RESIDERM January'2023 issue

EXECUTIVE EDITOR & PUBLISHER Dom Daniel

Editorial Board

Dr. Pragya Nair (MD)

Dr. Manjunath Shenoy M (MD, DNB) Shoma Sarkar (MBBS, MD)

Dr. Sushrut N. Save (MBBS, DNB, MNAMS)

Dr. Rutoo Polra (3rd Year Resident)

Dr. Dharmesh Parmar (3rd Year Resident)

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Published for the period of January 2023

PEARLS FOR THE YOUNG DERMATOLOGY RESIDENTS

Dear Residents, New Year Greetings!

Welcome to a year full of new beginnings, new journeys and new experiences.

This new year, we bring you the fourth issue of RESIDERM and we hope that it motivates and encourages you to bring forth the talent and creativity. Indeed, stress and burnout are significant concerns for residents in the field of dermatology, as well as in many other medical specialties. Residents always seek guidance and support from experienced colleagues and faculty members which helps them to grow more. Encouraging residents and faculty members to work together and develop supportive relationships can create a more positive work environment and reduce stress.

Our wonderful contributors not only are masters of Dermatology but continue to outshine in other arenas as well and this issue is our humble attempt at recognising and encouraging them to pursue and enrich the world with their efforts, creativity and experience.

Contributors of every issue of RESIDERM provide a valuable outlet for residents and help them maintain balance in their lives, which can in turn, contribute to overall well-being and help to grow them in a right direction. Encouraging residents to pursue their passions outside of work can also help foster a positive work-life balance and promote overall happiness and satisfaction.

So dear residents, hope you enjoy reading these motivational topics and articles of RESIDERM and push yourself to explore the right path to grow your career in this filed.

Happy reading.

We are looking forward to your contributions for the next issue.

-Dom Daniel Executive Editor & Publisher

Generalised Pityriasis Rosea with Palmoplantar Involvement

Dr. Rutoo Polra

3rd Year Resident

Department of Dermatology

Pramukhswami Medical College, Shree Krishna Hospital

Bhaikaka University, Karamsad, Gujarat

Dr. Dharmesh Parmar

3rd Year Resident

Department of Dermatology

Pramukhswami Medical College, Shree Krishna Hospital

Bhaikaka University, Karamsad, Gujarat

Dr. Pragya Nair

MD (Dermatology) Professor

Department of Dermatology

Pramukhswami Medical College, Shree Krishna Hospital

Bhaikaka University, Karamsad, Gujarat

Start-Up India Start-Up Clinic

Dr. Shoma Sarkar

MBBS, MD (Dermatology)

Dermatologist & Skin Specialist

Mumbai

Next Generation

Dr. Sushrut N. Save MBBS, DNB (Dermatology), MNAMS (SKIN & V.D.)

Dermatologist, Mumbai

Dr. Manjunath Shenoy M MD, DNB Professor and HOD

Department of Dermatology, Yenepoya Medical College, Mangalore, Karnataka

GENERALISED PITYRIASIS ROSEA WITH PALMOPLANTAR INVOLVEMENT

Generalised Pityriasis Rosea with Palmoplantar Involvement

Dr. Rutoo Polra

3rd Year Resident

Department of Dermatology

Pramukhswami Medical College, Shree Krishna Hospital

Bhaikaka University, Karamsad, Gujarat

Dr. Dharmesh Parmar

3rd Year Resident

Department of Dermatology

Pramukhswami Medical College, Shree Krishna Hospital

Bhaikaka University, Karamsad, Gujarat

Dr. Pragya Nair

MD (Dernatology)

Professor

Department of Dermatology

Pramukhswami Medical College, Shree Krishna Hospital

Bhaikaka University, Karamsad, Gujarat

Abstract

Pityriasis Rosea is an acute selflimiting papulosquamous disorder clinically characterized by a herald patch and followed by scaly oval patches on trunk and proximal extremities in a “Christmas tree appearance.” In approximately 20% of patients atypical clinical presentation is seen in respect to morphology, size, distribution, number, site, and course of disease which might pose a diagnostic problem. A case of 23 year old female who presented with acral, palmoplantar and facial involvement

of pityriasis rosea is presented here.

