Quick Answers for the Baffled Patient: What Does a Dermatologist Do?

A national survey reveals that Americans believe dermatologists focus their time on managing skin cancer and performing cosmetic procedures. Most also perceive their primary care physicians to have a more critical profession. This can influence crucial health decisions, particularly when choosing a doctor for skin disease treatment.   

Few people associate dermatology with serious illnesses because most skin disorders are benign and resolve quickly. But misconceptions about the dermatologist’s job ultimately contribute to therapeutic failure, unnecessary costs and prolonged suffering for patients.

What does a dermatologist do? And why is it important to go to the right specialist for your skin problems?

This article explains the scope of a dermatologist’s practice, what it takes to become a board-certified dermatologist and what you can expect when consulting a skin care specialist. 

What Is a Dermatologist?

A dermatologist is a licensed medical doctor specializing in the management of skin, hair and nail conditions. Dermatologic issues have various causes, so patients come from all walks of life. The practice is primarily outpatient-based. But dermatologists may occasionally provide in-hospital services to the critically ill and ward patients with hard-to-treat lesions.

What Does It Take to Become a Dermatologist?

Dermatologists are specialized physicians. Being lifelong learners, their careers are typically divided into the following phases:

• Pre-medical school

This phase can be as short as two years for straight medical programs and as long as four years for most bachelor’s degree programs.

• Medical school

Physicians learn the medical basics in four years. Prospective students must pass the Medical College Admission Test before starting formal training.

• Postgraduate medical internship

This is the entry point to residency. It consists of one year of clinical work, usually in internal medicine, pediatrics or surgery. Medical school graduates must have passed the US Medical Licensure Examination before starting internship.

• Dermatology residency

This stage comprises three clinical years devoted to dermatologic cases. A dermatologist typically spends 12,000-16,000 hours in specialty training.

• Board certification

Dermatology residency graduates take a series of exams required by the American Board of Dermatology. Board-certified dermatologists can practice in the field independently.

• Subspecialization

A dermatologist may choose to start their practice right away or pursue a subspecialty after board certification. Subspecialization—usually done by completing a year of fellowship in an ACGME-accredited program—makes them experts in diagnosing or treating specific skin issues.

Fellowship training is like going back to school. It’s generally difficult to pursue a fellowship while in private practice. But even without a subspecialty, practicing dermatologists can stay up to date by taking alternative continuing medical education (CME) paths, such as conferences, workshops, medical journal reading, etc.

What Is a Typical Day for a Dermatologist?

That depends on whether or not they teach at a medical institution.

Non-teaching dermatologists spend most days of the week in their outpatient clinics. They may do ward rounds to see hospitalized skin cancer patients or inpatients referred by other doctors.

Meanwhile, those affiliated with educational institutions schedule teaching sessions alongside their patient consults.  

Both teaching and non-teaching doctors attend CME activities regularly, which they need for recertification and maintaining their licenses.

What Issues Do Dermatologists Treat?

Thousands of conditions fall within the realm of dermatology, and it is beyond the scope of this article to discuss them all. But they are commonly classified based on anatomy, cause and treatment requirements.

The skin has many components, each vulnerable to injury or deformity. So there are as many skin issues as there are structure-specific disorders. For example, collagen loss or damage produces wrinkles in aging skin. Vitiligo is an autoimmune skin disorder that destroys pigment cells. Acne and seborrheic dermatitis involve abnormal sebaceous glands.

On the other hand, the causes of skin disease include the following:

• Infections such as cellulitis, head lice and warts
• Immunologic disorders, which pertain to conditions with an allergic or autoimmune component. Examples are atopic dermatitis and other forms of eczema. 
• Endocrine dysfunction, as in excessive hair loss or growth from an imbalance of testosterone-like hormones
• Metabolic abnormalities, as in mouth sores and hair loss from zinc deficiency 
• Connective tissue disorders, which may give rise to keloid scarring or skin laxity
• Environmental injuries, mostly coming from the sun, cigarette smoking, alcohol, pollution and substances encountered at work. Malignancies like basal cell skin cancer, squamous cell skin cancer and melanoma commonly result from chronically excessive sun exposure.
• Trauma, which may be due to accidents, burns and many others

Then there are those with an unknown cause or presumed to have mixed causes. Psoriasis, acne, rosacea and seborrheic keratosis are some examples.

Dermatologic conditions may also be classified according to the type of treatment they require.

• Medical skin problems arise from systemic disorders. Remedies include drug treatment and photomedicine. For example, minor skin rashes and lichen simplex chronicus respond to corticosteroids, which suppress the immune mechanisms that produce these blemishes. UV-induced actinic keratosis lesions, which often involve extensive areas, may be treated with photodynamic therapy.

• Surgical skin lesions are more localized and may be cut out using some form of energy. Laser therapy for sun damage and Mohs micrographic surgery for skin cancer are examples.

• Healthy body areas may have cosmetic issues if their appearance elicits feelings of dissatisfaction in patients. Medical and surgical approaches can make them look more attractive. For example, acne scars may improve with chemical peels. Laser hair removal is a popular cosmetic treatment among people who want to look bikini-perfect.

Most physicians have limited training in dermatology, so they may have a hard time diagnosing uncommon skin problems. But board-certified dermatologists have extensive education in this field, allowing them to identify even rare skin lesions easily. Early detection is vital when treating skin cancer, generalized pustular psoriasis and other potentially life-threatening dermatologic conditions.

What Services Do Dermatologists Provide?

As you may have guessed, dermatologists can give various treatments that may be classified under three categories.

