What does a dermatologist do?
A dermatologist is dedicated to everything that has to do with its main cause of existence: the skin. There are countless diseases that affect it that are very difficult and complex, so the degree of specialization both from the point of view of diagnosis and treatment is very important. To achieve this, the dermatologist is in charge of carrying out specific techniques, among which are the following.
1. Diagnostic Techniques:
• Biopsy : It is a simple procedure widely used by dermatologists. It consists the removal and microscopic examine of a piece of skin in order establish an exact diagnosis.
• Photobiology (solar simulator): sometimes it is necessary to resort to the reproduction of sunlight radiation with the appropriate devices to reach a correct diagnosis, since many skin diseases are related to exposure to light.
• Allergy tests : the diagnosis of skin allergies is very complex since it is very important to take into account the patient's own details such as age, occupation or hobbies. To confirm the suspicion of allergic eczema, we must sometimes perform allergy tests such as patch tests. These tests consist of the application of patches with the suspected allergy substances for a period of time. These patches are subsequently removed and the test is read. If they are positive, a small eczema is observed in the application areas.
• Taking samples for direct examination : Examination of scales or hair under a microscope is a simple and fast method that can offer us important information and help us rule out superficial infections such as those caused by fungi or parasites.
• Epiluminescence microscopy : It is also known as dermoscopy or dermoscopy. It is a non-invasive and painless technique that is used to examine skin lesions, especially moles and skin cancer, and helps to determine the anatomical structures that are not visible to the naked eye to decide which skin lesions require biopsy or removal. The lesion is examined with special optical equipment called a dermatoscope. This device can be a simple hand lens or be connected to a computer outputting a digital image that can be stored and examined in an automated manner.
• Cutaneous ultrasound : consists of the application of ultrasound to determine characteristics of skin lesions such as depth, shape, content or size. This technique not commonly used
• Selective sentinel node biopsy: Melanoma is a skin tumor that originates in melanocytes, the cells responsible for skin color and that protect us from the effects of solar radiation. When the melanoma is very deep, the melanocytes are more likely to reach a blood vessel or lymphatic vessel and give distant metastases. When this occurs in melanoma, in the vast majority of cases, the first place these metastatic cells arrive is the lymph nodes. These lymph nodes help the cells responsible for the body's defenses recognize cancer cells and stop them from spreading to the rest of the body. For this reason, it is sometimes possible to find metastatic melanoma spreading in these nodes before it spreads to the rest of the body.
2. Therapeutic Techniques :
• Cryotherapy : This is a procedure that uses cryogenic agents to treat skin conditions through frostbite. The most Used of liquid Nitro and that reaches on up to -196c – After freezing damage skin use to replace with new skin tissues use this treatment in infection of warts and molluscum and many time treatment us in malignant. On occasion, certain injuries may require multiple or repeated treatments.
• Phototherapy : These exposures use in many skin diseases. It can be exposure to Ultraviolet B (UVB) rays, ultraviolet A (UVA) rays, or a combination of both. Photochemotherapy is the therapeutic use of radiation in conjunction with a photosensitizing chemical. Psoralens associated with UVA are usually used and the main indications are psoriasis or cutaneous lymphomas, among many others.
• Laser therapy: the word laser is an acronym from the phrase "light amplification by the stimulated emission of radiation" Lasers work by producing an intense beam of bright light in which all the rays that form it have the same characteristics, which allows a large concentration of amount of energy at a point. The laser helps treat wrinkles, skin lesions and scars, or. There are different types of lasers whose usefulness is determined by the wavelength and type of emission as well as by the "target" of the skin with which it interacts.
• Thus we can find hair removal lasers such as the Nd-Yag laser, the alexandrite laser or the diode laser that act on the hair follicle. Others vaporize water from the skin such as the CO2 laser or the Erbium laser and others act on the pigments and are especially useful for angiomas, spots and tattoos such as the pulsed dye laser, the Nd-Yag or the alexandrite.
• Iontophoresis : Iontophoresis is a method of drug delivery that uses an electrical current to drive charged molecules through biological membranes. Iontophoresis is a non-invasive method that minimizes trauma, risk of infection, and damage to the skin. In dermatology it is used above all for the treatment of hyperhidrosis or excessive sweating.
• Infiltrations: Sometimes it is necessary to inject substances for the treatment of injuries to ensure that the drug reaches directly where we need it. They can be used from corticosteroids as it is done in alopecia aerate or in keloids or scars to bleomycin as it is used in warts.
• In cosmetics, fillers are also used to reduce wrinkles and give the skin a younger appearance. These include collagen, autologous fat, hyaluronic acid, hydroxyapatite, poly-L-lactic acid, and polymer implants among others.
• Facial expression lines and wrinkles can be reduced with botulinum toxin type A injections. This is a very safe and effective procedure when performed by an expert, and involves injecting very minute amounts into specific muscles to relax them. . This effect reduces fine wrinkles and is used to treat vertical lines between the eyebrows and on the bridge of the nose, lines and furrows on the forehead, and "crow's feet".
• Chemical Peels : Chemical peels are used to treat superficial lesions. The procedure consists of applying a chemical solution to promote the renewal of the outer layers of skin. This stimulates new growth of the same. New skin is generally smoother, less wrinkled, and more uniform in color. This technique can produce redness and scaling similar to a superficial burn depending on the type of peel used and the patient. This usually lasts from a few days to several weeks, depending on the strength and depth of the peel used. It is usually used for cosmetic purposes for the treatment of skin aging, spots, wrinkles or acne, but it can also be used for the treatment and prevention of skin cancer, among others.
• Dermabrasion and microdermabrasion: Dermabrasion is a procedure in which friction of the skin is produced to achieve the birth of a new skin to replace the previous one. This technique is used to treat scars, blemishes, and sun damage. During dermabrasion, an abrasive instrument removes the outer layers of the skin and smoothes the treated skin. The results are generally noticeable and long lasting. Microdermabrasion is a more superficial variant of this technique and uses microparticles to strip away the top layer of the skin (epidermis) and to stimulate new skin growth. This non-invasive treatment does not cause almost any discomfort and does not require any topical or local anesthetic, and it must be spaced out for two to three weeks before repeating it.
• Photodynamic Therapy: Photodynamic therapy is a cancer treatment that uses a porphyrin derivative, usually methylaminolevulinic acid, and a specific type of light to kill cancer cells. It is done by applying a cream on the skin that is not activated until it is exposed to light. The medication must be applied under occlusion for a time that is usually three hours. During this period, more accumulates in cancer cells than in normal cells. A special lamp is then used to shine the light on the skin, where the medicine becomes active and kills cancer cells. Photodynamic therapy causes little damage to healthy tissue and is often associated with a mild stinging or sore sensation. It is primarily used to treat tumors on or under the skin,
• Photopheresis : Extracorporeal photopheresis (ECF) is a therapeutic procedure based on the biological effect of psoralen and ultraviolet A light on mononuclear cells collected by apheresis and subsequently reinfused into the patient. The procedure has very few side effects, prolongs survival, and induces a 50-75% response rate in patients with advanced cutaneous T-lymphoma. In addition, numerous studies indicate that FEC is a potent agent for the treatment of solid organ transplant rejection, graft-versus-host disease, scleroderma, and other autoimmune diseases resistant to conventional treatment.
• Dermatological surgery : Dermatological surgery helps us to correctly diagnose and treat medically necessary and cosmetic conditions of the skin, hair, nails and mucous membranes. This includes all surgical, reconstructive, and cosmetic methods necessary for this purpose, including those listed above. The purpose of dermatologic surgery is improve the function and cosmetic appearance of skin.
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