Key-words: Palmoplantar, pityriasis rosea, acral, papulo-squamous, collarette scales

Introduction

Pityriasis rosea (PR), is an acute selflimiting papulosquamous disorder. It is clinically characterized by a herald patch or mother patch followed by the distribution of scaly oval eruptions on the trunk and proximal extremities along the Langer’s lines of cleavage giving characteristic “Christmas tree appearance”. The exact cause of PR

GENERALISED PITYRIASIS ROSEA WITH PALMOPLANTAR INVOLVEMENT

is not known but human herpes virus 6 and 7 have been suggested to be the most probable etiology.[1] The approximate incidence of PR is 0.5–2% and affects people of both sexes in 15–30 years age group but can also be seen in elderly and children.{2] The disease is self-limiting which improves in 2–8 weeks time. Most cases presents with typical pattern clinically but in approximately 20% of patients atypical clinical presentation is seen which might pose a diagnostic problem.[3] Atypicality can be seen in respect to morphology, size, distribution, number, site, and course of disease.[3]

Case report

A 23 year old girl presented to the Department of Dermatology with complaints of lesions and itching all over the body since 1 week. She gave history of non-specific upper respiratory tract infection before 1 week. She did not receive any other systemic medications in the recent past. She distinctly denied a history of tick bites or any travel. There was no history of skin disease in her past or in family members especially tinea, psoriasis and atopic eczema. On examination, erythematous annular plaques with peripheral rim of collarette scales over the body including arms, legs and chest [Figure-1a&b] were seen. There were no target lesions. Apart from cutaneous lesions, no abnormality revealed in general and systemic examination. There was no lymphadenopathy. Skin scrapings and KOH mount were negative for fungus. Complete blood counts and blood sugar levels were normal. Dermoscopic examination showed typical collarete scales suggestive of pityriasis rosea. [Figure-2] Patient was treated with oral Azithromycin (500 mg) topical steroids and calamine lotion for five days. Patient reported increase in the number of lesions with face involvement in the form of edema and erythema. [Figure-3a] She also developed palmoplantar erythema and thickening with lesions

extending over dorsum of hands and feet. [Figure-3b, c&d] Biopsy was taken to confirm the diagnosis which showed focal parakeratosis, a diminished granular layer, and spongiosis in epidermis. The papillary dermis showed edema and mild to moderate lymphohistiocytic perivascular infiltrate. Extravasated erythrocytes in the dermis were seen. [Figure-4a&b] Changes were suggestive of PR. Acyclovir (400mg TDS) was added to her treatment for 5 days. Patient is in follow up with

Discussion

PR literally means ‘rose colored scale’ and was named by the French physician Camille Melchoir Gibert in 1860, but recognized by Willan as early as 1798.[4]

Reactivation of latent human herpesvirus-6 and human herpesvirus-7 infection have been suggested as the possible etiologic agents. [1]

Figure 1: Erythematous annular plaques with peripheral rim of collarette scales over a) arms, b) legs

Figure 2: Dermoscopic examination showing typical collarete scales

Fig. 1. a)

Fig. 1. b)

Fig. 2

gradual improvement of lesions.

GENERALISED PITYRIASIS ROSEA WITH PALMOPLANTAR INVOLVEMENT

Predominant acral and flexural (axillae, groins and face) involvement is termed as PR inversa.[5] Acrally distributed PR is itself a very rare variety. Our patient had acral involvement without affecting axillae and groins which was reported by Zawar et al.[6] Palmoplantar involvement reported in our patient with facial erythema and edema, was the uniqueness of the case, not found in literature after extensive search. Cases of palmoplantar PR are reported, but rare.[7,8]

Atypical presentations of PR in clinical practice posses diagnostic difficulty, so a proper history, examination and follow up is required. Being a viral origin PR has a tendency to resolve and patients are lost in follow up with its course remains undiagnosed.

Acrally distributed annular scaly plaques with palmoplantar involvement should prompt a Dermatologist to think of dermatophytosis,psoriasis, secondary syphilis, drug eruption, erythema multiforme, acral necrolytic erythem, and erythema annulare centrifugum.

