The Dermatologist's Sphere of Expertise

Author : Dr Philippe Abimelec
Last scientific update : August 2012

The dermatologist is the medical doctor specialized in the treatment of skin diseases, diseases of the mouth, the genitalia, the nails and the scalp. In France, the dermatologist also treats sexually transmitted diseases. The dermatologist is also specialized in skin care and has the required expertise to correct imperfections due to age and sun, as well as the after-effects of skin diseases or accidents.

Here is a non comprehensive list of the conditions a dermatologist may treat.

The dermatologist can diagnose and treat inflammatory skin diseases

• Dermatitis (contact eczema and atopic eczema)
• Urticaria (hives)
• Pruritus (itching)
• Acne
• Seborrheic dermatitis and film states (dandruff)
• Rosacea, facial redness and erythrosis
• Psoriasis of the scalp, the nails and the genitals
• Lichen planus of the skin, mouth, scalp, genitals and nails
• Bullous diseases: pemphigus, bullous pemphigoid, cicatricial pemphigoid,herpes gestationis (pemphigoid gestationis), acquired bullous epidermolysis
• Other rarer diseases: granuloma annulare, necrobiosis lipoidica diabeticorum, pityriasis rubra pilaris…

The dermatologist can take care of congenital or genetic diseases of the skin

• Congenital epidermolysis bullosa
• Ichtyosis
• Neurofibromatosis
• Epiloia or Bourneville’s tuberous sclerosis

The dermatologist can treat skin reactions to medication (drug eruptions)

• Fixed drug eruptions, Erythema multiforme, Stevens Johnson, Toxic epidermal necrolysis (Lyell’s Syndromes), Drug Rash with Eosinophilia and Systemic Symptoms (DRESS Syndrome)

The dermatologist can treat skin infectious diseases and skin reactions to infections

• Diseases due to bacterias or their toxins
– Impetigo, lymphangitis, furuncle, abscess, carbuncle, staphylococcal, toxic shock syndrome
– Pityriasis rosea

• Mycoses due to fungi
– Superficial mycosis of the skin (ringworm, tinea cruris, tinea pedis), nails (nail fungal infections, tinea unguium) and over the scalp (tinea capitis), tinea versicolor
– Tropical mycoses (blastomycosis, histoplasmosis, coccidodiomycosis)

• Parasitic diseases and reactions to insect bites
– Ectoparasitosis (scale, lice, pediculosis of the pubis or pubic crab lice, chigger) and reactions to insect bites
• Viral diseases and skin reactions to viral infections
– Herpes labialis (cold sore) and genital herpes, measles, rubella, fifth disease, chicken pox, hand, foot and mouth disease (HFMD), herpangina, Gianotti-Crosti syndrome, skin rashes due to acquired immunodeficiency syndrome (AIDS) and viral hepatitis…

The dermatologist his the specialist hair diseases

• Scalp manifestations of skin diseases (eczema, psoriasis, lichen, reactions to medication…)
• Alopecia areata
• Andro-genetic alopecia (progressive hair loss or common baldness)
• Telogen and anagen effluvium (sudden hair loss)
• Anomalies of the scalp or the hair shaft accompanying or revealing systemic or genetic diseases

The dermatologist is the doctor who take care of nail diseases

• Nail manifestations of skin diseases (eczema, psoriasis, lichen, reactions to medications…)
• Nail manifestations of bone diseases (metastases, bone outgrowths, various arthropathies…)
• Benign outgrowths (ganglion cyst, glomangioma, onychopapilloma, “beauty spot” or nevus) and malignant tumours of the nails (malignant melanoma, Bowen’s disease, epidermoid carcinoma…
• ingrowing nails
• Nail anomalies consecutive to traumas
• Nail anomalies accompanying or revealing general or genetic diseases

The dermatologist can treat diseases of the mouth and lips

• Labial and oral herpes (cold sore)
• Oral localizations of various dermatoses (psoriasis, lichen, pemphigus, bullous pemphigoid, drug reactions…)
• Pre-cancerous keratosis
• Warts

