Dermatology

Dermatology is a medical speciality concerned with the study, diagnosis and management of conditions affecting human skin, as well as associated structures including hair, nails and mucous membranes. It encompasses both medical and surgical practices and addresses thousands of distinct disorders ranging from common inflammatory diseases to complex neoplastic, infectious and genetic conditions. Dermatologists are the physicians who specialise in this field and provide care to patients across all age groups.
The term dermatology entered English usage in 1819 and derives from the Ancient Greek derma, meaning skin, and logia, meaning study. Its Neo-Latin form, dermatologia, appeared in the seventeenth century. The modern discipline evolved rapidly from the eighteenth century onwards, with the first major centre of dermatological teaching and clinical documentation established at Hôpital Saint-Louis in Paris in 1708.

Historical Development

Dermatology’s roots lie in early anatomical and pathological observations of the skin. By the late eighteenth and early nineteenth centuries, authors such as Robert Willan and Jean-Louis-Marc Alibert had produced some of the earliest systematic textbooks and atlases dedicated to skin diseases. These works formed the foundation of dermatology as a distinct medical discipline and contributed to the classification systems still influential today.
Throughout the twentieth century, advances in histopathology, immunology, microbiology and medical technology greatly expanded the scope of dermatology. Techniques such as dermoscopy, phototherapy, cryotherapy, cutaneous laser surgery and Mohs micrographic surgery have enhanced diagnostic accuracy and therapeutic precision.

Training Pathways

Training in dermatology varies internationally but is characterised by prolonged and highly competitive programmes.
United StatesDermatologists first obtain a Doctor of Medicine or Doctor of Osteopathic Medicine degree, followed by a one-year internship in a medical, surgical or paediatric discipline. This is followed by a three-year accredited dermatology residency. Subspecialty fellowships of one or two years are available in areas such as dermatopathology, paediatric dermatology, immunodermatology, Mohs micrographic surgery, phototherapy, laser medicine, cosmetic dermatology and procedural dermatology. Dermatology residency positions are among the most competitive in the country. Workforce studies identify a longstanding national shortage of dermatologists, with fewer than 3–4 specialists per 100,000 population.
United KingdomTraining begins with a five-year undergraduate medical degree, followed by two years of foundation training in multiple specialties. Trainees then complete two to three years of internal medicine to obtain membership of the Royal College of Physicians. Application to Specialty Registrar training in dermatology follows, consisting of four years of specialist clinical education and culminating in the Specialty Certificate Examination. Successful completion qualifies the doctor to apply for consultant posts.

Clinical Subspecialties

Dermatology encompasses diverse fields, each addressing specific conditions or procedural approaches.
Cosmetic DermatologyDermatologists contribute significantly to minimally invasive cosmetic procedures. Many undertake additional training in laser techniques, botulinum toxin injection, dermal fillers and various rejuvenation procedures. Some dermatologists also perform surgical cosmetic interventions such as blepharoplasty, liposuction and facelifts, although most restrict their practice to lower-risk, minimally invasive treatments.
DermatopathologyDermatopathologists specialise in diagnosing skin diseases through microscopic examination of skin biopsies. This subspecialty may be pursued by dermatologists or pathologists through a one-year fellowship combining general pathology and dermatopathology. Many dermatologists acquire foundational dermatopathological skills during residency, enabling accurate clinicopathological correlation.
TrichologyTrichology concentrates on disorders of hair and scalp, including alopecia, hair-shaft abnormalities and hypertrichosis. Trichoscopy, a dermoscopic technique allowing high-magnification visualisation of scalp structures, is widely used to support diagnosis.
ImmunodermatologyThis field focuses on immune-mediated skin diseases such as lupus erythematosus, pemphigus, pemphigoid and other autoimmune blistering disorders. Specialists often operate immunopathology laboratories and rely on advanced histological and serological tests, as these diseases may mimic common dermatological presentations.
Mohs Micrographic SurgeryMohs surgery is a tissue-sparing technique for the treatment of certain skin cancers, allowing for intraoperative microscopic evaluation of tumour margins. Developed in the 1930s by Frederic E. Mohs, the method integrates precise excision with immediate histopathological assessment. Dermatologists may receive Mohs training during residency or through additional fellowships. As of 2021, a subspecialty certification in Micrographic Dermatologic Surgery is available for eligible dermatologists in the United States.
Paediatric DermatologyPaediatric dermatologists address skin conditions in newborns, infants, children and adolescents. Training may involve completing both paediatric and dermatology residencies or a dedicated post-residency fellowship. Disorders managed include congenital skin diseases, atopic disorders, infections and adolescent acne.
TeledermatologyTeledermatology uses telecommunications technologies to transmit clinical images and information for remote diagnosis and management. It improves access to dermatological expertise, particularly in underserved or rural areas, and includes provider-to-provider consultations as well as direct-to-patient services.

Scope of Clinical Practice

Dermatologists diagnose and manage more than 3,000 conditions involving the skin, hair and nails. These include inflammatory diseases (such as psoriasis, eczema, acne and urticaria), infectious diseases (viral, bacterial, fungal and parasitic), pigmentary disorders, benign and malignant tumours, environmental and occupational dermatology, and disorders of appendages such as nails and hair.
Diagnostic methods include visual inspection, dermoscopy, patch testing, laboratory evaluation, imaging and skin biopsy. Therapies range from topical and systemic pharmacological treatments to surgical and light-based interventions.