• Medical dermatology uses medications and photomedicine to deal with systemic abnormalities affecting the skin.
• Surgical dermatology uses energy to remove localized skin lesions.
• Cosmetic dermatology uses medical and surgical techniques to enhance the looks of an otherwise normal body part.

Board-certified dermatologists are experts in all three, but subspecialization further refines their ability to diagnose or treat specific conditions. As physicians, they are also responsible for teaching patients how to keep their skin healthy.

When Should You Start Seeing a Dermatologist?

Most patients are comfortable consulting their primary care physicians for their skin problems, which is perfectly fine. But you should consider going to a skin care specialist when you have:

• A skin growth or hair and nail symptoms unresponsive to your primary care provider’s treatments 
• A serious or chronic skin condition like cancer, atopic eczema or psoriasis 
• A cosmetic concern that is best handled by an expert

Keep in mind that the outcomes are generally better for skin lesions treated early.

Why Is It Important to See a Dermatologist for a Skin Disorder?

Consulting a specialist for a skin problem gives you the following benefits:

• • Cost-effectiveness Inaccurate diagnosis often leads to ineffective interventions, which can be costly over time. Additionally, a poorly managed skin condition or a botched cosmetic procedure may cause complications requiring hospitalization. Your dermatologist can save you money by providing the safest and most effective treatment for your skin problem.

• • Superior cosmetic results Your dermatologist’s specialized knowledge of the skin allows them to get rid of lesions with barely any trace of damage. They can preserve the function and appearance of the body areas they treat.

• • Better health outcomes Timely treatment limits skin damage, letting you recover quickly after therapy. Also, having healthy skin enhances most people’s self-image and psychological well-being.Most importantly, the sooner you eliminate a skin issue, the sooner you improve your quality of life. For school kids with eczema breakouts, that means less distraction from itching and scratching. For people with bad joint scars, that means greater mobility.

The worst that can happen is when an untrained provider confuses skin cancer with benign disease and gives you the wrong treatment. Spare yourself from trouble by consulting no less than an expert for your skin concerns.

You may read our article on finding the right dermatologist to learn more about getting expert skin care.

What Does a Dermatologist Do on the First Visit?

Many skin problems can be identified at first glance. Upon taking some personal information, your physician will examine the lesion while asking questions like:

• When and how did it start?
• Has it grown or spread to other body parts? If it has, how fast?
• How has the lesion evolved?
• Have you used any treatments? If you have, how has it responded?
• What factors aggravate or alleviate it?
• Is it accompanied by other symptoms?

Your doctor will also inquire about other relevant information like:

• Past illnesses
• Allergies
• Current diet and medications
• Family history
• Social history, specifically if you drink, smoke or spend a lot of time in the sun
• Occupational exposures
• Travel history
• Sexual history
• Vaccinations

After getting your complete medical history, they may ask permission to photograph the problem area for documentation and post-treatment comparison.

In some cases, it is enough to show only the lesion during the physical exam. But your specialist may ask permission to check other parts of your body to rule out complications or widespread involvement. They will also search for signs indicating that you require emergency treatment.

If they find you fit to be treated as an outpatient, your dermatologist may continue by performing simple in-office tests if they are necessary. One example is Wood’s lamp examination, which helps them confirm the presence of a fungal skin infection. They may also swab or scrape the lesion and check the tissue sample under a microscope. If your doctor wants to rule out cancer, they may schedule you for a biopsy.

To end your first consult, they will discuss the likely diagnosis and propose a treatment plan. If you agree to keep working with your dermatologist, you will be scheduled for your next session, which may be for a simple follow-up or a procedure.

Does Insurance Cover Dermatology?

It is common for patients to be concerned about the costs of seeing a skin care specialist. To answer this question, yes, insurance does cover dermatology consults and treatments, but only if they are medically necessary. Cosmetic dermatology procedures are usually paid out of pocket unless they can also address a health problem.

Health insurance typically pays for the greater part of your hospital fees, prescription medications, doctors’ professional fees and lab tests. The amount of coverage varies widely, so it is best to ask your insurance provider how much they can reimburse for your treatment.

Private insurance generally reimburses more than government health programs do. It is more expensive to get private insurance, but it is more widely accepted by doctors and available to more people.

Your dermatologist may or may not be affiliated with your health insurance provider. So you must ask before you book your first appointment.

Choosing a Specialist for Your Skin’s Special Needs

A primary care consult may suffice for common skin issues. But those that are stubborn, disabling, disfiguring or life-threatening are best left in expert hands.

Most physicians have limited training in dermatology. Meanwhile, board-certified dermatologists have mastered the discipline, so they can diagnose and treat a vast number of skin conditions safely and effectively. Seeing a bona fide specialist for your skin problems helps reduce unnecessary costs and produces better cosmetic and health outcomes.

Finally, many dermatologic treatments are pricey. Insurance providers cover the medically necessary ones but not physically enhancing procedures. So to make every penny count, trust only a reputable skin care specialist. 

Tired of Skin Regimens That Don’t Work? 

Many skin problems respond to cleansing, having a healthy diet and common doctor-prescribed remedies like antimicrobials and steroids. But conditions like skin cancer, autoimmune hair loss and vascular birthmarks do not go away without the help of a specialist.

At BHSkin Dermatology, our award-winning skin care professionals use various treatments skillfully to restore the glow in patients’ skin. Visit us at our Glendale or Encino clinic for a face-to-face consultation or use our telederm portal to talk to our doctors remotely. 

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