The dermatologist can treat diseases of the genitals (man and woman)

• Genital manifestations of skin diseases (eczema, psoriasis, lichen, reactions to medication…)
• Genital warts or condylomas
• Herpes genitalis
• Balanitis
• Vulvitis

The dermatologist also treats Sexually Transmissible Diseases (STD)

• Urethritis (gonococcia and urethritis due to chlarnydiae and mycoplasma and other non gonoccocal forms of urethritis), syphilis, chancroid… Genital warts (condylomas)

The dermatologist can treat benign skin outgrowths and skin cancers

• Benign skin outgrowths: seborrheic wart, fibrous histiocytoma, fibroma, papilloma, sebaceous adenoma, clear cell acanthoma, adnexal turnours (hidradenorna, trichoepithelioma, tricofolliculorna, fibrofolliculoma… ), Abrikossof’s tumour or granular cell tumour, xanthelasrna, “beauty spot” or melanocystic naevus, juvenile xanthogranulorna…
• Skin cancers: basal cell carcinorna, epidermoid carcinoma and adnexal carcinorna, malignant melanomas, skin lymphomas (T cell lymphoma), dermatofibrosarcoma…

Some dermatologists perform surgical dermatology

• Surgical removal of benign skin outgrowths (papillomas, viral or seborrheic warts, benign “beauty spot”…)
• Surgical removal of small skin cancers (basal cell carcinoma, squamous cell carcinorna, malignant melanomas…)

The dermatologist can also perform cosmetic dermatology

• Peeling or skin exfoliation
– Superficial peels (glycolic acid, trichloroacetic acid, Unna’s paste, salicylic acid, dry ice…)
– Medium depth peels (trichloroacetic acid (TCA) alone or combined with salicylic acid and/or dry ice, Obagi Peel..
– Deep peels (phenol)
• Dermabrasion
• Injection of filling substances (fillers) like collagen or hyaluronic acid (Restylane®, Restylane Fine-line, Perlane®, Juvederm®)
Laser and flash lamp treatments
- Red spots (birthmarks or port-wine stains and facial redness): pulsed dye laser and KTP laser
– Brown spots (lentigines and actinic spots) and removal of tattoos (Nd Yag Laser, Rubis Laser, Alexandrite Laser)
– Wrinkles: laser resurfacing with a C02 or Erbiurn-Yag laser, non-ablative lasers (pulsed dye laser and diode laser)
– Laser hair rernoval: Yag Lasers, Alexandrite lasers, intense pulsed light and Rubis Laser
– Acne (diode laser)
Botulinum Toxin injections for the treatment of glabellar frown lines and excessive perspiration (Botox®Allergan, Vistabel®)
Hair trasnplant surgery (mini-graft, micro-graft, follicular unit hair transplantation) developed by dermatologists

Specific treatments offered by the dermatologist

• PUVA treatment
• lontophoresis
• Photophoresis
• Dynarnic phototherapy (delta amino-levulinic acid).
• Intra-lesionnal injections of bleomycin and corticoids

 

As you can see, dermatology is a very broad field of activity, so much so some dermatologists specialize in certain aspects of the speciality. It is therefore possible to find a dermatologist specialised in skin diseases in children, the dermatologist specialized in diseases of the scalp, the dermatologist specialized in diseases of the nails, the dermatologist specialized in diseases of the genitals, the dermatologist specialized in sexually transmissible diseases, the dermatologist specialised in skin tumours and malignant melanomas, the dermatologist specialized in the treatment of psoriasis, the dermatologist specialized in the treatment of eczema, the dermatologist specialized in the treatment of allergies, the dermatologist specialized in internal medicine, the expert dermatologist in pathology (dermatopatology)…
These expert dermatologists generally step in as consultants and advise other dermatologists on difficult cases.

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