Skin Deep: An Insight into the Most Common Diagnoses and Procedures in Dermatology

Dermatology is a specialized branch of medicine dealing with the diagnosis, treatment, and prevention of skin, hair, and nail conditions. With over 3,000 skin disorders documented (1), dermatologists play a crucial role in helping patients maintain their skin health and overall well-being. This article provides an overview of the most common diagnoses and procedures in dermatology, aiming to raise awareness of prevalent skin conditions and the available treatment options.

Most Common Diagnoses in Dermatology

  1. Acne Vulgaris

Acne vulgaris, commonly known as acne, is an inflammatory skin condition characterized by the presence of comedones (blackheads and whiteheads), papules, pustules, nodules, and cysts (2). It primarily affects adolescents but can persist into adulthood. Acne is caused by a combination of factors, including increased sebum production, abnormal keratinization, inflammation, and the proliferation of Cutibacterium acnes (formerly Propionibacterium acnes) (3).

  1. Atopic Dermatitis

Atopic dermatitis, also known as eczema, is a chronic inflammatory skin disorder characterized by itching, redness, and scaling (4). It typically begins in early childhood and may continue into adulthood. Atopic dermatitis is associated with a genetic predisposition, a compromised skin barrier, and an overactive immune response (5).

  1. Psoriasis

Psoriasis is an autoimmune skin condition characterized by red, scaly, and sometimes itchy patches on the skin (6). It can occur at any age but most commonly presents between the ages of 15 and 35 (7). Psoriasis is a result of an overactive immune system, causing skin cells to grow and shed more quickly than normal.

  1. Skin Cancer

Skin cancer is the uncontrolled growth of abnormal skin cells, leading to the formation of malignant tumors. The most common types of skin cancer are basal cell carcinoma, squamous cell carcinoma, and melanoma (8). Excessive sun exposure, fair skin, and a family history of skin cancer are significant risk factors (9).

  1. Contact Dermatitis

Contact dermatitis is an inflammatory skin reaction caused by direct contact with an irritant or allergen (10). It presents as redness, swelling, itching, and sometimes blistering. Common triggers include soaps, detergents, cosmetics, and certain plants, such as poison ivy (11).

Most Common Procedures in Dermatology

  1. Cryotherapy

Cryotherapy involves the application of extreme cold to treat various skin conditions, including warts, actinic keratoses, and some skin cancers (12). Liquid nitrogen is the most commonly used cryogen, rapidly freezing and destroying abnormal skin cells (13).

  1. Excision

Excision is a surgical procedure used to remove skin lesions, such as moles, cysts, or skin cancers. The dermatologist numbs the area with a local anesthetic, then uses a scalpel to remove the lesion and a small margin of surrounding healthy skin (14).

  1. Mohs Surgery

Mohs surgery, also known as micrographic surgery, is a specialized technique used to treat skin cancer, particularly basal cell carcinoma and squamous cell carcinoma. The procedure involves removing thin layers of cancer-containing skin and examining them under a microscope until only cancer-free tissue remains (15).

  1. Laser Therapy

Laser therapy employs focused beams of light to treat various skin conditions, such as acne, scarring, pigmentation disorders, and vascular lesions (16). Different types of lasers are used depending on the condition and the patient's skin type (17).

  1. Chemical Peels

Chemical peels involve the application of a chemical solution to the skin, causing it to exfoliate and eventually peel off (18). This procedure can treat various skin concerns, such as acne, pigmentation, and fine lines, revealing a smoother, more even-toned complexion. Chemical peels range from superficial to deep, depending on the concentration and type of acid used (19).

  1. Photodynamic Therapy (PDT)

Photodynamic therapy (PDT) is a non-invasive treatment for certain skin cancers, pre-cancerous lesions, and other skin conditions, such as acne and rosacea (20). PDT involves the application of a photosensitizing agent to the affected skin, followed by exposure to a specific wavelength of light, activating the photosensitizer and destroying targeted cells (21).

  1. Biopsies

Skin biopsies are essential diagnostic procedures in dermatology, used to determine the nature of a suspicious skin lesion or rash. Different types of biopsies include shave biopsy, punch biopsy, and excisional biopsy (22). The samples are sent to a laboratory for histopathological examination, which helps establish an accurate diagnosis and guides appropriate treatment.

