Have you ever wondered what exactly dermatology PAs do daily? Spoiler alert, we rarely pop pimples. You may be interested in pursuing dermatology as a medical specialty after physician assistant school, or you may simply be wondering what exactly we do day to day. I am going to list out the most common skin disorders we treat and a little breakdown of each. This is by no means an exhaustive list. Every day is different and every patient is different. This is also simply my experience treating patients and another dermatology PA in a different part of the country may see more of one type of medical condition and less of another.
Okay, here we go.
Skin cancer
The number one thing I do as a dermatology physician assistant is skin exams. The point of skin exams is to detect skin cancer early so that it can be treated before it becomes a problem for the patient. So, there are three steps to this. I check a patient head-to-toe looking for anything that is possibly concerning for skin cancer. If I find something the second step is to biopsy it and send it to the pathologist to be checked. The third step is to treat the skin cancer. The third step I will sometimes take care of myself depending on the type of skin cancer and how early it was caught. If it is something more advanced then I schedule the patient with one of our Mohs surgeons for removal.
Check out this post to learn how to catch skin cancer early.
Acne
This is one everyone is familiar with. What you may not know is that there are several different types of acne and a million and one possible combinations of ways to treat acne. This is where the art of medicine can come in. As a dermatology PA, I have to first properly evaluate the patient. I need to learn about their: habits, medical history, medications, current skin care routine, diet and so much more before determining the best treatment regimen for them.
Read this post to learn what types of foods can worsen acne.
Eczema
Eczema is a chronic inflammatory condition that results in dry skin. Sometimes a biopsy is required to confirm the diagnosis and to ensure it is not a different type of rash. The most common areas to experience eczema are on the folds of your arms, behind your knees, hands, eyelids, and neck. However, sometimes it can be all over a patient’s body and extremely itchy. Children can experience eczema and may be more prone to it if they already have seasonal allergies and asthma. Mild eczema can typically be treated with topical medications and changing products used at home to hypoallergenic products only. Patients who experience moderate to severe eczema, also known as atopic dermatitis, may need systemic treatments like Dupixent, Adbry, Rinvoq, or Cibinqo.
Might be experiencing eczema? Read this.
Psoriasis
Psoriasis is a chronic autoimmune condition that can not only cause full-body rashes but also in some cases affect the joints. There is no cure but the amount of medications there are now for patients is incredible. I love treating psoriasis because these treatments can change patients’ quality of life. Take one patient covered in a head-to-toe rash, having trouble walking because of joint discomfort. If they are started on a medication known as a biologic, within several months that rash that they have had for years could be 95% gone and their joint pain drastically improved.
Psoriasis patients can learn a lot from this post.
Alopecia (hair loss)
Hair loss is a difficult diagnosis to come to terms with. Some types of hair loss are much easier to treat than others. There are two main categories of hair loss. Scarring alopecia and non-scarring alopecia. Within each category, there are several types of hair loss someone could be experiencing. Sometimes, a single individual could have multiple types of hair loss going on at once. Treating hair loss can involve setting expectations. With certain types of hair loss the main goal is going may be to prevent more hair from falling out and not necessarily to grow more.
This is a deep-dive description of the most common types of hair loss.
Warts
Warts can be seen in both children and adults. They are a virus and boy can they be stubborn. Patients typically come to see me after they have failed over-the-counter treatments. In the office, we have liquid nitrogen and cantharidin and I can prescribe prescription-strength medications that can treat those annoying warts once and for all. The key I have found to treating warts is consistency with treatment. If I freeze someone’s plantar wart once and then don’t see them back for 6 months then the wart will likely have regrown to the size it was to begin with. I normally need to see patients every 4-6 weeks for several months and sometimes longer until the warts have resolved.
Learn more about how to get rid of stubborn warts here.
Rosacea
Rosacea is a chronic inflammatory condition that can cause easy redness, burning sensations, and acne on the face. There are several different types of rosacea as well as different ways to treat each type. I always review the triggers of rosacea with my patients. Every patient may experience different triggers but the following are the most common: sun exposure, wind, stress, alcohol, spicy foods, and high intakes of caffeine or sugar. I typically recommend a patients keeps a journal and every time they have a flare they will write down everything they did and consumed within the last 48 hours. Avoiding triggers is important in treating rosacea.
Learn more here about the do’s and don’ts of treating rosacea
Hidradenitis suppurativa
Hidradenitis suppurative also known as HS can be a devastating medical condition to have. Like psoriasis, it is also a chronic autoimmune condition and there is unfortunately no cure. There are strong treatments that for some people can be extremely beneficial. For others, it may only help a little. HS causes recurrent abscesses in skin fold areas so think under the arms, under the breasts, in the groin and buttocks area. It can be excruciating and cause constant drainage that ruins clothing and can smell.
Hair removal can sometimes be helpful for HS patients. Read more here.
Other rashes
This category is very expansive. I am lumping in a ton of rashes here including seborrheic dermatitis, tinea, intertrigo, pityriasis rosea, allergic contact dermatitis, drug eruptions, lupus, granuloma annulare, lichen planus, prurigo nodularis, Grover’s disease, other blistering autoimmune conditions. The list goes on and on. Dermatology is where you go for all things that arise on the skin.
Learn more about 3 types of rashes that can flare in winter weather here.
Pruritus (itching)
Pruritus means itching. People can itch for a million different reasons. It can be due to a rash, something they are allergic to, or even something going on internally. Treating pruritus can be difficult. I always need to take a thorough history before determining the most likely cause. Sometimes it is obvious because they have a rash such as eczema. Other times it involves additional testing to find out why they are itching. For example, I may need to order blood work or patch testing which is where I can check to see if a patient is allergic to common allergens found in everyday household products.
How I initially approach itching in a patient.
There you have it. Once again this is by no means an exhaustive list. If you are in PA school or interested in switching to dermatology I hope this helps give you an idea of what to expect. If you are someone experiencing one of the above conditions then make sure you see your local dermatology medical provider. We can help!
*Disclaimer: Opinions expressed are solely my own and do not express the views or opinions of my employer. Information on this website is for education and entertainment purposes only. Content is my opinion. It is not substituted for your own doctor’s medical care or advice. One should not make any health or medical-related decisions based in whole or in part on any content on this site. Content is not intended to replace the services of a licensed, trained health professional. Content may not apply to you as an individual. Although I will update my website with current information, this website is not a definitive guide to dermatology.
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