars, wrinkles and unwanted hair.45
- Mohs surgery: a specific type of surgery for the treatment of skin cancer. Layers of skin are removed and examined under microscope in order to get rid of cancerous cells. Successive layers are removed until the surgeon is unable to find any cancer cells. Mohs surgery is only performed by Mohs surgeons - dermatologists who have completed specific additional medical training.46
- PUVA: an initialism that stands for "psoralen combined with ultraviolet A (UVA)" treatment. Psoralen is a drug that sensitizes the skin to radiation treatment. PUVA is used to treat severe skin diseases such as psoriasis, dermatitis, and vitiligo.3,47
- Skin grafts and flaps: dermatologists can repair parts of the body where skin is missing, possibly due to other surgery or an injury, using skin from elsewhere on the body. Skin can either be grafted, using a free piece of tissue without its own blood supply, or a skin flap can be created from skin tissue adjacent to the area of skin loss.48
- Tumescent liposuction: Liposuction is the removal of excess fat from the body. Dermatologists typically use a process called tumescent liposuction to do this, whereby large volumes of local anesthetic are injected into the fatty tissue being removed. The tissue is then sucked out of the body. Tumescent liposuction should not be considered a treatment for obesity, rather a procedure for body contouring. The process can be aided further with the use of lasers to selectively burst fat cells and help remove tumescent fluid.49,50
- Vein therapy: superficial leg veins - also known as spider veins - are small, dilated surface veins that may look unsightly. Sclerotherapy is a minimally invasive procedure that is usually the preferred treatment for spider veins. Dermatologists insert either foam or a solution into the vein which irritates the lining and causes it to shut. The vein becomes less distinct or disappears completely.51,52
When to see a dermatologist1
A dermatologist should be consulted by anyone with symptoms of a disease affecting the skin, hair, nails or mucous membranes. A dermatologist can also be consulted by anyone with more cosmetic concerns about the appearance of their skin, hair and nails - in this instance, a specialized cosmetic dermatologist may be preferable.
Particular conditions or concerns warrant referral to or consultation with specific types of dermatologist, such as: Cosmetic dermatologists, who specialize in treatments designed to enhance a person's appearance; dermatopathologists, who specialize in diagnosing diseases of the skin, hair, and nails by examining samples under a microscope; and Mohs surgeons, who specialize in treating skin cancer with Mohs surgery.