Definition
A dermatologist is a medical doctor who has specialised in medicine and then further specialised in diagnosing, managing, and treating conditions that affect the skin, nails, and hair in adults and children.
Dermatologists treat more than 3,000 diseases of the skin, hair, and nails, as well as cosmetic concerns.
Although dermatology is a medical speciality, most dermatologists are also skin surgeons and are specialists in managing both benign and malignant skin lesions.
Multidisciplinary teams are a key component in dermatology. Dermatologists work closely with other medical and surgical specialists such as oncologists, geneticists, plastic surgeons, rheumatologists, immunologists/allergists, histopathologists, specialist nurses, and allied health clinicians.
What do dermatologists do?
Trained dermatologists usually combine several activities:
- Seeing patients in public hospital clinics and/or private practices
- Acting as consultants to other specialists
- Teaching
- Research
- Education.
Dermatologists must have expertise in basic sciences including microbiology, pathology, biochemistry, physics, physiology, pharmacology and endocrinology. They must be familiar with all the other medical specialties because of their consultant work and because skin diseases are often associated with internal medicine conditions.
Dermatologists perform skin surgery to:
- Prevent or provide early disease control (eg, removing skin cancer)
- Improve the skin’s appearance by removing growths, discolourations, or damage caused by ageing, sunlight, or disease.
- Establish a definitive diagnosis (skin biopsy).
How are dermatologists trained?
Dermatologists are medical doctors. Before they can start practising, dermatologists receive more than a decade of training. Training programs vary by country, but in general, this includes:
- 3–4 years of university to earn an undergraduate degree
- 4–6 years of university to earn a medical degree and become a medical doctor
- 1–2 years of internship in medicine
- 1–3 years as a resident medical officer
- 4–6 years of advanced training in dermatology (usually as a registrar or training fellow who is closely supervised by experienced dermatologists).
During the course of dermatology training, trainees will generally sit and pass a rigorous fellowship examination, before graduating as a dermatologist.
What subspecialties are there in dermatology?
Some dermatologists choose to complete a further one to two years of fellowship training to subspecialise in an area of interest. These include but are not limited to:
- Medical dermatology – specialising in the management of severe inflammatory skin disease such as psoriasis and eczema, severe acne, blistering disorders such as pemphigoid and pemphigus, and connective tissue diseases such as lupus erythematosus. They are often consulted when there is a skin manifestation of an internal disease. They are likely to be fluent in the use of systemic and biological therapies for severe inflammatory disease. All dermatologists are experts in the diagnosis of benign skin lesions and skin cancers.
- Paediatric dermatology including the management of vascular anomalies, severe eczema and other inflammatory dermatoses in childhood, skin infection in children, and rare genodermatoses such as epidermolysis bullosa, ichthyosis and disorders of keratinisation (eg, keratosis pilaris) and ectodermal dysplasias
- Surgical dermatology including Mohs micrographic surgery
- Contact, occupational and industrial dermatitis
- Dermatopathology – a joint subspecialty combining dermatology and surgical pathology to understand the origin and diagnosis of dermatological disease at a microscopic level
- Hair disorders
- Nails
- Laser surgery
- Psychodermatology
- Vulval or male genital disorders
- Aesthetic or cosmetic dermatology
- Photodermatology — skin disorders due to light and ultraviolet radiation and the use of light-based therapies (UVB and PUVA).
There is flexibility in a career and training in dermatology that allows for research.
Is there ongoing training?
Continuing professional development (CPD) helps to keep dermatologists up to date and is a requirement for registration by various medical councils around the world including New Zealand, Australia, the United Kingdom, and the United States of America.
DermNet oversees an online CPD certification programme. This is accomplished through annual clinical audit, peer review, practice visits, publications, teaching, reading journals, and attendance at courses, symposia, lectures, and seminars organised by dermatological societies worldwide.
Is the work of dermatologists changing?
Dermatology is constantly adapting itself to meet the changing medical challenges of our society. New drugs may cause unusual side-effects; and substances such as pesticides, industrial compounds, and cosmetics continually pose new dermatological problems. More leisure time and outdoor work has increased the exposure to the sun and other hazards which can cause skin disease.
With the advent of new therapies for inflammatory skin disease such as biological agents and JAK inhibitors, what dermatology can offer has greatly expanded.
When to see a dermatologist?
The skin is the largest organ of the body and includes hair, nails, the mucosal areas of the mouth, and genitalia.
If you suffer from a skin condition, visit your primary care doctor or general practitioner. They will be able to perform an initial assessment with the knowledge of your medical history, current medications, previous treatments, and other factors that may impact your health.
If your skin condition is complex, high risk, or requires specialist care, your primary care doctor will refer you to a dermatologist. You can ask your primary care doctor for a referral to a dermatologist if you are concerned about your condition.
You can see a dermatologist in outpatient clinics in public hospitals or at their private rooms.
How to get an appointment with a dermatologist?
Arrange to see a dermatologist as soon as possible when symptoms of skin disease appear, or when current therapy is ineffective. Expert diagnosis, rapid cure, or good management means decreased cost and less suffering. In countries such as Australia and the United Kingdom, you need a referral to see a dermatologist from your primary care doctor; whereas in the United States, you can arrange to see a dermatologist directly. Patients are only seen by appointment. Many dermatologists in private practice can see you by self-referral.
Depending on which country you live in, you can find lists of qualified dermatologists in the various dermatological society /association websites:
- New Zealand — The New Zealand Dermatological Society
- Australia — The Australasian College of Dermatologists and the Australian Health Practitioner Regulation Agency (AHPRA)
- United Kingdom — The British Association of Dermatologists and NHS UK
- United States — American Academy of Dermatology Association.
What is the difference between a dermatologist and a skin specialist?
Other practitioners may sometimes use titles such as:
- Skin cancer specialist
- Skin cancer physician
- Skin specialist
- Cosmetic doctor
- Cosmetic surgeon
- …and other similar terminology.
Please note that this may not be the same as a board-certified dermatologist. You can always check the credentials of a clinic or practitioner to see if they are a registered dermatologist.
What to expect when visiting a dermatologist?
When you visit a dermatologist, they will take a full history of your presenting complaint, including your current medical problems, current medications, smoking status, and sun exposure history.
They will then perform a physical examination. By using a dermatoscope, they can perform a full skin examination of your moles and other skin lesions. Furthermore, depending on your presenting problem, or if they detect a suspicious lesion, they might perform a skin biopsy procedure on the same day of the visit. You can expect to be provided with a treatment plan and a prescription if needed.