Dermatology and Aesthetic Medicine

01Purpose and scope

• This manual supports the course Dermatology and Aesthetic Medicine. It describes how skin assessment, medical dermatology, and elective aesthetic procedures are organized in clinics, hospital outpatient departments, and dermatology practices, and where those settings differ from one another.
• The scope covers diagnosis and treatment planning for common skin conditions such as acne, eczema, psoriasis, rosacea, and skin cancer screening. It also covers cosmetic work such as neurotoxin injections, dermal fillers, chemical peels, and laser or light-based treatments. It does not teach any single procedure in technical depth. Readers are assumed to be licensed clinicians, nurses working under a written protocol, or trainees working under direct supervision.
• Scope limits matter. Who may perform each intervention, which products are approved for which uses, and what supervision is required all depend on jurisdiction, licensing board rules, and facility policy. Check the current authoritative source in your region and your employer's credentialing rules before acting on anything described here. This guidance does not replace qualified professional judgment, approved procedures or required authorization.

02Core principles

• Start with the patient's goal and the working diagnosis, not the device or the product on the shelf. A cosmetic request is sometimes a sign of a medical problem, such as body dysmorphic concerns, an untreated inflammatory condition, or a lesion that needs biopsy before any cosmetic work is considered.
• Assess skin type with a recognized tool. The Fitzpatrick scale is widely used to estimate how skin responds to sun and light energy, but it is imperfect. Patients with darker skin tones need extra attention to the risk of post-inflammatory hyperpigmentation and, with some energy devices, to scarring and keloid formation.
• Treat conservatively and in stages where the procedure allows it. Lower doses, small test areas, and staged sessions let you see the response before you commit to a full treatment. Expectations should be set in writing, including what is unlikely to change and how long results usually take to appear.
• Know when to refer. Pigmented lesions with asymmetry, irregular borders, or recent change, rapidly growing nodules, vascular compromise after filler, and patients on immunosuppressive therapy all call for a different pathway than routine aesthetic care.

03Planning and preparation

• Intake starts with a structured history. Record current medications, anticoagulants and antiplatelet agents, recent isotretinoin use, prior adverse reactions, allergies including latex and local anesthetics, pregnancy or breastfeeding status, autoimmune disease, and any previous cosmetic work in the same area. Ask about supplements, because several can affect bleeding and healing.
• Photograph the treatment area before any intervention under standardized lighting and with a documented consent for clinical photography. Baseline images are one of the most useful quality tools in aesthetic work, because memory of a face before treatment is unreliable and patients often recall their appearance differently from the photographs.
• Decide on the procedure and the product before the visit ends. Confirm that the product is labeled for the intended use in your jurisdiction, check the lot number and expiry date, and stock reversal agents where they exist. Hyaluronidase is the usual reversal agent for hyaluronic acid filler. An emergency kit and a written protocol for anaphylaxis should be available in the room before any injection.
• Set a plan with an estimated number of sessions, a follow-up interval, and a cost estimate in writing. Consent discussions should cover common and expected effects, uncommon but serious risks, realistic alternatives including no treatment, and what the patient should do after hours if something goes wrong.

04Recommended workflow

1. 1
   : Confirm the patient's identity, the reason for the visit, and whether the encounter is diagnostic or cosmetic. Record which clinician holds responsibility for the decisions made during the visit.
2. 2
   : Take the history and examine the skin under adequate light. Describe lesions with consistent morphology terms such as macule, papule, plaque, nodule, scale, or erosion, rather than informal labels.
3. 3
   : Settle the working diagnosis and decide whether a biopsy, culture, patch test, or referral is needed before treatment. If the answer is unclear, defer the cosmetic procedure and document why.
4. 4
   : Take standardized baseline photographs, record the Fitzpatrick type, and mark the treatment area on the patient's skin or on a diagram in the chart.
5. 5
   : Obtain informed consent in a private room with enough time for questions. Use a teach-back check, where the patient explains in their own words what will happen and what to watch for, and provide written information in the language the patient reads best.
6. 6
   : Perform the procedure using the agreed dose, energy setting, or volume. Record the product name, lot number, units or volume injected, depth or energy settings, anesthetic used, and the sterile technique applied.
7. 7
   : Give written aftercare instructions, a clear route for contacting the practice about complications, and a review appointment. Record the immediate outcome and any adverse event before the patient leaves the clinic.

