Source: adapted from UEMS YEARBOOK 2008 – SPECIAL Edition 50 YEARS

Dermatology and Venereology

Diseases of the skin and the sexually transmitted diseases (STI) in Continental Europe are dealt with by Dermato-Venereologists. In the United Kingdom and Ireland however, dermato-venereology is split into two separate specialties, Dermatology and Genitourinary Medicine.

Dermatology
The skin should be looked at as an organ, with all sorts of functions. The speciality that occupies itself with the diseased skin is defined as follows: Dermatology is an organ speciality that involves the diagnosis, treatment (both medical and surgical) and prevention of diseases of the skin and subcutis, adjacent mucosae, cutaneous appendages as well as skin manifestations of systemic disease. It also encompasses the promotion of good skin health. (UEMS Training Charter for Medical Specialists., UEMS, 2001)

Venereology
Sexually transmissible infections (STI’s) are comprised by the venereological part of the specialty (named Genitourinary Medicine in the UK and Ireland): Venereology includes the diagnosis, treatment and prevention of sexually transmissible infections and other medical conditions of the genital tract. It also concerns the promotion of good sexual health. (UEMS Training Charter for medical specialists, UEMS, 2001)

The contents of Dermatology and Venereology

Dermatology
Dermatology covers a broad area. The skin is the coat of the human being, it protects, it is representative and sensual, it is an important part of the immune defense mechanisms of the body, it needs maintenance and protection, and it can become injured and diseased. Therefore the dermatologist needs a broad knowlegde, with as the central part, of course, the diseased state of the skin, being it congenital or acquired, and the availability of treatment procedures. Probably there are at least 2,000 different skin conditions, varying enormously in severity, from at first glance trivial to severe life threatening. And the patients are of all ages, from the neonate to the very old. Because the speciality covers such a broad area, it knows many fields of interest, most with roots in basic science:

• Immunodermatology, involving the defense mechanism of the skin. Allergology is part of this, the allergic and pseudoallergic reactions on substances from our environment, side effects of drugs and chemical agents of other origin included. But also autoimmune diseases such as lupus erythematodes,dermatomyositis,various vascultis types, autoimmune blistering diseases, and the skin complications of the use of immunosuppressive drugs in cancer and organ-transplant patientas well.
• Occupational and environmental dermatology, dealing with skin damaging factors in the work and private situation.
• Photodermatology and Phototherapy are dealing with the good (therapeutic) and bad (skin cancer) effects of UV-(sun / artificial) light on the skin.
• Paediatric dermatology focuses on the special problems of the young child, congenital and genetic diseases included.
• Geriatric dermatology, on the contrary, deals with the aged skin
• Infectious skin diseases, being it bacterial, viral, fungal or parasitic, have as an extra aspect that they are contagious and can become epidemic. And they can offer microbial resistance problems.
• Tropical dermatology has gained massive interest over the years because of the increase in travelling to tropical countries. It often concerns parasitic and mycotic infectious skin diseases.
• HIV-infection is basically a STI, but when the immunodeficiency of AIDS develops, it goes with a range of systemic and dermatological problems.
• Vascular pathology involves the varicose veins and their treatment, and arterial disease. Resulting chronic leg ulcers can be a disabling disease.
• Psychodermatology deals with the influence of the psyche on the skin, and the problems for the individual suffering of a skin disease.
• Aesthetic and cosmetic dermatology in particular focuses on proven concepts of the scientific background of skin biology and medical cosmetology, the maintenance of beauty, an area with many aspects aesthetic skin corrections and proven cosmetic procedures included.
• Dermatopathology investigates skin biopsies and material from (dermato-)surgery, for diagnostic and research purposes.
• Treatment procedures include the pharmacology of topical and systemic preparations, but also dermatological surgery, electrosurgery, cryotherapy, lasertherapy, radiotherapy and phototherapy.
• Other fields of interest are epidemiology and evidence based medicine, prevention of skin diseases and rehabilitation, and research to improve dermatological services, pharmacotherapy and health economics.