Literature search says 8% of patients had scalp involvement in PR which was seen in our case also.[9]

Several unusual variants are reported in the literature which includes unilateral or along the lines of blaschkos, inverse, lichenoid mainly with drugs like gold, captopril, barbiturates, D-penicillamine, and clonidine, vesicular, papular, purpuric, hemorrhagic, erythema multiforme like, urticarial and those involving mucosae, palms and soles, flexures, face and presenting as exfoliative dermatitis.[10]

Two characteristic histopathological findings of PR are extravasated erythrocytes in the dermis among 66% cases as described by Ackermann, and dyskeratotic cells in the epidermis I among 55% of cases as described by Okamoto

et al.[11] Typically focal para keratosis, a diminished granular layer, and spongiosis are seen in epidermis with exocytosis of the infiltrate. The papillary dermis shows some edema and mild to moderate lymphohistiocytic perivascular infiltrate.

No treatment for PR is recommended on the basis of evidence - based medicine as it remains a self-limiting exanthematous disease. Most patients needs emollients, antihistaminics, and topical steroids. The macrolides in PR act through anti-inflammatory and

Figure 4 (a): Focal parakeratosis, diminished granular layer, and spongiosis in epidermis with edema and mild to moderate lymphohistiocytic perivascular infiltrate in papillary dermis. (H&E stain 10X)

(b) Extravasated erythrocytes in the dermis. (H&E stain 40 X)

Figure 3 (a): Facial erythema with scaling over scalp

Figure 3 (b) Palmar erythema with scaling extending to forearm

Figure 3 (c&d) Erythema with collarete of scale over dorsum of hands & foot

Fig. 3. (a)

Fig. 3. (b)

Fig. 3. (c)

Fig. 3. (d)

Fig. 4. (a)

Fig. 4. (b)

GENERALISED PITYRIASIS ROSEA WITH PALMOPLANTAR INVOLVEMENT

immunomodulatory actions rather than the antibiotic effect. Acyclovir seems to be a promising therapy leading to faster resolution of lesions and helping in relieving pruritus. There are few studies evaluating the role of phototherapy in PR which works by altering the immunology in the skin.[12]

References

1.Vag T, Sonkoly E, Kemery B, Ongradi J. Avidity of antibodies to HHV – 7 suggests primary infection in young adults with pityriasis rosea. J Eur Acad Dermatol Venereol 2004;18:738 40

2.Zawar V, Jerajani H, Pol R. Current trends in pityriasis rosea. Expert Rev Dermatol 2010;5:325-33.

3.Chuh A, Zawar V, Lee A. Atypical presentations of pityriasis rosea: case presentations. J Eur Acad Dermatol Venereol 2005;19:120-6.

4.Relhan V, Sinha S, Garg VK, Khurana N. Pityriasis rosea with erythema multiforme - like lesions: An observational analysis. Indian J Dermatol 2013;58:242.

5.Gibney MD, Leonardi CL. Acute papulosquamous eruptions of the extremities demonstrating isomorphic response. Inverse pityriasis rosea. Arch Dermatol 1997;133:654.

6.Zawar V. Acral pityriasis rosea in an infant with palmoplantar lesions: A novel manifestation Indian Dermatology Online Journal 2010 ; 1 (1): 23.

7.Bukhari I. Pityriasis rosea with Palmoplantar plaque lesions. Dermatol Online J 2005;11:27.

8.Deng Y, Li H, Chen X. Palmoplantar pityriasis rosea: two case reports. J Eur Acad Dermatol Venereol 2007;21:406-7.

9.Vijay Zawar Pityriasis Amiantacea-Like Eruptions inScalp: A Novel Manifestation of Pityriasis Rosea in a Child International Journal of Trichology; 2010 .-2 (2);113-115.

10. Vijay Zawar. Giant pityriasis rosea. Indian J Dermatol 2010:55(2):192-4.

11.Okamoto H, Imamura S, Aoshima T, Komura J, Ofuji S. Dyskeratotic degeneration of epidermal cells in pityriasisrosea: Light and electron microscopic studies. Br J Dermatol. 1982;107:189–94.

12.Lim SH, Kim SM, Oh BH, Ko JH, Lee YW, Choe YB, et al. Low-dose ultraviolet A1 phototherapy for treating pityriasis rosea. Ann Dermatol 2009;21:230-6.

START-UP INDIA START UP CLINIC

Dr. Shoma Sarkar MBBS, MD (Dermatology) Dermatologist & Skin Specialist Mumbai

S ART UP INDIA S ART UP CLINIC

I always wanted to build my empire so from single entity we have grown to multiple entities which was only possible through lot of hard work and dedication. It was only after my 10 years of hardships which paid me of, and I was able to sponsor myself for my first clinic in 2019.

