Quackery and dermatology

Why is dermatology more prone to quackery?

Though quackery is an age-old practice in medicine, dermatology is witnessing an unprecedented and dangerous trend in quackery. Several factors make dermatology more prone to quackery:

• Skin diseases are visible and thus associated with immense psychological distress, making patients seek quick solutions which may be in the form of miracle creams, herbal concoctions, or unapproved devices/procedures.

• The chronic and recurring nature of many dermatological conditions leads to frustration with conventional standard treatments. Many alternative medicines and home remedies make false claims of providing a complete cure and being safe compared to modern evidence-based medicine.

• Social stigma and embarrassment may deter patients from seeking proper dermatologic consults, making them targets for unqualified practitioners.

• There is an ever-increasing desire to look young, so device-based, minimally invasive, and other antiaging and aesthetic procedures like LASER hair removal, chemical peels, microneedling, botulinum toxin injections, LASER toning, facials, fillers, and hair transplants are becoming very popular, and their demand is exponentially increasing.

• Most importantly, the general population lacks awareness about the qualifications and credentials required to practice dermatology, the scope of dermatologists' treatment of not only skin diseases but also nail and hair-related issues, and procedural dermatology for varying indications, including hair transplants.

Forms of quackery in dermatology

Medical specialties do not have watertight compartmentalisation and frequently have overlapping areas of practice. There is a significant intersection, particularly between fields such as dermatology and rheumatology, dermato-surgery/procedural dermatology and plastic surgery, tropical dermatology and infectious diseases, etc. Unregulated practices related to dermatology are more commonly observed in aesthetic and procedural dermatology, and the management of sexually transmitted infections compared to medical dermatology. These practices occur in various forms across different clinical disciplines.

• Miraculous cures are promised for non-medical, mainly psychological issues such as instant fairness of complexion, facial glow, and hair regrowth, etc, using treatment modalities that are not standardised, do not disclose contents, and are unsupported by scientific evidence.¹ Misuse of topical steroids on the face for pigmentation and fairer skin tone has been a matter of concern for long.²

• Unregulated aesthetic procedures such as chemical peels, laser treatments, and injectables performed either by non-medical persons or untrained doctors can lead to serious complications. The death of two young professionals following a hair transplant by unqualified, self-proclaimed hair transplant surgeons is a harsh reality in India.³

• Many over-the-counter creams, ointments, and supplements that claim to be ‘organic’ or ‘Herbal’ are promoted with exaggerated claims to be harmless and without side effects, often guarantee a complete cure for chronic skin conditions without any scientific validation. On the contrary, they may cause allergic contact dermatitis and/or worsen existing diseases.

• Non-dermatologists and dermatologists offer unregulated, brief certification courses in device-based aesthetic procedures for financial gain, churning out unqualified practitioners/quacks in the aesthetic market.

Role of social media and quackery in dermatology

False claims advertised on social media by unqualified and untrained individuals lure vulnerable consumers to fall prey to dubious and questionable skin treatments. The common man is attracted to these misleading advertisements, false promises of quick results, and heavy discounts on treatment costs in one or the other pretexts, without being aware of the potential dangers involved that may even cost a patient’s life. It is indeed unfortunate that qualified dermatologists are investing their time, money, and energy in competing with these quacks both within and outside the medical field.

How to combat quackery in dermatology

Addressing quackery in dermatology in India necessitates a comprehensive and coordinated multipronged approach, given the numerous existing gaps at various stages. Although efforts have been ongoing for several years, it is imperative to prioritise this issue through a unified approach that engages all stakeholders and operates concurrently on multiple levels.

• IADVL initiatives: The Indian Association of Dermatologists, Venereologists, and Leprologists (IADVL) task force against quackery (ITAQ) was established to curb the exponential rise of quackery in dermatology.⁴ The status of ITAQ has been changed from a task force to a committee with the inclusion of the legal and ethical cell.

  • ITAQ should clearly define who is authorised to practise medical or procedural dermatology and to what extent. It should also establish disciplinary measures for offenders within the IADVL community.

  • ITAQ should actively help to report unlicensed and unqualified practitioners with evidence and details of the involved personnel. To date, it seeks the coordination of national and state representatives to amplify concerted efforts and increase awareness at all levels, involving state medical councils and other regulatory authorities.

  • The nomenclature of cosmetic dermatology should be replaced by aesthetic dermatology

  • A qualified dermatologist’s batch for the IADVL members/relevant membership of all countries must be displayed in the clinics as a testament to a legitimate qualification to practice dermatology.

• Patient and public awareness: It is essential to ensure that practitioners performing cosmetic dermato-surgical procedures are appropriately qualified. The public should be informed about potential risks or complications associated with procedures conducted by unqualified individuals. The national body can share this information regularly in the print and social media.

• Role of regulatory authorities: Authorities should clearly define medical expertise and make information about qualified procedure providers easily available to the public. It is desirable to have stricture rules and prompt actions for non-compliance.

• Professional Vigilance: Dermatologists must report quack practices and support evidence-based medicine.

• Social media regulations: strict enforcement against misleading advertisements are needed. Dermatologists should focus on ethical medical practice and avoid competing with unqualified practitioners using questionable tactics on social media.

Quackery in dermatology is a growing concern that endangers patient safety and public trust. To combat quackery in medical and aesthetic dermato-surgery, there must be stronger regulations, public education campaigns, and active reporting of malpractice by the medical community. Only through a combined effort can we safeguard patient safety, uphold the standards of ethical dermatological care, and the credibility of the dermatological profession.

Long live IADVL! Long live IJDVL!

Archana Singal, Editor-in-Chief, IJDVL