Medical Dermatology Treatments Explained

A suspicious skin lesion can split up a crowd of patients in two.

The first group would want dramatic changes at the soonest time possible. Terms like “laser therapy” and “Mohs surgery” do not faze them. They are the dermatologic surgeon’s patients.

The other would take a more conservative approach. They’d rather wait for an ointment or pill to kick in than “go under the knife.” They are better served by medical dermatology.

What skin treatments fall under medical dermatology? And when is drug therapy better than surgery for a skin issue? This article explains medical dermatology treatments, the skin problems they solve and what you can expect during therapy.

What Is Medical Dermatology?

Medical dermatology is a discipline that deals with skin changes resulting from “systemic illness” or disease processes affecting the entire body. The lesions range in size and body distribution, but they are all treated primarily with drug therapy. Occasionally, dermatologists combine pharmaceuticals with light-based technology to get rid of resistant skin disease. Insurance covers these treatments because they address a health need.

How Does Medical Dermatology Differ from Surgical Dermatology?

Surgical dermatology uses energy-based tools rather than medications to correct skin flaws. For example, lasers depend on light energy, whereas mechanical energy drives a scalpel’s incisions. Dermatologic surgery procedures also yield faster and longer-lasting results than medical treatments.

Surgery is more appropriate for localized areas of skin injury that do not go away with medication. The American College of Surgeons does not consider injections into the skin, muscles and blood vessels as surgical treatments.

You may read our article on surgical dermatology for more information about its procedures.

What Is the Difference Between Medical and Cosmetic Dermatology?

Cosmetic dermatology works on body areas that have no functional or medical issues. It is merely for aesthetic enhancement. A cosmetic procedure may or may not involve surgical techniques. Insurance companies do not cover cosmetic dermatology treatments since they are not medically necessary.

You can check out our article on cosmetic dermatology to learn more.

Regardless of their differences, these disciplines are part of general dermatology training. So expect board-certified dermatologists to be experts in all three.

What Skin Conditions Do Medical Dermatologists Treat?

Systemic disorders can transform the skin and its parts in various ways. Many such changes go away upon elimination of the underlying disease. But the stubborn ones are left to the medical dermatologist’s expertise, especially if they are life-threatening or hard to identify. They may be classified as follows:

Infectious

Skin infection may be due to bacteria, viruses, fungi or parasites. Shingles, warts, leprosy, scabies and athlete’s foot are some examples.

Immunologic

Hypersensitivity and autoimmune disease both result from immune disorders.

Some skin problems associated with hypersensitivity are short-lived. Allergic rashes are the most common examples. Others, like eczema (atopic dermatitis), persist and flare from time to time.

Autoimmune disorders may also have a brief or long course. Some conditions, like alopecia areata (autoimmune hair loss), do not usually lead to serious health problems. But others, such as bullous pemphigoid and Stevens-Johnson syndrome, can become fatal.

Endocrine

Hormonal fluctuations may also bring a patient to the medical dermatologist’s office. For example, an imbalance of sex hormones can cause excessive pigmentation or hair growth. Hair brittleness, facial flushing and increased palm-sweating may accompany thyroid problems. Nail changes and skin thickening are symptoms of growth hormone hypersecretion, and so on.

Metabolic

Nutritional deficiencies deplete the skin’s vitamins. Vitamin B12 or folic acid insufficiency produces skin discoloration. Niacin and vitamin A deficits cause distinct forms of dermatitis. Severe zinc inadequacy leads to mouth sores and hair loss. These are just some examples. In countries like the US, nutritional deficiency may be due to prolonged illness, diarrhea and poor dietary choices.

Nutrient excesses can also damage the skin. For example, chronically high blood sugar is associated with unusual darkening of skin fold areas like the back of the neck, a condition called “acanthosis nigricans.”

Connective Tissue Disease

Connective tissues like collagen glue the cells together to keep the organs intact. Some patients are born with connective tissue disorders that make the skin lax and fragile. Examples are Ehlers-Danlos syndrome and Marfan syndrome.

