Diagnosis
Medical History
The first step of any contact with a physician is the medical history, and this is particularly important in Dermatology. In order to classify a skin eruption, the FVH Dermatologist will ask detailed questions on the duration and temporal pattern of skin problems, itching or pain, relation to food intake, sunlight, over-the-counter creams, and clothing. When an underlying disease is suspected, an additionally detailed history of related symptoms will be factored in (such as arthritis in a suspected case of lupus erythematosus).
Physical Examination
Dermatology has the obvious benefit of easy access to tissue for diagnosis. Physical examination is usually done under bright light and preferably involves the whole body. At this stage, the specialist may apply Wood’s light, which may aid in diagnosing types of mycosis or demonstrate the extent of pigmented lesions, or use a dermatoscope (an invaluable new instrument that enlarges a suspected lesion and visualizes it without reflected light). The dermatoscope is helpful in differentiating a benign naevus from melanoma or a seborrheic keratosis from a mole. A morphological classification of dermatological lesions is important in the diagnosis of dermatological disorders. Dermatologic diagnosis is often dependent upon pattern recognition of lesions and symptoms.
Microbiology
Culture and Gram staining of suspected infectious lesions may identify a pathogen and help direct therapy.
Biopsy
If the diagnosis is uncertain or a cutaneous malignancy is suspected, the FVH Dermatologic surgeon may perform a small punch biopsy (using local anaesthesia) for examination under the microscope by a trained dermato-pathologist.
Any mole that is irregular in colour or shape should be examined by a Dermatologist to determine if it is a malignant melanoma, the most serious and life-threatening form of skin cancer. Following a physical examination and a dermatoscopic exam your Dermatologist may biopsy a suspicious mole. If it is malignant, it will have to be excised.
Conditions
Dermatitis, the condition when a patient is afflicted by a rash, is a common dermatologic problem treated routinely by FVH Dermatologists. The two very common types of dermatitis are Contact Dermatitis and Atopic Dermatitis.
Contact Dermatitis – is a skin condition which occurs when the skin comes in contact with a substance which causes an allergic reaction (allergic contact dermatitis) or when there is an injury to the surface of the skin (irritant contact dermatitis). Allergic reactions are an individual condition and can be caused by a number of substances which we may come into daily contact with. As a prelude to treatment, the FV Hospital Dermatology Department might conduct a number of tests to determine which substance is causing the allergy.
Atopic Dermatitis – this skin condition is passed from parents to children. It can occur at any time in life and is most prevalent in families who have a history of allergies. This condition cannot be cured but can be effectively treated to control the symptoms of itching and dry skin.
FVH Dermatologists are experts in Immuno-Dermatology which is the diagnosis and management of skin diseases driven by altered immune system including blistering (bullous) diseases like pemphigus; in Venereology, the subspecialty that diagnoses and treats STDs (sexually transmitted diseases such as herpes); and phlebology, the specialty that deals with problems of the superficial venous system.
In addition, there is a wide range of congenital syndromes managed by dermatologists, who also know well the diagnosis and treatment of skin diseases in children.
Common dermatologic conditions and diseases include:
- Acne
- Seborrheic dermatitis
- Bullous & blistering diseases
- Dermatitis
- Eczema
- Urticaria and Angio-oedema
- Naevus & pigmented lesions
- Erythrodermia
- Psoriasis
- Excessive sweating
- Discoid lupus Erythematosus
- Scabies
- Superficial fungal infections, Yeast infections
- Viral diseases: Herpes, Shingles, Molluscum contagiosum, warts, etc
Treatments
Dermatologic Procedures
The most common procedures done during the consultations are the removal of warts, of beauty marks, the treatment of skin allergies which are simple procedures which can be attended to in the FVH Out-Patients Department. Laser, cosmetic procedures using botulinum toxin (“Botox”), soft tissue fillers and sclerotherapy are also routinely carried out.
Techniques available to an FVH Dermatology Surgeon include lasers, traditional scalpel surgery, electrosurgery, Cryotherapy, photodynamic therapy.
Some specially trained Dermatologists perform skin cancer surgery.
Cosmetic Dermatology
Cosmetic dermatology has long been an important part of the field, and Dermatologists have been the primary innovators in this area of Medicine. In the 1900s, Dermatologists employed abrasion to improve acne scarring and fat micro-transfer was used to fill in cutaneous defects.
Nowadays, Dermatologists are at the forefront in the development of safe and effective employment of lasers, new dermal filling agents (collagen and hyaluronic acid), botulinum toxin (“Botox”), nonabrasive laser rejuvenation procedures, intense pulsed light systems, photodynamic therapy, cryotherapy, and chemical peeling.
The Waldman UV7002 therapy system
Psoriasis is a chronic, non-contagious autoimmune disease which affects the skin of 2% population. It varies in severity from minor localized patches to complete body coverage and can also cause inflammation of the joints, which is known as psoriatic arthritis at the ratio of 10-15 % patients. The cause is not known, but it is believed to have a genetic component. Factors that may aggravate psoriasis include stress, excessive alcohol consumption, and smoking.
The Waldman UV7002 therapy system
According to Dr. Guillaume Orieux, Head of FV Hospital Dermatology Department, “Psoriasis has long been a stigma to the patients, hindering them both physically and psychologically. Treatment by exposing them to UV light (phototherapy) can help keep psoriasis under control. The newly developed Waldman UV7002 therapy system is a relief to patients, re-initiating them into the community with better self-image. This machine can treat patients with narrowband UVB, with UVA and even both during the same session. Electronic microprocessor control with continuous measurement of intensity and entry of dose values. This provides comprehensive safety and efficient comfort with the management of patient data and treatment regimens.”
Reduction of excessive sweating by electric current
Palm and sole sweating is a common problem among adults, especially those younger than 25 due to excessive stimulus of sympathetic nerves on the spinal cord which control the sweat gland activities. The excessive stimulus has not been fully explained but genetics may play part. Also, worry, scare, and over-anxiety may lead to the ailment.
To minimize sweating, dermatology doctors will suggest topical cream, botox injections or iontophoresis depending on the severity of the sweating. For palm sweating, an option is doing an operation to cut the sympathetic nerves.
Patients during iontophoresis treatment
According to the American Academy of Dermatology, iontophoresis has proven to have an 83% success rate for people with sweaty palms and sweaty feet without the need for surgery. Treatment involves putting the affected areas into a small container filled with water for 20-40 minutes. A mild electrical current is then passed through the water to block the sweat glands. In the first treatment session, the process is repeated every other day for ten days during the first 4 weeks. Then, patients are switched to a maintenance schedule, ranging from once per week to once every four weeks, depending on the individual.
