Dermatology

Dermatology is the medical specialty that diagnoses and surgically treats the largest human organ - the skin.

Dermatology also treats diseases that affect other parts of the body which are connected to the skin or skin related; hair, nails and mucous membranes (mouth and genitals). 

The specialty of Dermatology incorporates the dermatological component that makes the diagnosis, the treatment and the follow up of the diseases of the skin as well as hair and nails. Venereology studies the treatment and the investigation of sexually transmitted diseases. It is a medical-surgical specialty, since it encompasses both the clinical approach and the surgical approach.

The most common dermatological conditions include:

Acne:

Is a quite frequent skin disease, which affects most adolescents, but is not restricted to them. The main changes occurring in the skin and hair are related to hormonal activity which begins in this phase.

Alopécia:

Alopecia Areata is a disease that causes hair loss. The etiology is unknown, but there are some factors involved, such as genetics and the autoimmune system. The hair begins to fall leaving small or large areas without hair.

Skin Cancer:

Cancer is caused by the abnormal and uncontrolled growth of skin cells. Skin cells are arranged in layers. The different types of skin cancer are defined according to the affected skin layer. The most common are basal cell carcinomas and squamous cell carcinomas. More lethal and rare than carcinomas are melanomas which are the most aggressive type of skin cancer. Ultraviolet radiation is primarily responsible for the development of cutaneous tumors, and most cases are associated with excessive exposure to the sun or the use of tanning chambers. Despite the high incidence, non-melanoma skin cancer has a low death rate and can be cured easily if detected early. Therefore, examine your skin regularly and seek a dermatologist immediately if you notice spots / skin blemishes or suspicious signs.

Melanoma:

Has the worst prognosis and the highest mortality rate. Although the diagnosis of melanoma usually brings fear and apprehension to patients, the chances of cure are more than 90% when the disease is detected early. Melanoma usually looks like a dot or a spot on the skin. It’s  colour is brownish or blackish. However, when it comes to melanoma, the "dot" or "spot" usually changes color, shape or size, and can cause bleeding. Therefore, it is important to watch your skin constantly, and immediately seek a dermatologist if you notice any suspicious blemish. However, even when there are no suspicious spots, one should visit the dermatologist at least once a year.  Spots may arise in places that may be  difficult for the patient to see. In addition, an injury considered "normal” may be suspected to the physician.

People with fair skin, phototypes I and II, are at greater risk of developing the disease, which may also occur in dark skinned individuals or higher phototypes, although it is rare. Melanoma originates from melanocytes, cells that produce melanin, the pigment that gives color to the skin. It usually appears in areas of the body most exposed to solar radiation. In the early stages, melanoma develops only in the most superficial layer of the skin, which facilitates its surgical removal and cure. In later stages, the lesion is deeper and thicker, which increases the chance of metastasis in other organs and decreases the chances of a cure. Therefore, early diagnosis is essential. Cases of metastatic melanoma, in general, present a worse prognosis and have a reduced number of therapeutic options. Inheritance plays a central role in the development of melanoma, relatives of patients diagnosed with the disease should undergo preventive exams regularly, because the risk increases when there are cases registered in first-degree relatives.

Dermatitis or Contact Eczema:

An inflammatory reaction of the skin resulting from exposure to an agent capable of causing irritation or allergy. There are two types of contact dermatitis: irritant and allergic.

Hemangioma:

Benign tumors consisting of capillaries and blood vessels. They appear on the skin as blotches or reddish and purplish tumors. They may represent only aesthetic changes, but cases that occur from birth may be more extensive and lead to bleeding, coagulation disorders and the compression of neighboring organs. The transformation of a hemangioma into a malignant lesion is extremely rare.

Actinic Keratosis:

Red and scaly lesions. It most often appears on the face, ears, lips, back of the hands, forearm, shoulders, neck, scalp, or other areas of the body exposed to the sun. Initially, the lesions are small, and it is usually easier to recognize them by touch as the lesion is scaly. The presence of keratoses indicates sun damage, and the lesion may progress to skin cancer.

Hives:

They are red and swollen lesions, like welts, that are quick to appear on the skin and are very itchy. The lesions may be small, isolated or join together to form large red parches, of varying shapes. It can appear on any part of the body. Usually the lesions change place, some disappear and new ones appear.

Warts:

They are benign proliferations of the skin caused by the human papillomavirus (HPV). The infection occurs in the more superficial layers of the skin or mucous membranes, activating the abnormal growth of epidermal cells.

Vitiligo:

Is a disease characterized by the loss of pigment of the skin. The lesions are formed due to the decrease or absence of melanocytes (the cells responsible for the formation of melanin, pigment that gives color to the skin) in the affected places. The causes of the disease are not yet know, but autoimmune alterations appear to be associated with vitiligo. In addition, emotional changes or traumas may be among the factors that trigger or aggravate the disease.

