Dermatology is not just aesthetics

Having volunteered in many skin cancer screening support events, I have seen the problems that patients with skin cancer have. Besides facing increased risks of death, patients often have lost loved ones, digits and vision. And to keep up with efforts to help more people understand this aspect, I have recently written an article on the effects of sun on the skin and importance of sun protection for a health magazine. To my surprise, the article was placed in the Aesthetics section of the magazine and efforts to correct this have been met by the editor saying that they considered matters of the skin as merely aesthetics.

This was deeply disappointing to me as it sun protection and its parent specialty dermatology was more than a mere aesthetics to me. And as I discussed more with my friends, it appeared that the editor was right, many of my friends both in and outside of medical fields often had the perception that dermatology was just aesthetics. This finding was similar to a recent study of perception of dermatologists by Brezinski and colleagues where a significant proportion of their surveyed population thought dermatologists spend a large part of their time doing cosmetic procedures. 1 This thought is a highly detrimental one as it has repercussions on the funding of future development of dermatology in the country.

As a discipline which covers the “largest organ of the body”, dermatology is more than just aesthetics. Some have said that it is one of the disciplines with the greatest number of individual diagnoses. As a specialty, dermatologist are highly trained in the skills of observation and pattern recognition. Their training allow them to recognize the innumerable patterns which occurs between the patient history, physical examination, dermascopy—i.e. A small hand held microscope—and histopathology findings to come to a diagnosis and provide a optimal therapy for their patient. Their skills is most apparent in the management of skin cancers which is the cancer with the highest prevalence in the country. As we grow older, the accumulated sun damage will result in photo-aging and development of other “spots” on the skin. A lot of the changes may be benign, but some of them may be cancers. The observation skills of the dermatologist allow them to tell the difference make the right call before removing pieces of tissue for microscopic observation. The research of dermatology in this area has led to earlier diagnosis and more optimal treatment for skin cancer patients. Early research was able to link sunlight with skin cancer and led to development of public health awareness campaigns to encourage more sun avoidance and better sun protection practices.

This public health awareness has allowed more to know that dermatology as a manager of skin cancer. However, it is more than that.

As outpatient discipline, it also have a role in the management of many chronic conditions which often perceived to have only aesthetic consequences. But these conditions often has a negative self-perception of the individual and affect their self-confidence and lead to self-isolation. The “infectious and angry” look of the skin spots might also prevent others from interacting with individuals. This will result in a decrease in the quality of life of individuals. It is also important to understand that the “skin spots” are not just like “spots on a painting”. They also often might cause itch where at low levels might lie below consciousness, but at its worst might result in unstoppable scratching. Uncommonly the skin spots might also cause pain.

As an inpatient discipline, dermatology is part of the alliance of healthcare providers which provide care for their patients. Besides caring for patients who may be on a more severe spectrum of the outpatient conditions, dermatologists have an important role in the management of drug reactions and allergies which may range from a rash to a burn like condition which is life threatening. They also have an important role in the management of infections, cancers and many other conditions.

The length and human attention for reading limits for this article restricts one from covering the entire scope of the subject. If you really want to find out more about the subject, I recommend taking a peek at the textbook, Dermatology by Bolognia and colleagues or have a friendly visit to friendly dermatology community. And I hope that one is better understand that dermatology is more than just aesthetics.

Shunjie Chua is a student at the School of Medicine.