At first place you need to be dedicated and sincere at your job. You have to be very honest with yourself and with people around. Transparency is the key to the business here. You cannot get into the rat race then that is a short peak. I would only say that you please be very straight, transparent with your diagnosis, with your treatment protocols, and do not try to cheat anybody for quick money.

There is no impossible word in my dictionary at least, I attempt everything possibly. You have to be meticulous in what you do. Freedom comes with a lot of responsibility. You have to be empathetic. You have to be approachable. You have to be open to learning.

1.When did you start your practice?

I started my practice in 2008.

2.Reflect on your thoughts and experience. My experience as a Dermatologist was a roller coaster ride and also lovely in terms of exposure. I have faced a lot of hardships since I am from a non- medico background, I never had a proper direction towards mydelf. The risk factor was always there. But I always wanted to build my empire so from a single entity we have grown to multiple entities which was only possible through lot of hard work and dedication.

3.Did you have financial, personal and emotional support while starting?

Although I had emotional and personal support but lacked when it came to financial support. I was not financially sound to sponsor myself for a clinic and that was the prime reason I had to work under many clinics and pharma company. It was only after my 10 years of hardships which paid me off very well, and I was able to sponsor myself for my first clinic in 2019.

4.I will never forget the first step to start my practice......

In my initial years I have worked with a lot of clinics, some of them were corporate and some were local. I some of them were corporate and some were local. I worked with Neutrogena as a company where I used to work as a consultant for almost three years. So, I learned the business in both ways the clinical part of it and other part of it where the drug industry is involved. Apart from this I started many training programmes right at the beginning of my career. Starting with small time trainings, training one or two doctors at a time, that has

come up a long way now, I have a learning curve and today I properly run an academy where I train doctors. I am also associated with a lot of multinational companies for training doctors across India.

5.What are the challenges in developing the right practice management strategy?

In the first place you need to be very dedicated and sincere at your job. There has to be a lot of perseverance, persistence and confidence in what you do, a lot of hardships may come your way. Throughout your learning years be always open to learning. In my career there were a lot of times when I attempted and failed, but I rose up again and again tried. You have to be very honest with yourself and with people around. Transparency is the key to the business here. You cannot get into the rat race then that is only for a short peak. Secondly, you have to be meticulous in what you do.

6. Ways to handling your professional responsibility and discipline...

Success comes with only discipline which has to be taken care of. So one thing which is very important is, that you have to have discipline in life. In simple terms, coming to your clinic on time, attending your patients on time, taking less holidays for yourself in the initial years of your practice, making yourself available to your patients whenever it is possible, dedicated hours, there has to be dedicated us to your learning and your studying and also giving back to your colleagues or giving back to your juniors where you want to. Whatever you have learned, you have to give it back. The moment you give back, you acquire more. That is very important in an individual practice specifically because when we

START-UP INDIA START UP CLINIC

10.Patients counselling is the first part of practice management -my opinion. You have to know the mindset of the patient. Is the patient open to these kinds of treatments? What is the inhibitions? So, counselling is definitely important part of your practice which has to be adhered to. Give time to your patients, understand what they need as you're strong in your subject so make your consultation strong so that they stick with you.

10.Patients counselling is the first part of practice management -my opinion. You have to the mindset of the patient. Is the patient open to these kinds of treatments? What is the inhibitions? So, counselling is definitely important part of your practice which has to be adhered to. Give time to your patients, understand what they need as you're strong in subject so make consultation strong so that they stick with you.

start individual practice, you are by yourself; you are not answerable to anybody. But freedom comes with a lot of responsibility.

start individual practice, you are by yourself; you are not answerable to anybody. But freedom comes with a lot of responsibility.

7.How do you manage staff issues and complaints?

7.How do you manage staff issues and complaints?

Because I have come from a background of a peripheral municipal hospital where I did my post-graduation. So we were used to dealing with a lot of ayas and staff nurse and head nurse and seniors. So there was a hierarchy maintained. So it's not only about an individual person in a clinic to run the business successfully. It's the team effort. So your staff has to be dealt very sensitively. Irrespective of the designations, you have to respect everybody working with you as an organization right from the door to the chair. So I have learned in this journey that you have to be empathetic towards your staff. You have to treat them as your family. It indirectly contributes the company's growth. My staff is with me there for the last 14 years now. Regarding the issues and complaints, as a doctor when I have to take care of an organization, all the things are possibly taken care of with good table discussion.

