The Last Word: Dr Ruth Harker

By Dr Ruth Harker / 01 Feb 2020

Dr Ruth Harker argues why she believes dermatology training is essential in aesthetic practice and why many practitioners need to become better educated

Dermatology is the study of the structure and the functions of the skin, the diseases that can affect it and their management. It includes topics from skin cancer to skin ageing and common diseases such as acne, eczema, rosacea, psoriasis and rashes, as well as psychology. It is a vast area of medicine and one that many dermatologists devote their lives to. Non-surgical aesthetic nurses, dentists and doctors are looking, touching, feeling, assessing and treating the skin on a daily basis; however, many don’t have training in dermatology; in other words, skin. Here I am going to explain why I believe this is a problem, and what we can do to solve it.

The issue

The skin is the largest organ in the body with a complex, five layer structure that performs many functions. It has a barrier function; literally keeping the outside world out and being waterproof so the body tissues do not become waterlogged. It has a protective function and covers the body’s contents, a defence action to cold, controls sebum production, contains various types of nerve sensors for pain, pressure, heat and cold, and has an immune function, amongst other important roles. Many rashes and lesions, for example, are manifestations of occult systemic disease and genetic disorders.1,2

However, if an aesthetic practitioner does not have training in this area, then it can put patients at risk. For example, if the practitioner cannot diagnose a skin cancer, is this satisfactory for patient care? Some aesthetic practitioners are consultant dermatologists or dermatologists in the hospital training grades, while a number of GPs perform extra study and practice to become GPERs (GPs with extended range).3 These doctors will have had a minimum of nine years’ training, with others having a lot more. Some nurses may work in a dermatology department of an NHS hospital, privately for dermatologists or in a mole clinic, so have learnt much during their work. Other nurses and doctors may have a postgraduate Diploma or Master’s in clinical dermatology. Obviously, these practitioners are in a good position to diagnose and treat the skin. However, the fact is that the majority of aesthetic practitioners are injectors; some with only a day or two of group injectable training. The standard of the training courses may vary and, very often, they do not include much dermatology education. The concern is that while these practitioners may be skilled injectors, they may miss an important diagnosis relating to the patient’s skin health. 

I believe that the rationale that aesthetic practitioners should have dermatology training is undeniable; there is no possible reasoning for us not to have it. 

Medical students do receive some education in dermatology; between two to six weeks depending on the medical school, and perhaps may perceive that this is adequate to specialise in dermatology and treat dermatologic conditions. However, only a small percentage of doctors will have a post-graduate qualification in dermatology or a hospital post in dermatology. Some doctors now aren’t committing to the usual three-year hospital training after medical school and want to go straight on to become an aesthetic practitioner. So, although they will have the title ‘Dr’, they may have practised little medicine or dermatology. 

Similarly, it’s common for many nurses and dental students, unless they have independently sought additional training, to gain little dermatology training. I don’t believe this is enough to work in aesthetics and more is needed. Alongside this, as injectable treatments are inserted under the skin, many practitioners may believe that dermatology knowledge isn’t important. However, as mentioned dermatology is vast and includes treatments that are performed under the skin.

The solution

Seek to gain a Diploma or Master’s in dermatology. There are also various Level 7 courses in aesthetic medicine, which include dermatology, so I recommend that practitioners pursue a course that includes this. I also believe that the ultimate aim is that all aesthetic practitioners – doctors, dentists and nurses – will achieve a Level 7 qualification. Associations such as the British College of Aesthetic Medicine (BCAM) or the British Association of Cosmetic Nurses (BACN) offer good guidance to direct candidates to the best accredited courses. 

BCAM has a new exam for full membership for dentists and doctors and will have a detailed module on dermatology.4 There are also specialist dermatology groups such as the British Association of Dermatologists (BAD) and The British Dermatological Nursing Group (BDNG) which can assist practitioners looking to educate themselves in dermatology. In addition, there are many good textbooks for further reading1,2 and some aesthetic training providers that have specialist courses in cosmetic dermatology, which I believe can also be useful for aesthetic practitioners.5

Summary

My views are endorsed by the BCAM, which promotes thorough further training of fully qualified doctors and dentists to ensure that they are the correct practitioners to treat the general public for cosmetic procedures.

The Joint Council for Cosmetic Practitioners (JCCP) is composed of representatives from BCAM, the BAD, BAPRAS, BAAPS and the BACN and is striving to achieve agreement on clinical standards for patient safety, acceptable to the relevant regulatory bodies.6 If aesthetic practitioners are educated in dermatology, then I believe they are providing a better and safer service to their patients. It should of course be emphasised that practitioners should never treat outside of their skillset – always refer to a suitable professional.

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