SMF

I was saddened to read recently that Sam has been advised by a dermatologist to stop using aftershave. Unless the curriculum of a dermatology residency has changed dramatically (and I don't see how it could given there is a mere four years to learn it all), we should remember that dermatologists know precisely the same as the rest of us with regard to cosmetics and so on. A long time ago I worked for a dermatologist and while he had vast experience (and a huge private practice—I saw patients for him in his NHS clinic) he had few rules about skin care. Too much soap or detergent will dry the skin and cause problems. Very dry skin should be washed with Ung. Emulsificans instead. Avoid things you are allergic to (I was delighted to learn that plant juice can cause allergic rashes, sometimes only when activated by UV light: phytophotosensitivity.) Otherwise he offered no advice on everyday skin care and did not see it as his job, nor his field of expertise. He was all about the diagnosis of a rash or lesion, and correct treatment of the same. That's all pattern recognition and a decent memory. I was lucky in that I have a knack for pattern recognition and having met a rash once I would always recognise it again.

A funny tale about things you can be allergic to and cosmetics. A young woman who thought herself beautiful came to me with a rash on her eyelid margins. It wasn't seborrhoea or demodex infestation, so I told her to stop using make-up for a few days and see if it resolved. If it did, change brands. "No make-up? No way!" She demanded a dermatology referral, so I warned her of the wait (socialised medicine has its disadvantages) and sent one in describing the problem the diagnosis and the proposed treatment. When she finally saw the derm he told her to stop using her make-up....she was so cross that she never came to see me again. No doubt we both felt relief at that.

Interesting observations about the limitations of dermatology.

It sounds similar to the stereotypical GP's ignorance regarding diet, though I hope this one is changing as the importance of diet - and the public's misconceptions thereof - is becoming ever more apparent.

Thanks again for the medical insights from our trusted source, Chris.

- Murray