Recollections of an Office Visit by, the then pre-teen, Barry Mayer, M.D., FACR My uncle had a dairy farm in Orange County, New York where I spent all summer and most of my vacations working and playing from the ages of about 7 to 11 years old. Our family primary care physician was a loyal referrer to Dr. Louis Chargin, a renown Bronx dermatologist. As a youngster I had seen him at least once for problems I can’t remember now. One summer, when I was around ten, I developed an annular eruption about 2-3 inches in diameter on the extensor surface of my right forearm. It was a mystery to … Continue reading
Doctors First, Specialists Second
One morning, I pulled an empty chart from the rack on the examination room door: new patient, Ms. Judith Cornish, age forty-seven. I knocked twice and entered. “Good morning, I’m Dr. Shaw,” I flipped open the chart. “You are Ms. Cornish?” (I always used last names. It was formal, I know, but I preferred erring on the side of respect, not familiarity). I extended my hand. She sat, leaning forward in a chair, one very lean leg crossed over the other. “Good morning. Yes, I’m Judy,” she said in a husky voice. She shook my hand half-heartedly. In five seconds, I had processed a huge amount of diagnostic information: One, … Continue reading
A Pain in the Bottom
Bottom: “Ready. Name what part I am for, and proceed.” A Mid-Summer Night’s Dream, I, ii. Abstract: Over a one-month period a 17-year-old male presented with severe recurrent rectal discomfort clinically diagnosed as proctitis with anal fissure. Both episodes responded to a course of antibiotics and topical steroid ointments. On clinical examination the degree of rectal mucositis corresponded to that of his anterior oral mucosa, apparent side effects of oral isotretinoin therapy. A history of constipation may have contributed to the finding of anal fissure. Several similar cases have been documented in the medical literature. Clinicians would do well to consider the possibility of isotretinoin-induced proctitis in patients on oral … Continue reading
Listen to the Patient…
Notes from the Xanadu Clinic, Norfolk Island, South Pacific The patient is a 65 yo man with a one week history of intense lancinating pain in the right upper quadrant. He was examined by his internist who suspected gall bladder disease and ordered an abdominal ultrasound. It was negative, so an abdominal CT scan was scheduled. Between the ultrasound and the CT scan the patient developed a rash on the abdomen and back. He attributed it to one of the new drugs he was prescribed for his abdominal symptoms. I saw him today for elective surgery of a skin cancer. I greeted him with “How are you today?” He answered, … Continue reading
Dermatoscopic Diagnosis of Scabies
Dr. Cohen is a dermatology resident at LECOM/Alta Dermatology in Mesa, Arizona. Email YC. Keywords: scabies, dermoscopy, delta sign, triangle sign, diagnosis Scabies is an itchy skin condition caused by a tiny burrowing mite called Sarcopetes scabiei. A scabies diagnosis can be confirmed by taking a skin scraping and seeing the scabies mite, scybala (its pellet-shaped feces), or ovum under the microscope. However, the traditional scabies preparations can be challenging to obtain in certain patient populations, such as young children. Dermatoscopy’s advantage is that it is non-invasive, painless and highly diagnostic in practiced hands. We would like to briefly discuss the typical dermatoscopic features that are seen in patients with … Continue reading
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
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
Sun and Heart Health
This is a challenging TED video that all who are interested in “practicing safe sun” should watch. “Our bodies get Vitamin D from the sun, but as dermatologist Richard Weller suggests, sunlight may confer another surprising benefit too. New research by his team in Edinborough shows that nitric oxide, a chemical transmitter stored in huge reserves in the skin, can be released by UV light, to great benefit for blood pressure and the cardiovascular system. What does it mean? Well, it might begin to explain why Scots get sick more than Australians.” Perhaps, the slavish avoidance of ultraviolet light recommended by many dermatologists is not a panacea.
In Poor Taste: Terbinafine-induced dysgeusia in a 58-year-old man
Abstract: This is a case report of dysgeusia and glossodynia in a 58-year-old man, which he developed during a 12-week course of oral Lamisil (terbinafine) prescribed as treatment for presumed onychomycosis. Although these side effects are documented in the medical literature, many clinicians are either unaware of them or neglect to mention them to patients prior to prescribing the drug. The literature suggests that dysgeusia is more likely to develop in the older patient who has a low BMI. There is no known treatment for the disorder, which may resolve on its own or become permanent. Keywords: terbinafine, Lamisil, dysgeusia, ageusia, hypogeusia, altered sense of taste, medication side effects, onychomycosis, … Continue reading
Acne Unmasked
Bukowski on Acne From Ham on Rye Black Sparrow Press 1982 Ham on Rye, a semi-autobiographical novel, follows Henry Chinaski, Bukowski’s thinly-veiled alter ego, during his early years. It contains harrowing descriptions of Bukowski’s suffering from acne conglobata and his reflections on the dermatologists who treated him. Fortunately, today, isotretinoin can help most of these patients. Here are some excerpts from Ham on Rye: Chapter 29 I was ashamed of my boils at school. At Chelsey, you had a choice between gym and ROTC. I took ROTC because then I didn’t have to wear a gym suit and nobody could see the boils on my body. Handling the rifle … Continue reading