05Quality checks, risk controls and compliance

• Injection and energy-based procedures carry specific risks. Filler can cause vascular occlusion, which needs immediate recognition, a plan for urgent treatment, and access to a reversal agent. Other risks include infection, delayed inflammatory nodules, herpes simplex reactivation before laser or deep peels in susceptible patients, photosensitivity with certain topical actives, and burns or pigmentary change with energy devices. Patients taking isotretinoin may fall under pregnancy prevention programs, and the requirements for those programs differ by country and sometimes by state.
• Track indicators that show whether the practice is working. Useful measures include the complication rate by product and by procedure, unplanned return visits within a set period, completeness of consent and photo documentation in chart audits, adherence to time-out checks before injection, and patient-reported outcomes. Set targets locally based on your case mix. Small clinics see few cases each month, so trends can look dramatic from a handful of events and should be read with caution.
• Compliance obligations commonly include safe storage of prescription products, sharps and medical waste disposal, record retention periods, adverse event reporting for devices and drugs, and rules on advertising and before-and-after images. These rules vary by jurisdiction. Consult the national regulator, the relevant medical or nursing board, and your facility's policies. Where the content of this section conflicts with those sources, follow the sources.

06Collaboration and documentation

• Dermatology and aesthetic work involves several roles. The treating clinician owns diagnosis, consent, and decisions about the procedure. Nurses and medical assistants may perform tasks delegated under a written scope, and the delegation must match licensing rules. Pharmacists or the practice manager may handle product stock and traceability. Pathologists and referring physicians depend on clear clinical history and accurate lesion location on the requisition form.
• Documentation is the main evidence that care was appropriate. A good note states the presenting concern, relevant findings, working diagnosis, options discussed, consent given, product and dose used, and follow-up plan. Photographs belong in the clinical record under the same access controls as other images. Electronic records with lot tracking reduce errors when a product recall occurs, but they add time at the point of care, so the template should be short enough to use every time.
• Adverse events should be reported internally and, where required, to the manufacturer and the regulator. Clinicians should discuss complications with the patient honestly and promptly, and record that conversation. Shared messaging between the front desk and clinical staff should use the same description of aftercare, since mixed instructions are a common source of complaints.

07Measures and continuous improvement

• Review clinical data on a fixed schedule, such as monthly for small practices and quarterly for larger groups. Look at complications, near misses, consent audits, and patient feedback together rather than in isolation. A near-miss log, where staff record events that were caught before harm occurred, often reveals process gaps earlier than complaints do.
• Use audits of photographs and notes to check whether standards are being met. Compare results across clinicians and products only when case volumes are large enough to support a fair comparison. Changes to protocols should be tested on a small scale first, such as a revised time-out script or a new reversal agent stocking rule, and then reviewed after a defined period.
• Continuous improvement involves trade-offs. Detailed data collection improves safety but takes clinician and staff time away from patients. Strict protocols reduce variation but can slow care when a patient has an unusual presentation. Decide which measures matter most for your setting and drop those that do not change decisions.

08Common mistakes and how to prevent them

• Treating a cosmetic request without a proper skin examination is a frequent error. Prevent it by requiring a documented examination for every first visit, even when the patient asks only for a quick treatment. A suspicious mole that is missed during a filler appointment can become a serious problem later.
• Skipping baseline photographs leaves the practice unable to show what changed and makes disputes hard to resolve. Make photographs part of the standard checklist and do not allow the procedure to start until they are saved to the record.
• Using product without a traceable lot number or using a product outside its labeled use creates recall and liability problems. Keep a product log at the point of use, and require the clinician to confirm labeling before opening a vial.
• Under-recognizing vascular occlusion or delaying the response to it causes avoidable harm. Train all staff on early signs such as blanching, severe pain out of proportion to findings, or skin mottling, and keep a written emergency pathway posted in the treatment room.
• Overpromising results is common when marketing and consultation blur. Set expectations in writing, use realistic before-and-after examples with consent, and document what the patient was told about uncertainty.
• Assigning tasks beyond a staff member's authorized scope happens when clinics are busy. Write down who may do what under which supervision, and audit the schedule against that document.

09Practical checklist

• Confirm identity, reason for visit, and whether the encounter is diagnostic or cosmetic.
• Take a full history covering medications, anticoagulants, isotretinoin use, allergies, pregnancy status, and autoimmune disease.
• Examine the skin under adequate light and describe lesions with standard morphology terms.
• Decide whether a biopsy, referral, or deferral is needed before any cosmetic work.
• Record the Fitzpatrick type and take standardized baseline photographs with consent.
• Confirm product labeling, lot number, expiry, and availability of reversal agents and an emergency kit.
• Complete informed consent in a private room and check understanding with teach-back.
• Document product, dose or energy, technique, and immediate outcome in the chart.
• Provide written aftercare, a complication contact route, and a scheduled review.

★Learning sources

• Micro Degree: Dermatology and Aesthetic Medicine
• Micro Degree: Healthcare Administration Practice
• Micro Degree: Physiotherapy Assistant Operations
• Micro Degree: Cardiac Care Support