An in-depth look into the endeavors of the dermatology department at the University of California, San Francisco, (UCSF) reveals that clinical care is anchored by a foundation of research and education.

The dermatopathology department at the University of California, San Francisco, receives 80,000 specimen consults every year. (Photo courtesy of University of California, San Francisco)

The UCSF Medical Centers are strong in general dermatology, dermatologic surgery (including the approximately 1,500 skin cancer procedures performed annually), cutaneous oncology and dermatopathology.

By the numbers

A typical patient may be the 65-year-old man with chronic obstructive pulmonary disease referred by his primary care physician for admission due to a severe psoriasis flare upon systemic steroid withdrawal.

Pyoderma gangrenosum and hypereosinophilic syndrome are among the more challenging conditions seen by UCSF dermatology hospitalists, says Lindy P. Fox, director, hospital consultation service, and assistant professor of clinical dermatology. They also specialize in treating graft vs. host disease, soft tissue infections, fungal infections and fever with rash.

UCSF is currently developing a program to expand the dermatology hospitalist service to centers outside the UCSF Medical Centers, says Timothy G. Berger, M.D., director of clinics and executive vice chairman, department of dermatology, and associate director of the dermatology residency program.

Pediatric dermatology

The Birthmarks and Vascular Anomalies Center was founded in 1991, and its seven-member staff is led by pediatric dermatologist and director Ilona Frieden, M.D.

While patients are referred for more common capillary malformations, such as port wine stains and salmon patches, the majority of referrals are for more debilitating and potentially life-threatening vascular tumors and malformations.

In addition to hemangiomas, the staff treats a variety of venous, lymphatic, arteriovenous and mixed malformations, including lymphangioma, cavernous hemangioma, glomangioma, Klippel-Trenaunay syndrome and Proteus syndrome. Because many of these are chronic malformative diseases rather than curable vascular anomalies, treatment focuses on alleviating the most debilitating aspects of the disease.

Through the pediatric fellowship program, UCSF has seeded and propagated other vascular anomaly treatment programs now available in many dermatology centers, Dr. Berger says.

Conjunctive programs

The UCSF dermatology community outreach efforts and its dermatopathology department serve as notable complements to the institution's clinical care programs.

The three full-time and two part-time dermatopathologists review approximately 80,000 tissue specimens each year, and of these, about 10,000 are previously prepared slides making diagnosis more challenging.

"This is a very high-powered service," Dr. Wintroub says. The department's special research interests include the molecular cytogenetics of melanoma, cutaneous lymphoma, vascular neoplasms and inflammatory skin disease.

Research and education

Successful research programs ultimately lead to better patient care, and the UCSF dermatology department has consistently ranked among the top five in terms of National Institutes of Health research funding for the past decade, Dr. Wintroub says.

In 2007, the department received 20 research grants totaling $2.6 million, and in 2004 it received $3.5 million.