The most common venereal conditions include:

Scabies:

it is one of the most frequent human parasites, caused by the mite Sarcoptes scabiei var. hominis, which only parasites the human being. In adults it can be acquired through sexual contact. The most frequent complaints include: itching (especially at night); papules and / or persistent nodules and itch lesions in characteristic locations.

Sexually Transmitted Infections (STIs):

STIs are transmitted from infected people to their partners during sex. They are caused by microorganisms - bacteria, viruses and parasites. Anyone can get an STI if they have vaginal, anal or oral sex with someone who is infected. Transmission is made easy if you do not use a condom and have multiple sexual partners. People with a single lifetime sexual partner may acquire an STI if that partner has sex with other people and contracts the infection.

Often STIs do not show symptoms for months or years. In these cases it is only through specific analyzes that it is possible to know who is infected. When there are symptoms, these may appear soon after sexual contact, or take weeks, months or years to emerge. Sometimes the symptoms disappear without any treatment, but the infection remains in the body. Some of the most common symptoms include: abnormal vagina, penis, or anus discharge; burning or painful urination; wounds or blisters in the genital area; itching or irritation in the genital area; pain in the lower abdomen or during intercourse.

• Gonorrhea: see information leaflet of the Portuguese Society of Dermatology and Venereology
• Chlamydia: see leaflet of the Portuguese Society of Dermatology and Venereology
• Genital herpes: see information leaflet of the Portuguese Society of Dermatology and Venereology
• Human Papilloma Virus Infection: see information leaflet of the Portuguese Society of Dermatology and Venereology
• Pubis Pediculosis: see leaflet of the Portuguese Society of Dermatology and Venereology
• Syphilis: see leaflet of the Portuguese Society of Dermatology and Venereology

The most common examinations or diagnostic techniques performed during na appointment in Dermatology and Venereology  include: 

Skin observation

sometimes with magnifying glass and special lighting;

Skin biopsies

Removal of a small portion of the skin under local anesthesia for pathological diagnosis;

Collection of cells, skin  hair or nails

To investigate for microorganisms (fungi or bacteria);

Contact tests / allergy tests

They are used for the study of contact dermatitis and consist in the application for 2 days of adhesives containing allergens, on the  torso. At the end of that period the skin is checked to see what effect the allergens had on the skin. 

Sensitivity to sunlight tests

Photo-tests and photoepicutaneous tests: exposing the skin to various types of light (ultraviolet, visible or infrared) and evaluating the immediate skin reaction and again after one or two days.

Dermatoscopy

Is used mainly to identify skin blemishes and consists in observing the deeper layers of the skin with a magnifying glass and special lighting. It can be done using  a manual or digital dermatoscope; this permits the recording of  the characteristics of the lesions and comparing them over time.

Confocal Laser Reflective Microscopy

A  technique that permits the examination of the epidermis and papillary dermis, with a resolution comparable to a pathological examination, identifying microanatomic structures and individual cells with high resolution.

Interventions & Treatment Techniques

Classic Dermatologic Surgery

For the removal of skin lesions, sometimes with simple cutting and direct suturing techniques, sometimes with skin grafting (harvested from other areas) or proximal skin flaps to cover the area after removal of large lesions . Dermatologic surgery also includes nail or capillary correction surgery and surgery with micrographic control for large malignant tumors (Mohs surgery).

Criotherapy

Consists in the application of extreme cold (freezing of the skin with liquid nitrogen) to destroy benign lesions or sometimes also malignant lesions.

Electrotherapy

It is based on the use of electric current to destroy small skin lesions (warts) or in association with classical surgery to electrocoagulate blood vessels which bleed during surgery.
 

Curettage

Consists in the removal of small superficial lesions (contagious molluscs or warts) with a device similar to a spoon but with sharp edges.

Phototherapy or Photochemotherapy

It consists of exposing the skin to ultraviolet rays in isolation or after local application or administration of medication that promote the effect of radiation. They are used in particular in psoriasis, adult atopic eczema, vitiligo or skin lymphomas.

Photodynamic Therapy

A specific medicine is applied to the skin and irradiation hours later with red light. The drug is absorbed and metabolized by some "sick" skin cells which are activated by the red light which then  leads to the destruction of these cells.

Laser Therapy

There are several types of LASERS, some called ablative, because they destroy damaged tissues (for example, benign and malignant tumors, warts and condylomas), and other non-ablatives used mainly in cosmetic techniques (photodepilation, removal of brown spots or angiomas. )

Dermocosmetic Techniques

In addition to LASER and intense pulsed light, there are other techniques, such as peelings, dermabrasion, botulinum toxin injections and the application of fillers, regularly practiced by Dermatologists seeking to improve the cosmetic aspect of skin diseases or photoaging