Improve image of dermatology

Some cynical advertising type once claimed that "Image is everything." While this appears to be a bit of hyperbole, the point that he made is worth considering with regard to dermatology's standing in society.

This was brought into full view for me this morning while I was listening to a radio report describing a Food and Drug Administration (FDA) hearing on a new drug for attention deficit hyperactivity disorder (ADHD). This was rejected by an expert panel because of three reports of Stevens-Johnson syndrome associated with its use. The physician who testified against the approval of this drug was not a dermatologist and appeared to be a little confused about the relationship between Stevens-Johnson syndrome and erythema multiforme. In addition, he cited a high mortality rate for Stevens-Johnson syndrome, while in reality it is about 5 percent. He apparently confused relatively mild Stevens-Johnson syndrome (the three reported cases were of this type) with its far more devastating variant, toxic epidermal necrolysis.

Relatively few people are aware that the pediatric dermatologist exists. The first person whom most families consult about dermatologic problems in their children is the family pediatrician. The vast majority of these individuals lack sufficient understanding of cutaneous disease to be helpful in complex cases. The American Academy of Dermatology (AAD) does an excellent job of presenting dermatology's many facets. It would be very helpful for the Academy to emphasize the fact that there are dermatologists with special knowledge and experience in skin problems involving children, and that many of these dermatologists are also pediatricians. Complicated skin problems in children are well within the purview of our specialty.

We know that dermatologists with extra training in dermatopathology are typically superior to pathologists with only board certification in dermatopathology. There is no substitute for the comprehension of the clinical disease process that the dermatologist/dermatopathologist possesses as he or she approaches the assessment of a histologic skin section. Most physicians and insurance plan administrators have no understanding of this. The choice of where to send a skin specimen for evaluation is often made on a financial basis rather than on the basis of the skill of the physician who interprets the biopsy specimen.

Nothing impresses the powers that be more than data showing improved patient care outcomes in one situation as opposed to another. Rather than grumble individually about poor dermatopathology services from general pathologists, perhaps we should establish an informal national data bank of missed diagnoses by these individuals to motivate insurance carriers to re-evaluate the quality of the dermatopathology services offered.