Dermatology approaches differ around the world

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Nellie Konnikov, MD: “We recognize that it is crucial to unify and diversify dermatological practice on a global stage.”

The practice of dermatology is not standardized. Practices and education that are common in Europe or Latin America may be relatively unknown in the United States, and vice versa.

“Dermatologists recognize that there may be multiple techniques to achieve similar clinical goals,” said Nellie Konnikov, MD, clinical professor of dermatology at Boston University School of Medicine and chief of dermatology at the Boston VA Healthcare system. “Each and every practitioner brings his/her own experience and expertise to dermatology practice.

“At the same time, we are keen to learn from one another and share our practices and ideas in order to develop and advance. Part of the mission of the Academy is to ensure the strengthening of professional relationships and the exchange of information and standards of care across national borders. We recognize that it is crucial to unify and diversify dermatological practice on a global stage.”

Dr. Konnikov collaborated with international experts to create an Aug. 22 forum for the Summer Academy Meeting, “Around the World (in 120 Minutes)” (F016), to explore alternative approaches to common problems in dermatology. As secretary-general of the International Society of Dermatology, Dr. Konnikov brings broad knowledge and a multicultural approach to dermatology around the globe.

All dermatologists strive to achieve the best results in clinical, procedural, and cosmetic dermatology, yet the techniques used to accomplish these goals vary depending on training knowledge, and available resources. Dr. Konnikov noted that while U.S. dermatologists typically opt for a surgical approach to non-melanoma skin cancers, European clinicians often select cryotherapy as the procedure of choice.

Paola Pasquali, MD, of the Pius Hospital de Valls in Spain, discussed the safety and efficacy of cryotherapy for various skin problems. She also explored the clinical reasoning that has led European clinicians to prefer freezing as the first line of treatment.

There also are different approaches to common problems, such as acne and rosacea, based on local standards, training, and access to medications and specialized devices. Lajos Kemeny, MD, PhD, DDSc, professor and head of dermatology and allergology at the University of Szeged, Hungary, and Bertrand Richert, MD, professor and director of the dermatology clinic at Brugman University Hospital, Brussels, discussed European practices and preferences in medical dermatology.

Societal preferences have encouraged cosmetic dermatologists in Latin America to extend and expand their scope of practice. While cosmetic dermatology in the U.S. tends to focus on the face and other specific areas, cosmetic dermatologists practicing in other regions have developed techniques to sculpt the entire body.

Brazilian expert Doris Hexsel, MD, principal investigator at the Brazilian Center for Studies in Dermatology and medical director for Hexsel Dermatology Clinics in Porto Alegre and Rio de Janeiro, explored some of the typical cosmetic practices used across Latin America that are less well-known in Europe and the United States. She shared many novel techniques in cosmetic dermatology that she has developed.

Global population dynamics also are affecting dermatology. Practices in cosmopolitan cities often see a diverse pool of patients. Clinicians must consider a plethora of techniques, standards of care and protocols that support the patient’s culture and previous care.

“Dermatologists in many parts of the world have developed particular strengths and expertise in certain areas due to differences in medical practices,” Dr. Konnikov said. “We need to know and consider these alternative approaches to give us more flexibility and adaptability in treating our own patients.

“In today’s global medical world, more and more of us are working with colleagues who have trained in centers of excellence that have developed their own approaches to treating dermatologic conditions that we all see. It is not that one approach is always better than another approach, but that having multiple approaches and techniques at your command will give you more opportunities to produce better outcomes for your patients.”

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