Dermatology: Where are We Coming from and Where are We Going to?

Abstract

For centuries, skin diseases have been described according to their macromorphological appearance and classified according the morphological description. The system of grouping morphological features in skin diseases followed the same principles as defined by Carolus Linnaeus (1707–1778) in the taxonomy of plants and animals. The major development of the morphological description of skin diseases was following extensive application of dermatopathology on skin biopsies. By integrating macro- and micromorphology, a new system for description of skin diseases had been created the primary efflorescences. The primary efflorescences constitute a set of macromorphological characteristics, which are indicative for the most important general pathological features (1). This system has served and still serves the classification of skin diseases. The primary efflorescences are the essentials in descriptions, diagnosis, and treatment of dermatoses. Dermatoses are classified from the point of view of the fundamental pathologic process involved. In other words, the classification is made according to the essential lesions. During the last four decades important new insights in the genetics, pathophysiology, and cell biology have provided crucial information about the etiology and pathogenesis of skin diseases and have developed dermatology from a morphology driven discipline into an etiology based discipline. These observations have impacted the system of classification of skin diseases and the possibility for targeted treatments. The development of etiology based disease classification and targeted treatments have brought dermatology in better alignment with other medical disciplines such as internal medicine, rheumatology, and gastroenterology. In particular, the multidisciplinary approach in systemic diseases provides etiological concepts beyond the boundaries of the individual disciplines. Skin diseases are easily accessible for inspection and investigation. That is why skin diseases are at the frontiers for advancement of insights in the etiology and pathogenesis of diseases and for understanding the mode of action of treatments. A major question is whether classical dermatology in general practice can serve to the patients in the light of new developments? On one hand, there is a major challenge for teaching and continuing education. On the other hand, dermatology networks around centers of excellence are and will be of major importance in the future.