EN
The skin gives a problem away sooner than other organs — which is exactly why living with uncertainty about it is so hard. One person treats psoriasis or eczema for years and the flare-ups still come back. Another notices a mole that has changed and cannot get a clear answer as to whether it is dangerous. German dermatology is strong above all in removing that uncertainty first: establishing a precise diagnosis, and only then choosing the treatment.
Why people come to Germany for skin
There are a great many skin diseases, and they sit at the meeting point of several specialities — dermatology, allergology, oncology, plastic surgery. German hospitals take account of that: a complex case is seen not by one doctor but by specialists working together, and the decision is made jointly. For a patient that means a chronic condition will not be treated for years with the same ointment out of habit, but its cause will be worked out.
The second difference is access to current medicines. In severe psoriasis, atopic dermatitis and other chronic inflammatory skin diseases, biological drugs that act on the mechanism of inflammation have entered practice. They reach treatment without years of delay, and are matched to the individual patient.
First, an accurate diagnosis
The dermatologist’s main instrument is careful examination of the skin under magnification. Dermoscopy shows the structure of a mole or a rash without any intervention, and digital dermoscopy also stores the images: at the next visit the new picture is compared with the old and any change is seen. For people with many moles the whole skin surface is mapped — that way it is easier not to miss the one suspicious spot.
If something raises questions, a biopsy is taken — a small fragment of tissue — and examined under a microscope. It is the histology that gives the final answer as to whether a lesion is benign. Where spread is suspected, ultrasound, CT or MRI is added. Nothing superfluous is ordered: the set of investigations is matched to the situation.
How the treatment is chosen
The approach depends on the diagnosis. Chronic inflammatory conditions — psoriasis, eczema, atopic dermatitis — are managed in combination: topical treatments, systemic and biological therapy where needed, plus work on the triggers. Such a disease usually cannot be abolished altogether, but making flare-ups rarer and milder is a realistic goal.
Benign lesions — warts, skin tags, molluscum contagiosum — are removed where necessary. The method is chosen for the case: laser (most often a CO2 laser), cryotherapy with liquid nitrogen, electrocautery, or ordinary excision with a scalpel. Each has its indications; if the tissue has to go for histology, for example, laser vaporisation will not do and excision is chosen instead.
Moles and skin cancer
The number of skin cancer cases in Germany has risen markedly over recent decades: around 25,000 people a year develop melanoma alone. More than nine cases in ten are linked to ultraviolet light — sun and sunbeds. The good news is that when it is found early the outlook is as a rule far better, which is why people at risk are advised to have their skin examined regularly.
For some skin cancers (basal cell and squamous cell carcinoma) Mohs micrographic surgery is used: the tumour is removed layer by layer, each layer examined under the microscope immediately, and the surgeon stops as soon as the margin is clear. That removes the tumour completely while disturbing the least possible healthy skin — which matters on the face. Mohs surgery is not used for melanoma; there the approach is set separately by a tumour board.
This material is for information only and does not replace a consultation with a doctor. Whether treatment is possible, what it will involve and what it will achieve can be determined only after an examination at the clinic in person.