Because I have come from a background of a peripheral municipal hospital where I did my post-graduation. So we were used to dealing with a lot of ayas and staff nurse and head nurse and seniors. So there was a hierarchy maintained. So it's not only about an individual person in a clinic to run the business successfully. It's the team effort. So your staff has to be dealt very sensitively. Irrespective of the designations, you have to respect everybody working with you as an organization right from the door to the chair. So I have learned in this journey that you have to be empathetic towards your staff. You have to treat them as your family. It indirectly contributes the company's growth. My staff is with me there for the last 14 years now. Regarding the issues and complaints, as a doctor when I have to take care of an organization, all the things are possibly taken care of with good table

8. My way to handle patients.......

Be very patient. That's thing which has been taught to me. More than the prescription, they also want your time and your perspective. So sometimes patients deviate from their main indication. So I give a lot of time to my patients and I charge them well. So that's how my practice has been. But because I have been given so much of time, my patients are all related to me in some way or the other. And that makes it easier for me to convince them for any treatments.

8. My way to handle patients....... Be very patient. That's one thing which has been taught to me. More than the prescription, they also want your time and your perspective. So sometimes patients deviate from their main indication. So I give a lot of time to my patients and I charge them well. So that's how my practice has been. But because I have been given so much of time, my patients are all related to me in some way or the other. And that makes it easier for me to convince them for any treatments.

9.Improving patient satisfaction is a very important step to increase the practice. There are so many doctors around with so many similar kinds of services, improving satisfaction by imparting proper knowledge and services. Why a patient chooses to come to my clinic, that's only because of the experience, staff treatment when they are in house. One patient doesn't stick to one treatment all the time. They keep adding services. And that's how you are supposed to ensure your patients stick to you, not running from clinic to clinic. Your ambience is a one more thing which is very important in here.

9.Improving patient satisfaction is a important step to increase the practice. There are so many doctors around with so many similar kinds of services, improving satisfaction by imparting proper knowledge and services. Why a patient chooses to come to my clinic, that's only because of the experience, staff treatment when they are in house. One patient doesn't stick to one treatment all the time. They keep adding services. And how you are supposed to ensure your patients stick to you, not running from clinic to clinic. Your ambience a one more thing which is very important in here.

11. I take care of my patients to the best of my capability. When procedures are painful, which is uncomfortable is bieng carried out, this is where you have to handle your patients really well and this is what ensures that your patient stays with you for long. So with experience you have to know how to handle them well.

11.I take care of my patients to the best of my capability. When procedures which are painful, which is uncomfortable is carried out, this is where you have to handle your patients really well and this is what ensures that your patient stays with you for long. So with experience you have to know how to handle them well.

12. As a Dermatologist what is your duty towards your patients in clinical practice management? Obviously, there is two different things when it comes to aesthetics and when it comes to clinical. Clinical is easy because it's just a diagnosis and there are medications which you have to work on. Aesthetics is more about counseling

12.As a Dermatologist what is your duty towards your patients in clinical practice management? Obviously, there is two different things when it comes to aesthetics and when it comes to clinical. Clinical is easy because it's just a diagnosis and there are medications which you have to work on. Aesthetics is more about counselling.

13.What problems did you face while setting up your practice?

The first problem was the finances. As doctors, we are not taught to deal with the business. Basically, we are good doctors, but we are not taught to be good businessmen or good entrepreneurs. I did have my downfalls and had my calculations going wrong and it was a learning curve for me but all this have helped me build my career.

13. What problems did you face while setting up your practice? The first problem was the finances. As doctors, we are not taught to deal with the business. Basically, we are good doctors, but we are not taught to be good businessmen or good entrepreneurs. I did have my downfalls and had my calculations going wrong and it was a learning curve for me but all this have helped me build my career.

14.How do manage patient’s satisfaction on a day-to-day basis in clinical practice?

Counselling and be through with your subjects, it has to be strong. you cannot goof around with your

14. How to manage patient’s satisfaction on a day-to-day basis in clinical practice? Counseling and be through with your subjects, it has to be strong. you cannot goof around with your

START-UP INDIA START UP CLINIC

patient as there is so much available online so people know what they are coming for and people know what they're getting. So I would only say that you please be very straight, transparent with your diagnosis, with your treatment protocols, and do not try to cheat anybody for quick money.

