Dermatology is a pretty interesting field. I had the privilege of working with my town’s local dermatologist last week. She’s quite skilled and has a very interesting range of patients. Doctors (including myself) are sometimes too quick to refer, so I thought I’d try and learn about clear management plans for some common issues and a bit more about diagnosing some of the weirder ones. While you can biopsy just about anything, it’s much nicer for the patient if you can treat it without needing to take that step. Saves time, relieves the stress of waiting for results, and avoids creating a scar (however little).
I was shocked by how emotional people could be in a specialist’s office. There were patients afraid of skin cancer, one who’d been battling an ulcer for a year with little progress and much frustration, and those with (to others) tiny cosmetic issues that proved central to their self-view. Tears flew, people fainted, oh it was dramatic! But what struck me most was how a clear plan from an experienced specialist could give them hope for their acne/eczema/actinic keratoses or whatever. Even putting a name to what they were confronting seemed to make a world of difference.
There are lots of diseases that are simply restricted to the skin. The more fascinating dermatological concerns are the ones that signal other illness. Dermatologists have to be like radiologitsts – knowing a bit about all kinds of diseases, so they can put the skin – like the CT image – in context . I thought I’d never see a Derm specialist order a chest x-ray, but sure enough, for a patient with cutaneous sarcoidosis, that was the thing to do.
Being very much based on the visual sense, pattern recognition, and remembering that atypical presentations of common diseases are more frequent than rare diseases, seeing lots and lots of patients with a knowledgeable preceptor or colleague seems the way to learn. That, or looking at lots and lots of pictures.
To that end, here are the best 10 slide shows from 2010 on MedScape: some of the key ones are Derm. Of course you can learn more than just skin diagnoses from slideshows; I didn’t take the Radiology and Cardiology out of this post since they are pretty useful for browsing too. You’ll need a login (free) to access: