डर्म्याटोलोजी (युनानी शब्द डर्मा, "छाला"बाट साभारित) चिकित्साको एउटा क्षेत्र हो। यो क्षेत्र छाला र छालाको अङ्गहरू (रौं, नङ, पसिना ग्रन्थि आदि)सँग सम्बन्धित छ। डर्म्याटोलोजीमा विशिष्टता भएका चिकित्सकलाई डर्म्याटोलोजिस्ट भनिन्छ।
Dermatologists are physicians (medical doctors) specializing in the diagnosis र treatment of diseases र tumors of the skin र its appendages. There are medical र surgical sides to the specialty. Dermatologic surgeons practice skin cancer surgery (including Mohs' micrographic surgery), laser surgery, photodynamic therapy (PDT) र cosmetic procedures using botulinum toxin ('Botox'), soft tissue fillers, sclerotherapy र liposuction. Dermatopathologists interpret tissue under the microscope (histopathology). Pediatric dermatologists specialize in the diagnoses र treatment of skin disease in children. Immunodermatologists specialize in the diagnosis र management of skin diseases driven by an altered immune system including blistering (bullous) diseases like pemphigus. In addition, there are a wide range of congenital syndromes managed by dermatologists.
Residency training program in North Americaसम्पादन
A minimum of १२ years of college र post graduate training is required to become a dermatologist in the United States र Canada. This includes graduation from a ४-year college, a ४-year medical school followed by a year of post graduate training in medicine, surgery or pediatrics (called an internship) after which a physician may apply for admission to graduate dermatology residency training. Dermatology residencies are among the most competitive. Following the successful completion of formal residency training in dermatology (३ years) the physician is qualified to take certifying board examinations (written र oral) by the American Board of Dermatology or the American Osteopathic College of Dermatology. Once board certified, dermatologists become Diplomates of the American Board of Dermatology or the American Osteopathic College of Dermatology AOCD. They are then eligible to apply for fellowship status in the American Academy of Dermatology. Some dermatologists undertake advanced subspecialty training in programs known as fellowships after completion of their residency training. These fellowships are either one or two years in duration. Fellowships in dermatology include pediatric dermatology, surgical dermatology including MOHS micrographic surgery, dermatopathology (pathology of skin diseases) र dermatological immunology.
Training program in Australia
An Australian specialist dermatologist will have completed ६ years of medical school, one internship year र at least one year of general medical or surgical service in the public hospital system, prior to becoming eligible for specialist training in dermatology. The selection process is rigorous र transparent; candidates must pass science र pharmacology exams र engage in monitored र assessed practical training in medical र surgical dermatology. At the completion of the ५ year training programme, trainees sit a national written examination held over two days. Successful candidates may then proceed to the practical viva examination (held over २ days) after which they may apply for fellowship status with the Australian College of Dermatologists.
Training program in Indiaसम्पादन
To be a dermatologist in India, a minimum of ३ years of training is required after graduation from medical school र internship. The period involves rigorous training in all aspects of general dermatology, cosmetic dermatology, venereal diseases (including HIV) र leprosy. At the end of the training period the resident has to go through written tests र clinical exams. The degree clinical exams. The degree clinical exams. The degree clinical exams. The degree clinical exams. The degree clinical exams. The degree clinical exams. The degree clinical exams. The degree clinical exams. The degree clinical exams. The degree clinical exams. The degree clinical exams. The degree vvawarded is MD (dermatology, venereology र leprosy). Most specialists also go for certification by the national board (for the award of 'diplomate of national board').
The skin is the largest organ of the body र obviously the most visible. Although many skin diseases are isolated, some are manifestations of internal disease. Hence, a dermatologist is schooled in aspects of surgery, rheumatology (many rheumatic diseases can feature skin symptoms र signs), immunology, neurology (the "neurocuteaneous syndromes", such as neurofibromatosis र tuberous sclerosis), infectious diseases र endocrinology. The study of genetics is also becoming increasingly important.
Venereology र Phlebologyसम्पादन
Venereology, the subspecialty that diagnoses र treats sexually transmitted diseases, र phlebology, the specialty that deals with problems of the superficial venous system, are both part of a dermatologist's expertise.
Cosmetic dermatology has long been an important part of the field, र dermatologists have been the primary innovators in this area. In the १९००'s dermatologists employed dermabrasion to improve acne scarring र fat microtransfer was used to fill in cutaneous defects. More recently, dermatologists have been the driving force behind the development र safe र effective employment of lasers, new dermal filling agents (collagen र hyaluronic acid), botulinum toxin ("Botox"), nonablative laser rejuvenation procedures, intense pulsed light systems, photodynamic therapy, र chemical peeling.
