As the most superficially visual organ, our skin has held great significance for its ability to reflect an individual’s overall health. Any readily visible alterations have long been recognized as not just isolated manifestations of the skin, but as a signal of greater systemic disorder, potentially requiring serious attention and treatment of vital systems. Exploring the evolution of dermatology through the lenses of medical history, culture, and technology reveals that the skin is more than just a protective barrier, but also an organ that has shaped, and has been shaped by, science and society. This paper will serve as an introduction to these points of discussion, which will be further examined in future works.
     Since antiquity, humans have attempted to understand the purpose of our skin and the root cause of cutaneous ailments; Mesopotamians scholars understood skin conditions as a result of divine punishment or the gods inscribing signs onto the body to be read.[1] Greek physicians thought that skin conditions were a result of an imbalance in humors,[2] and Romans were among early peoples who attempted to detail various dermatologic conditions and potential natural remedies. With significant advances in medical research over the next several centuries and the Renaissance ushering in a break to the taboo of cadaveric dissection,[3]
several physicians, including some later considered to be the first dermatologists, started describing the composition of skin itself as well as the pathologic changes underlying cutaneous disease, aided by large developments in microscopic instruments which, for the first time, made it possible to observe the cellular physiology of the organ.[4] The beginning of the 19th century brought in even greater advancements, with the first school of dermatology opening in France in 1801 [4] and the legendary Vienna School of Dermatology bringing great attention to the medical discipline, with medical atlases featuring a wide variety of diseases [5] for physicians to learn from and dedicated institutions conducting serious research on the pathophysiology of skin conditions. Into the 20th century and the modern age of medicine, new tools and therapies were pioneered to image and treat skin conditions; an early form of dermatoscopy used a modified optical device to distinguish between different kinds of tumors,[4] and treatments like phototherapy and micrographic surgery sought to shrink and remove lesions.[4] All the while, this remarkable progress has not been experienced equitably, as the evidence base of modern dermatology continues to disproportionately focus on lighter skin tones, leaving considerable gaps in the understanding and representation of skin color;[6] fortunately, great progress has been made over the last few decades to further our understanding on this topic.

     Beyond its medical significance, the skin has long occupied a unique place in society; across cultures and throughout history, it has also served as a medium for beauty, status, and self-expression. Concurrent to humanity’s interest with our skin, people have sought to apply cosmetic substances to their skin to cleanse, beautify, or alter their appearance, processing like stones, plant, and animal material to create preparations which can be applied for medicinal and ceremonial purposes, in addition to aesthetics.[8] Accordingly, cosmetics have been an integral part of every society, representing important cultural traditions and values. Beginning in the late nineteenth century, industrialization and a rise in consumer culture transformed the
role of cosmetics, placing a greater emphasis on ideals like personal identity and self-presentation.[9] This shift laid the foundation for the modern beauty industry, which has continued to expand through mass media and (more recently) social media platforms and has raised important ethical questions about the medicalization of typical skin variations and the physician’s responsibility to provide evidence-based care while remaining attentive to patient’s cosmetic goals. Similar ethical considerations apply to both skin of color and artificial intelligence in dermatology. The historic underrepresentation of skin of color in dermatology education, research, and clinical databases has contributed to disparities in the recognition and treatment of numerous, such as delayed diagnosis of melanoma in patients with darker skin tones.[10] Similarly, the development of AI-assisted tools for diagnosis is limited by a a lack of training data representing darker skin types while also raising important concerns regarding patient privacy, informed consent, transparency, and algorithmic bias in the use of potentially identifying dermatologic images.
     Over the next few issues, I will explore these various aspects of dermatology in greater detail, further exploring the history of dermatology alongside the longstanding underrepresentation of skin of color, how skin presentation has influenced our conception of beauty and commercialization, and how visualization of the organ has scientifically advanced and how it continues to be shaped in advances in computer vision. As the skin plays an integral role in shaping human identity, a deeper look into its medical history and continued impact is crucial to understanding how our largest organ isn’t just a container meant for
holding the remainder of the body.