The human body has several built-in defense mechanisms that protect us from foreign organisms that may cause disease. Internally, the immune system takes the lead protecting us from infection. Externally, the skin – the body's largest organ – plays an enormous role in preventing those invaders from gaining entry to the body in the first place.
To care for this critically important organ, you may need the help of a dermatologist, "a specialist doctor who cares for the skin, hair, nails, and mucus membranes," says Dr. Christen M. Mowad, a dermatologist with Geisinger in Danville, Pennsylvania. "That encompasses a lot of diseases and conditions – by some reports it's over 3,000 conditions and diseases," she says.
Among the most common conditions you might need a dermatologist for are acne, rosacea, eczema, psoriasis, hair loss and vitiligo, a disease that makes the skin lose its pigment in patches. In addition, some dermatologists perform cosmetic procedures such as Botox injections and laser surgery.
[See: 7 Ways to Prevent Skin Cancer.]
"Skin cancer is also a huge component of what we do," Mowad says. The American Cancer Society reports that cancers of the skin are "by far the most common of all types of cancer." There are several different types of skin cancer to watch out for, with melanoma being the deadliest. Although melanoma accounts for only about 1 percent of skin cancers, it causes most skin cancer deaths. The ACS estimates that more than 91,000 new melanomas will be diagnosed in 2018 and more than 9,000 people will die of the disease this year. Seeing a dermatologist for an annual skin check can point out skin cancers sooner, which may help reduce your risk of dying of the disease.
But a good dermatologist can improve more than just the health of your skin. "Many of these diseases [a dermatologist treats] are more than just skin deep," Mowad says. "We might be able to identify an underlying disease process because of a cutaneous [skin] finding." Because your skin is such a major part of your body, Mowad says it actually "provides a window inside the body in many cases." Skin conditions can point to other internal problems, so dermatologists often "end up working with many of our subspecialists in the internal medicine world to help diagnose some of these skin conditions that also have internal ramifications." Some examples of these sorts of conditions include psoriasis, which can be a sign of diabetes or arthritis. Other skin conditions may point to an underlying pulmonary disease, high cholesterol, high blood pressure or even celiac disease, Mowad says.
No matter which condition you're being treated for, Mowad says "education is an important part of what we do once we've diagnosed or set up a management plan. Educating people and getting them to understand and be engaged in the process of treating the condition or taking care of the condition, it's very important that the patient understands and is aware of the process. I think that helps them with compliance," she says.
So what makes a good dermatologist? Dr. Suzanne Olbricht, chief of dermatology at Beth Israel Deaconess Medical Center in Boston and an associate professor of dermatology at Harvard Medical School, says, "a good dermatologist has really very good visual skills," augmented by years of training that helps them identify conditions when they see them. Olbricht, who's also the president of the American Academy of Dermatology, says good dermatologists also have good communication skills. "Like any good physician, a good dermatologist is a physician who listens, lets you ask questions, answers your questions, and doesn't try to sell you something for a problem different from what you came in for."
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That said, she notes that even if you came in to have a bump on your nose checked out, most dermatologists will probably also want to check the rest of your skin. "Most dermatologists at one point or another will want to do a complete skin exam, and that's something that I find that patients don't think in advance might happen." If you come in for a rash on your hand, be prepared for the doctor to ask you to put on a gown so she can check all of your skin for other potential problems. "Certainly, the dermatologist will look at what you find troubling, but most dermatologists almost always want to look at the rest of your skin, too, to find lesions you maybe can't see. If that spot on your nose is skin cancer, we want to look at your back to make sure that you don't have a skin cancer there, too," she says.
When looking for the right dermatologist for your needs, Olbricht recommends starting by determining whether the doctor you're considering is a board-certified dermatologist. "Board-certified dermatologists went to college and then went to medical or osteopathy school followed by an internship and then three years of dermatology residency. So, this is training that's only in dermatology." To achieve board-certification status, these doctors must also pass a rigorous exam, and to remain certified, they must continue their education and take additional examinations every 10 years.
Certified dermatologists can go on to join the American Academy of Dermatology, which hosts a zip-code based doctor finder search on its website. Olbricht says 92 percent of board-certified dermatologists join the Academy, and most will proudly display these credentials on their website. The initials FAAD after the doctor's name also indicate he or she is a fellow of the American Academy of Dermatology.
Mowad agrees that board certification is important. "Lots of health care providers offer some dermatological care, but as board-certified dermatologists, we feel we have the additional education and training that specializes us in the care of the skin." If you can't be seen directly by a certified dermatologist, she recommends looking for a practice that's under the direction of a board-certified dermatologist. In those cases, you may see a nurse practitioner or a physician assistant who works closely with a board-certified dermatologist and can call on their expertise as needed.
Mowad also recommends asking friends and family for recommendations, as that can offer you some insight into how a particular physician conducts exams.
To prepare for your first visit with a new dermatologist, Mowad recommends making a list of all medications you take regularly – or bringing them with you. "Certainly, if you've been using dermatologic treatments, either creams or oral medications, make sure that we know what they are and the duration you've been on them." If you've had any other skin-related treatments or procedures, like a biopsy, be sure to tell your doctor when they occurred and where they took place. "It's always helpful to have that information or at least know how we can get that information so we don't have to repeat things unnecessarily." It's also helpful to know your own skin and your family history. "Especially if there's a concern about skin cancer, know your own and your family's history. We often ask questions about tanning bed use, sunburns and blistering sunburns as children," she says.
Both Mowad and Olbricht recommend everyone get an annual skin check and remain vigilant for changes to this important part of the body. "The skin is a dynamic thing, and it changes with time. One skin check doesn't cover you for your lifetime," Mowad says. Therefore, "it's very important that you're aware of your skin, aware of any changes that may be occurring and then bring them to the attention of your dermatologist if that happens."
