Clive Anderson - AT THE DERMATOLOGIST IN THIS first article in the series we will introduce the dermatologist. A dermatologist is a doctor who specialises in the treatment of diseases of the skin, hair and nails. Dermatologists also treat diseases affecting the genitalia and the inside of the mouth.
These physicians proceed after graduating as doctors to do further intensive medical and surgical training. The focus of this training is the anatomy and physiology of the skin, hair and nails; the diagnosis and treatment of diseases of the skin, hair and nails and the surgical management of these conditions. In addition many dermatologists choose to develop additional skills and knowledge in a specific area of skin disease.
The skin is the largest and most visible organ of the body. It is also one of the most complex. Its main purpose is to shield the body from the outside environment and to protect against infection. It also plays an important role in our social interactions. Over 2,000 diseases of the skin exist and it is common for us all to suffer from a skin disease at some time in our lives.
Some 15 per cent of visits to the general practitioners office are for conditions of the skin. The dermatologist is uniquely placed by virtue of his/her training and clinical experience to offer the best care of these conditions. Yet dermatologists do more than diagnose and treat skin diseases. They are trained in allergy, immunology, and sexually-transmitted diseases and in relevant aspects of internal and environmental medicine and surgery of the skin.
COSMETIC
The past few decades have seen an unprecedented increase in the number of persons seeking to improve their appearances. The rise in cosmetic dermatology has been phenomenal. As specialists in the anatomy and physiology of the skin, dermatologists are at the forefront of offering safe methods of skin rejuvenation. This desire dermatology (cosmetic dermatology) as distinct from clinical dermatology (treatment of skin diseases) now forms a significant part of the practice of dermatologists worldwide.
Jamaican dermatologists are not to be left behind and have ensured that those innovations which are safe and effective for our population are offered. To this end it is now possible (or soon will be possible) to undergo Laser resurfacing of the skin, Liposuction for body contouring, Microdermabrasion, Sclerotherapy for varicose veins, Botox injections for treatment of facial wrinkles, and chemical peels for a variety of therapeutic and cosmetic indications, in the safe hands of the dermatologist.
A survey in the USA indicated that the most common non-surgical procedures during 2002 were in descending order: -
1. Botox
2. Microdermabrasion
3. Collagen injections
4. Laser hair removal
5. Chemical peels
Interestingly, women had 88 per cent of all cosmetic procedures and 44 per cent of these procedures were performed in persons age 35-50 years.
The future for dermatology appears very bright indeed. The advances in the mapping of the human genome and consequent advances in genetics will make a large difference in our understanding of disease and directly influence how dermatologists treat their patients.
Greater understanding of the risk factors for the development of skin diseases will help us to prevent these diseases. Inflammation of the skin plays a significant role in numerous skin diseases from acne to eczema and the new biological agents being formulated will add considerably to our arsenal of therapeutic agents. Other promising areas are the continued development of laser therapy, photodynamic therapy and narrow-band UV therapy for chronic skin conditions.
Challenges facing the dermatologist will be the aggressive marketing of Cosmeceuticals (not quite a drug and not quite a non drug). Products marketed to perform all sorts of wonders on the skin from the eradication of acne overnight to the banishment of cellulite. It will be our task to keep ourselves informed so as to help our patients differentiate between science and hype, and the safe from dangerous products.
The continued and apparently increasing use of various products to bleach or tone the skin is a particular challenge for dermatologists. Our efforts to educate the populace of the harmful effects of these products have so far proved ineffectual in face of the advantages these persons perceive in being a 'browning' - male or female. Perhaps our duty lies not in trying to stop the practice but in providing a safe and effective means of achieving the desired bleaching. What do you think?
Dr. Clive Anderson is a dermatologist.
