Cosmetic dermatology: What you need to know

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~ INTRODUCTION

Cosmetic dermatology is a relatively new subspecialty that covers the dermatologic management of facial and skin appearances.

Some of the conditions such as wrinkling and other normal age-related skin changes are regarded as purely cosmetic and, as such, are specifically excluded from most medical insurance schemes. Other conditions within the scope of cosmetic dermatology are pathological processes. These include disfigurements as a result of congenital deformities, skin diseases or trauma and are in reality medical treatments. Examples of the latter include birthmarks, facial telangiectasia, acne scarring, and post-traumatic tattooing. It is not uncommon for patients to present with what they perceive as simple disfiguring blemish only to find they have percutaneous changes or, in some instances, intraepidermal carcinoma (Bowens disease) or superficial basal cell carcinoma.

One of the many functions of the skin is its role in social and sexual communication. Skin pathology that interferes with this function can result in stigmatization and social isolation with obvious psychological repercussions. The availability of medical treatment for the maintenance of a healthy clear skin and the correlation of disfiguring abnormalities is an important feature of medical care.

~ MEDICAL ETHICS

As with any medical discipline, an ethical approach is essential. Unfortunately there is a paucity of funding for quality research in this field making it difficult to practice evidence-based medicine. The situation is further complicated by a lax regulatory environment. For example, in the US, lasers are regulated as devices not drugs; this means that approval is based on safety, not effectiveness. Another problem is lack of regulation as to who can use lasers. In Victoria, Australia, there are no controls at all on who may own or operate a laser. Hair removal lasers are often owned by non-medical people and operated by beauticians. The lay public, and some medical practitioners, can become confused in an environment of misleading advertising an self-promotion.

It is important that financial issues do not cloud ethical responsibilities. The primary objective of a medical practitioner must always be the welfare of patients. Put simply, it is always a medical practitioners responsibility to recommend the safest and most cost-effective solution to any patient-perceived problem. This means that if a conventional treatment will do the job as safely and effectively, a more

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