Clinical and esthetic dermatology: Two sides of a coin

Change is the only constant in life. Ones ability to adapt to those changes will determine your success in life. – Benjamin Franklin

Thus in this ever-changing world, a physician should learn, adapt, and grow to cater the changing needs of patients and the society. The practice of dermatology is no different. From its humble beginnings, the field of dermatology in India has progressed and flourished and, in turn, nurtured many subspecialties with esthetic and procedural dermatology being in the forefront. This progress from a purely medical specialty to a procedural aided branch is welcoming given the plethora of opportunities that it has opened coupled with better understanding of pathogenesis of various dermatoses and availability of new therapeutic options and biomedical instruments.

From a patient’s perspective, improvement in quality of life is as important as curing an ailment. A cosmetic dermatologist is a specialist, who focuses his/her practice in treating esthetic concerns. Aspects of cosmetic dermatology include the maintenance of healthy skin, the prevention and treatment of skin aging and photodamage, rejuvenation procedures, and many others. Cosmetic dermatology also deals with skin diseases that have great impact on the patient’s appearance such as acne, rosacea, and certain pigmentary disorders. A desire to look younger and healthier and a want to reverse the signs of aging has helped to flourish the field of esthetics in dermatology practice over the past 10–15 years. Furthermore, given that, many dermatoses are more of a cosmetic concern, the availability and utility of products and energy intensity devices in recent years to treat these concerns have increased the demand for cosmetic and procedural dermatology.

In the current era, the practice of medical dermatology and cosmetic dermatology is so interwoven that it is difficult to delineate the two. While cosmetic dermatologists put the spotlight on “desire,” medical dermatologists target the “disease” aspect of dermatology. Theoretically, medical dermatology is considered by the health-care industry and insurance companies to be different than cosmetic dermatology, as it is geared toward fixing a health problem or injury. It is medically necessary and therefore usually covered by insurance. Whereas cosmetic dermatology is perceived as want rather than a need and so financially not supported by state or insurance covers. However, the two represents different sides of the same coin. One cannot practice cosmetic dermatology without a sound knowledge of medical dermatology and “pure” medical dermatology would devoid the patients of holistic treatment. Concerns have been raised that esthetic dermatology might be a frivolous specialty, guided by the market that is aimed primarily at profit. The focus, however, needs to be patient centered and scientific based to avoid the ethical dilemma.

A good dermatologist should balance medical and esthetic dermatology in clinical practice. For this, it is essential that the dermatology training curriculum give due weightage to different aspects of esthetic and procedural dermatology and medical teachers also need to keep updated with the expanding horizon of course curriculum for dermatology. However, many postgraduate programs in India fail to provide adequate exposure in this new subspecialty, thus increasing the demand for observerships/fellowships post-completion of dermatology residency. On the other hand, sound dermatology knowledge is essential to explore the full reach of esthetic practice and the potential complications that may arise out of procedural/cosmetic dermatology. Therefore, it is desirable that the esthetic dermatologist updates medical dermatology knowledge with regular refresher courses, e-education platforms by national societies such as IADVL and CMEs/conferences.

The growing concern about esthetic dermatology is lack of quality data to support and recommend the use of various cosmeceuticals, dermaceuticals, and interventional procedures. The aim of this dedicated journal is to encourage research and gather literature in the specialty of cosmetic dermatology that would further help in the growth of this field and also aid cosmetic dermatologists to practice evidence-based medicine.

Esthetic dermatology is a form of preventive medicine, with a major impact on patient well-being and quality of life. A growing demand for esthetic dermatology in the coming years and the considerable economic and health-care impact of the same makes it a lucrative career choice among young dermatologist. Having said that, the biggest challenge for dermatology in this decade will be not losing the roots in basic and clinical dermatology and less attractive subspecialties such as dermatopathology, contact dermatitis, photobiology, sexually transmitted infections, and leprosy at the cost of esthetic dermatology. A good balance between cosmetic and medical dermatology is essential for a successful practice.