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The Job

Dermatologists study, diagnose, and treat diseases and ailments of the largest, most visible organ of the body, the skin, and its related tissues and structures: hair, mucous membranes, and nails. They study a patient's history, conduct visual examinations, and take blood samples, smears of the affected skin, microscopic scrapings, or biopsy specimens of the skin. They may order cultures of fungi or bacteria, or perform patch and photosensitivity tests to reveal allergies and immunologic diseases. They may also evaluate bone marrow, lymph nodes, and endocrine glands. Usually dermatologists send skin, tissue, or blood specimens to a laboratory for chemical and biological testing and analysis.

Dermatologists treat some skin problems with prescribed oral medications, such as antibiotics, or topical applications. Certain types of eczema and dermatitis, psoriasis, acne, or impetigo can usually be treated with creams, ointments, or oral medicines.

Exposure to ultraviolet light is used to treat such conditions as psoriasis, and radiation therapy is occasionally used to treat keloids (scar tissue that grows excessively).

Some skin conditions and illnesses require surgical treatment. There are three types of skin cancer—basal cell carcinoma, squamous cell carcinoma, and malignant melanoma—which must be removed surgically. Dermatologists may use traditional surgery, where the cancerous cells and surrounding tissue are cut away, but some cancers can be removed by lasers, frozen by cryosurgery, destroyed with a cautery device (high-frequency electric current), or destroyed by radiation therapy. Another type of surgery dermatologists use is Moh's surgery, in which progressive layers of skin and tissue are cut out and examined microscopically for the presence of cancers. Dermatologists also perform skin graft procedures to repair wounds that are too large to be stitched together. After removal of a skin tumor, for example, they take a portion of skin from another part of the patient's body, such as the thigh, and attach it to the wound. Since the skin graft comes from the patient's own body, there is no problem with rejection.

Not all surgeries that dermatologists perform are major. There are many conditions that can be treated with simple outpatient procedures under local anesthetic, including removal of warts, sebaceous cysts, scars, moles, cosmetic defects of the skin, boils, and abscesses. Hair transplants are usually done in the doctor's office, as are laser treatments for disfiguring birth defects, cysts, birthmarks, spider veins, and growths.

Certain diseases can manifest themselves in a skin condition. When dermatologists see that a skin problem is a sign of an illness in another part of the patient's body, they recommend treatment by other specialists. If a patient complains of itchy or scaly skin, for example, it may be an allergy. Boils may be a sign of diabetes mellitus, and a skin rash may indicate secondary syphilis. Dermatologists must often consult with allergists, internists, and other doctors. In turn, many dermatologists are called on by other specialists to help diagnose complicated symptoms.

Dermatologists not only deal with the physical aspects of skin afflictions, but the emotional aspects, too. Patients often have to face embarrassment, ridicule, and rejection because of their skin ailments, and dermatologists can help them overcome this kind of trauma.

Within the field of dermatology there are some subspecialties. Dermatoimmunologists focus on the treatment of diseases that involve the immune system, including allergies. They may use a procedure called immunofluorescence to diagnose and characterize these skin disorders. Dermatopathologists study the tissue structure and features of skin diseases. Dermatologic surgeons perform Moh's micrographic surgery and cosmetic procedures, including collagen injections, sclerotherapy (the injection of varicose veins with a fluid), and dermabrasion (a planing of the skin using sandpaper, wire brushes, or other abrasive materials). Pediatric dermatologists treat skin disorders in children. Occupational dermatologists study and treat occupational disorders, such as forms of dermatitis from chemical or biological irritants.

Some dermatologists combine a private practice with a teaching position at a medical school. Others are involved in research, developing new treatments, and finding cures for skin ailments. A few work in industry, developing cosmetics, lotions, and other consumer products.

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