Malignancies

Mohs surgery can eliminate a slow-growing skin cancer like squamous cell carcinoma. But melanoma has a higher risk of recurring and spreading even decades after the first tumor has been removed.

When that happens, the dermatologist may still consider a surgical approach if the new skin growth is operable, i. e. its size is manageable and it does not involve vital structures. Otherwise, systemic therapy may be recommended.

Medical treatment may also be considered for cancers originating from other body systems. Examples are T-cell lymphoma and Kaposi sarcoma, which often have skin manifestations.

Environmental

Environmental causes of skin disease include sun exposure, radiation exposure, thermal injuries, occupational hazards and many others. Actinic keratosis is a precancerous skin disorder resulting from years of UV damage. Frostbite can injure the skin and deeper tissues. Chemicals like arsenic, mercury, chlorine and benzene in factory fumes can also produce skin abnormalities.

Unknown or Mixed Causes

Many skin issues have no known source. Psoriasis, rosacea and sarcoidosis are a few examples, although they share some features with autoimmune disorders. For instance, psoriasis responds to UVB phototherapy, which is thought to modulate the skin’s immune function. Meanwhile, there are those like acne that are presumed to be multifactorial.

The conditions mentioned here barely scratch the surface. Skin disease has innumerable manifestations, and only a board-certified dermatologist has the expertise to identify them all correctly. A less qualified provider may give you the wrong diagnosis, and worse, subject you to a potentially harmful procedure.

What Are Considered Medical Dermatology Treatments?

Medical dermatology therapy has several forms:

Topical Preparations

Topical medications are the first-line therapy for many skin disorders. They reach their targets directly, preventing damage to normal skin tissue and other organs. These formulations are applied to the skin and include cleansers, ointments, lotions, creams and others. Below are some common active ingredients:

Steroids

Steroids are chemically related to cholesterol and the stress hormone cortisol. They weaken the immune response, curbing skin inflammation and itchiness. But chronic use can lead to skin thinning and fragility. Hydrocortisone, a first-line eczema treatment, is an example. Triamcinolone, a drug injected in keloids to reduce their size, is another.

Retinoids

Retinoid molecules look and work like vitamin A. They normalize cellular growth and immune cell activity in skin tissue. The topical acne treatment tretinoin is a retinoid.

Humectants and emollients

Humectants like glycerin and sorbitol attract water from their surroundings. In contrast, emollients like lanolin and petrolatum are water-insoluble, but they trap moisture on the skin’s surface. Both keep the skin soft and less vulnerable to flaking and itching. They are particularly useful for people with chronic inflammatory conditions like psoriasis and eczema.

Antivirals

Topical preparations for cold sores contain antivirals like acyclovir and penciclovir.

Antibacterial agents

Various substances have antibacterial properties. The ones frequently used for skin infections are mupirocin, azelaic acid and benzoyl peroxide.

Antifungals

Clotrimazole, tioconazole and miconazole are common ingredients of antifungal creams and ointments.

Antiparasitic agents

These medications include pyrethrins, permethrin and metronidazole. Head lice, scabies and rosacea are some conditions treated with topical antiparasitic drugs.

Photo-protective agents

These substances protect the skin from UV rays and include sunblock ingredients like zinc oxide, titanium dioxide and PABA.

Cytotoxic medications

Topical cytotoxics inhibit cell growth mechanisms and are used on immunity-driven and premalignant lesions. Coal tar and 5-fluorouracil belong in this class. Dermatologists sometimes inject bleomycin into large, stubborn warts to reduce their size.

Keratolytic agents

These substances make thick skin easier to remove. They can remedy various skin problems, including mild psoriasis and acne. Chemical peel ingredients safe for home use include salicylic acid and glycolic acid.

Disease-specific topical treatments are not included here but are discussed in our other articles.

Systemic Medications

Your dermatologist will consider systemic drugs—those circulated by blood—when the lesions are widespread and other treatments are either ineffective or unsafe.

Among the topical agents mentioned above, the ones with systemic versions are steroids, retinoids, antimicrobials and cytotoxics.

