Dermatology

doi:10.1136/bmj.320.7238.850

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Peter A Foley, senior lecturer in dermatology (FOLEYP@svhm.org.au)

University of Melbourne, Department of Medicine (Dermatology), St Vincent's Hospital Melbourne, Fitzroy, Victoria 3065, Australia

Accepted 2 January 2000

Dermatology is a diverse specialty. It is one of the few areas of medicine in which a specialist can be both physician and surgeon, treating malignant and non-malignant disease in a population ranging from infants to adults. It is constantly evolving. In recent years, dermatology has incorporated techniques and treatments from other disciplines, such as genetic studies and the use of immunosuppressive agents, and pioneering work in the rapidly expanding area of laser therapy has broadened the diagnostic and therapeutic horizon. Advances in the understanding of dermatological conditions have allowed dermatologists to refine treatments.

Summary points

Lasers are now used for depilation and for removing tattoos without leaving scarring

Photodynamic therapy is increasingly being used to treat skin tumours

Narrowband ultraviolet B light has largely replaced other forms of phototherapy for psoriasis and severe atopic dermatitis

Kaposi's sarcoma is associated with human herpesvirus 8

Better understanding of androgenetic alopecia has allowed the development of effective treatment with finasteride

More specific immunomodulatory drugs, including those adapted from other areas of medicine, are now being used in dermatology

Methods

The recent advances discussed in this review are common knowledge among dermatologists. The choice of topics is personal and, after a review of the major dermatological journals, covers a selection of aetiological and therapeutic areas that are making a difference in practice now or are likely to do so in the very near future.

Lasers

Laser therapy in dermatology is expanding rapidly and can be used to treat vascular and pigmented lesions, to remove tattoos, for depilation, and for skin resurfacing. It is now possible to choose laser treatments based on a specific wavelength, pulse width, and fluency. This allows selective targeting and destruction of specific cellular and subcellular structures while the normal surrounding structures are spared thermal damage. Scarring and other complications are minimised.1^{– …}