Cosmetology versus cosmetic dermatology – A personal view

The definition of a term often has a wider impact on the direction of the road of development and progress and on the way, others look on the subject.

The word “cosmetic” is derived from the Greek “kosméo,” what means decoration or to decorate. The Swiss medical doctor and scholar Theodor Zwinger differentiated between kosméo for the honorable women and men and kommotike, the dressed up, in his book “Theatrum vitae humanae” (1565).

The discussion if kosméo is a part of medicine or rather the contrary is possibly as long medicine exists. When beauty is considered the natural expression of health, cosmetics are a part of it.

The use of cosmetic products is not restricted to a profession, of course. Cosmetics in one way or another may have been used as long as mankind exists. Cosmetic products with a benefit for human skin are classified as cosmeceuticals, a term coined by Albert Kligman almost 40 years ago. Nevertheless, they are not for any treatment of skin disease. Some, however, may be useful in the prevention of skin disorders such as humectants and moisturizers to prevent occupational hand dermatitis or sun-blockers to prevent ultraviolet-light induced skin aging. The use of cosmetics, however, is not based on medical knowledge or skills.

The dermatologist who is interested in cosmetic/esthetic dermatology should be a dermatologist first. The skills to diagnose and treat medical conditions are essential to perform cosmetic/ esthetic dermatology in a serious way. The model of doctor and patient provides a patient-oriented basis. It reflects professionalism, integrity, and confidentiality. The esthetic treatment with this background is for patients and not for clients or customers. Such a doctor would never ignore a malignant melanoma when a patient asks for facial filler treatment.

In contrast, a retail model offers products/treatments the customer can choose, like in a mall. The relationship is purely economical. There is no care, no empathy.

Cosmetology has become a specialty offered by several universities in my home country Germany. The study is based on chemistry, pharmacology, biology, and business economics to be useful in cosmetic industry. Medicine is not a part of it.

Under this view, the term cosmetology would be a misnomer for cosmetic/esthetic dermatology at all.

A dermatologist, however, should have basic knowledge in the field of cosmetology to better understand ingredients, composition, and application of cosmetics or cosmeceuticals. The true basis is natural sciences. The dermatologist should use this knowledge to question advertising claims made by the cosmetic industry. Otherwise, she or he would not be better than a beautician “trained” by marketing staff.

In my experience, it is not uncommon that patients seeking cosmetic/esthetic treatments present skin diseases, sometimes unknown by themselves. Here again, a dermatologist is challenged to treat the patient in a holistic way.

Cosmetic/esthetic dermatology has developed from experience-based into a scientific subspeciality. For numerous procedures, prospective, randomized controlled studies are available currently. The range of treatments, techniques, and technologies has widened enormously. Nowadays, we have antioxidants, neuromodulators, stem cell activators, etc., we have lasers and lights, ultrasound and radiofrequency, single and combined treatments. Further progress can only be achieved within the field of dermatology in particular and medicine in general. May cosmetic/esthetic dermatology live “long and prosper,” as Leonard Nimoy used to say.