What is an Osteopathic Dermatologist?

Lacey Elwyn, D.O. & Paul M. Graham, D.O.

If you or someone you know is interested in pursuing a career as an osteopathic dermatologist, please refer to this article for a comprehensive explanation on the intricacies of this applicable and effective approach to a specialty that exemplifies the osteopathic profession.

There are two types of physicians in the United States, a medical doctor “MD” and a doctor of osteopathic medicine “DO”. Both physicians complete four years of medical school and go on to residency training in the specialty of their choice. Andrew Taylor Still, MD, DO, founded osteopathic medicine in 1892. Dr. Still proposed that disorders within the musculoskeletal system directly contributed to physiologic pathology. DOs are unique in that their training encompasses osteopathic medicine, in which the focus entails a holistic approach; mind, body, and soul. Osteopathic medicine emphasizes the principle that the body has the inherit ability to heal itself. Moreover, it stresses that structure and function are interrelated and that manipulation can aid in our body’s ability to heal. During medical school, osteopathic physicians, DOs, are not only trained to be medical doctors, but are also trained extensively in osteopathic manipulative therapy (OMT). OMT is a specialized technique using physical adjustment maneuvers to increase the body’s inherent ability for healing.

As osteopathic physicians, we hold the special skill of OMT, which can often complement diagnosis and treatment regimens for disease. As with many internal diseases, the treatment of patients with skin disorders can be enhanced by the application of OMT. Dysfunction within the musculoskeletal system directly contributes to underlying medical conditions. This dysfunction of the musculoskeletal system presents as a viscerosomatic reflex. Viscerosomatic reflexes can be detected by phyical examination, determined by tissue texture change, asymmetry of motion, restriction of motion, and tenderness (TART), and can aid the osteopathic physician in making the correct diagnosis.

To properly illustrate, the adrenal cortex plays a large role in the circulatory androgens, which can stimulate the pilosebaceous unit to secrete sebum and exacerbate acne. Patients with hormonal acne from hyperandrogenism will have a viscerosomatic reflex from the adrenal glands that can be detected on physical examination by an osteopathic dermatologist. The identified viscerosomatic reflex for the adrenal glands is palpated at the thoracic vertebrae level, T₉-T₁₀ . Osteopathic dermatologists can complement their acne treatment regimens with OMT. It is known that sympathetic nerves innervate the adrenal cortex via the celiac plexus and greater splanchnic nerves. Osteopathic manipulative therapy can complement medical treatments by normalizing increased sympathetic tone. It is hypothesized that inhibition of the celiac plexus will normalize the increased sympathetic tone from the adrenal cortex; decrease the increased androgen-induced sebum production, and improve hormonal acne. The previous example nicely illustrates how the specialty of dermatology utilizes Dr. Still’s approach to medicine and provides a unique opportunity to complement diagnosis and treatment of common dermatologic diseases in daily practice. Other examples in which OMT can be utilized in dermatology lies within the treatment of chronic venous stasis (leg swelling), facial edema (facial swelling), notalgia paresthetica/brachioradial pruritus (localized itching), and hyperhidrosis (increased sweating). Some internal diseases present with skin findings prior to being diagnosed. Based on the osteopathic principle that the body is capable of self-regulation, self-healing, and health-maintenance, many dermatologic conditions can be improved. These include skin disease that are largely due to over activity of the immune system, such as atopic dermatitis, psoriasis, vitiligo, and alopecia areata.

Dermatology is a multifaceted specialty that can benefit from the utilization of osteopathic techniques. Furthermore, evaluation and management of the psychological impacts that many skin diseases have are effectively addressed with an osteopathic approach. Based on the treatment of the whole person, we as osteopathic physicians can help facilitate an environment within the body that normalizes over activity and induces our body’s innate ability for self healing.

Additional information about dermatology residency programs n the United States

The main representative organization for all DO physicians is the American Osteopathic Association (AOA). Specific to dermatology, DO dermatologists are currently certified through the American Osteopathic College of Dermatology (AOCD) via the American Osteopathic Board of Dermatology (AOBD). Osteopathic dermatology residency training consists of a one-year traditional rotating internship, followed by a three-year osteopathic dermatology residency. The AOCD currently has 31 certified osteopathic dermatology residency programs, as well as 4 Mohs micrographic surgical fellowships, 2 dermatopathology fellowships, and 1 pediatric dermatology fellowship. The main representative organization for all MD physicians is the Accreditation Council for Graduate Medical Education (ACGME).  Specific to dermatology, MD dermatologists are certified via the American Board of Dermatology (ABD). The American Academy of Dermatology (AAD) is the largest dermatology group in the United States, representing all ABD certified dermatologists both nationally and internationally. In 2016, the AAD finally voted in favor of fellowship membership for AOBD certified DO dermatologists. The AOA and ACGME have functioned independently for many years, but have recently decided to merge into one accreditation system through the ACGME. Some osteopathic dermatology residency programs have already successfully received ACGME accreditation. As all the AOA residency programs move towards ACGME accreditation, one way the DOs can preserve their osteopathic distinction is by applying for Osteopathic Recognition. The new AOA Standards, set deadlines for programs to either apply for ACGME accreditation, or stop accepting trainees if the trainees cannot complete the program by June 30, 2020. If the osteopathic dermatology residency program does not apply to the ACGME by the deadline, January 1, 2018, it will not be able to participate in the February 2019 AOA Match.

Encourage your dermatology (or other specialty) residency – DO or MD – to apply for Osteopathic Recognition through the ACGME: http://www.acgme.org/What-We-Do/Recognition/Osteopathic-Recognition

References:

1. Campbell SM, Sammons DL, Sarsama-Nixon RM, et al. Dermatology: A Specialty That Exemplifies the Osteopathic Medical Profession. 2011; 111:335-338.

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