Clerkie Life: Didn’t Expect This From Derma

Of all my rotations, I can say I learned the MOST in derma, probably because I started from knowing close to nothing.

Why? We didn’t have a separate derma subject back in med school. The most that we covered was describing skin lesions during physical examination.

I honestly feel like I missed out on a lot! I think I would have really enjoyed Derma as a subject. Anyway.

Derma Is NOT Easy

In the out-patient department, we encountered many cases of scabies, carbuncles, and impetigo, which we previously learned how to manage in Community Medicine.

What makes dermatology complicated though is the secondary lesions that develop because the patient took too long doing self-management with “katinko” and “BL cream”.

Diagnosis is very difficult, in my opinion. A dermatologist should be comfortable to ask detailed and probing questions, and have excellent descriptive abilities to properly document the skin lesions.

derma rotation

Half the time, we were struggling to describe patients’ skin lesions using proper words that can be communicated precisely with other doctors. Half the time, we were sorting through old charts. Haha, very clerkie.

One time, I referred a patient for having wheals all over her abdomen, for which I thought anti-histamine would suffice. Upon further probing of my senior, it turns out the patient also had the itch on her buttocks, groin, and underarms, but was too embarrassed to consult about that. I guess I was too embarrassed to ask myself. Wrong move. I missed the classic “circle of hebra”. The patient’s allergic reaction was due to her scabies!

Procedures, Procedures!

A lot of people think that dermas only do cosmetic procedures like facials, removal of comedones, injecting botox, etcetera. People seem to forget that there’s also a surgical aspect in dermatology!

I got to assist (or umm take pictures haha) on the day our residents did free surgical procedures on all sorts of bumps and lumps.

My favorite was this cute chubby skin tag. It was successfully removed in less than five minutes, using a neat technique that I intend to try myself one day.

derma skin tag

Other skin tags are kind of icky, but this one is very cute! Hahaha!

They put a needle horizontally through the base of the skin tag, and made a quick incision under and against that needle to remove the whole mass. It left a nice, straight cut which was closed with one stitch. So neat.

Part Physician, Part Counselor

Skin conditions, being external manifestations of disease, can really affect the mental well-being of patients. I know this from experience.

Of all my siblings, I am the only one who didn’t outgrow my skin asthma condition. I’ve always had very problematic and sensitive skin. I regretfully triggered my skin asthma last September when I mindlessly snacked on lots of fried chicken skin. It hasn’t been fully controlled ever since. Notice why I almost never wear short shorts? 🙁

Now think of teenagers with severe acne vulgaris, or middle-aged women newly diagnosed with psoriasis.

derma psoriasis nails

Nails of my psor patient. “Describe the PE findings on the nails, doctora…” *croo croo*

A dermatologist should understand that skin disease may have more of an effect on a patient’s psyches than diabetes, hypertension, or other internal conditions with no obvious symptoms. I learned that dermas should take the time to understand how the patient feels about the disease, because this will also help in evaluating the effects of treatment.

If I were to choose derma one day, my motivation would be because I know what it’s like to have difficult skin, and it would be fulfilling to help others deal with their (usually and hopefully) benign condition. Not to mention the intellectual stimulation, patient interaction, and of course, the weekends off!

Dr. Pimple Popper Though

You’ve probably heard about Dr. Sandra Lee, the internet’s favorite pimple popper. I bet you didn’t expect this from derma either!

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