home father, and we have three children: 5- and 11-year-old sons,
and our 8-year-old daughter. My daughter has bilateral cochlear
implants and is thriving at Walden School. I am the residency
program director and medical student clerkship director for the
Division of Dermatology at UofL. My instincts about my boss, Dr.
Jeff Callen, were completely correct. He has bolstered my career in
academic dermatology, and helped me forge connections not only
locally, but nationally within the dermatology community. He also
provides endless support. I have a busy clinical practice and have
made connections with local primary care doctors, rheumatologists,
nephrologists and oncologists. I also inherited the yet-to-be-iden-
tified running gene, but in my true fashion, after running monthly
half-marathons, I tore a hip cartilage and ruptured a tendon. And no,
I do not administer botulinum toxin (though I am the recipient of it).
**ANSWERS**
Patient 1 has eruptive xanthomas, and these were the
presenting sign of uncontrolled diabetes mellitus and
extremely high triglycerides ( >1000s).
Patient 2 has classic cutaneous dermatomyositis without
muscle involvement. She was ultimately diagnosed with
esophageal carcinoma. Dermatomyositis is associated
with an internal malignancy in approximately 10-20%
of patients. Other extracutaneous findings can include
myositis (proximal muscles, esophagus) interstitial lung
disease, and myocarditis.
Patient 3 was diagnosed with dermatitis herpetiformis
via skin biopsy for direct immunofluorescence, the gold
standard test. Dermatitis herpetiformis is a manifesta-
tion of gluten sensitivity, and up to 90% of patients have
celiac disease as demonstrated on small bowel biopsy.
Avoidance of gluten can completely control this skin rash.
Patient 4 was diagnosed with IgA vasculitis, also known
as Henoch-Schönlein purpura, via two skin biopsies. Di-
rect immunofluorescence demonstrated IgA deposition
in the blood vessels of the skin. Given this diagnosis,
additional testing, including urine studies were per-
formed. The patient was found to have nephrotic-range
proteinuria, and IgA nephropathy was confirmed on
kidney biopsy. She is now improved on dapsone and
systemic steroids.
agers who are finally able to walk with confidence after completing
a course of isotretinoin. I have patients with psoriasis who can now
wear short sleeves without feeling ridiculed after being started on a
biologic therapy. One of my patients is a teenager with such severe
eczema that she couldn’t sleep at night and had to miss school on a
regular basis for skin infections. Now, after treatment with immu-
nosuppressives, including cyclosporine, she is able to attend school,
be a cheerleader and lead a normal life with the biologic dupilimab.
I have also diagnosed genetic conditions associated with internal
malignancy based on benign growths on the face noted purely on
skin examination. I also, unfortunately, see no shortage of patients
with inadequately treated mental illness who pick at their skin,
believing they have parasites and come in with disfiguring scars.
I still hear, however, echoes of “What a waste” in the community.
While consulting for a newborn baby with neonatal pemphigus on
a recent Sunday morning, the NICU MDs looked up at me and my
resident and said “Wow, Dermatology is here!” Yes, we are.
Dr. Courtney Schadt is an Associate Professor, Residency Program Director and
Clerkship Director for the Division of Dermatology at the University of Louisville.
She is also the Chief of Dermatology at the Robley Rex VA Medical Center.
STAY Connected
www.glms.org
facebook.com/Greater-Louisville-Medical-Society
@LouMedSociety
I am thankful that I listened to my instincts and pursued der-
matology. Every day, I look forward to my job and the challenging,
interesting patients I take care of. @LouMedSociety
My clinics are not filled with only “complex” patients like the ones
above. I also perform skin checks, treat acne and warts. I have teen- linkedin.com/groups/Greater-Louisville-Medical-Society
MAY 2020
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