What are the different areas of dermatology

Dermatology: With a sure instinct, without fear of contact

Alexander Zich completed the first two years of his further training as a dermatologist in a practice in Berlin.

Dermatology is more than just looking at moles. Dr. med. Alexander Zich as part of his further training as a specialist in dermatology in a Berlin dermatologist's practice. He not only takes care of preventive care and aesthetics, but also carries out minor surgical interventions.

At first everything is just red. ”Dr. med. Alexander Zich has to laugh when he says that. He can still remember his beginnings in dermatology - the challenge of differentiating between skin diseases such as psoriasis and eczema. But when he examines patients today, he recognizes the differences between benign and malignant skin changes.

Zich now carries out laser treatments independently. A steady hand is required, especially with small stains.

Zich is a doctor in further training in the dermatological practice clinic of Dr. med. Raoul Hasert in the Mitte district of Berlin. For two years he has been training to become a specialist in skin and venereal diseases. At that time he already had quite a few pigments under the dermatoscope. “Learning to see” is one of the most important aspects in dermatology and applies to all areas of the subject - from the conservative-curative to the allergological to the cosmetic-aesthetic part. This range is what makes Zich so enthusiastic. He could easily have entered the parental practice for gynecology and obstetrics. But the ability to help a diverse patient base with a variety of treatments eventually drew him into dermatology. And in the Hasert practice he has the opportunity to get to know almost the entire spectrum of dermatology. Aesthetics and their laser therapies make up part of this. The latter are becoming more and more important, and different types of devices are used depending on the skin problem. Small vasodilatation can be done, for example, with a so-called KTP laser - potassium titanyl phosphate and the wavelength of green light allow the tissue to absorb the laser beam well. Superficial skin changes such as wrinkles, benign pigmentation marks, but also white skin cancer in the early stages can be treated with an erbium laser. This allows the top layer of skin to evaporate within seconds, but does not stress the surrounding tissue as much as other types of laser. In general, laser therapy is used in phlebology, in the area of ​​anti-aging treatment, but also in the removal of tattoos. The Hasert practice carries out three to five of these light treatments a day, with a seasonal trend: In summer there is a tendency to laser less, especially on the face. After all, exposure to the sun can cause unwanted pigmentation after the treatment. After about two months of training, Zich performed his first laser treatment. First on the back and under the guidance of his boss. He now works independently and on the whole body: “It takes a sure instinct. Small stains in particular require a steady hand to be able to remove them. "

As important as the cosmetic part of dermatology is, it is by no means all about aesthetic considerations. This is also confirmed by Dr. med. Uwe Schwichtenberg, Chairman of the State Association of Bremen Dermatologists and senior doctor in several dermatological practices. The man from Bremen already advertised his subject at the Doctors' Day in 2016 in front of young medical professionals. In an interview with the DÄ studying medicine, he affirmed: “The essential characteristic of dermatology is versatility. As an organ subject, one has the advantage here of combining internal and surgical fields of application. And in addition to the routine diagnoses, there are also many 'orphan diseases' waiting to be discovered - a little interest in Dr. So House can't do any harm. "

In addition to his daily work, Zich acquired the laser safety officer certificate in his second year of further training. This allows him to carry out laser treatments later in his own practice.

The Hasert family practice offers enough space for the broad spectrum of dermatology: The main part is on the third floor of an old building in Berlin on Friedrichstrasse, and over the decades the premises have been expanded to create an extensive, winding practice through openings to neighboring apartments. In addition to six consulting rooms and laser rooms, there are two operating rooms - a fortunate circumstance for Zich and his enthusiasm for surgery. Here, too, he benefits from his instinct. His first surgical interventions were small trial excisions. This was followed by spindle excisions, during which he cut out larger areas of skin with a scalpel.

Zich appreciates the opportunity to try things out. And he knows that honest self-reflection is just as welcome in the practice team: “If you don't trust yourself to do something, then that's okay. The boss then supports and helps. ”He recently had his first transplant. "I removed a large basal cell carcinoma from a patient's nose and even had to cut it again after the histological tissue examination by the pathologist," he says. Then Zich removed loose skin in front of the auricle and placed it on the nose. Reflecting on his own learning curve in retrospect on such interventions shows Zich how much he has taken with him from the past two years: “To see where I started and now stand - that I treat with biologics and perform operations myself, that fulfills me with pride. "

For many, dermatology is still filled with disgust. Diseases such as abscesses, fungal infections, or warts contribute to this reputation and make some young medical professionals dismiss the idea of ​​a career in dermatology. For the 30-year-old doctor, however, there was no fear of contact from the start: "Once you deal with the skin diseases and their pathology, you perceive the symptoms very differently." Pain was an initial obstacle for Zich: “Such an abscess is inflamed, you can't simply numb it with an injection. And ice spray helps, but it hurts the patient if you poke into it. ”In the meantime, he feels it is a welcome change in addition to the aesthetic interventions that are often associated with high standards, but also pain treatments - for example, the pus from an encapsulated inflammation allow. When the pain finally subsides, they are above all grateful for the relief that the young doctor gives them.

