October 13, 2008
While a primary care physicians can be the best people to see for many ailments,
there are times when they will recommend that a patient see a specialist. One such
specialist that sees patients of all ages is a dermatologist.
"Dermatologist: A dermatologist is a physician who is trained to evaluate and
manage pediatric and adult patients with benign and malignant disorders of the skin,
hair, nails and adjacent mucous membranes. A dermatologist has had additional training
and experience in the following:
Dermatologists also manage cosmetic disorders of the skin, including hair loss,
scars, and the skin changes associated with aging."
- The diagnosis and treatment of skin cancers, melanomas, moles, and other tumors
of the skin.
- The management of contact dermatitis and other inflammatory skin disorders.
- The recognition of the skin manifestations of systemic and infectious diseases.
- Surgical techniques used in dermatology.
Understanding what a dermatologist is can help a new patient know what to expect
when seeing this specialist for the first time. Additionally, it can help to know
some of the reasons a primary care physician might recommend that one of his or
her patients see a dermatologist.
For some, the first recommendation comes when there is a concern.
"It is well known that young women in the U.S. have recently had significant
increases in the two most common non-melanoma skin cancers, basal and squamous cell
carcinoma. Now the same appears true for melanoma, the deadliest form of skin cancer.
A report from the National Cancer Institute appearing in the Journal of Investigative
Dermatology (JID) reveals startling melanoma trends among young Caucasian women.
Melanoma incidence had been skyrocketing among older adults for decades, but it
wasn't until the 2001 publication of a study from the Surveillance, Epidemiology,
and End Results (SEER) program, covering the period from 1973 to 1997, that a melanoma
increase was seen among Caucasian women born after 1960."
For some, the recommendation comes when a doctor is concerned about the potential
for a problem in the years to come.
"Everyone has moles, sometimes 40 or more. Most people think of a mole as a
dark brown spot, but moles have a wide range of appearance. ... Moles can appear
anywhere on the skin. They are usually brown in color but can be skin colored and
various sizes and shapes. The brown color is caused by melanocytes, special cells
that produce the pigment melanin. ... Sun exposure increases the number of moles,
and they may darken. During the teen years and pregnancy, moles also get darker
and larger and new ones may appear. ... At first, moles are flat and tan like a
freckle, or they can be pink, brown or black in color... As the years pass, moles
can change slowly, becoming more raised and lighter in color. Some will not change
at all. ... Recent studies have shown that certain types of moles have a higher-than-average
risk of becoming cancerous. They may develop into a form of skin cancer known as
malignant melanoma. Sunburns may increase the risk of melanoma.
People with many more moles than average (greater than 100) are also more at risk
While helping people to avoid and treat skin cancer is a part of their job, dermatologists
do far more than look at skin that could potentially be cancerous.
"The skin is the largest and most visible organ of the body. It reflects the
health of the body and acts as a barrier against injury and bacteria. Unfortunately,
at one time or another, nearly everyone has some type of skin disease - infants,
children, teenagers, adults and the elderly. One in six (15%) of all visits to the
family doctor (GP) involves a skin problem."
For teens, the first time that they are referred to a dermatologist may be when
they want help dealing with acne.
"Acne is a skin condition which has plugged pores (blackheads and whiteheads),
inflamed pimples (pustules), and deeper lumps (nodules). Acne occurs on the face,
as well as the neck, chest, back, shoulders, and upper arms. Although most teenagers
get some form of acne, adults in their 20's, 30's, 40's, or even older,
can develop acne. Often, acne clears up after several years, even without treatment.
Acne can be disfiguring and upsetting to the patient. Untreated acne can leave permanent
scars; these may be treated by your dermatologist in the future. To avoid acne scarring,
treating acne is important. ... Acne is not caused by dirt. Testosterone, a hormone
which is present in both males and females, increases during adolescence (puberty).
It stimulates the sebaceous glands of the skin to enlarge, produce oil, and plug
Issues with the skin can affect those of any age. Those from 6 months to 106 years
can have problems with their skin where the cause may seem unknown.
"Atopic dermatitis is the most common of the many types of eczema, and sometimes
people use the two terms interchangeably. But there are many terms used to describe
specific forms of eczema that may have very similar symptoms to atopic dermatitis."
Other skin problems can be the result an infection. In some cases, the problem will
go away on its own, in other cases, medical treatment can help speed up the healing
"Many of us have had a wart somewhere on our bodies at some time. Other than
being a nuisance, most warts are harmless and go away on their own. More common
in kids than in adults, warts are skin infections caused by viruses of the human
papillomavirus (HPV) family. They can affect any area of the body, but tend to invade
warm, moist places, like small cuts or scratches on the fingers, hands, and feet.
Warts are usually painless unless they're on the soles of the feet or another
part of the body that gets bumped or touched all the time. Kids can pick up HPV
-- and get warts -- from touching anything someone with a wart has used, like towels
and surfaces. Kids who bite their fingernails or pick at hangnails tend to get warts
more often than kids who don't because they can expose less-protected skin and
create open areas for a virus to enter and cause the wart."
"Cold sores are small and painful blisters that can appear around the mouth,
face, or nose. They are sometimes referred to as fever blisters, and they're
caused by herpes simplex virus type 1 (HSV-1). Kids can get cold sores by kissing
or sharing eating utensils with an infected person. ... Colds sores in the mouth
are very common, and many kids get infected with HSV-1 during the preschool years.
The sores usually go away on their own within about a week."
For a more comprehensive list that includes a variety of potential skin problems
that people can have, the following site has links to further resources:
"There are many types of skin infections that require clinical care by a physician
or other healthcare professional. Listed in the directory below are some, for which
we have provided a brief overview."
Questions of the Week:
What might cause you or someone you know to visit a dermatologist? What do you think
your peers and family members know about what a dermatologist is and what a dermatologist
does? What should you, your peers, and your family members know about this medical
specialty? How can it help you have more educated conversations with your primary
care physician if you are familiar with the role that a dermatologist can play in
your overall medical care?
Please email me with any ideas or suggestions.
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