Question of the Week

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:

  • 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.
  • Dermatopathology.
  • Surgical techniques used in dermatology.
Dermatologists also manage cosmetic disorders of the skin, including hair loss, scars, and the skin changes associated with aging."

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 for melanoma."

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 the pores."

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 process.

"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.
Note: Due to increasing amounts of SPAM sent to this account, please include "QOW" in the subject line when sending me email.

I look forward to reading what you have to say.

Health Community Coordinator
Access Excellence @ the National Health Museum

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