Venereology
Sexually Transmitted Diseases (STI) have their origin in inter-human relationships. That means that besides the somatic aspects, concerning the patient with his or her diseases, there are psychosexual, social and epidemiological aspects. The HIV/AIDS epidemic recently has shown the impact of sexually transmitted diseases on the community. Prevention of STD's is a main field of interest in this respect. The fact that several STD's express themselves by skin symptoms, elucidates the connection between venereology and dermatology.

The European Board of Dermatology and Venerology

The UEMS Section Dermatology and Venereology (UEMS-DV) has created the European Board of Dermatology and Venereology (EBV) to have the disposal of a body to cooperate with other important European DV organisations. In Europe, besides the UEMS Section of Dermatology and Venereology (DV) that represents all the nations DV societies, the three other dermato-venereological organisations with an umbrella function, each covering special areas of interest, are:

The European Academy of Dermatology and Venerology, EADV, joining the European dermatologists and venereologists. The main activity is organising continuing medical education (congresses, fostering courses)

The European Society for Dermatological Research (ESDR) dealing exclusively with basic research and focussing on obtaining insight in fundamental skin disease processes, with improvement of treatment options as a final goal! In 2007 the European Skin Research Foundation was established to support young researchers from all EU-countries.

The European Dermatology Forum (EDF), the representative group of university professors, is promoting high quality of the specialty. This further concerns the stimulation of research and clinical practice on all fronts, and the quality assurance of DV patients are incl. european guideline development, the EBDV / UEMS functioning as a clearing house. Besides that the EDF stimulates i.p. the communication of the speciality with patient organisations and health care officials and politicians.

Euroderm Excellence is an annually 5 days residents training meeting in Dermato-Venereology to update young clinicians before end of their residents time organised by the EDF.

There also exists a multitude of European dermato-venereological organisations that are giving special attention to one aspect of the specialty, for example pediatric dermatology, occupational dermatology, photodermatology, dermatosurgery, dermatooncology psychodermatology, pigment dermatology and dermatopathology. They are dealing with research as well as with patient care.

Activities of the section

• Charters of training
  Requirements for the specialities Dermato-Venereology (The Majority of the member states 25/27) and for Dermatology and Venereology (UK and Ireland) was approved by the section 2001.
• Continual Medical Education
• Visitation of training centres
  Quality of training is one of the most important factors in the domain of quality of medical care. In the member states national professional authorities assesses, improve and control specialist training in their countries. An important feedback instrument in quality improvement is the visitation of training centres. The charter published 2001 (Eur Acad Dermatol Venereol 2001; 15(3): 193) on visitation in Dermatology and Venereology presents both the general outlines as well as detailed guidelines.
• Log book for training
  Guidelines for the contents of a log book has been developed and are published in the EADV Journal 2008.
• European board examination
  The European Board Examination in Dermato-Venereology is under continuous development and the first examinations have taken place in August 2007 and 2008. It is a two-days examination. A diploma is given to those who pass the examination. The certificate has to be approved by the national authorities, because the UEMS European examination does currently not have a legal status. The goal is to harmonize the residents training in the EU. This will be a way for different countries to find out if their training gives the required skills. Residents from UK, and Ireland who are specialists in Dermatology or Genito-Urinary Medicine can take one part for the examination and get diplomas just for the part done (Dermatology or Venereology).

Cooperation with other specialities

• Multidisciplinary Joint Committee of Immune Mediated Disease
  Sections with similar interest on Immune Mediated Disease and Allergology has formed and agreed on a letter of intent and have been approved by the Management Council in Munich in November 2005.
• Dermatopathology
  The Presidents of the two Sections Dermato-Venereology and Pathology have agreed on a road map for the future of Dermatopathology in Europe. A board examination in Dermatopathology organized by the Int. Com. DermPath (ICDP) under the umbrella of both UEMS-sections is given every year in Frankfurt / Germany and is running very successfully.

 

Harald Gollnick 
Ing-Marie Bergbrant