Conclusion

Dermatology encompasses a wide range of skin, hair, and nail conditions, with acne vulgaris, atopic dermatitis, psoriasis, skin cancer, and contact dermatitis among the most common diagnoses. Common dermatological procedures, such as cryotherapy, excisions, Mohs surgery, laser therapy, chemical peels, photodynamic therapy, and biopsies, are designed to diagnose and treat various skin concerns effectively. Understanding the prevalence and treatment options for these conditions is crucial in promoting skin health and improving patients' quality of life.

References:

    1. Hay, R. J., Johns, N. E., Williams, H. C., Bolliger, I. W., Dellavalle, R. P., Margolis, D. J., ... & Gudjonsson, J. E. (2014). The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions. Journal of Investigative Dermatology, 134(6), 1527-1534.

    2. Williams, H. C., Dellavalle, R. P., & Garner, S. (2012). Acne vulgaris. The Lancet, 379(9813), 361-372.

    3. Bickers, D. R., Lim, H. W., Margolis, D., Weinstock, M. A., Goodman, C., Faulkner, E., ... & Begolka, W. S. (2006). The burden of skin diseases: 2004 a joint project of the American Academy of Dermatology Association and the Society for Investigative Dermatology. Journal of the American Academy of Dermatology, 55(3), 490-500.

    4. Silverberg, J. I. (2017). Public health burden and epidemiology of atopic dermatitis. Dermatologic Clinics, 35(3), 283-289.

    5. Boguniewicz, M., & Leung, D. Y. (2011). Atopic dermatitis: a disease of altered skin barrier and immune dysregulation. Immunological Reviews, 242(1), 233-246.

    6. Nestle, F. O., Kaplan, D. H., & Barker, J. (2009). Psoriasis. New England Journal of Medicine, 361(5), 496-509.

    7. Rachakonda, T. D., Schupp, C. W., & Armstrong, A. W. (2014). Psoriasis prevalence among adults in the United States. Journal of the American Academy of Dermatology, 70(3), 512-516.

    8. Rogers, H. W., Weinstock, M. A., Feldman, S. R., & Coldiron, B. M. (2015). Incidence estimate of nonmelanoma skin cancer (keratinocyte carcinomas) in the US population, 2012. JAMA Dermatology, 151(10), 1081-1086.

    9. American Cancer Society. (2021). Skin Cancer Prevention and Early Detection. Retrieved from https://www.cancer.org/cancer/skin-cancer/prevention-and-early-detection.html

    10. Zirwas, M. J., & Molenda, M. A. (2008). Dietary nickel as a cause of systemic contact dermatitis. Journal of Clinical and Aesthetic Dermatology, 1(2), 39-43.

    11. Usatine, R. P., & Riojas, M. (2010). Diagnosis and management of contact dermatitis. American Family Physician, 82(3), 249-255.

    12. Kuflik, E. G. (1994). Cryosurgery updated. Journal of the American Academy of Dermatology, 31(6), 925-944.

    13. Nouri, K., Ballard, C. J., & Patel, T. (2012). Cryosurgery. Dermatologic Clinics, 30(4), 523-530.

    14. Kirby, J. S., & Miller, C. J. (2012). Informed consent in dermatologic surgery. Dermatologic Clinics, 30(2), 207-212.

    15. Muzic, J. G., Schmitt, A. R., & Baum, C. L. (2017). Mohs micrographic surgery. Dermatologic Clinics, 35(4), 439-452.

    16. Alexiades, M. (2018). Lasers and energy devices for the skin. CRC Press.

    17. Tanzi, E. L., & Alster, T. S. (2003). Cutaneous laser surgery: the art and science of selective photothermolysis. Dermatologic Clinics, 21(3), 435-443.

    18. Sarkar, R., Garg, V. K., & Mysore, V. (2017). Position paper on mesotherapy. Journal of Cutaneous and Aesthetic Surgery, 10(1), 60-66.

    19. Atiyeh, B. S., Dibo, S. A., & Hayek, S. N. (2009). Wound cleansing, topical antiseptics and wound healing. International Wound Journal, 6(6), 420-430.

    20. Morton, C. A., Szeimies, R. M., Sidoroff, A., & Braathen, L. R. (2013). European guidelines for topical photodynamic therapy part 1: treatment delivery and current indications–actinic keratoses, Bowen’s disease, basal cell carcinoma. Journal of the European Academy of Dermatology and Venereology, 27(5), 536-544.

    21. Dolmans, D. E., Fukumura, D., & Jain, R. K. (2003). Photodynamic therapy for cancer. Nature Reviews Cancer, 3(5), 380-387.

    22. Leffell, D. J., & Headington, J. T. (2000). Punch biopsy instrument: use and applications. Dermatologic Clinics, 18(3), 423

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