Dermatology Grand Rounds

Grand rounds in dermatology is pretty unique. Each week, faculty invite patients who are interesting, educational, or difficult cases. Then the whole department, perhaps 40 of us faculty, residents, and students tromp from room to room seeing the patients. It must be quite overwhelming to have so many clinicians come stare at a rash and ask the same questions. I really am appreciative of the patients allowing themselves to be poked and prodded by strangers. Since so much of dermatology is visual and tactile, meeting an actual patient is so much more visceral, memorable, and effective than staring at photographs.

One of the patients we saw last week was a 40 year old with new onset facial puffiness, edema, and weight gain. Her skin findings included violaceous striae on her abdomen and scars (keloids) on her arms from a car accident. It was a fantastic case for me as a medical student because I immediately recognized it as Cushing's syndrome. She was being presented because she was getting intralesional injections of corticosteroids to her scars to improve their cosmesis, and apparently, the keloids acted as a reservoir, dispensing triamcinolone systemically and leading to iatrogenic Cushing's. Fascinating.

The other cases tended to be somewhat obscure diseases; we had a 14 year old with a genetic defect in keratinocyte formation and a 50 year old with Darier disease. Nevertheless, it's really fun watching the diagnostic giants of the department think through these challenges; from the questions they ask, the focused physical they do, I learn a lot about their thought process.