The Great Imitator

“Know syphilis in all its manifestations and relations, and all other things clinical will be added unto you.” Sir William Osler Henry Foong, a dermatologist from Malaysia and a good friend, recently wrote me about a patient he’d seen with primary syphilis. The disease we used to call “lues” or notate with the Greek letter ∑ (sigma) is becoming more common in Malaysia, in his experience. This reminded me of a memorable case I saw in the late winter or early spring of 1973. At the time, I was a first year of dermatology residency at New York University. I was not a happy camper. I was tired of New … Continue reading

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ODEAR: Most-Favored Specialties

Hi, Dr. Elpern, I am contacting you in hopes that you may be able to assist me in attaining my goal of gaining acceptance to a Dermatology residency, and also to see if you had any advice on how to shine during my dermatology rotations, or any contacts at my away school who may assist me in research opportunities such as case reports/letters. I receive emails like this with regularity.  In the 1960s when I was in medical school, dermatologists were at, or near, the bottom of the physician feeding chain.  Internists, with their haughty demeanor, were the self-proclaimed real brains of medicine and lorded it over most other practitioners.  Radiologists … Continue reading

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Stations of the Heart: Book Review

“Stations of the Heart: Parting with a son” by Robert Lischer is a moving and important book by the father of a 33 yo man with metastatic melanoma.  It chronicles the last three months of Adam Lischer’s life.  The book describes the medical, spiritual and philosophical aspects of Adam’s death.  It’s a valuable resource.  I have typed out a few pages of quotations which may interest you.. There are many medical details that a dermatologist would like to know, but they are less important than the view from the family’s standpoint. See Book Review: Stations of the Heart. Quotations from Stations of the Heart.

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Zen and Dermatology Practice

Zen Buddhism has a lot to teach us as physicians, as dermatologists. Consider these two quotes from respected roshi: The practice is the teacher. Your practice is your teacher. Maurine Stuart. Teaching is not difficult, Listening is not difficult either. What is truly difficult is to become conscious of what you have in yourself and be able to use it as your own.   DT Suzuki, The Marvelous Cat

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Music as Complement to Surgery

Dermatologists perform office surgery almost daily. Our awareness of the growing interest in, and literature on, music as an adjunct in the perioperative period led us to survey the use of music during 100 consecutive office procedures in a dermatology practice.  We found that the effects of music were salutary for patients and the investigators.  Music is a simple, inexpensive, safe and effective adjunct to office surgery. We hope that this report will be of help to physicians who wish to provide music to ease patients during office procedures. For full paper:  Music and Surgery Appendix: Music Study Appendix Keywords: music, medicine, surgery, perioperative, playlists, dermatologist, dermatology

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GoodRx

Keywords: pharmceutical prices, drug prices, generics, savings A funny thing happened on the way to the pharmacy… I was robbed. It’s a strange reality in these United States, that the price of a pharmaceutical varies wildly from one drugstore to another. Patients on Medicaid and, or, those with insurance drug coverage usually do pretty well, but individuals who do not have some form of a prescription plan get it in the neck. Over the past few years, the price of some common drugs has gone through the roof. Doxycycline is an example. It used to be that 60, 100 mg capsules could be bought for four dollars at a Target … Continue reading

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Skin Microbiome .Net

We may not see them, but we need them. An estimated one hundred trillion microorganisms inhabit the human body.  This includes bacteria, fungi, viruses, protozoa and mites.  There are gut, skin, respiratory, bone and even nervous system microbiomes – and this may be an incomplete list.  We are only beginning to understand how these microbial communities impact health and disease. Dr. Yoon Cohen has started a web site called Skin Microbiome that will serve as a repository for the emerging literature on this subject.  Disorders such as acne, atopic dermatitis, perioral dermatitis, psoriasis, rosacea, seborrhea, seborrheic dermatitis, skin ulcers and many more appear to be caused or exacerbated by an … Continue reading

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The Art and the Calling Reincarnated

In 1991, I was asked to edit a section for the Archives of Dermatology on “social and political” issues in dermatology. This became a column called “The Art and the Calling” that addressed the medical humanities. It was short-lived since the editors were not particularly interested in the humanities.  They preferred addressing the politics of medicine. “The Art and the Calling” received many positive comments and so, we will reprint the articles here and encourage our readers to submit new essays of their own.  The International Journal of Dermatology has a section called “On A Human Scale” which publishes occasional pieces and I will help you to submit there as … Continue reading

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A Guide for the Akamai Browser

 A 54-year-old carpenter presented to the dermatology clinic for evaluation of a lesion on his right forehead that turned out to be benign.  He also mentioned that his barber brought to his attention some thick furrows he has in his scalp.  These had developed slowly over the past decade or so. Examination of his scalp shows deep furrows consistent with a diagnosis of cutis verticis gyrata .  The patient, after searching the Web, had arrived at the same diagnosis. Since cutis verticis gyrata (CVG) can be associated with acromegaly, I asked the patient about changing hat size, hand size, etc.  He says that over the past 10 or 15 years, … Continue reading

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Red Face Syndrome

Rhoda, a 41 year-old professional woman, has had a facial eruption off and on for a number of years.  It began with perioral dermatitis but evolved over time to the “red face syndrome.” What follows is her story and her dermatologist’s office notes. I had been diagnosed with perioral dermatitus many moons ago and was prescribed some wonderful topical steriod ointment to treat the red, ugly, pimply like eruptions. My dermatologist clearly warned me….”do not keep using this medicine, it will rebound and makes things even worse.” At the time I took it seriously; used the ointment for a few days and things cleared up nicely. Then the monster returned!!!!!  … Continue reading

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