There was outrage over the sudden rise in the price of the EpiPen. But the rise in many other pharmaceutical prices gets less attention but is just as concerning. It can be easy to forget issues like this until they affect us personally. My two encounters with irrational drug price increases for dermatologic conditions are a reminder of how pervasive this problem is today. I have rosacea, a ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 40-year-old man is evaluated for a firm, flesh-colored lesion that has been growing on the back for several months. Foul-smelling material can be expressed from the lesion. The patient is bothered by the periodic drainage. He is otherwise healthy and takes no medications. On physical examination, vital signs are ...

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It all started with John F. Kennedy’s campaign for the presidency.  After eight years with President Eisenhower’s baldness and Vice President Nixon’s receding hairline, the American public was ready for a change.  Kennedy had great hair, which he flaunted by appearing bareheaded at his inauguration.  A new political maxim was established that day; to win in American politics, it’s not what’s in your head, but what’s on your head that ...

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Some may think that being a dermatologist means taking care of the “superficial.” I beg to defer. We spend a great deal of time performing procedures and talking to patients. During our visits, patients share their truth, and open up their hearts to us in meaningful and vulnerable ways.  We hear about their relationships, their work, their fears, and their struggles. We become a part of their inner circle of ...

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Take one-half tablet three times per day with meals, increasing by half each week until reaching a maximum of three tablets three times per day. Did you get a new prescription from your doctor? If so, there is a 50 percent chance you will not adhere to label directions. Either the instructions are too complicated, the drugs are too expensive, you do not like the way the medicine makes you feel ...

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Here is some news about cancer that isn’t widely known and is hiding in plain sight: Deaths from melanoma -- a skin cancer that has lethal potential -- have declined dramatically over the past several years. And while that fact alone is surprising, so is the reason behind the drop. Let’s make something clear at the outset: too many people die from melanoma. It is not the ...

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Global climate change is reaching a critical mass. Since the advent of the industrial revolution, we have seen the global mean temperatures increase by 1°C (1.8°F), and significant steps must be taken by 2030 to mitigate an even larger global temperature increase of 1.5 to 3C as predicted by 2030. In other words, we are in dire need of change. This change is not only reliant on governmental policy change but is ...

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I didn't match dermatology the first time. It was a harrowing experience, and I had a chip on my shoulder until the day I opened my match envelope. The reality is that in the last ten years, dermatology has become the most competitive specialty in medicine. Hundreds of extremely qualified applicants are disappointed each year. Therefore, not matching is not a reflection of one's qualifications as a future ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 40-year-old man is evaluated for a new skin rash of 10 days' duration. The rash appeared abruptly and is not tender or pruritic. The patient has poorly controlled type 2 diabetes mellitus. His current medications include metformin and glyburide. Family history is unremarkable. On physical examination, vital signs are ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 32-year-old man is evaluated for an intermittent pruritic rash of 8 years' duration. Medical history is significant for mild persistent asthma. His only medications are an albuterol inhaler and an inhaled glucocorticoid. On physical examination, vital signs are normal. There is mild xerosis with erythematous plaques on the bilateral ...

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Quick quiz question: two people are diagnosed with melanoma -- Sarah Sunburn, an adamant sun-worshipper, and Paula Pale-All-The-Time, a fanatical sun-avoider. Who is more likely to die of the disease? The answer is pale-faced Paula. Surprised? Let me unpack this mystery and explain why sun exposure simultaneously kills people, while making the cancers they are diagnosed with appear to be less life-threatening. I will start with what you probably know already. Melanoma ...

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Long ago, and far away, I encountered a patient that changed the way I practice. I was with a medical student while examining a middle-aged woman who presented with a dramatic eruption that was probably DRESS syndrome (DRESS syndrome was not yet described). I prescribed prednisone and asked her to come in a few days later so I could assess her progress. She returned – I did not recognize her ...

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Informed consent is the cornerstone of medical ethics. And every physician must defend this sacred principle from every form of evil that would seek to dismantle, degrade and debase it. If informed consent is the sun, then privacy, confidentiality, dignity, and trust are planets that go around it. For without informed consent, the descent of health care into amorality is inevitable, and the doctor-patient relationship is doomed to ruination, oblivion, ...

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The headline scrolling across the bottom of an evening news show certainly grabbed my attention: a new blood test had the possibility of detecting early melanoma and saving thousands of lives. And then there were more reports elevating this early research report to a point that I became quite interested -- and frankly concerned. News flash: The research is far from being shown to have proven value in the early diagnosis of ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 24-year-old woman with longstanding atopic dermatitis is evaluated for an acute worsening of her disease in the past week. She has had increased pruritus and now has multiple painful areas within the involved skin. She has been applying petrolatum jelly and triamcinolone ointment and washing with gentle cleansers without improvement. ...

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One of my colleagues sat on a wheeled clinic stool at the end of the examination table and told the patient, which was in this case an actor, “Everything looks great.” After, he swiveled around to face the instructor and the small group of onlooking medical students behind him. Our instructor also turned to us and said, “Very good job. But can anyone tell me what he did wrong?” He ...

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A warning about examining your friend's medical condition. Brad Nieder is a physician and comedian and can be reached at the Healthy Humorist.

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 50-year-old man is evaluated for a firm, darkly pigmented papule on his back that has been growing steadily over a period of several months. His medical history is unremarkable, and he takes no medications. On physical examination, vital signs are normal. The skin lesion is a 0.5-cm darkly pigmented, ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 32-year-old man is evaluated for a 2-week history of a rash on his face and midchest. He describes the rash as consisting of small, reddish “lumps” that are intensely itchy; they develop and begin to resolve with development of new lesions. He otherwise feels well. Medical ...

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American physicians deserve to be paid well for their work. As a physician, myself, I know what it takes to become a doctor in the U.S. Four years of late nights in the college library in hopes of achieving a GPA commensurate with medical school admission; then four years of medical school, which makes the college work load feel light in retrospect; then, in my case, three years of residency ...

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