Cosmetic dermatology: An integral part of current dermatology curriculum

Jasleen Kaur Sandhu

 Department of Dermatology, Government Medical College and Hospital, Chandigarh, India

Correspondence Address:
Jasleen Kaur Sandhu
Department of Dermatology, D Block, Level 5, Government Medical College and Hospital, Chandigarh - 160 031
India

History has witnessed the quest of human race for eternal youth and flawless beauty. In the modern era, this endless search for healthy youthful skin has led to the evolution of a specialized field of “Cosmetic Dermatology.” It is a sub-specialty of dermatology that deals with all the aesthetic aspects of skin. It includes management of skin conditions that are mainly of cosmetic concern to the patient. Many a times it is confused with cosmetology and the work sphere of a cosmetologist. The cosmetologist is a nonmedical professional qualified in giving all forms of beauty care and gives skin, hair, and nail treatments like hair coloring, makeup application, facials, nail art, and lengthening.^[1] The work sphere of a cosmetologist has very little to do with science.

“Cosmetic Dermatology,” a term first suggested in 1983 by Morganti, has been under the scanner for its definition, evidence-based practice (or a lack of it!), and confusion with cosmetology and cosmetic pharmacology.^[2] With the establishment of national and international societies of cosmetic dermatologists, this dermatology specialty is on a firm ground now, but still its integration with the basic postgraduate dermatology curriculum is not yet complete because of the never-ending debate on whether it is a hope for the patients or an unnecessary hype.

Chasm between medical and cosmetic dermatology has been there since its inception in the later part of 20^th century. The medical dermatologists, many a times, label the cosmetic practice as undue hype for varied reasons. First and the foremost issue raised by them is of the ethics of treating cosmetic skin conditions. It is contended that most of these are not pathological conditions but are rather variations of normal physiological state and performing procedures exposes the patient to unnecessary risk for treating an otherwise harmless condition.

In answer to this argument, it can be stated that the present day cosmetic skin treatments are backed by scientific evidence. Years of research have provided ample literature to identify the better and safer treatments. Moreover, even though these conditions may be physically harmless, but the psychological impact of these cannot be negated. Studies have shown the adverse impact of cosmetic impairment on the psyche of the affected individuals, which may range from depression to suicidal ideation in the worst case scenarios.^[3] Cosmetic dermatology comes as a much needed hope for these kindred souls. It has been well documented that procedural intervention to improve the physical flaws, caused due to diseases like acne or vitiligo and even in nonpathological cases of cosmetic surgery for improving appearance, has led to significant emotional benefits in the form of increased self-esteem and improvement in quality of life indices.^[4],[5]

The proponents of “hype” brigade further go on to say that many procedures and products are being launched in the beauty market every day for purely commercial gains. To popularize these, a hype of unrealistic results is created with minimal effort to back it with scientific evidence. To make the matters worse, the corporate manufacturers of cosmetics keep coming up with enormous number of new products, which claim to repair sun damage and reverse aging. They do so with penchant, taking full advantage of the loophole in the existing law which is not as stringent in its norms of safety and efficacy for cosmetics as it is for drugs. This argument, however, should not be used to take away the credit which goes to cosmetic dermatology in giving genuine benefits by using topical drugs and treatments which have undergone rigorous clinical tests for efficacy and safety for cosmetic conditions like rhytides, pigmentation, rosacea, acne, and scarring in multiple studies. Sufficient literature has accumulated over time for cosmetic treatments like botulinum toxin and filler injections, chemical peels, laser and light treatments, nonablative radiofrequency, and hair and fat transfers to confidently label these as evidence-based practice.^[6]

Today, cosmetic dermatology is undoubtedly the fastest growing specialty. Since the latter part of last century, cosmetic procedures have witnessed approximately 500% rise.^[7] The increasing demand, predictable safe treatments and immediate payment to the treating dermatologist have led to more and more dermatologists opting for cosmetic dermatology, some even doing so exclusively. For this reason, many feel that this “hype” of cosmetic dermatology has led to a shortage of dermatologists practicing the much needed medical dermatology. To counter this, it can be contended that “change is the only constant.” This change occurred in other mainly medical specialties like otolaryngology, cardiology, and radiology, which also ventured into advanced cancer and facial surgeries, interventional cardiology, and interventional radiology, respectively. In much the same way, dermatology cannot be confined to just writing prescriptions. In fact, the technical advances in cosmetic dermatology such as better molecules, laser, and light devices have immensely helped in treatment of dermatological problems, which in the past were being limited by medical treatment alone. For instance, in a patient of acne or pigmentary facial condition, addition of some cosmetic intervention like chemical peeling and laser or light treatment to the usual medical treatment gives improved results. Therefore, for a holistic practice, a healthy mix of medical, cosmetic, and surgical dermatology is the need of the hour.

The integration of cosmetic dermatology into post graduate dermatology curriculum in India is still a process in evolution. It is encouraging in certain areas like vitiligo, acne, and laser surgery, as these find a regular place in the residency training; but it is still lacking in anti-aging and hair restoration procedures for which the interested dermatology graduates have to spend extra time and effort for additional trainings after residency. Setting up of dedicated cosmetic dermatology and hair clinics and inclusion of these procedures in the list for postgraduate curriculum are some of the steps that may help to accelerate the process.

The last century has also witnessed increased life expectancy, with its doubling in figures from 1900 to 2000 and is still improving further. This is attributed to advances in medical science leading to success in control of infectious diseases with vaccines, antibiotics, and public health measures to improve the sanitary conditions. In sync with the longer life came the increased demand for cosmetic dermatology, which aims to achieve eternal youth and physical beauty, thus providing a good quality to the increased length of life. In addition, research in this area may also help in solving the complex riddle of aging, as skin, by its easy accessibility, has long been considered as an ideal model to study the aging process.

This century might be in for many ground breaking advances like genetic engineering, cloning, stem cell research, and nanotechnology to reach new heights in medical sciences. All these are going to revolutionize the field of dermatology, both medical and cosmetic. Therefore, rather than dismissing cosmetic dermatology as a hype, the need of the hour is to incorporate it as an essential part of dermatology training. The way forward is not separately, but together on the path to a future of healthy, young, and a near perfect world.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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