So my 13-year-old son has a weird skin rash around his nose for month, that isn’t acne, and we take him to the pediatrician, who is stumped but who says, “No, it’s not impetigo. He doesn’t have to stay home from school.” Gives us a prescription for ointment, $35.00! Well, we’ve known him for years, and trust him, so we bite the bullet and do it.
A month goes by, the rash doesn’t get better. Pediatrician says, “Take him to a dermatologist.” The one serious dermatologist in town, who makes a point of saying, “I don’t do cosmetic dermatology, only skin diseases,” on Thursday breezes into the cubicle, with an observing Family Practice physician in tow, barely glances at the rash, spends the next 15 minutes delivering a lecture on “peri-oral dermatitis” (when we raise our hand cautiously and, when called upon, venture to point out that “peri-oral dermatitis” is just fancy Latin for “yeah, he has a rash around his mouth”, we are brushed aside while the instructional juggernaut rolls on). When we turn down an opportunity to have our son take tetracycline pills for the next three (3) years (“um–I’m not comfortable with giving antibiotics ‘just because’”), with a shrug we are given a prescription for yet another ointment, this time plain old hydrocortisone with some sulfer/sulfa added, and dismissed. As we stand there at the little window settling up with the receptionist, behind us in the cubicle we hear the lecture continuing…
After only 2 applications of the miracle ointment, Friday and Saturday, ($$$), the rash is much worse. (We’re busy going out of town, so we forget a few times.) Sunday night we tell the kid, “Well, some people are allergic to sulfa–you have an aunt who is. Put some of it on the inside of your elbow tonight, and we will look at it in the morning.” In the morning (this morning) the inside of his elbow is red and puffy. “Okay, kiddo, you’re now officially allergic to sulfa, I guess.” We tell him to wash his face good and get the rest of it off, whatever’s left from Saturday’s dosage. We give him some regular over-the-counter hydrocortisone out of the first-aid kit to try.
So then, 20 minutes later, I finally get around to looking up “peri-oral dermatitis” on the Web, and lo and behold, the first two hits, from the New Zealand Official Dermatology Website, and from the Merck Manual, say that not only does any kind of cream make this worse, but also any kind of STEROID cream will make it REALLY WORSE. So once again he goes upstairs to wash his face, second time in an hour. Some kind of new world’s record. And yeah, after only 30 minutes of hydrocortisone cream on his face, the rash is a lot worse.
So now I’m sitting here really seriously annoyed with this doctor. How could someone who calls himself a serious dermatologist NOT KNOW that (a) cream makes it worse, and (b) steroid cream makes it REALLY worse? It’s not like the Merck Manual is some alternative medicine publication.
The Better Half says, mildly, “Maybe there are other factors at work–after all, he IS the doctor, he’s supposed to know. Maybe what was going through his mind was ‘this couldn’t hurt, and it might help.’” I say, “But it’s obvious that it COULD hurt. Even in darkest New Zealand they know better than to put steroid cream on it, so I think he just was in a hurry to demonstrate his expertise to this other doctor and get rid of me. Also, he knows that people want to go home with medicine, and he didn’t bother to talk to me enough to find out that I was intelligent enough to understand if he said, ‘Creams won’t help this, they’ll just make it worse.’” (And yes, I was the one to take the kid to the doctor. I can get out of the house if I need to. And this was important.)
I say, “It’s as if I went to the orthopedic specialist and he told me to put a heating pad on my ankle.” Every website I’ve visited for foot/ankle injuries says, “Don’t use heat–use cold.”
The rule for doctors is, “First, do no harm.” I think this guy was way out of line. We’re going to just keep it clean and take vitamins for a month and let his body deal with it, and if it still isn’t better, we are definitely going to find another dermatologist.
But at least we did find out that it’s evidently not impetigo, and I even pried a note to that effect out of this doctor. (He was understandably reluctant to commit himself to paper.) I do trust him that far, to know impetigo when he sees it.
And no, I’m not including the pediatrician in this rant, because he couldn’t be expected to know specialist stuff like that. But I do expect someone who bills himself as “the Skin Disease Guy” to know that.