Dermatology Clinical Units
The breadth of dermatologic disease can be broadly classified into primarily medical and surgical/ procedural dermatology. Some medical dermatology problems are rather straightforward in many patients with respect to diagnosis and treatment options. However, other medical dermatologic disease can have life-threatening complications of the disease or treatment required to manage the disease. The faculty that practice predominantly medical dermatology routinely see mild to moderately severe medical dermatologic disease with residents on a daily basis. In addition, these faculty also work with residents in diagnosing and managing very severe medical dermatologic disorders both in outpatient and inpatient settings.
Surgical/procedural dermatology can be subdivided into conventional and advanced surgical dermatology. Residents participate in removal of both benign and malignant lesions with excisional technique or other destructive modalities throughout their residency. Additionally, residents are instructed on advanced surgical dermatology (Mohs surgical technique).
Another more recently developed functional unit of dermatology is cosmetic dermatology. This discipline includes various types of laser therapy, liposuction, injection of various filler materials, chemical peels, and use of Botulinum toxin for wrinkle effacement and hyperhidrosis. Dermatology residents work with the faculty in performing all of the above surgical and cosmetic techniques.
A broad spectrum of dermatologic medical disease is seen at University of Iowa Hospitals and Clinics inpatient and outpatient services, Children’s Hospital of Iowa, the Iowa City Veterans Affairs Medical Center inpatient and outpatient services, and several outreach clinics of University of Iowa Health Care. These patients come from the local community as well as the State of Iowa and surrounding states, including western Illinois, eastern Nebraska and northern Missouri.
Many patients are referred by primary care and specialty physicians for further diagnosis and treatment of difficult problems related to skin disease. All patient care is delivered in conjunction with faculty.
Many of the department’s faculty have a primary clinical and research interest in life-threatening or potentially disabling skin diseases such as cutaneous lymphoma, severe psoriasis, allergic contact dermatitis-eczema, autoimmune blistering diseases (pemphigus, bullous pemphigoid, epidermolysis bullosa acquisita, linear IgA bullous dermatosis, dermatitis herpetiformis) and rheumatic skin disease (lupus erythematosus, dermatomyositis, scleroderma, vasculitis, etc.). A multidisciplinary Lymphoma Clinic has recently been established in the department and other subspecialty clinics are being developed. Long-term management of these disorders is provided by the residents teamed with specific faculty members. Patients with severe skin disorders may be admitted to the inpatient Dermatology Service at University of Iowa Hospitals and Clinics. At present, this is a relatively low-volume service. There is an active inpatient consultation service for patients admitted on other department services who have cutaneous disease. They are seen by dermatology residents and faculty working as a team. The collegial team concept is emphasized throughout the Dermatology residency and all other activities of the Department of Dermatology.
Surgical skills are honed throughout the residency, both at University of Iowa Hospitals and Clinics and the adjacent Veterans Affairs Medical Center. The dermatologic surgery unit is currently comprised of one full-time Mohs surgeon and two full-time faculty with interests in cosmetics and excisions. The unit functions in an integrated role with the department. This provides an ideal setting for postgraduate education in medical and surgical dermatology. Residents are exposed to the principles of dermatologic surgery throughout their training and gain experience in the surgical management of skin disease. Throughout the three years of Dermatology training residents evaluate patients with surgical problems in the general dermatology clinic, present the relevant findings to the surgical staff, and participate in a surgical plan. The residents are assigned to the surgery service for a three-month rotation in their second year, during which they are involved in the management of a full range of complex dermatological surgery cases. They prepare oral presentations for teaching conferences on surgical principles and present interesting cases, which illustrate these principles.
Faculty of the dermatologic surgery unit frequently collaborate with faculty from Head and Neck Surgery, Oculoplastic Surgery, Plastic and Reconstructive Surgery, and other surgical services. Residents have the opportunity to care for patients at the initial evaluation, throughout the operative procedures, and during the rehabilitative and repair phases. Residents also attend multi-specialty tumor conferences, which serve an important educational and management role for higher risk tumors.
The resident physician is frequently involved in the evaluation and management of a large number and variety of cutaneous tumors. The residents are exposed to other procedures including surgical repair and reconstruction, skin grafting, laser and nail surgery, and aesthetic techniques. Journal review is done on a regular basis with an emphasis on dermatologic surgery. Residents play an important role in teaching basic principles of skin surgery and cutaneous oncology to medical students.
Residents receive continuous training in dermatopathology throughout the three-year residency. One or two conferences a week are devoted exclusively to dermatopathology. Didactic conferences, “unknown” conferences, and monthly “great cases” conferences are attended. During “unknown” conference, eight to ten glass slides are put out for review and independent study. The faculty dermatopathologist then discusses the cases with the residents, emphasizing diagnostic features and the histopathologic differential diagnosis. Also, in the weekly conference schedule, the histologic findings of patients presented are reviewed via a digital projection microscopy system. Slides from tumors scheduled for surgical procedures are reviewed with the dermatologic surgery faculty to best determine the most appropriate surgical procedure. Once each month, the dermatopathologist and the resident assigned to dermatopathology present “great cases” of the month. Slides are reviewed by projection microscopy.
During the second or third year of the residency, each resident spends a three-month block of time on dermatopathology. During this time they, along with a pathology resident, are responsible for looking at the slides and arriving at a preliminary diagnosis. The resident assigned to dermatopathology then meets with the dermatopathology faculty to formally read all of the slides and arrive at the final diagnosis.
In addition to formal teaching and pathology sign out, there is an extensive teaching set of instructive dermatopathology slides available for independent study.
The Department of Dermatology facilities contain a phototherapy treatment suite. Whole body narrow band UVA, UVB and PUVA, and hand/foot PUVA treatments are delivered to patients with a wide variety of photoresponsive diseases, including psoriasis, cutaneous T-cell lymphoma, vitiligo, lichen planus, eczema, and generalized pruritus. Treatments are provided under the supervision of faculty and resident physicians. Extracorporeal photophoresis is available for the treatment of selected cutaneous T-cell lymphoma patients.
Dermatologic Research Program
The research program in the Department of Dermatology at University of Iowa College of Medicine is currently expanding. In addition to MD faculty, currently two Ph.D. full-time faculty participate in basic science research. The 4,000 square feet of dedicated bench research space was completely renovated, ceiling-to-floor, in 1999 to produce a state-of-the-art facility. Currently immunobullous disease is a major focus of research.