Specialty spotlight – dermatology

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

• You can find more information on the training pathway from the Joint Royal Colleges of Physicians Training Board.
• Learn more about the recruitment and interview process by visiting the ST3 recruitment page.

Dermatology resources

• British Association of Dermatologists
• American Academy of Dermatology

RCP resources

• Census of consultant physicians and higher specialty trainees in the UK: dermatology 2013–14
• Consultant physicians working with patients – dermatology chapter
• Julia Smedley on behalf of the OHCEU and BOHRF Dermatitis guideline development groups. Concise guidance: diagnosis, management and prevention of occupational contact dermatitis. London: RCP, 2011.
• NHS Plus, Royal College of Physicians, Faculty of Occupational Medicine. Dermatitis: occupational aspects of management. A national guideline. London: RCP, 2009.
• Royal College of Physicians and British Association of Dermatologists. The prevention, diagnosis, referral and management of melanoma of the skin: concise guidelines. Concise guidance to good practice series, No 7. London: RCP, 2007.
• Clinical Medicine articles:
  • Sedgwick CL, Hall PE, Ratnarajah A, Natkunarajah J, Hogh L, Lesson of the month 1: A rash decision. Clin Med 2015;15:206–7.
  • Aslam A, Griffiths C. Drug therapies in dermatology. Clin Med 2014;14:47–53.
  • Samarasekera E, Smith C. Psoriasis: guidance on assessment and referral. Clin Med 2014;14:178–82.
  • Smedley J. Concise guidance: diagnosis, management and prevention of occupational contact dermatitis. Clin Med 2010;10:487–90.
  • Greaves M. Dermatology: the last 30 years – a rollercoaster ride. Clin Med 2009;9:588–94.
• Clinical Medicine CME dermatology section (2012):
  • Duhovic C, Child F, Wain E. Management of cutaneous T-cell lymphoma. Clin Med 2012;12:160–4.
  • Cookson H, Smith C. Systemic treatment of adult atopic dermatitis. Clin Med 2012;12:172–6.
  • Lacy K, Karagiannis S, Nestle F. Advances in the treatment of melanoma. Clin Med 2012;12:168–71.
  • Grattan C. The urticarias: pathophysiology and management. Clin Med 2012;12:164–7.
• RCP library resources
  • ejournals and ebooks available online to members [email library@rcplondon.ac.uk for a password] include
    • Burge S, Wallis D. Oxford handbook of medical dermatology (Oxford : Oxford University Press, 2011
    • Gawkrodger D J, Ardern-Jones M R. Dermatology (Churchill Livingstone, 2012)
    • Morris-Jones, R. ABC of Dermatology (BMJ Books, 2014)
    • Dermatology (01/01/1998 – present)
    • Indian Journal of Dermatology, Venereology and Leprology (01/01/2004 – present)
  • Books available by postal loan from the library include
    • Chowdhury M M.U et al. Dermatology at a glance (West Sussex : Wiley-Blackwell, 2013).
    • Gawkrodger D J , Ardern-Jones M R. Dermatology (Churchill Livingstone, 2012)
    • Graham-Brown R, Burns T. Lecture notes : dermatology (West Sussex : Wiley-Blackwell, 2011)
    • Gawkrodger D  J. Dermatology : an illustrated colour text (Edinburgh : Churchill Livingstone, 2008)
    • Parish L C. Atlas of women's dermatology : from infancy to maturity (London : Taylor & Francis, 2006)
    • Samman P D. A history of St John's Hospital for Diseases of the Skin, 1963-1988 (Oxford : Radcliffe Medical Press, 1990)

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.