Skin Science


The other day , I happened to be filing away my previous articles when I noticed that in each article I had written ‘ see your dermatologist ‘. This set me thinking as to why I had found it necessary to say this. This was a subconcious thought which was penned down because I have come to realise in my practice that there is a lot of misconceptions about what a dermatologist ‘cures’.

Just the other day I was treating a patient for Acne & after finishing she turned around & asked me ‘ Doc, do you know a nail specialist ?’ I thought she meant it was for decoration or beauty , but she wanted a medical ‘Nail Specialist’. She was astounded when I said, ” excuse me but that is my field of specialisation”. The point of this long winded conversation is that , this is an article I should have written first & then gone on to different skin conditions. But I was a fledgeling writer, whose passion is Dermatology & aim is to bring about an awareness about it . Well its better late than never , so here goes…. the Basis of Skin science & what is a Dermatologist .

Dermatology is the science of skin, hair , nails & mucous membranes. Dermatology evolved as a speciality from Internal medicine in as late as the 19th century. Prior to this, skin diseases were treated as external diseases & came under the preview of either a physician or alternative medical practitioners. In the past 40 years the character of Dermatology changed & the work of a Dermatologist now embraces every aspect of the biology of skin, normal & abnormal. The Dermatologist is also a Specialist in Sexually transmitted Diseases, Leprosy & in the present decade Cosmetic counselling & laser treatments of the skin & hair.

The skin is the largest organ in our body & changes in its normal morphology is a byplay of both environmental or external factors & internal or systemic disorders. The skin is composed of a….. stratified , cellular Epidermis , Dermis..composed of connective tissue, skin organelles & Subcutaneous Fat.

Hair & Nails are termed as appendages and are variations of these layers of the skin as adapted to their functions. In a true sense, the hair & nails are non nucleated structures, which in layman terms is ‘ dead’ tissue. The root of the hair & the nail matrix are situated deep in the dermis, and are the growing component of these structures respectively. Changes in hair structure (perming), colour ,straigtening etc are purely surface phenomena which involve chemical reactions & restructuring of keratin. Similarly in the case of nails, the matrix or root is situated under the proximal nail fold & hence the warnings….do not push back the cuticles during manicure & pedicure because by doing this one exposes the matrix space to infection & damage which leads to irreversible nail damage and loss. The main functions of the skin & its appendages are:
1. Protection……to prevent entry of harmful materials.
2. Resists mechanical shock
3. Regulates heat loss from the body…( sweat)
4. Mediates sensations.
5. synthesis of Vit D
6. Excretion of toxins.
7. Psychosocial & psychosexual communication in man. Enhancement of cutaneous signals by applications of cosmetics & perfumes is considered as a cultural extension of this biological mechanism.

The epidermis is the Barrier of impermeability because of the bonded layers of the topmost layer , i.e stratum corneum. Dermis is the ‘support’ of the skin. Collagen is support & Elastin is the ‘ TONE’ of the skin.

If you consider these functions of the skin, it is easily understandable why a Dermatologist will tell you not to scrub away your dead layers daily, which is in direct contrast to what an advert says. If the layer is removed it will expose the underlying skin to the environment , allowing for entry of allergens & exposing it to harmful effects of sunlight etc. It is also this principle of barrier function & selective permeability of the skin , that asks how do superficially applied vitamins, oxygen delivery etc work ? In today’s day & age it is not enough for a Dermatologist to know only about diseases, but it is imperative to have an adequate knowledge of cosmetics , their usage, their effects & side effects.

Unitl 10 years ago the hallmark of a dermatologist was a magnifying glass. Today we have advanced to Lasers. This shows progress in the teaching & learning of skin science. Dermatologists work in conjunction with Plastic Surgeons in many an institute because it is they who can identify skin lesions, predict their extent into the tissue & also observe immediate skin changes & reactions during procedures. The skin is an external indicator of many an internal systemic disease even before overt symptoms. Here, a skin specialist is invaluable. I do not exaggerate when I say that as a student we have picked up Leukemia, AIDS & of course numerous cases of Diabetes from skin signs only. Working in a Govt. hospital exposes one to such a variety of skin , hair, nail & sexually transmitted disorders that it can boggle your mind. No one believes that a skin specialist can have emergencies in their line of work. This is another fallacy. Who do you think has to diagnose & institute immediate treatment of severe allergic reactions, drug reactions, bullous skin diseases, Leprosy reactions etc ? Even newborn skin emergencies are not a rarity especially in third world countries.

Even in the UAE in the course of my practice I have come across many such cases who have come in for a routine checkup & clinical history & investigations reveal an internal condition. Skin thus involves an extensive knowledge of internal disease, pharmaceutical preparations & funnily enough of consumer products like soaps, detergents, hair dyes, nail polishes, footwear etc. This is important in cases of allergic dermatoses & reactions. Your Dermatologist is also your Psychiatrist because the skin & the Psyche are irrevocably bound to each other. There is a separate section on Psychosomatic (skin ) Disorders. Studies have recognised how many a mental condition can effect a skin disease & vice versa. Acne & pigmentation sends a teenager into a tizzy & skin changes of ageing probably scares all of us. Environmental study in dermatology is not too far because of changing conditions & their effect on skin, ageing, cancers etc. Most European countries have Dermatologists who are also known as cosmetologists & Aesthetiqe surgeons.

Since the advent of Skin lasers the face of dermatology has changed & evolved manifold. In Australia it was the work of Dermatologists who brought into the forefront dangers of the sun & ways to avoid, diagnose & treat skin cancers. Sun awareness programmes are run by skin specialists . The Dermatologist is still considered an indulgence in many countries, but in the western world & developed countries people routinely visit a skin specialist for advice on day to day skin care, cosmetic usage, sun blocks, treatment of excessive sweating, odours, prevention of ageing & even to get a special glow on their face. It is time that a skin specialist becomes an ‘entree`’ and not just a ‘dessert’ , viewed as indulgence only.

To lend credibility to cosmetic products it is still necessary to write or advertise as ‘ DERMATOLOGICALLY TESTED’ , isnt it !

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