I started my dermatology career 28 years ago in the Department of Medicine, National University of Singapore, under the mentorship of the late Professor Chan Heng Leong. It was the good old apprenticeship system. You follow the master, observe, discuss, learn and read up on your own. The emphasis then was still largely medical dermatology.
However, the ensuing 20 years turned out to be a rather exciting time. This was the time when laser surgery entered the field of dermatology. Firstly, CO2 laser, the workhorse laser. Thereafter, other lasers followed it e.g. Pulse dye laser and Q- switched YAG pigment removal laser. Soon after that, Botox came into the fold and with Hyaluronic acid fillers gradually replacing the cow collagen fillers, cosmetic dermatology began to make major inroads into modern dermatological practice.
This was also the time when large scale randomized control trials were the norm and dermatology was no different. Any new drug that was introduced needs to have solid trial evidence to show that it was both effective and safe e.g. Telfast in urticaria, Cyclosporin A in psoriasis, and topical Protopic in atopic dermatitis.
Historically, the first evidence of dermatological disease was discovered in the Egyptian mummies 5000 years ago. The ancient Egyptian medical text Ebers Papyrus included a formula to remove wrinkles and blemishes. The old testament of the Bible, written 2700 years ago, also recorded for us the details of dermatological diseases and their treatments. However, modern dermatology only began about 200 years ago in Europe and the past 20-30 years saw the emergence of molecular dermatology.
Modern research has helped us to unravel the many complex issues of inflammatory dermatosis, such as atopic dermatitis and psoriasis. Innovative treatment targeting the critical pathways of such problems will hopefully replace the now commonly used shot-gun steroid treatment, making treatments more effective with less side effects. New target-specific drugs are also now available for us to treat psoriasis e.g. Humira, Stelara and Tremfya heralding the new era of biologic treatment. Same goes for chronic idiopathic urticaria with Xolaire and atopic dermatitis with Dupixent.
There are many lasers or devices for dermatologists to choose from these days depending on what we are treating. Some are real gems while many are a waste of time! Continued advances in the field of laser medicine will see the introduction of many more new devices for we are forever seeking better and more effective technologies. We have moved away from ablative laser to non-ablative laser and now back to fractional ablative laser for the treatment of acne scars and aging skin. Constant change is the norm but one thing has emerged constant is that patients prefer the latest outpatient treatments that have minimal down time.
Whether it is medical or aesthetic skin concern, patients need doctor’s honest opinion as to which is the best treatment that they should undergo. There are many options and choices and dermatologists have to make a prudent recommendation and be the guardian of our patient’s interest. Despite all the advances in research and technologies, sound judgement and professionalism still remains the cornerstone of our profession.
