Dermatologists interpret tissue under the microscope (histopathology). Pediatric dermatologists specialize in the diagnoses and treatment of skin disease in children. Immunodermatologists specialize in the diagnosis and management of skin diseases driven by an altered immune system including blistering (bullous) diseases like pemphigus. In addition, there is a wide range of congenital syndromes managed by dermatologists. Physician Assistants that have specialized in, or have extensive experience in dermatology, work in this specialty as well. The skin is the largest organ of the body and the most visible. Although many skin diseases are isolated, some are manifestations of internal disease. Hence, a dermatologist is schooled in aspects of surgery, rheumatology (many rheumatic diseases can feature skin symptoms and signs), immunology, neurology (the "neurocuteaneous syndromes", such as neurofibromatosis and tuberous sclerosis), infectious diseases and endocrinology. The study of genetics is also becoming increasingly important. Cosmetic dermatology has long been an important part of the field, and dermatologists have been the primary innovators in this area. In the 1900's dermatologists employed dermabrasion to improve acne scarring and fat microtransfer was used to fill in cutaneous defects. Dermatologists specializing in cosmetic dermatology typically use non-invasive procedures to reverse the signs of aging. Botox has been used since it was FDA approved for the treatment of wrinkles. It is used to minimize wrinkles such as frown lines and crow's feet. Fillers are used to "fill in" lines on the face and to minimize the appearance wrinkles. Brand names of fillers include Restylane, Perlane, Juvederm, Radiesse and Cosmoplast among many others. Dermatologists are also the pioneers of energy based treatments for the skin and these include lasers, intense pulsed light, radiofrequency, infrared light and photodynamic treatments.
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