Crosscurrents Buffeting Dermatology Today

Dermatology has unfortunately become a target of vicious criticism for it’s over indulgence in cosmetology primarily because its lucrative aspect. However, a lot of research is going on globally in the focus areas of melanomas and carcinomas, psoriasis. engraftment, gene expression and coding for sequences for epidermal and dermal proteins. Concern for cutaneous health and appearance: The dermatological patients who are fortunately no longer treated as pariahs and isolated, demonstrate a mounting awareness of their skin and cosmetic health.

This augurs well for the nascent but actively developing chapters of cosmetology and dermatological surgery, whose practitioners’ need to keep focus and strive actively to seek funds in the face of competing life threatening conditions. Dermatologists must however, not remain obsessed with cosmetology only and opt out of treating less glamorous but important endemic conditions.

Preventive dermatology: While the genetic basis of disease remains paramount, role of environmental factors like climate will increase due to our own environmental insults. Efficient preventive education as regards avoidance of solar radiation should specially address the young high-risk group. Unless pollution and environmental degradation is restricted there will be no let up in the progressive increase of cutaneous and nasobronchial allergies.

Patient education: The ever-improving tools of communication offer exciting prospects. Rather than dispense just topicals, pertinent information and knowledge should be imparted to the patients, increasing their compliance as well as satisfaction and decreasing complications and exploitation due to wrong prescriptions by quacks.

Complementary medicine: Antibiotic resistance, diabetes, asthma, eczema, etc. have surfaced in epidemic proportions, perhaps because of winning the battle against infection. This has encouraged supporters of alternative paradigms.

Standardising dermatological vocabulary: The lack of standard definitions of dermatological terms continues to stunt the growth of dermatology. A precise dictionary of the subject is mandatory.

Priorities in future research: As the aetiopathogenesis of many dermatoses like psoriasis, vitiligo, alopecia areata, atopic dermatitis and the mechanism underlying the commonest dermatological symptom of pruritus are not clearly understood, a high priority in future research to unravel these

Mysteries  will   facilitate theirprevention and treatment.

Art of dermatological practice: As improved scientific knowledge has made practice of evidence-based medicine mandatory, there is a real danger of the very ‘art of medicine’ being swept away by this ‘science of evidence’. The progress in dermatopathology has led to the downplaying of clinical skills and shrinkage of the textbook coverage of principles of clinical diagnosis. This trend must be reversed by thoughtful and critical appraisal to strike a judicious balance between logic and intuition integrating the wisdom of the historical data collected from the patient.

Teledermatology: With increasing bandwidth, cheaper and efficient 3D web cameras, teledermatology has come to stay and is sure to rapidly evolve as a cost-effective mode of delivering dermatologic healthcare to remote locations. Besides clinical management and follow up of patients, easy references to textbooks, journals and on-line atlases over the web are additional advantages of information technology. Yet there is no substitute to the doctor’s human touch. Inspiration, Compassion and Ethics forms the basis of all treatment and a dermatologist definitely needs to remember it.