Does your dermatologist have the right qualifications?

In Ireland, skin treatments are offered by everyone from beauticians, and even dentists, to doctors who may have only a basic medical degree, yet sometimes describe themselves as a cosmetic dermatologist or as specialising in clinical dermatology. Others state that they are on the Medical Council’s specialist register, without explaining that, in their case, this refers to having had GP training.

They operate from private clinics with impressive websites that make extensive claims about their doctors: a quick check of the Medical Council register will reveal whether they do have a specialist registration that it recognises. In many cases there is none.

Asked if there is any restriction in this country on who can use the title “dermatologist” in any form, such as “cosmetic dermatologist”, the Medical Council will say only that “From a regulatory perspective, under legislation it is an offence for a doctor or doctors to falsely represent themselves as registered within the specialist division if they are not on this division of the register.”

It adds that “if the Medical Council was made aware of such an instance, the Garda could be notified and it could also go through the Medical Council’s complaints process”. It’s also the case that any advertising doctors use about their services should not be “misleading”.

More than a year ago, a group of dermatologists did alert the Medical Council to doctors giving the impression they are fully qualified dermatologists, but to date they say there is no sign of any investigation having taken place. The Medical Council says that when it receives a complaint about a doctor, the Preliminary Proceedings Committee investigates and decides whether the case should go on to become an inquiry before the Fitness to Practise Committee.

“If an inquiry is held in public, it is only at this stage that details of a complaint become available, as to make details of the complaint public before the inquiry could be deemed to prejudice the outcome.”

Ireland has one of the lowest numbers of consultant dermatologists in Europe, with 47 in active practice for an estimated population of 4.6 million last year, and 14 of these work only in private practice.

Consultant dermatologists are doctors who have undergone at least 13 years of training before being qualified to use this title. Unfortunately, this area of medicine, like opthalmology and plastic surgery, suffers from being confused in the public mind with the overlap by commercial interests so, as consultant dermatologist and Mohs micrographic surgeon Dr Patrick Ormond says, it is “amazing that people sometimes think you’re not a doctor”. One dermatologist was asked whether she offered waxing.

Plastic surgeons (from the Greek “plastikos”, meaning to shape or mould; nothing to do with plastic) who offer reconstructive and cosmetic surgery have undergone similarly lengthy training, but as the Irish Association of Plastic Surgeons (IAPS) points out: “Unfortunately, there are a number of doctors using the term cosmetic surgeon without holding any surgical qualifications.”

According to the Medical Council, the term cosmetic surgeon is “not a speciality we recognise. In the interests of safety, the public deserve reassurance that the practitioners undertaking either surgical or nonsurgical treatments have undergone formal training recognised by the Medical Council, examinations by an independent authority, and ongoing professional education in the appropriate speciality,” says Margaret O’Donnell, the president ofIAPS.

With skin being the largest organ in the body, affected by 200 common conditions, many GPs do have an interest in dermatology and may have completed a distance-learning course or a diploma in dermatology.

But that still doesn’t make them a dermatologist with the experience and skill to diagnose and manage the full range of skin diseases. GPs do play a “vital role”, according to dermatologists, as do other specialists such as paediatricians.

The first port of call for anyone with a concern about their skin should clearly be their own GP, who will know which dermatologist to send a patient to.

Dr Rosemary Coleman, a consultant dermatologist, regularly receives calls from people who have had treatments go wrong and who want to be seen quickly. Dr Ormond has seen people burned by topical treatments and peels, and with reactions to imprecisely placed fillers.

One beautician told a woman her melanoma just needed “freezing”, after lasering it five times in a year. Another woman was treated several times with laser for what looked like a broken blood vessel before she went to her GP, who recognised it as cancer and referred her promptly to a dermatologist.

Two years ago, a British Department of Health review group of the cosmetic sector said it was surprised to discover that nonsurgical interventions, accounting for 90 per cent of procedures, which “can have major and irreversible adverse impacts on health and wellbeing, are almost entirely unregulated”.

"It's a minefield," says Dr Rosemarie Watson, president of the Irish Association of Dermatologists (irishdermatologists.ie). "It's not going to be easy to fix, and that's why patients need to be well informed."

Dr Patrick Treacy, chairman of the Irish Association of Cosmetic Doctors, says “aesthetic medicine is really a new medical specialty within these past 15 years, at times still finding its feet and looking for endorsement by the royal colleges of further education”.

Treacy says it is practised by registered and licensed medical practitioners, mostly general practitioners with an interest in dermatology. “They normally would have taken numerous different courses and examinations outside conventional medicine before medical insurance companies would cover or endorse them.”

Treacy says cosmetic doctors welcome regulation of the industry. “Cosmetic treatments of all types should be carried out only by qualified clinical professionals who are prescribers or under the supervision of such professionals. We need to end the practice of administration of treatments by unqualified and untrained individuals . . . in unsuitable facilities.”