Frequently Asked Questions
What is a Dermatologist?
A dermatologist is a physician who has expertise in the diagnosis and treatment of pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. Dermatologists have extensive training and experience in the diagnosis and treatment of skin cancers, melanomas, moles, and other tumors of the skin, contact dermatitis and other allergic and nonallergic disorders and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. The dermatologist also has expertise in the management of cosmetic disorders of the skin such as hair loss and scars.
What is dermatology?
Dermatology is the science of the aspects of human skin biology and those diseases and syndromes that can cause functional changes of the skin as a part of that particular disease's process.
Dermatology is dependant upon the visual information the skin provides by its appearance and the conceptual knowledge of the doctor and the doctor's ability to organize and integrate both types of information into a proper diagnosis.
What type of training should you expect a Certified Dermatologist to have?
The physician's education includes four years of undergraduate school, four years of medical school, and one year of internship. Once a medical school student graduates and successfully completes a licensing exam for one or more states, the new doctor may practice. However, after the internship year, many elect to specialize. Formal specialty training is known as a "residency program." The residency curriculum, duration of the program, and final comprehensive testing for certification are usually established by a specialty board.
Residency and certification requirements in dermatology are set by the American Board of Dermatology, Inc. The primary responsibility of the Board is to assure that dermatologists possess the skills and knowledge necessary to provide competent care for patients with skin diseases. The Board requires a physician to complete a three-year dermatology residency program approved by the Board. Once the training is complete the physician is eligible to take the two-part comprehensive examination. A physician who successfully completes both the written and clinical portions of the examination, will be certified. "Board Certified" means the physician has met all Board requirements and has been certified as a "Diplomate" of the American Board of Dermatology, Inc.
What are some other characteristics of Dermatologists?
Some Board Certified dermatologists enter an additional one or two year training program to qualify for certification in a subspecialty such as dermatopathology or dermatological immunology. Both of these subspecialties have training and certification supervised jointly by the American Board of Dermatology and the American Board of Pathology.
How do you describe the Practice of Dermatology?
Dermatologists are trained and qualified to diagnose and treat a wide spectrum of skin diseases and disorders. At least 90% of their time is spent in direct patient care. Among the more frequently diagnosed and treated clinical conditions are:
Dermatitis
Acne
Dry Skin (Xerosis)
Hair & Scalp Conditions (Seborrheic Dermatitis, Psoriasis, Dandruff)
Conditions Requiring Surgery.
How does a Dermatologist evaluate my condition?
Typically there are three elements to an examination: Patient History, Physical Examination and Laboratory Evaluation.
Patient History refers to the dermatologist learning everything about the patient's condition that has occurred outside the doctor's office. The history can include past medical history, family history (including allergies), and a review of recent "systems routine" which might consist of questions such as, "Have you been sick to your stomach?" or "Has the daylight been hurting your eyes?"
Physical Examination allows the dermatologist to pick up excellent clues as to the identity of the disease by the type and distribution of the lesions.
Laboratory Evaluation is the additional testing that is often necessary to make or confirm the diagnosis. Among the laboratory procedures commonly used are:
Microscopic Evaluation
Culture (& Sensitivity)
Skin biopsy
Patch Tests
Woods Light Examination
What type of tests does a Dermatologist use to evaluate my condition?
Potassium Hydroxide (koh) Exam
With a KOH exam a physician can confirm immediately if a patient has a fungal infection. A KOH exam cannot, however, determine the exact species of fungus responsible for the infection.
The skin is scraped at the edge of a lesion (hair and nail clippings may also be used), and the scraping is placed on a slide with a drop of 10% to 20% potassium hydroxide (KOH) solution. A small coverslip is then placed over the droplet of solution, and the slide is gently heated over a flame. When placed under a microscope, the presence of fungi is revealed by hyphae (branched filaments) and spores (the reproductive body of fungi).
Wood's Light Examination
A Wood's light is a hand-held ultraviolet light filtered through nickel-plated glass. Examining the skin with a Wood's light in a darkened room is useful in the diagnosis of fungal and bacterial infections because certain fungi and bacteria fluoresce specific colors under Wood's light illumination. For example, Microsporum canis, a fungus that can cause scalp ringworm, makes the hair fluoresce bright blue-green.
Wood's light also accentuates contrasts in pigmentation, so Wood's light examination helps physicians delineate pigmentary disorders.
Cytologic Smear
Cyto means "cell," and cytology is the branch of biology that deals with the formation, structure, and function of cells. A smear is a thin specimen for examination usually prepared by spreading - smearing - the material on a slide. The specimen is stained to enhance contrast, and then examined under a microscope.