15.The one experience which increased your confidence to start your practice. When I was shuttling between clinics, I realized that I was not losing patience. The patients who were coming to me in my first clinic were following me to the other clinics where I was practicing. So that ensured that people were coming for me. And that is what gave me the confidence. Secondly, because I come from a background which had a little bit of entrepreneurship in the family, I was of a different mindset. Very early in my practice I realized that I have to get a digital marketing in place. Not only digital, but PR, editorials, writing articles. This was

something which I was doing right at the beginning, even when I was working for other clinics. All these things were simultaneously building up my brand. And in these coming years it has really helped me because when I shifted to my own clinic, the scare of me not having patients was not there.

16.What are the unique and different skills one should have to start an individual practice?

As a dermatologist, you should have your basics very strong, identify your area of interest, because dermatologist is a youth subject. You cannot be jack of all and master of none so you have to pick up one skill set for yourself, stick to it, get trained properly to it and keep upgrading your skills. That's how you will be an expert and you will be able to create a name for yourself as an individual.

17.What particular strengths are required to be a good dermatologist?

Your knowledge has to be very strong along with some confidence.

What you have to ensure is that you know well what you practice. Your treatment should come as a conviction. The patient should get satisfied and convinced with what you're selling them. Also you need to have some honesty, discipline while practicing.

18.Was there any specific guidance on good practice management given to you by your seniors?

Unfortunately, this is something we did not have. Now the times have changed. It's not the fault of our seniors. But the seniors were also not been exposed to so much of media that time. Now you have a lot of channels, like a lot of conferences, journals and seminars. These things were not so prevalent during our times.

19.Are you satisfied with your practice income?

If I say I am satisfied, then I will never grow. It doesn't mean that I am greedy. But there is always a scope of improvement, which I keep on

doing. For me, every day is stepping up. When I talk about satisfaction, it's not about comparing me to some other person. It is comparing me with what I was in the last two years and what I’m today. So, for me mapping my own progress is important.

20.Anything you would have done differently today. One has to keep learning and attempting it without thinking about the consequences or thinking about whether it is going to be right or am I going to only succeed. I would look at every opportunity as opportunity to grow whatever work it came through.

21.Today I am a successful Dermatologist having a good practice...

Not only good practice, you also have to be empathetic. You have to be approachable; you have to be open to learning, impart knowledge and to actively participate in lot of public speaking, in a lot of conferences, seminars, trainings and workshops.

22.Any advice for today's residerm, tomorrow’s dermatologist. When you pass out, you are intimidated and you really want to make it big and you get into the zone of becoming too overwhelming, sometimes overbearing. So, hold on your horses. You have to be really paced out for yourself. This is something which I would advise my juniors to specifically, as I said, take it slow, do not jump into a huge investment right at the beginning. Prepare a structure for yourself and start from there, prepare a roadmap, stick to it, this is how you're supposed to monitor yourself and do not lose hope or patience in this process.

23.Nothing is impossible, everything is possible

–Absolutely there is no impossible word in my dictionary at least. As I said I attempt everything possibly. I do not wait for the results or do not contemplate the results what it

would be. My job is to attempt. So I’m very thankful to my journey of last 15 years of my practice that there were failures, there were mistakes, there was a time when I was put down but I'm grateful it happened to me and because of which today I am so confident of what I am today.

24.Word of mouth publicity vs social media engagement.

It has to be both the ways. Word of mouth is best way of publicity but it takes time. Social media publicity is something that you build a brand of your individual. It's important to engage into social media right at the beginning. You might feel at start it is expensive. When I started my website, there where people mocking me that why do you need presence online, but all that have definitely added to my growth and I am glad I stuck with my guns.

25.Tips on engaging with pharma and device companies.

Clear and transparent with your deals, what you want and how you want it to be done and being reciprocative.

26.Give a few tips on innovation in practice management and how did you innovate?

I don’t know how much have contributed towards innovation, but I have trained a lot of people without remuneration. For me creating a niche is Innovation.

Dr. Sushrut Save

MBBS, DNB (Dermatology), MNAMS (SKIN & V.D.)

