A dermatologist is a medical doctor specializing in the diagnosis, treatment, and prevention of diseases affecting the skin, hair, and nails. Their practice includes complex surgical and cosmetic interventions. Dermatologists act as medical experts managing chronic conditions and as surgeons performing procedures to excise growths or enhance appearance. Their scope covers diagnosis and medical treatment, surgical removal and correction, and minimally invasive aesthetic enhancements.
Diagnostic and Therapeutic Procedures
The initial step in managing a skin condition involves diagnostic testing. Skin biopsies are common procedures performed to remove a small tissue sample for microscopic examination. Biopsy methods depend on the lesion’s depth, including shave, punch, or excisional (removing the entire lesion).
Patch testing is a diagnostic tool used to pinpoint the cause of allergic contact dermatitis. This involves applying small amounts of potential allergens, such as fragrances or metals, to adhesive patches, typically placed on the patient’s back. The patches remain in place for 48 hours, and the skin is checked for a reaction after a period of time, as the allergic response is delayed.
Therapeutic procedures focus on destroying or managing abnormal tissue without extensive surgical incision. Cryotherapy uses liquid nitrogen to freeze and destroy precancerous growths or benign lesions such as warts. Phototherapy uses controlled exposure to specific wavelengths of ultraviolet light (UVB or UVA) to treat widespread inflammatory conditions like psoriasis, eczema, or vitiligo. Dermatologists also manage chronic skin diseases through systemic medications, including oral antibiotics, retinoids, or immunosuppressants.
Excising and Corrective Surgical Procedures
Dermatologists are trained skin surgeons who routinely perform excisional procedures to remove cancerous, precancerous, and benign growths. A standard surgical excision involves cutting out the entire lesion along with a surrounding margin of healthy tissue. The resulting wound is closed with sutures, and the specimen is sent for pathological analysis to confirm clear margins.
For certain skin cancers, especially those on the head, neck, hands, or feet, Mohs micrographic surgery is used. This procedure is performed in stages: the surgeon removes a thin layer of tumor and immediately examines the margin under a microscope in an on-site lab. If cancer cells are detected, the surgeon removes only an additional thin layer from that specific spot until no cancer remains. Mohs surgery preserves the maximum amount of healthy surrounding tissue.
Scar revision techniques improve the appearance and texture of healed wounds. Subcision is used for depressed scars, where a specialized needle breaks up fibrous bands tethering the scar tissue to the underlying structure. This release allows the scar to elevate and encourages new collagen production. For very deep, narrow scars, such as ice-pick acne scars, a dermatologist may perform a punch graft, replacing the scarred tissue with a small plug of healthy skin.
Aesthetic and Minimally Invasive Treatments
Aesthetic procedures focus on rejuvenation and enhancement. Injectable treatments are popular. Neuromodulators, like botulinum toxin, are injected into specific facial muscles to temporarily block nerve signals. This relaxes the underlying muscles and smooths dynamic wrinkles such as crow’s feet and frown lines.
Dermal fillers, typically composed of hyaluronic acid, are distinct from neuromodulators. They are used to restore lost volume, plump lips, soften creases, and contour the face. These gels are injected beneath the skin surface to stimulate collagen production. Effects can last from several months up to a year or more.
Laser and light-based therapies offer a wide spectrum of non-surgical treatments. Ablative lasers, such as CO2 or Erbium, create controlled micro-injuries to the skin’s surface, promoting aggressive resurfacing to treat deep wrinkles and scarring. Non-ablative lasers and intense pulsed light (IPL) target specific pigments, treating vascular lesions, unwanted hair, or pigmented spots caused by sun damage.
Chemical peels involve applying a customized chemical solution to the skin, causing controlled exfoliation of the outer layers. The depth of the peel is adjusted to address issues ranging from mild acne to pronounced sun damage and fine lines. Minimally invasive procedures like microneedling use fine needles to create controlled punctures in the skin. This stimulates a wound-healing response that boosts collagen and elastin production, improving overall texture and firmness.