Last Word

By: Dr Nick Lowe
Created on 25th November 2011

Consultant dermatologist Dr Nick Lowe, who has worked extensively in both the UK and America, explains why ‘derm culture’ has yet to hit British shores

Dermatology as a specialty is better recognised in almost every other developed country in the world than it is in the UK. If you take France, which has almost exactly the same population as Britain, they have more than 5,000 consultant dermatologists, to our 500.

The main reason for this is that all specialist medical training in the UK is funded by the National Health Service, which controls the number of specialists that they think we need. In America, as in other countries, the number of training places is based on patient demand.

Of course, because aesthetic procedures are not provided on the NHS, physicians are not trained in administering them, whereas in the US it is part of the curriculum, alongside skin cancer surgery and the treatments we would usually associate with dermatologists, for acne, rosacea and other skin conditions.

Many US dermatologists also take extra fellowships in cosmetic surgery, which might seem surprising in the United Kingdom, where we are used to the idea that only plastic surgeons should offer cosmetic surgery – not that that is always the case – but in the States dermatologists are trained in surgery and in fact many cosmetic surgical procedures were first described by dermatologists.

Modern laser skin surgery was developed by Professor Leon Goldman, a dermatologist, back in the 1960s, as a treatment for tattoo removal, and even micrograft hair transplantation was described by Norman Orentreich, a dermatologist in NewYork, so there is a long history of dermatologists making major breakthroughs in the USA.

Because of this combined training, most American derms run a joint practice, offering both cosmetic and medical dermatology. This, coupled with the fact that there are more of them, means that people tend to build up a life-long relationship with their dermatologist.

Americans start off seeing a derm in their teens for acne and other adolescence-related skin problems and so by the time they grow up it has become the norm.

In the UK you would visit a GP about acne and because of the lack of specialists, you are unlikely to be referred to a dermatologist, so the whole concept of having a special doctor to deal with your skin never gets established.

However, I think the idea of dermatology as a specialty is developing over here, particularly in the cosmetic arena. A small group of us established the British Cosmetic Dermatology Group, as an arm of the British Association of Dermatology, about 15 years ago, and membership is growing slowly.

It’s important to remember that if you are seeking a treatment for a problem of the skin, a dermatologist has been trained in all aspects and so can offer the most balanced approach.