Dermatologist, Mumbai

NEXT GENERATION

Watching my father practice always intrigued me and motivated me to further explore this field of dermatology. I loved dermatology from the inception having watched my dad all my life. I was especially interested in dermatosurgery and my mentors encouraged me towards it. Well the relationship has always been so friendly that I never really felt the pressure of working with my father.

To become a true clinical dermatologist, a first hand experience is always fruitful . Satisfaction only comes with owning your decisions. Whatever career you opt for, medicine or not, is for you to decide.

Luck also plays an enormous factor (more than you think).

To retain the passion for your field despite the stresses and trade offs remains a challenge for every dermatologist. Keep Learning.

1.Share your story - Today you are the Dermatologist of Next generation in your family. I come from a family of doctors and it was sort of understood that I would be pushed towards the medical profession as a natural progression. Don't get me wrong. I loved it from the start. I saw my father and sister as role models and I always nursed a desire to become a doctor. I would as a child would always be in awe of people from the medcial profession. Watching my father practice always intrigued me and motivated me to further explore this field of dermatology.

2.This field of dermatology was chosen by you on your own or under the pressure from your family of Dermatologists.

I loved dermatology from the inception having watched my dad all my life and K.J. Somaiaya medical college provided me with an excellent foundation for a young clinical dermatologist like me to be inspired into becoming good. They had excellent teachers who fueled my dreams.

I was especially interested in dermatosurgery and my mentors encouraged me towards it.

3.Your choice for Dermatology was derived from what type of interests and challenges found in your 1st generation of Dermatologist.

The thrill of seeing a new presentation for even the commonest of skin diseases each time. The difficulty in diagnosis back the due to lack of facilities available, even simple ones such as a skin biopsy really made me wonder if something could be developed later on in

order to circumvent these challenges.

4.How is your relationship in your previous generation (Mother- Daughter/Son or Father –Daughter / Son) Father and Son. Well the relationship has always been so friendly that I never really felt the pressure of working with him. We have always shared a very friendly working environment, discussed cases at work and yes even over dinner many a times!

Dr. Nitin Save: Father of Dr. Sushrut Save

5.Was any specific guidance in your career given by your first generation : well I always live by his words, infact his message to me was priceless “learning is the only asset which no one can steal from you and it will always appreciate. So keep learning!”

6.Which inspiration did you capture from your 1st generation. Every single patient has to be treated with utmost care and patience. Every single complaint of the patient deserves attention, even if it is the last one at the end of a long and tiring day. He taught me empathy and responsibility.

7.Without my parents being a Dermatology, I could not be a successful Dermatologist explain it.

Absolutely, Dermatologist is a field where you need to be passionately inclined. yes cosmetology is very lucrative and drives the choices of most people to select this profession. But to become a true clinical dermatologist, a first hand experience is always fruitful. To be able to see everything and yet get puzzled by the actual diagnosis is always thrilling!

9.Did you have any financial, personal and emotional support from your family? Always and at all times. They form the backbone of who I’m and provide me the courage and strength to go forward.

10.How would you compare the differences between – your father’s residency and your residency?

I would say miles apart. Back then the teachers and residents were equally enthusiastic about the subject. Now, somewhere down the line residency is more about finishing the tasks at hand just to move on to the next one and the whole point of understanding, exploring and discussing each cases

gets bleaker with each passing year and with new set of rules. Of course it’s not all negative, cosmetology, lasers and dermatosurgery now occupy an important role in today’s curriculum which was absent back then which has lead to a sort of revolution in the field of dermatology.

11.Today I am a successful Dermatologist of next generation. Your viewpoint.

Everyone in medicine goes through a lot of struggles before they become susccessful. Almost every medical professional I know has thought about leaving medicine once in their lifetime.

Satisfaction only comes with owning your decisions. Whatever career you opt for, medicine or not, is for you to decide.

12.Any motivational tips for the new and young Dermatologist. A medical career demands a lot from your side- physical, mental, financial & social stress. A lot depends on how you handle this constant stress. Luck also plays an enormous factor (more than you think). Not every brilliant student goes on to become a great dermatologist but sometimes average and below average students go on to have very successful careers. To retain the passion for your field despite the stresses and trade offs remains a challenge for every dermatologist.

