Tuesday, May 27, 2008

Dermatology: more than skin deep

Finishing up the edits on the transcript from the oral history interview with Dr. Frances Jean Judy Storrs, M.D., I came across what has to be the best plug ever for people to go into dermatology. Interviewer Matt Simek asks Storrs to describe her most unusual case. Read through the slightly creepy bits to get to the heart of dermatology's attraction:

SIMEK: Have you ever had a most perplexing case? Or one that just stands out in your mind as being the most innovative solution or the most intriguing or the most incredible case?

STORRS: Well, in the contact dermatitis work that I do, I see, you know, lots and lots of fun and interesting cases. They’re almost all things that we can solve. But I’ve had a couple of patients who I remember dramatically. One of them is, well, I guess three. One of them is a young man who is still alive who has a severe blistering disease. A horrible blistering disease where his hands look like this, they’re totally in a glove shape. And he has just a little tiny movement of his thumb. He has blisters all over his body, and he has to come here two or three times a week for dressings and physical therapy. And then his whole body is covered in dressings. And he has difficulty eating. So any mucosal surface of his body is in terrible straits. The inside of his mouth is filled with blisters.

And he told me once, he said, “The one thing that bothers me the most about this disease–” he’s managed, he’s lived a long while and he’s done some wonderful things. He’s a great inspiration. He says, “The thing that bothers me the most about this disease is it never goes away. I never get a holiday from this disease.” And many of the other diseases that we have, we can in fact treat people and give them holidays from it. They can have a vacation. He can never have a vacation.

So that’s one of the horrors of genetic diseases, certain genetic diseases. And it makes us be very excited about the new basic research that’s being done in genetics. Because some of those things have potential for solution in the future.

The second patient I had that I can remember very well is a woman with horrible psoriasis. Arthritic psoriasis of all of her joints and her wrist. And the only place she didn’t have psoriasis was where she wore rings and bracelets. Copper bracelets and rings on her fingers. And those fingers were perfect. And all the other fingers were misshapen from psoriatic arthritic changes. So that made me mindful of the role that alternative medicine and faith and the patient and placebos, that all those things can play in medicine.

And the third patient is one, another person with a genetic disease who had numerous, numerous skin cancers on his body, and eventually became very misshapen and eventually died. And watching him from his childhood until he died, and looking after him during that period of time, punctuated, for me, the role that really awful skin disease can play in families. Because his disease had a catastrophic effect on his family. And there are many, many other skin diseases that do the same thing.

As I tell people all the time, lots of people think that dermatology is acne. The people that we really look after, the population never sees. Because what they have is so awful and so difficult for them until we can look after them and make them better that they’re home. They’re covered up. They’re home, they’re in their houses, and they’re not out where you can see them. So we have a chance to really, maybe more than any other specialty, make really dramatic, visible changes in people’s lives so they’re able to regain control of their lives in a way that they wouldn’t be able to do if we weren’t able to look after them. So that’s cool.

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