I’m going to admit, dermatology wasn’t one of the placements I was looking forward to. I’m sure I wasn’t alone in this either. Luckily, after two weeks at dermatology, one can say I was very much positively surprised!
Here are some of my expectations from before the placement and my insights of the specialty after my two-week placement.
1. You see acne and eczema everyday
On the contrary, most of the times it was a toomah.
During our two weeks there, I saw two acne patients and probably around five eczema patients. Skin cancer patients on the other hand? I definitely lost track. They came by the truckloads. Perhaps the reason why I thought dermatology = eczema and acne is because those are the only two skin problems I ever sought medical help for. Also, I’m brown. So what skin cancer?
2. Apart from acne and eczema, it’s all about too much sun
So many patients come in with different skin lesions, many explained by too much sun exposure. However, when I was studying about the different diseases we saw at the hospital, I was surprised that it is so much more than that. This really became apparent for me when I was reading about psoriasis. I mean in this case, it is even the opposite.
Psoriasis is a skin condition which has a complex immunological pathogenesis – a lot more than just simple skin damage. It has been shown that sunlight has a therapeutic effect, improving the patients’ disease. Consequently, psoriasis patients in Sweden actually get offered a free three-week “therapeutic” vacation in the south of Europe. Not bad eh?
This is just one of the many skin conditions that is not because of sun damage.
3. There is a cream for everything
Rash? Take this cream. Acne? Take this cream. Palmoplantar pustulosis? Take this cream.
Although there is some truth in this (yes, the main treatments for those conditions I mentioned are creams), it’s only a very, very small part of what dermatologists do to treat patients. Dermatologists also prescribe other forms of medication like injections and tablets, and also perform surgery of course – via liquid nitrogen “freezing” or excision! They also treat their patients in different baths and therapeutic light therapy, which is basically therapeutic solariums. Also, did you know that dermatologists in Sweden are venerologists (STD-specialists) too? Yup, if there’s some funny business going on down below, you go to a skin doctor.
4. Most dermatologists are women
When we came to the clinic during our first day, I was positively surprised that our supervisor was a very friendly and jolly male överläkare or consultant. There were actually a lot more male dermatologists than I thought, because he wasn’t the only one I met at the three hospitals I visited. At our main hospital there were at least three!
5. Most patients are vain
My thinking before the placement: “Patients who come to dermatology are vain which is why they’re super self-conscious about their skin.” Boy was I wrong.
In cases of acne and eczema, I thought patients come in because they want to make themselves even prettier by treating the disease. I realised that they come in because they want to be pretty. Because they don’t think they are.
There is apparently a link between acne and negative mental well-being, and this I could definitely see from some of the patients I met. Many develop low self-esteem and even a form of dysmorphism, because of their skin problems. Definitely the opposite to what I thought in the beginning.
6. Dermatology is a “clean” specialty
What I mean by clean is that there is no need for messy tubes here and there, sputum/faeces/sweat etc. samplings, no need to open patients up etc. The speciality relies mainly on the visual evaluation of a person’s condition. See, clean. Although it might be so most of the time, there are definitely exceptions.
During our first visit to the dermatology ward, we visited a patient with a rare but severe cutaneous vasculitis called pyoderma gangrenosum. If you’re curious, do google it, but be wary of what you will see. I warned you. Keep in mind though, the photos you will find on google are very, very far from what I saw. The patient we saw basically had no flesh all the way down to his tendons, on both feet extending above his ankle. Exactly like how you would see a fixed cadaver model of feet muscles for anatomy. But this time the specimen is alive. That is not what I would”clean” at all, and I don’t even want to start about the smell…
7. Skin lesions will no longer be dots for me after two weeks
Jokes nope, still dots.