Dr Paul Charlson argues the value of dermatological training for aesthetic practitioners
Aesthetic medicine and dermatology are interrelated specialties and, as such, it is harder to practise aesthetics effectively without a thorough understanding of the skin and how it functions. Conversely, having knowledge of aesthetics is complementary to modern dermatological practice. For this second point, it is important to note that the boundaries between what the state provides through a taxation-funded NHS and the private medical sector are becoming increasingly blurred – and this is particularly noticeable in dermatology. We no longer live in a society where people are content with the options that the NHS provides. From both my own experience, as well as that of colleagues, it has been noted that patients are increasingly consulting us on what aesthetic procedures are available, how they work and where they can go to receive treatment. However, NHS clinicians working in dermatology and primary care, who also work as aesthetic practitioners in the private sector, regularly encounter the difficulty of this multifaceted and interlinking interface. In order for our patients to make informed treatment choices, it is reasonable to advise them of all the options available. Whilst consulting within the NHS, good practice dictates that we should endeavor to answer patients’ direct questions about aesthetic treatments not available on the NHS reasonably and briefly. It is ethically prudent of NHS doctors and nurses to suggest patients do their own research, especially when they receive direct enquiries. This is frustrating as we are aware of the variability of quality within the aesthetic industry, and want to ensure our patients seek treatment from a practitioner who is clinically and ethically sound. Dermatology and aesthetic medicine are natural bedfellows. In my NHS practice as a GP and as a GPSI in dermatology, I am often confronted with conditions that can also be classed as aesthetic concerns. A typical example of this is melasma, which is often distressing for patients and cannot be comprehensively treated by an NHS prescription for Azeliac acid, a retinoid and sun block. Whilst being beneficial, these treatments only form part of a range of accessible options. There are excellent effective alternatives, which would be denied to a patient if the practitioner had no knowledge of their efficacy and indications.
Furthermore, from the point of view of NHS clinicians, rosacea is another distressing condition, characterised by facial telangiectasia, which can be easily treated by vascular laser. It can be very helpful if practitioners are able to advise a patient of how lasers work and how they can aid the treatment of rosacea in a private aestheticclinic. Acne scarring is another example of an aesthetic concern where there are little treatment options available within the NHS. Sound knowledge of other treatments can really help guide patients to make safe and effective choices. From an aesthetic practitioner’s perspective, skin lesion recognition is a valuable skill to bear. I advocate that all aesthetic practitioners should have basic training and understanding of how to recognise malignant or premalignant lesions. Many patients with aesthetic concerns have signs of ageing, most commonly from their 40s onwards, which is often associated with sun damage. As we know, solar-related skin lesions such as basal cell carcinomas, actinic keratosis, Bowen’s disease and melanoma are more common within this group. In my experience, many patients who seek aesthetic treatments are sun-bathers or use sun beds, which increases the risks of solar damage and raises the incidence of these lesions. Being able to use a dermatoscope, in particular to aid recognition of lesions, is very helpful in planning lesion management. This is often crucial if a surgical procedure is required and, with the correct diagnosis, can also ensure you avoid advising or performing unnecessary surgery. An understanding of dermatology can also help the practitioner choose suitable topical cosmeceutical agents for patients – further guaranteeing an effective treatment outcome. Similarly, when complications arise as a result of aesthetic treatments, it is really helpful for practitioners to understand how the skin might react and have the knowledge to correct the problem with confidence. Complications are inevitable, thus handling them correctly and having the understanding of how to treat them effectively can avoid potential medical litigation arising in the future. Traditionally, dermatology has not been a particularly well- taught subject at undergraduate level and, as a consequence, many doctors and nurses entering aesthetic practice will have significant gaps in their knowledge of skin function and care. Considering each of the points made in this article, I argue that anyone considering a career in aesthetics should also gain basic dermatological training at an early stage in his or her career. As dermatology is a visual subject, where pattern recognition is crucial, spending time in a dermatology clinic is very helpful. Most practitioners are happy to welcome colleagues into their clinics so I would certainly recommend contacting consultants in their local Trust or community clinics. Many dermatology courses are also available, and organisations such as the Primary Care Dermatology Society (PCDS) and the British Association of Dermatologists (BAD) run excellent short courses. I found the diploma in Practical Dermatology particularly beneficial to my understanding of skin function and care. Although these courses require a significant investment in time and money, they do provide an excellent dermatological grounding for aesthetic practitioners. In the future I believe a module on dermatology – specifically tailored to aesthetics – should form part of all diplomas in aesthetic medicine. The purpose of this piece is not to claim that dermatology training is absolutely essential to becoming an aesthetic practitioner, but to highlight that it is complementary to an aesthetic practice. The benefits to both the patient and to the practitioner are worth the effort from a clinical, as well as a commercial, point of view.
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