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Dermatology is interdisciplinary to the core

Yale Medicine Magazine, 2022 Issue 168 More than skin deep
by Christopher Hoffman


Dermatologists at YSM often have a secondary or even tertiary specialty, because the skin as an organ is connected to so many systems in the body.

The Department of Dermatology is the “Waldo” of Yale School of Medicine: It’s everywhere. Perhaps no department at the school has a greater presence or influence in other clinical and research areas.

Ask the department chair, Richard Edelson, MD ’70, the Aaron B. and Marguerite Lerner Professor of Dermatology, why this is the case, and he has a simple answer: “Many people think of dermatology as skin deep,” he said. “But dermatology itself is among the most interdisciplinary of specialties. If you were to invent an organ that could tell you the most about the body, it’s the skin.” That means dermatology naturally overlaps with many other practice areas and fields of study, including oncology, immunology, rheumatology, genetic medicine, and even biomedical engineering, he said. As the understanding of the nexus between the skin and illness has deepened, dermatology has expanded deeper into other practice fields—a trend in which Yale has been at the forefront.

“Our department virtually to a person is interdisciplinary,” Edelson said. “It’s woven into our fabric.” As a result of this cross-pollination, he notes that numerous faculty in the Department of Dermatology also hold membership in other departments. Several have even risen to leadership positions in their cross-specialty. “To think we just take care of acne and warts is a misconception,” said Jean Bolognia, MD, professor of dermatology.

Onco-Dermatology: Cancer Treatments Cause Skin Issues

Take Jonathan Leventhal, MD, director of the Onco-dermatology Programat Smilow Cancer Hospital at Yale New Haven Health Hospital. Trained as a dermatologist, Leventhal focuses on treating the hair, skin, and fingernail conditions caused by cancer and cancer treatments. Such side effects as hair loss have long been associated with chemotherapy, but new targeted immunotherapieshave added many more to the mix, including severe acne, painful skin cracks on the feet, and bleeding fingernails. These new side effects are sometimes so intense that treatment has to be curtailed or even halted. Leventhal’s job is to work with oncologists to mitigate the fallout so that treatment can continue unabated.

“A majority of [cancer] patients will have some sort of dermatological problem,” said Leventhal. “It’s a serious issue. Many patients seen by [oncodermatology] clinics are able to stay on their cancer therapies, and they report improved quality of life. It is definitely the most rewarding part of what I do.”

The need for his specialty arose as cancer treatments become more sophisticated, first in the 1990s and even more so in the 2000s, Leventhal said. “Now there’s dozens,” he said. “I’m just seeing more and more patients get these treatments. So the problem is worsening, which is actually a good thing because immunotherapies have improved treatment of cancer.”

Michael Girardi, MD, department vice chair, is another Yale dermatologist who has broadened his horizons, branching out into oncology and genetic medicine. Co-director of the Yale Cutaneous Lymphoma Group, Girardi focuses on better understanding of the disease and developing treatments for it. He and his laboratory team, for example, have identified genetic markers for the illness and are working with the Yale Center for Molecular Discovery to create new therapies to treat it.

“The skin is the window into the body,” Girardi said. “Anything that’s going on in the body can manifest itself in the skin.” As scientists’ understanding of that powerful interconnection deepens in the coming years, Girardi predicts dermatology will become even more interdisciplinary. He sees opportunities in many areas, such as being to cure diseases by altering the skin’s microbiome.

Many people think of dermatology as skin deep. But dermatology itself is among the most interdisciplinary of specialties. If you were to invent an organ that could tell you the most about the body, it’s the skin.

Richard Edelson, MD

Girardi says the ability and willingness to work across disciplines and practice areas at Yale have been vital to his work. “No way I could have done what I did in the professional world without this collaboration,” he said. “It has to do not only with how welcoming my colleagues [in other specialties] are, but how willing they are to get together and exchange ideas.”

Immunology is yet another area of close overlap between dermatology and other specialties, Edelson said. Human evolution assigned an extremely high percentage of disease-fighting T-cells to the skin. “When humans were cavemen, their unprotected skin was subjected to constant inflammation and abrasion,” Girardi said. While modern humans may no longer face such constant attacks on their skin, that genetic heritage endures; the skin retains those protective and regenerative features as the guardian of internal organs, he said.

Interdisciplinary Nature of Dermatology

Dermatology isn’t just a leader in interdisciplinary work. The department also has one of the highest rates of mentorship in the medical school. Dermatology comprises just 1% to 2% of the school’s faculty but mentors 15% to 20% of the medical students, school statistics show. Edelson traces his department’s outsized role to its strong tradition of mentorship and to the popularity of dermatology as a subject among students who choose to do a fifth year to complete their MD thesis.

Girardi also attributed the high number of department mentees to the growing interdisciplinary nature of the specialty. That enables students to do interesting clinical and research work in a variety of areas, he said.

And it isn’t just medical students whom the department goes out of its way to foster. More than a decade ago, it created a mentorship committee that meets once a year with junior faculty members to help guide them in their careers, said Bolognia, who runs the program. The idea is to ensure that the department’s up-and-comers are laying the groundwork for future promotion and a successful career. Advice ranges from improving collaboration and networking to helping them secure invitations for lectures. “Everyone has strengths and weaknesses,” Bolognia said. “Suggestions are based on areas that need more attention.”

The committee emphasizes progressive career development so there is no panic when it is time for a promotion. “We don’t want to wait until the year prior to a scheduled promotion to give advice,” Bolognia said. “That advice is coming way too late. You have to give advice that reflects a reasonable timeline.”