Dr. S. Radovanovic: Warns that tattoos can bring you infections

Consultant dermatologist Dr Spasoje Radovanovic gives an exclusive insight into life as a dermatologist and how he treats those in his care.

Tell us your background.

I was born in Serbia where I started and finished all my education – primary, secondary, medical school and specialization. I have been practicing as a dermatologist for over 20 years.

What do you find is the most common skin complaint from your patients?

Most dermatologists will probably agree that the majority of our work-load falls into two categories. The first is inflammatory skin disorders such as eczema, psoriasis and acne. The second is skin cancer and skin lesions (lumps and bumps).

Talk about patients with a psychological problem.

The skin and mind is a hugely interesting and expanding area. We are really becoming aware how closely these two are linked and most dermatologists will group this into largely two areas – there are skin diseases that can be associated with psychological distress; such as acne and psoriasis - and then there are psychiatric disorders that can manifest with skin problems; such as trichotillomania and dermatitis artefacta. The approach to dealing with these is, on the whole, different. The first group are likely to benefit from talking therapies and often as the skin is controlled, the distress also improves. The second group may need some input from other medical specialties as well as a dermatologist. Personally, I think it is important to ask patients how their skin disease affects their daily life. I have had patients with acne becoming socially isolated, or patients with hand psoriasis wearing gloves even under hot conditions, or not wanting to go swimming, or not wanting to wear skirts. When the skin is good, these challenges can often be taken for granted. But skin disease can cause huge psychological morbidity and if you don’t ask the question, people may not necessarily volunteer quite what an impact their skin is having on their general well-being. If I have ongoing concerns, then I would recommend review by a clinical psychologist.

Reports indicate that skin cancer is on the rise in the Sub Saharan countries including Botswana, especially Melanoma. Why do you think this is the case?

Incidence of skin cancer has increased all over the world especially in developing countries because of the damaged ozone layer in the atmosphere. In fact a recent report by the World Health Organisation (WHO) estimates that 21–87% of the general population in developing countries has skin disease. The sun changed the spectrum and more UV (ultra-violet) radiation now comes to the earth surface.

Why is sunlight harmful to our skin (despite popular belief that dark skin is not affected by the sun’s harmful rays)? How exactly does the sun affect our skin?

Sun radiation is divided in three parts according to the energy it carries: IR (infrared), Visible Light, and UV (ultraviolet). Only UV radiation is harmful. It carries enough energy to produce ionisation of different molecules in the skin. Ions are chemically active and interact with genetic material of skin cells, to produce mutations. The nature of X-rays is similar to UV radiation, but carries even more energy. In other words UV radiation is "softer" than X-rays but still poses danger.

What beauty trend have you seen over the course of your career that you wish would go away?

Definitely tattooing, it may transmit all diseases that may be transmitted with needles (e.g. Hepatitis B, HIV, Syphilis), and it may even cause allergy due to the injected paint.

What is the one anti-aging myth you wish everyone would stop believing?

A long time ago, when I was young, doctors recommended the sun as healthy for the skin and general health. Suntanned and bronze models advertise cosmetic products. Some still believe in it.

What do you find the most rewarding about the work you do?

I prefer to treat real diseases than cosmetic problems. It sounds like a cliché, but it is an honour and a privilege to be a doctor.  People see you at their most vulnerable and share intimate details of their lives.  To be able to make a difference, however small it maybe, is a unique position to be in and not one I take for granted.  There is nothing more satisfying than being able to diagnose, treat, and reassure others. 

And what are the challenges?

The hardest part of the job is delivering bad news, such as telling someone they have metastatic cancer.  There needs to be a balance between providing reassurance and an honest discussion regarding prognosis, particularly if it is bleak. There is still no easy way to do this. 

Do patients always follow the advice you give them?

I think the crux of answering this is based on making sure I try my hardest to establish good rapport with those I am treating. I think if you trust your doctor, you are much more likely to stick to a treatment plan that they recommend.  People have busy lives and what tends to happen is that people may ease off their treatment plan when their skin improves. It’s all about developing a practical, happy medium that improves the patient but causes minimal interference with their life.

On a basic level, what skills does your job demand?

If a doctor were a computer, it would have a slow processor and a large hard drive. Doctors just have to be hard working, no special skills needed.

How is the job market/demand in the dermatology field? How do you think it will develop over the next five years?

American statistics say that 30,000 people need one dermatologist. Now there are only five (5) dermatologists in Botswana. This is a prospective job for young doctors.