Zich came into contact with dermatology during his studies in Halle an der Saale. He completed his practical year at the dermatological ward of the University Clinic in Halle and gained his first experience in differentiating between dermatoses and all their red nuances. In the meantime, he also noticed less common illnesses. Like recently when a patient came to his office with symptoms of psoriasis. However, the clinical picture did not clearly match the diagnosis of psoriasis: “At some point you get a glimpse of the skin layer in which the inflammation is located. And that was one of the cases in which I brought the boss in. ”Zich's suspicions were confirmed and he was diagnosed with parapsoriasis en plaques - a rare chronic dermatosis.

The constant exchange with the trainer and his colleagues, including two doctors in training, gives Zich security in daily work. Surgical interventions are always carried out in coordination with the boss, who was also there at the beginning of the laser treatments and instructed Zich in the technology and methods. Additional courses, for example on botox treatment, complement the practical experience in practice. “We are really grateful that we are given this freedom to try things out and learn. Our boss has complete confidence in this. And still is always at our side if we have any questions. "

Zich's patients come not only from the different city districts, but also from the Berlin area and around the world. “We have the bricklayer here as well as the start-up entrepreneur. And of course people from very different cultural backgrounds, patients from Arab countries as well as from other European countries or the USA. ”For Zich, treating them all with the greatest possible sensitivity is part of the medical self-image. “You have to accept and acknowledge every patient with their problem: There is a pressure of suffering and the person needs help now.” Zich experiences every day in a very different way: “Someone does not report until late who have already spread eczema over a large area. And others come with even the smallest skin changes. ”Especially in the case of the latter, there are colleagues who take such patients less seriously. For Zich it is important: "Each patient is individual in his perception and you simply have to learn to deal with it in everyday practice." Psychological sensitivity is another part of dermatology. With an area of ​​up to two square meters, the skin is the largest organ and visible to the outside world - even from this point of view it is understandable why the psychological dimension of skin diseases is so important.

It is still open whether Zich will later go into his own branch or work in the clinical area. After his time in the practice, he first went to further training in the clinic. Should he later decide to set up his own practice, the chances are good: a third of the roughly 3,500 dermatologists established in Germany are about to retire, and successors are not only being sought far away from metropolitan areas. The extent and division of working hours can be chosen relatively freely in dermatology, as the Bremen dermatologist Schwichtenberg knows: “I don't know of any subject that can be combined so well with family obligations. Night shifts, emergencies, time-critical follow-ups - all of this is manageable in dermatology. And the practices are nowadays getting bigger and bigger, so that the doctors working there are able to coordinate with each other. ”These advantages are currently attracting women in particular to dermatology awarded to female doctors. But it is also young doctors like Zich who appreciate advantages such as regular working hours in everyday practice.

Before the next patients come to the consultation in the afternoon, Zich still has time to get a snack in the busy area of ​​Berlin Mitte. Then he will see many shades of red again - and know how to classify them with a practiced eye and diagnostic competence. ■

How do you get into dermatology?

The specialist training to become a dermatologist takes place within 60 months with a training officer at a training facility. The extent to which a division into clinical and outpatient sections is possible or necessary is determined by the respective training regulations. In conservative-curative dermatology, acute phenomena and allergic reactions are treated. This is supplemented by the operative area, which includes clinical pictures such as skin cancer, nail diseases or phlebological diseases. The branch of aesthetic dermatology includes, for example, botox treatments, the removal of tattoos or permanent hair removal, as well as aesthetic operations. Dermatohistopathology and dermatooncology are also sub-areas of this broad-based subject. The professional field also opens up opportunities for all those who want to work as an expert. The field of psychodermatology deals in detail with those skin diseases whose development can be traced back to psychosocial causes or which have psychosocial consequences for those affected. These can be patients with skin tumors, HIV or AIDS, or people with occupational dermatoses.