I hid behind my mother and asked myself, “Do I dare look again?” In all of my six years, I had never seen such an unusual-looking person. In front of me stood a lady with white hair and ghostly pale skin flecked with scattered brown spots. Why did she look like that? If she was indeed my mom’s sister, why wasn’t she brown like everyone else in the family? Years later, I learned that my aunt had vitiligo affecting her entire body. Unfortunately, I realized that prejudice is a common reaction to physical afflictions, and I regretted that, as a small child, I had been so frightened of her based solely on her appearance.
Soon after meeting my aunt, my mother was diagnosed with psoriasis, and I myself with contact dermatitis. Skin disease quickly became a common theme in my life, and my interest in dermatology grew. I also remember my mother soaking the thickened, cracked skin covering her elbows, knees, and soles in a tub of tar for relief. Carrying these memories with me, I embraced every opportunity to focus on skin conditions as a medical student. Once I began clinical clerkships, I continued to find “dermatology” patients during each rotation: babies with severe eczema in pediatrics, a patient with metastatic melanoma in surgery, a woman with pulmonary sarcoidosis who presented with cutaneous granulomas in internal medicine, and in family medicine, numerous patients with skin conditions that often bewildered their primary care providers. The more patients I saw with skin diseases, the more I wanted to see and learn.
During my third year of medical school, I spent every Thursday afternoon in the dermatology clinic at a local county hospital. I completed several dermatology rotations, soaking up all the information I could. One of the most memorable cases I saw was during my pediatric dermatology rotation at Major Children’s Hospital. One little girl, “Christina,” came in for a giant congenital melanocytic nevus covering at least half of her upper body. Her parents expressed a desire for treatment because, although they had accepted Christina as she was, other children at school were teasing her about her condition. This experience illustrated that discrimination based on skin conditions transverses all ethnicities and all ages. Christina’s case further explained that skin disease also affects an individual’s mental well-being. Such discrimination based on seemingly harmless skin conditions severely limits an individual’s quality of life and may result in significant psychological debilitation for patients and their families. An individual’s skin affects the first impression they make [implied from above]. As I realized how severely these conditions impacted daily life, my understanding of the critical role of skin disease and the impact of effective treatment continued to deepen. “Mr. Davis,” a patient with severe, widespread psoriasis involving 80-90% of his body, served as a real-life example of what an impact treatment can make. When I first saw Mr. Davis, recalling my own mother’s battle to control her limited psoriasis, I knew he must be miserable. He had failed every topical agent available, so the decision was made to begin him on a TNF-alpha antagonist. Not only did Mr. Davis’s skin lesions clear, but he felt his quality of life had improved considerably within months of starting this new medication. Unlike hypertension or diabetes, the clinical manifestations of dermatologic conditions are visible for the world to see.
To so clearly see the results of treatment in the patient’s skin quality—not masked in a lab value, as they might be for many internal conditions—is not only gratifying to the health care provider, but also aids in restoring the patient’s self-esteem. Soon after seeing Mr. Davis, I began collaborating with other dermatology students and staff to research treatments for psoriasis. We conducted a retrospective chart review examining the sustained efficacy of adalimumab in the treatment of psoriasis. We found that patients had an excellent response to this drug is exciting to think that information we provided may contribute to the FDA approval of this drug for psoriasis. Through this research and cases like Mr. Davis’s, I have found that one of my favorite aspects of the field is the response to treatment. Another appealing aspect of dermatology is the highly academic nature of the area, which demands that residents and faculty continually educate themselves and others. As president of a student-run melanoma awareness group, Check Your Skin, I traveled to local middle schools to educate students about skin protection and skin cancer detection. The workshops required an enormous amount of initiative and flexibility to design presentations that captivated the children's attention while delivering our message. Through this experience, I began to develop my teaching skills, which are essential for the highly academic field of dermatology. I have further demonstrated my desire to learn and teach through the several articles I have completed, which both further my understanding of these skin conditions and contribute to the collective knowledge base of the field.
I have always known that skin disease is essential in my life. Until medical school, my role was as a patient, a family member, and a supporter of those affected. But as a medical student, my role in dermatology became more active: I was able to educate others about skin diseases and begin diagnosing and treating their conditions as part of a larger team. Throughout my medical school career, I have worked with patients affected with a wide variety of diseases, cutaneous and otherwise, but I will never forget that first encounter with my aunt and how afraid of her I was simply because of her skin disease. Dermatologic conditions significantly impact patients’ quality of life. Whether it is the embarrassment caused by disfiguring acne, a decline in social status as experienced by my aunt, or the taunting and teasing of young Christina, dermatology is more than skin deep. I have seen that dermatologic conditions extend over multiple medical specialties, making knowledge of these conditions invaluable to any physician. I possess the desire and skills to excel in dermatology, and I delight at the prospect of joining the field that diagnoses and treats these conditions and ultimately helps restore a sense of self-confidence in our patients.
