Dermatology

After earning a medical degree (M.D. or D.O.), the length of training in the United States for a general dermatologist to be eligible for Board Certification by the American Academy of Dermatology, American Board of Dermatology or the American Osteopathic Board of Dermatology is a total of four years. This training consists of an initial medical, transitional, surgical, or pediatric intern year followed by a three-year dermatology residency.[2][10][11] Following this training, one- or two- year post-residency fellow ships are available in immunodermatology, phototherapy, laser medicine, Mohs micrographic surgery, cosmetic surgery, dermatopathology, or pediatric dermatology. For the past several years, dermatology residency positions in the United States have been one of the most competitive to obtain.[12][13][14]

The United States has been experiencing a national shortage of dermatologists for more than a decade. A study published by the Journal of the American Medical Association reported fewer than 3.4 dermatologists for every 100,000 people.[15]

In the UK, a dermatologist is a medically qualified practitioner who has gone on to specialize in medicine and then sub-specialize in dermatology. This involves:

• Medical school for five years to obtain an MBBS, MBBCh or MB, BChir degree.
• Two years of Foundation rotations in various specialties.
• Two to three years training in general medicine to obtain a higher degree in medicine and become a member of the Royal College of Physicians.
• Having obtained the MRCP examination, applying to become a Specialty Registrar (StR) in Dermatology and training for four years in dermatology.
• Passing the Specialty Certificate Examination (SCE) in Dermatology before the end of training.

Upon successful completion of the four-year training period, the doctor becomes an accredited dermatologist and is able to apply for a consultant hospital post as a consultant dermatologist.

In Pakistan in order to become a certified dermatologist, a person must first complete a five year medical degree (MBBS, MB, etc.) which includes a supervised one year medical internship.[16] After this they are officially accredited by the College of Physicians and Surgeons Pakistan and can practice as a physician. They then have to specialize in dermatology by either completing the Membership of the College of Physicians and Surgeons (MCPS) process which generally takes two years,[17] or the Fellowship of the College of Physicians and Surgeons(FCPS), which takes four years.[18] Completing either of these programs by passing their respective standardized exams will allow one to legally practice as a dermatologist in Pakistan.

A Cosmetic dermatology unit in SM City North Edsa, Philippines

Dermatologists have been leaders in the field of cosmetic surgery.[19] Some dermatologists complete fellowships in surgical dermatology. Many are trained in their residency on the use of botulinum toxin, fillers, and laser surgery. Some dermatologists perform cosmetic procedures including liposuction, blepharoplasty, and face lifts.[20][21] Most dermatologists limit their cosmetic practice to minimally invasive procedures. Despite an absence of formal guidelines from the American Board of Dermatology, many cosmetic fellowships are offered in both surgery and laser medicine.[22]

A dermatopathologist is a pathologist or dermatologist who specializes in the pathology of the skin.[23] This field is shared by dermatologists and pathologists. Usually, a dermatologist or pathologist will complete one year of dermatopathology fellowship. This usually includes six months of general pathology, and six months of dermatopathology.[24] Alumni of both specialties can qualify as dermatopathologists. At the completion of a standard residency in dermatology, many dermatologists are also competent at dermatopathology. Some dermatopathologists qualify to sit for their examinations by completing a residency in dermatology and one in pathology.

Trichology specializes in diseases, which manifest with hair loss, hair abnormalities, hypertrichosis and scalp changes. Trichoscopy is a medical diagnostic method, which is used by dermatologists with a special interest in trichology.

This field specializes in the treatment of immune-mediated skin diseases such as lupus, bullous pemphigoid, pemphigus vulgaris, and other immune-mediated skin disorders.[25] Specialists in this field often run their own immunopathology labs.Immunodermatology testing is essential for the correct diagnosis and treatment of many diseases affecting epithelial organs including skin, mucous membranes, gastrointestinal and respiratory tracts. The various diseases often overlap in clinical and histological presentation and, although the diseases themselves are not common, may present with features of common skin disorders such as urticaria, eczema and chronic itch. Therefore, the diagnosis of an immunodermatological disease is often delayed. Tests are performed on blood and tissues that are sent to various laboratories from medical facilities and referring physicians across the United States.

The dermatologic subspecialty called Mohs surgery focuses on the excision of skin cancers using a technique that allows intraoperative assessment of most of the peripheral and deep tumor margins developed in the 1930s by Dr. Frederic E. Mohs. The procedure is defined as a type of CCPDMA processing. Physicians trained in this technique must be comfortable with both pathology and surgery, and dermatologists receive extensive training in both during their residency. Physicians who perform Mohs surgery can receive training in this specialized technique during their dermatology residency, but many will seek additional training either through preceptorships to join the American Society for Mohs Surgery[26] or through formal one to two years Mohs surgery fellowship training programs administered by the American College of Mohs Surgery.[27]

This technique requires the integration of the same doctor in two different capacities: surgeon as well as pathologist. In case either of the two responsibilities is assigned to another doctor or qualified health care professional, it will not be considered to be Mohs surgery.

Physicians can qualify for this specialization by completing both a pediatric residency and a dermatology residency. Or they might elect to complete a post-residency fellowship.[28] This field encompasses the complex diseases of the neonates, hereditary skin diseases or genodermatoses, and the many difficulties of working with the pediatric population.[29]

Teledermatology is a form of dermatological practice where telecommunication technologies are used to exchange medical information and treatment through audio, visual, and data communication, including photos of dermatologic conditions, between dermatologists and non-dermatologists who are evaluating patients, along with dermatologists directly with patients via distance.[30][31][32] In India, during the severe coronavirus situations, some of the dermatologists have initiated online consultation with their patient using some of popular apps like Practo, Apollo Pharmacy, Skin Beauty Pal, Lybrate and more. This subspecialty deals with options to view skin conditions over a large distance to provide knowledge exchange,[33] to establish second-opinion services for experts,[34] or to use this for follow-up of individuals with chronic skin conditions.[35][36] Teledermatology can reduce wait times by allowing dermatologists to treat minor conditions online while serious conditions requiring immediate care are given priority for appointments.[37]

Dermatoepidemiology is the study of skin disease at the population level.[38] One aspect of dermatoepidemiology is the determination of the global burden of skin diseases [39][40] From 1990 to 2013, skin disease constituted approximately 2% of total global disease disability [41] as measured in disability adjusted life years (DALYS).[42]