• Systemic steroids and cytotoxics treat malignancies and immune disorders.

• Systemic retinoids like oral isotretinoin (Accutane) and bexarotene have wide applications, including acne and skin cancer therapy.

• Antimicrobials reaching the blood are for advanced infections.

Others that are more effective when locally injected or systemically delivered are analgesics, antihistamines and biologics.

• Analgesics reduce pain. Those that disrupt the inflammatory process include ibuprofen and aspirin. Those that do not interfere with inflammation include oxycodone and acetaminophen.

• Antihistamines minimize itchiness. Systemic administration makes them appropriate whether or not the skin is intact. Cetirizine is one example.

• Biologics like etanercept are agents derived from living organisms. They act on various immune mechanisms and can shut down one’s immunity. Dermatologists will consider them only as a last resort against resistant, severe inflammation.

Drugs can reach the systemic circulation in many ways. Oral intake, intravenous injection and nasal spray are some examples.

Therapeutic Photomedicine

Phototherapy exposes extensive skin areas to light energy of a specific wavelength. It gets rid of abnormal cells and modulates cell growth and immune activity in the skin. Ultraviolet light is the most frequently used.

UVA and UVB are types of ultraviolet radiation with wide applications in dermatology. UVA, discussed further below, has less energy and works better when combined with a light-sensitizing substance. UVB is stronger and may be used alone or together with a topical or systemic medication. UVB phototherapy is the first line of treatment for moderate to severe psoriasis.

Combined Drug and Light-Based Regimens

These treatments require the use of a photosensitizing agent before exposing a skin lesion to powerful light beams. Photochemotherapy and photodynamic therapy (PDT) belong in this category.

UVA light radiation combined with oral or topical psoralens (PUVA) is a form of photochemotherapy. Psoralens bind to the skin lesion cells’ genes where they can amplify UVA damage. The procedure increases a patient’s cancer risk. But the dermatologist may recommend it for advanced, hard-to-treat cases of vitiligo, psoriasis, etc.

In contrast, PDT relies on aminolevulinic acid (ALA), a drug that uses blue light energy to split the oxygen molecules in skin tissue. The small toxic particles released selectively destroy abnormal cells. Precancerous lesions and early-stage skin cancer are PDT’s most important indications. ALA does not bind to DNA molecules, so it has a much lower cancer risk.

Eye protection is necessary when undergoing these procedures.

This list covers only the most important medical dermatology treatment options. A bona fide skin care expert has many more. During your visit, your dermatologist will formulate a therapeutic regimen based on your personal needs. Do not hesitate to ask if you have any questions about your treatment.

When Should You Seek Medical Treatment for a Skin Concern?

Some patients do not see a doctor for a skin problem unless it starts to cause some form of deformity or functional disability. But these are signs that the condition is already advanced and may not be completely reversible anymore. So if you find an unusual skin lesion, have it checked immediately for any of the following reasons:

• You experience loss of sensation or intolerable pain or itchiness on the affected area.
• It is growing or spreading fast.
• It bleeds even with the slightest trauma.
• It has an irregular shape or pigmentation.
• You think that it could be medication-related. Prompt action is needed for presumed drug-induced conditions like Stevens-Johnson syndrome as they can progress rapidly.
• You have had skin cancer treatment previously.
• You have an inborn or acquired immune disorder.
• You have a family history of cancer.
• You have other risk factors for developing skin cancer, such as smoking or chronic sun exposure.
• You have other symptoms like weakness, recurrent fever, rapid weight loss, diarrhea, vomiting, loss of appetite, etc.
• You think it could be contagious, and you live with close contacts. For example, warts and fungal infections may seem harmless, but you can easily pass them on to children, elderly people and others with weak immunity.
• The lesion persists despite regular washing or skincare product use.

Keloid-prone individuals should also seek treatment early, even for less serious problems like acne. Keloids can cause significant deformity and are better prevented than treated.

When Is a Medical Dermatology Treatment Preferred Over Surgery?