Cytologic smears are usually used to diagnose blistering diseases, such as herpes simplex. Cytologic techniques can also be helpful in the diagnosis of molluscum contagiosum. The top of a blister is removed with a scalpel, and the contents and base of the blister are gently scraped, placed on a slide, stained, and examined under a microscope. Microscopic examination reveals cell characteristics that are diagnostic for certain diseases.
Culture
Cultures are useful in the diagnosis of fungal and bacterial infections. A culture, unlike a KOH examination, identifies the exact species of infecting organism.
Material is obtained from a lesion and placed in a test medium and allowed to grow. Within several days to several weeks a characteristic growth appears. Examination of the culture under the microscope identifies the exact species of infecting organism.
Patch Test
Patch testing helps identify allergens responsible for allergic contact dermatitis. Test materials are applied to the skin under patches which are left in place for 48 hours. When the patches are removed, the sites are inspected for positive reactions.
BIOPSY
A biopsy is the removal of tissue for study and diagnosis, usually under a microscope. Biopsies are not needed to diagnose most cutaneous disorders, but biopsy is imperative in some cases and useful in others. For example, suspicious nodules must be biopsied to rule out malignancy; information acquired from a biopsy can be useful in diagnosing lupus erythematosus.
Biopsy is also sometimes used to completely remove lesions.
There are several biopsy techniques. The punch biopsy is a simple procedure that removes 2-8 mm of tissue for pathologic study without causing much discomfort to the patient. After a local anesthetic, a biopsy punch - a circular instrument with a sharp cutting edge and a handle - is drilled into the skin with a back-and-forth cutting motion until it reaches into the layer of fat beneath the skin. The specimen is then gently lifted out and snipped off. Simple pressure usually stops the bleeding.
Very superficial lesions can be biopsied or removed with the shave biopsy technique. The lesion is simply shaved off by moving a scalpel back and forth or with a slight scooping motion. Shave biopsies are easy to do and heal quickly.
In an excisional biopsy, the entire lesion and, sometimes, the surrounding tissue is removed (excised). Excisional biopsy is preferred when a lesion has actively expanding borders, the boundary between the lesion and normal skin needs to be examined, or the lesion may be a melanoma.
What should I expect from my visit to the dermatologist for my skin problem?
an interest in you, your condition and your concerns
a medical/dermatologic history that is relevant to your skin condition
a physical exam that encompasses all areas pertinent to your complaint laboratory studies--skin scraping and/or biopsy; blood, urine, x-ray other laboratory studies as indicated by your condition or concerns
Remember, unlike other specialties, at least 90% of the dermatologic diagnosis is based upon observation of the rash, growth, tumor or skin condition--frequently the dermatologist may already know what is wrong just by looking, but a history and further examination, directed by the history, is necessary for confirmation
a reasonable explanation of the diagnosis or suspected diagnosis and any tests or procedures that may be necessary for investigation or confirmation
a complete explanation of what and why the prescribed medication and/or treatment
a reasonable explanation of the more common adverse reactions that might occur as a result of medical intervention--as the patient, it is best to remember:
that the medications and treatments recommended by your dermatologist have the best chance of helping and the least chance of harming you,
that any drug or any treatment, can do anything, to anyone, at any time,
that it is impossible for any physician to know all things, about all things, at all times, but she/he should be willing to listen and"look up" required information, therefore,
to listen for the honest "I don't know, but I'll find out" of the conscientious, caring physician an estimate as to the monetary cost (if possible) of fees for services, tests and medication
What should I do to provide my dermatologist with the best chance of making the right diagnosis and prescribing the right treatment for my skin condition?
1. Provide your dermatologist with an honest and accurate history of your condition.
When did it start?
Where did it start?
What have you put on it, either over-the-counter (OTC) or prescription, either yours or someone else's?
What makes it better or worse?
What do you think is the cause?
Does it itch?
Does it hurt?
Does the itch/hurt wake you from sleep at night?
Did you ever have this before, what was it called, what was it treated with, did it get better with the treatment?
Does anyone else have the exact same thing?
2. Bring all your medicines, both over-the-counter (OTC) and prescription, in the exact same containers that you keep them in, not just a list of medicines.
Why?
To help avoid allergic reactions.
To help avoid the possibility of drug interactions.
To determine the amount of medication, either pills or topical cream, that has been used or is left.
Because there will then be no question as to what you are taking, how much, when, and why.
Because the medicine in the container may not be what you think it is.
Because generic medications can usually only be identified by direct visual examination.
Because the directions on the label may be wrong, and because the warning labels on the container may not be applicable to you. What medications do you take on a regular basis, either prescription or OTC? Why?
What medications do you take intermittently, either prescription or OTC? Why?
Are you allergic to any medications, either prescription or OTC? in what way?
Do you have allergies other than to medications? In what way?
3. Most importantly
COMPLIANCE, COMPLIANCE, COMPLIANCE--how else will you know if the diagnosis is correct and the treatment works? |
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