What do dermatologists ACTUALLY do?

A comment from the latest podcast episode from The Beauty Brains made me realize that the perception of dermatologists in the popular consciousness skews toward the superficial and aesthetic part of what we do. But the practice of dermatology is not just pimple popping, vampire facials, Botox, and trying to sell you stuff you don’t need, we are trained in all things skin. I thought I would spend a moment to highlight the lesser known aspects of our speciality. 

What does dermatology training entail exactly? Well, after kicking enough butt in your undergraduate studies, you will have the privilege of hustling through at least 4 years of medical school.  Some people, like me, take time during medical school to do extra research. I did my work on the science of the skin barrier at UCSF. After medical school, you have one year of intensive training in general internal medicine. I spent the year taking care of really sick people at Mount Sinai Medical Center - 16 hour days, night shifts, and 2 days off every 14 days. 

After my intern year (nothing like Grey’s Anatomy - all work, no sleep and too tired to do much else), I had a full 3 years of dedicated dermatology training. I trained in the Bronx at the Albert Einstein College of Medicine, had the most amazing mentors and got the chance to treat a wide range of skin disease.  After that, we have to sit for an intensive board exam covering everything we have learned over the past 3 years. If you pass this, you can finally call yourself a board-certified dermatologist.  

What is the range of skin disease that dermatologists are trained to treat? Isn’t it just zits and wrinkles? Nope, definitely not, that is just a fraction of what we see.  If you haven’t had your life affected by a skin condition, you are fortunate. I have many patients who may not have a life-threatening skin disease, but one which affects every aspect of their life and their self-confidence.    Head to toe atopic dermatitis (a.k.a. eczema), psoriasis affecting nearly 100% of your skin, and painful severe cystic acne over your entire face, back, and chest are just a few examples.   

Skin disease is sometimes a manifestation of severe underlying disease, so we often treat patients that have debilitating itch from kidney failure or very uncomfortable rashes from their lupus. Sometimes the skin does crazy things and blister up, like pemphigus vulgaris, bullous pemphigoid, or even completely necrose and fall off, like in toxic epidermal necrolysis.  We work closely with primary care doctors and other specialists in the treatment of these patients and it is one of the most gratifying aspects of what I do. 

I have had the opportunity to work in Botswana as the only trained dermatologist in the entire country and provided care to many people with severe skin manifestations of HIV and advanced infectious diseases of the skin (leprosy, botryomycosis) that wouldn’t normally have access to a skin specialist.  Camp Discovery is another organization that provides an awesome experience for kids whose lives are affected by skin disease.  When I volunteered with them, I met one of my dearest friends, Rochelle, who has been an inspiration in her willingness to share her own experience with a skin condition called ichthyosis.

There are also subspecialties within dermatology, which usually require another year of dedicated training on top of the 4 years of residency after medical school. I did a year of dermatopathology fellowship, where I was trained to examine skin biopsy specimens and provide diagnoses from what I saw microscopically. Many of my friends did training in a specialized surgical technique for the treatment of skin cancer called Mohs surgery. There are also fellowship programs dedicated to pediatric dermatology, as well aesthetic dermatology.

I won’t deny that there aren’t some dermatologists that are unscrupulous and are trying to make a quick buck from trying to sell you procedures and creams that may not work.  However, I know there are many more dermatologists that are driven by a desire to improve the lives of their patients and provide the best care they can. Please leave a comment if your life has been positively impacted by the work of a dermatologist! I would love to hear from you.  

If you have more questions about specific skin diseases, the American Academy of Dermatology and DermNetNZ are great resources!