Below are some of the most important reasons why your dermatologist would choose a medical regimen over surgery to treat a skin disorder:

• The lesion has a good response to the currently available medical options.
• The underlying cause is systemic, so the risk of recurrence or failure after surgery is high.
• The lesions are widespread or involve important structures.
• You have a health condition that can make surgery or anesthesia unsafe for you.
• Cost is a significant concern.
• You can’t consent to surgery for personal reasons.

But ultimately, you and your doctor are partners in this journey. Working together is the easiest path toward healthier skin.

What Can You Expect When Getting Medical Therapy for a Skin Condition?

Every medical dermatology patient is different, but generally, the following happens in the course of therapy:

Before Treatment Starts

On your initial consult, your doctor will ask you for a complete background of the problem and your full medical history. They will then perform a physical exam, and if necessary, order diagnostic tests. After the evaluation, the dermatologist will discuss what they think of your condition and what you need for treatment. In some cases, medical clearance is required before starting therapy.

During Treatment

When undergoing a medical regimen for a skin concern, you are expected to do the following:

• Stick to the treatment and follow-up schedule.
• Watch out for any side effects.
• Avoid any substance that may interact with your medication.
• Seek help immediately for problems that you think may be related to your therapy.
• If you are being treated for an infection, you may be advised to inform your close contacts and encourage them to get checked.

Meanwhile, your physician will monitor your progress and look for signs of untoward drug reactions. From there, they will see if the treatment should continue, stop or be combined with another.

What to do when under medical therapy for a skin lesion:
	Stick to the treatment and follow-up schedule.
	Watch out for any side effects.
	Avoid any substance that may interact with your  medication.
	Seek help immediately for problems that you think  may be related to your therapy.
	If you are being treated for a highly contagious skin  infection, inform your close contacts and encourage  them to get checked.

When the Treatment Course Is Over

After the therapy, your dermatologist will advise you to do the following:

• Minimize your exposure to possible causative factors, e. g. by wearing personal protective equipment at work, using sunblock outdoors, smoking cessation, etc.
• Maintain good hygiene.
• Report late side effects, if there are any.
• Take prescribed maintenance meds, if there are any.
• Follow up with your primary care physician.
• If you just finished skin cancer treatment, schedule a follow-up when instructed. The doctor needs to make sure that the tumor does not recur or is promptly taken out if it does.

Most medical therapies will not keep you from your normal routines. But you may need to avoid vigorous activity during or after some treatments. Phototherapy and PDT require little or no downtime. But patients who just had cancer chemotherapy may take up to a year to recover from some of the drugs’ side effects.

Your physician will explain other treatment-specific instructions during your visit. Strict adherence to the therapeutic plan will help you get the best results.

Because Healthy Skin Reflects Inner Wellness

Medical dermatology is a specialty that deals with skin problems caused by systemic disorders. The lesions that medical dermatologists treat respond to drug therapy, light-based treatment or a combination of both. Medical therapy of skin disease takes time, so patience and treatment adherence are critical to success.

If you think you need a medical dermatology appointment, make sure that it’s with no less than a true skin care professional. The skin manifestations of systemic disease are plenty, and someone unqualified can mix them up. Only a board-certified dermatologist, with their sharp clinical eye for skin disorders, can guarantee the effectiveness and safety of your treatment.

Let LA’s Best Restore Your Skin’s Health

Taking care of your skin is part of a healthy lifestyle. It’s not easy, but you can rock it, especially when you have the best skin care professionals by your side.

At BHSkin Dermatology, our award-winning specialists help countless patients get rid of stubborn blemishes and restore their skin’s radiance. If you have a bothersome skin problem, feel free to consult our doctors. Visit us at our Glendale or Encino clinic or use our virtual portal. Book your appointment today!

Author: Don Mehrabi

Don Mehrabi, MD, FAAD, is LA’s leading board-certified dermatologist who treats patients, builds the BHSkin clinics, and raises three kids. This blog builds on medical studies combined with Dr. Mehrabi's first-hand experiences from practicing in Encino-Tarzana, Glendale, and online