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Summer 2014, Vol. 22 No. 2

Hong Kong J. Dermatol. Venereol. (2014) 22, 55-56


Editorial

Saving dermatology

Stephen Lee 李啟焱

As doctors, we strive to provide high quality service to the sick and medically disadvantaged. We try to enhance life and give patients a fair go and help those in need. Lest we forget, medicine is a special vocation and not just a job. We must not lose sight of our fundamental calling of helping the sick.

Doctors are indeed privileged members of society. Clinicians are well rewarded by the occupational satisfaction that their vocation brings and by the respect of their patients that they enjoy. In a recent survey of professions conducted in Australia, nurses are perceived to be on top, followed by doctors, pharmacists, dentists, high court judges and others in descending order. The ranking centres on ethics and honesty.

Dermatology is an important facet and spirit of medicine. Dermatologists owe the public and themselves this pledge: to be the best and fairest in the provision and maintenance of skin health, wherever they may be serving. Unite and grow, in research and clinical practice. Hold hands and collaborate, and right the imminent wrongs and chase away the threatening obstacles on the horizon.

At this point of medical evolution, worldwide support and recognition are what dermatology needs and deserves. Meanwhile, the somewhat existential question of what has dermatology become begs insightful pondering. Are we at the crossroads of real and virtual medicine? Gloss aside, with increasingly high definition images abound in both research and clinical practice, it is time to reflect and refresh. From one day to the next, we manage to the best of our ability the aftermath of acute and chronic skin problems in the name of dermatology, our chosen vocation.

It is humbling to have in our hands, the capacity and skills to save and transform lives. Dermatologists may not always be cognisant of this. Almost ironically, this oblivion could in fact be a blessed and healthy driving force to advance egalitarian dermatology. Purity is magic and dermatology practised at its professional best is truly wonderful.

Itch as a sensory input in negative overdrive, can be an annoying distraction. Like chronic pain, unremitting itch may be profoundly demoralising. Atopics young and elderly will attest to that plight. Severe and sudden alopecia areata ending tragically in suicide has been reported. It is no happy news to experienced dermatologists that dermatologically induced disfigurement can indeed be fatal. Medical dermatology is certainly not supercilious.

By contrast, wrinkles are generally harmless yet defining residents of the skin world and until recent times they were ubiquitous and dormant. Alas, they have had an amazing awakening and are challenging itch and pain as the latest sensations. Vanity medicine has arrived and it will probably stay. Out goes orthodox medical dermatology and in comes futuristic cosmetology? The answer could well be blowing in the monetary wind.

In a similar vein, cosmetic dermatology, whatever its definition may be, has been establishing roots and gaining acceptance as a proper branch of dermatology. In the East and the West, cosmetic dermatology has had a meteoric rise and it is still gathering strength. Internationally, there is a plethora of skin related subspecialties, from lasers to scalpels and from cosmetic physicians to cosmetic surgeons. Dignified "patients" involuntarily down-marketed to the status of "clients", consumers of skin health have been caught up in this mesmerising skin circuit for all. Everyone appears to be a skin doctor of some unspecified description. Suddenly, for every skin imperfection and complaint there is endless love. Is it time to rejoice or should we be at least vigilant?

Re-inventing dermatology with a forward-looking compass and incorporating the latest technologies is a momentous opportunity we should seize now. It is not too early to revalidate dermatology: there is too much to lose if we opt for the waiting game. Act now or future generations of dermatologists will never thank us for our navel-gazing inertia.

Being provocative, or alternatively, pensive and sobering, is not necessarily unfitting and unbecoming for Easter. It can be soul cleansing and revitalising. Spring has sprung and there is much to do. Immerse in the art and science of dermatology and be counted as your contributions do matter. Join the new dawn as it rises and see the light!

Stephen Lee
李啟焱