Dr. Manjunath Shenoy M MD, DNB Professor and HOD Department of Dermatology, Yenepoya Medical College, Mangalore, Karnataka

MY JOURNEY FROM RESIDENT TO HOD IN DERMATOLOGY TO IADVL PRESIDENT 2024

Residency was enjoyable, guided well by my seniors about to do what and not. I was active in cultural, sports and student-union activities too. Honest to his students and colleges, good listener to his colleagues, firm decision maker, works for his department and institution’s growth, promotes his colleagues and students to prosper in academics.

Ability to recognise advance-learning students and promote them to achieve better, recognise slow-learner’s and support them, jovial, humorous and willing to step down to give a chance to others. We should be very professional in performing our duty and to intelligently manage time for curricular and extracurricular activities.

Got university best teacher award in HOD category. Got IADVL president’s appreciation award, Prof Ratan Singh award, State oration. I connect all of them to my teaching career. It’s an opportunity to be a resident and to learn under someone’s supervision. Later, you’re all alone.

If not done justice to the residency program and miss an opportunity to learn, it’ll have negative impact on your future practice.

Dedicate yourself to the objectives of residency program.

1.Memories of your first day as a Resident. "I thought I am one lucky Doctor to get into Dermatology……

I was not very happy since it was my second choice (my first love was internal medicine).

Infact I took PG entrance test again (during Dermatology residency) but got just enough rank to get Dermatology again!

But, now extremely happy that I didn’t get internal medicine and remained with Dermatology.

2.A brief note of your 3 years as a Resident.

Was enjoyable. Guided well by my seniors about to do what and not. Learning was fun. Massive OPD cases, 10-15 admissions plus 20 bed-Leprosy unit full of cases.

Never felt pressure since all PGs and faculties worked together. Indeed, I was active in cultural, sports and student-union activities too.

3.Your thoughts on the last day of your residency i.e now that you have passed out and as a Dermatologist do you still think yourself to be lucky to have got into Dermatology. Absolutely, because I joined and passed out Dermatology when scope of the subject was elevating and the trend still continuing.

4.Why you chose teaching field as a career against a full time practice. Constant income and the Itch to teach. I am forced to update, hence a better care for patients. Institutional support helps in research and publications that brings you in limelight.

5.What are the problems faced in your Journey to become an HOD?

No problems at all due to increasing number of medical colleges we had enough opportunities. In fact, I have a problem to come out of it

6.What according to you makes a good Professor/HOD of Dermatology in a Medical College?

Honest to his students and colleges, good listener to his colleagues, firm decision maker, works for his department and institution’s growth, promotes his colleagues and students to prosper in academics, ability to recognise advance-learning students and promote them to achieve better, recognise slow-learner’s and support them, jovial, humorous and willing to step down to give a chance to others.

7.As an HOD any fond memories of Resident Doctors approaching you with their problems and concerns and how you help them resolve it. There are many…

Mostly related to academics but few personal problems too. Can’t share them since it’ll be obvious.

8.Any particular achievements of your Resident that made you happy as a HOD today. A student went on to do MRCP

Two passed out DNB. Two did post doctoral fellowships. All others are very well placed as consultants. I’m very happy.

9.Any mistakes in this journey and how Residents should avoid the same?

Big mistake, my occupation in extracurricular activities during early residency. Missed plenty opportunity of learning or performing procedures. My HOD warned me

and brought me to the right path, and I thank him for that. We should be very professional in performing our duty and to intelligently manage time for curricular and extracurricular activities.

10.Any personal achievements?

Nothing of huge substance. Got university best teacher award in HOD category. Got IADVL president’s appreciation award, Prof Ratan Singh award, State oration. I connect all of them to my teaching career.

11.Anything that you would have done differently today that you feel Residents will encounter going forward. Nothing much.

It’s just the patient care, more vigorously and academics, more aggressively.

12.Would you advise your residents to embark on a similar Journey: From a Resident in Dermatology to Teaching profession. Depends on their interest. As a full time teacher, can bring a lot of goodwill from your student community and colleagues. Patient care seems to be better since you have colleagues to discuss on a difficult case. But, I think, every clinician should do a private practice (at least for limited hours) so that we think independently too. As a full time practitioner you can plan your day much better and balance your life.

13.Your special advice to the Residents?

It’s an opportunity to be a resident and to learn under someone’s supervision. Later, you’re all alone. If not done justice to the residency program and miss an opportunity to learn, it’ll have negative impact on your future practice. Dedicate yourself to the objectives of residency program.

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