Dermatologic surgery (sometimes referred to as "Dermosurgery") is surgery performed by a dermatologipt physician. A dermatologic surgeon (sometimes known as a "Dermasurgeon") is a dermatologist with a special interest in this field who has applied for fellowship status in the American Society for Dermatologic Surgery, a professional organization dedicated to supporting र educating these physicians.
Techniques available to a dermatologic surgeon include lasers, traditional scalpel surgery, electrosurgery, cryosurgery, photodynamic therapy, liposuction, blepharoplasty (cosmetic eyelid surgery), minimally-invasive facelift surgery (e.g., the S-lift), र a variety of topical र injectable agents such as dermal fillers including fat transfer र hyaluronic acid.
Some specially trained dermatologic surgeons perform Mohs cancer surgery, which can be an effective method for the treatment of recurrent, indistinct, or difficult skin cancers.
Any mole that is irregular in color or shape should be examined by a dermatologist to determine if it is a malignant melanoma, the most serious र life-threatening form of skin cancer. Following a visual examination र a dermatoscopic exam (an invaluable new instrument that illuminates a mole without reflected light), a dermatologist may biopsy a suspicious mole. If it is malignant, it will be excised in the dermatologist's office.
The first step of any contact with a physician is the medical history. In order to classify a cutaneous eruption, the dermatologist will ask detailed questions on the duration र temporal pattern of skin problems, itching or pain, relation to food intake, sunlight, over-the-counter creams र clothing. When an underlying disease is suspected, an additional detailed history of related symptoms will be elicited (such as arthritis in a suspected case of lupus erythematosus).
Dermatology has the obvious benefit of having easy access to tissue for diagnosis. Physical examination is generally done under bright light र preferably involves the whole body. At this stage, the doctor may apply Wood's light, which may aid in diagnosing types of mycosis or demonstrate the extent of pigmented lesions, or use a dermatoscope which enlarges a suspected lesion र visualizes it without reflected light. The dermatoscope is helpful in differentiating a benign naevus from melanoma or a seborrheic keratosis from a mole. A morphological classification of dermatological lesions is important in the diagnosis of dermatological disorders. Dermatologic diagnosis is often dependent upon pattern recognition of lesions र symptoms.
If the diagnosis is uncertain or a cutaneous malignancy is suspected, the dermatologic surgeon may perform a small punch biopsy (using a local anesthetic) for examination under the microscope by the dermatologist who is a trained dermatopathologist.
The skin is obviously accessible to topical local therapy. Antibiotic creams can help eliminate infections, while inflammatory skin diseases (such as eczema र psoriasis) often respond to steroid creams or topical anthralin. Dermatologists are innovators of new immune enhancing treatments, like topical imiquimod for superficial cancers र injection immunotherapy for warts as discussed below.
Topical medications treat many dermatological diseases, but dermatologists also use oral medications. Antibiotics र immune suppressants or immune enhancing agents (injection immunotherapy or topical imiquimod) for dermatological diseases or tumors. Isotretinoin ("Accutane") is used for severe cystic acne vulgaris र often produces a life-time remission of this disfiguring disease. Isotretinoin prescribing in the U.S. is now controlled by a cumbersome FDA governmental website called iPLEDGE. Various new modalities of treatment are in the foray, with the advent of laser technology things are quite promising.
Photomedicine involves the use of ultraviolet light, often in combination with oral or topical agents, to treat skin disease (eg. psoriasis or mycosis fungoides).
Surgical intervention by a dermatologic surgeon may be necessary, for example, to treat varicose veins or skin cancer. Varicose veins can be treated with sclerotherapy (injecting an agent that obliterates the vein) or the long-pulsed Nd:YAG laser. Skin cancers can be managed with excision (including Mohs cancer surgery), cryosurgery, x-ray, or with the recent topical immune enhancing agent imiquimod. above section on "Dermatologic Surgery" for more details.
From the basic science of cutaneous genetics र immunology, to the practical application of new knowledge र technology in the diagnosis र management of skin disease (like psoriasis) र surgical treatment of skin cancer, dermatologists have been among the leaders in the field. The annual meeting of the American Academy of Dermatology is one of the keys for rapid dissemination of new knowledge to the practicing dermatologist र dermatologic surgeon.
- British Association of Dermatologists
- American Academy of Dermatology
- DMOZ - Skin Conditions, Diseases, Disorders
- DermatologyChannel - Your Dermatology Community
- Dermatology Review - A dermatology forum
- SWISDOM / DOIT-Dermatology Online with Interactive Technology
- On-line Dermatology Journal Club (via JournalReview.org)
- Journal Watch Dermatology
- Skin diseases र disorders - dermatology atlas
- American Society for Dermatologic Surgery
- American Society for Mohs Surgery
- National Psoriasis Foundation
- American Society for Laser Medicine र Surgery
- Australasian College of Dermatologists
- The Community for Teledermatology - telederm.org - Freely Available Online Teleconsultation र Teledermatology Service in Dermatology
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