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Specialty spotlight – dermatology

Hear from experts Dr Karen Gibbon, consultant dermatologist, and Dr Andrew Lock, dermatology specialist registrar, as they discuss why they love working in the specialty and what the training pathway involves.

Introduction to dermatology

Dermatology is a specialty focused on the science, diagnosis and management of disease affecting the skin, hair, nails and contiguous mucous membranes in adults and children.

Skin problems account for a third of disease in childhood and about a quarter of GP consultations. It is the most common reason for referral into secondary care. Skin cancer is more common that all other cancers put together.

Dermatology is a highly diverse and challenging field with approximately 2000 dermatological diagnosis. The case mix varies with location but about half relates to the diagnosis and management of skin lesions, including skin cancers, and the other half relates to inflammatory diseases of the skin.

Dermatologists are based in secondary care but also provide services at community locations too. In addition to outpatient services most Dermatologists will provide a consult service for hospital inpatients. Dedicated dermatology beds for inpatients are allocated but the requirement for inpatient care has diminished due to advancement in therapies. Larger centres provide on call services.

Dermatologists support care delivered by GPs and specialist nurses and also have a considerable role in the delivery of education. Several UK centres have an international reputation for research and there are excellent opportunities for Dermatologists to develop academic careers.

It is a privilege to practice dermatology. It is a fascinating speciality which provides an opportunity to treat people of all ages with a diverse range of skin disorders. It is a highly visual specialty with both medical and surgical components. It is a mix of acute and chronic diseases presenting in both a well population and in people with complex medical needs affording the opportunity to work closely with GPs in the community and with other specialities in hospitals.

Mark Griffiths, consultant dermatologist, Royal Free Hospital, London

Training and working in dermatology

Dermatology resources

RCP resources

Historical highlights from the library, archive and museum collection

Skin diseases were not presented as a dedicated medical area until Girolamo Mercuriali’s De morbis cutaneis (The diseases of the skin), of which the library has the second edition of 1585. We also hold De morbis cutaneis, published 1714, by Daniel Turner (1666–1740), the first full book in English dedicated to the subject. This pioneering work paved the way for the specialty of dermatology.

The baton was taken up by Englishman Robert Willan (1757–1812), the first person in the country to classify diseases of the skin. He is attributed as writing the world’s first list of skin diseases from an anatomical standpoint, being the first person to identify the childhood rash erythema infectiosum.  The library holds five of his books including the landmark On Cutaneous Diseases.  The RCP houses his painted portrait and the historic library of the British Association of Dermatology in its Willan Room.  The library also holds seven books by Willan’s protégé Thomas Bateman (1778–1821), who continued and expanded upon Willan’s work.

In the early 20th century little attention was being paid to dermatology. However there were pioneers who transformed the field and establishing dermatology as a medical speciality in its own right. One such pioneer was an Arthur Whitfield (1868–1947). Whitfield came to prominence as the ‘physician to the skin department’ in King’s College - the first to hold this position. Reflecting the standing of dermatology at the time, the skin department was initially only allocated two beds for patients.

Whitfield specialised in treating fungal infections.  His research in the area led to the development of ‘Whitfield’s Ointment’, a combination of salicylic and benzoic acids used to treat athletes’ foot. Much of the contemporary dermatological knowledge was included in Whitfield’s textbook for students and GPs, A handbook of skin diseases and their treatment, from 1907. In it, identification of, and treatment for, a wide range of conditions was discussed, including eczema, tuberculosis, tumors and leprosy. Physicians were instructed on using arsenic for atrophy of the nail, mercury for syphilis and thyroid extract for hair loss as well as how to use lotions, powders, ointments, pastes, varnishes and plasters. Photographs of rare conditions and rare symptoms of common illnesses such as psoriasis and impetigo were included. These images were taken by Whitfield himself as the best teaching examples.