Skin. The largest bodily organ. Moisture barrier. Immune barrier. Canvas for various types of art. Pin cushion for piercings. Source of pleasure and pain. Dermatology is the study of skin and its diseases. It is a medical/surgical specialty within medicine. A specialty that is somewhat young and greatly sought after by medical students as they choose their career path as newly minted physicians.
The lifestyle, the intelectual stimulation, the procedural opportunities, monetary compensation, and perceived job satisfaction are all driving forces for pursuing this specialty. My exposure to Dermatology prior to medical school was non-existent. In medical school my dermatology course was taught by a rather arrogant physician who more or less lectured at and down to us. First impressions are lasting ones. But, I was still intrigued by skin and its nuances.
So, I just finished a Derm rotation as an Intern with a brilliant private practice Dermatologist. I have a newfound respect for this specialty and most importantly our most important organ, our skin.
My attending was a unique individual. Not your stereotypical new age Dermatologist. He is a self-affirmed "Rural Doc/Dermatologist". He hunts, fishes, goes on wildlife educational getaways. He brings his dog to work and takes him for walks throughout the day. He has motion sensor cameras set up in the wild woods and mountain ranges of the Berkshires. Also, he is a successful author of two crime/mystery novels. His patients adore him. They have read his books and readily inquire as to when a third novel will be available.
I've witnessed patients bringing in a favorite book of theirs to share with him. Some bring in baked treats for him and the whole office staff. Others bring in homemade beer. Needless to say, I ate and drank well this rotation!
I have learned that not every blemish is cancer. Nor is every mole something to lose sleep over and sunblock is a must! I've seen 90-year olds with skin like a teenager and 30-year olds with skin so Sun-aged they look like someone would expect a 90-year old's skin to look (wrinkled, leathery, "sun" spots galore).
Some people look like they've been birdshot with age spots (Seborrheic keratoses). Others have a scant speckling of moles, freckles, and/or cherry angiomas. The more surface are of skin protected from the Sun, the less blemishes, typically. Unless one's genetics just predispose them to being spotty all over.
Suntan lotion, sunscreen, and sunblock are not the same thing. I think most people know and understand this concept. However, I lost faith in this position after my foray into Dermatology. My attending asks every patient about their Sun protection habits. Most dismissively say they use sunblock on a regular basis. Some hesitate and cautiously answer in a confirmatory way. Others, usually those quite golden brown in complexion, don't have to say anything. One patient said he uses olive oil. Can't say that works. Tanning lotion...nope. Baby oil. Um, no. SPF 5000...overkill. I've learned SPF 30 is just right.
Acne, its not just a teenage thing. Pimples can plague us at any age. They are a part of growing up, a ticket to adulthood if you wish. I hated pimples when I was a teenager, wasted money on useless over the counter products, and took great pleasure in popping my zits. My grandparents never made me feel self-conscious about my zits, nor did they suggest I seek professional help. So, I don't truly understand the need to have a "clean and clear" face all the time.
Acne patients and their parents kind of annoyed me. My attending as well. It was hard to empathize with them. There are more important things to worry about in life than a couple of zits. The Derm Doc is great with his acne patients and their parents but I definitely felt he and the medical assistants as well, felt they were just your typical overly superficial types. Granted, there are some outliers with severe inflammatory acne. I feel for them. They are scarred for life by their zits, more so if they are a popper/picker. One thing I learned, its not okay for patients to pop their zits but its okay for the dermatologist to express the goo from "bacne" blackheads, pimples, and such. Guilty pleasures of the specialty?
Skin procedures are cool and somewhat cathartic. If I knew Derm was an opportunity to do procedures with nearly every patient encounter I might have gone into it! Biopsies, excisions, shavings, freezing with liquid nitrogen...sweet!
Sadly, insurance companies have restricted what they will and will not cover. Skin tags, age spots, anything that can be construed as "cosmetic" is not covered. Do not even get me started on this...insurance should not dictate how any of us physicians practice medicine. Freezing things with liquid nitrogen is wicked! Cutting off lesions that could be cancer is amazing and curative (99.9% of the time at least). Lancing cysts...whoa!
The doc said to one patient, who had a cyst about the size of a ping-pong ball on their back, "you'll notice a smell of stilton cheese" as he expressed this thick, white, er...cheesy substance from the cyst. I'll never look at any stinky cheese the same way again. Neither will the patient.
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