(Dermatology for dummies… and ER docs)
My favorite rash story comes from a cruise ship. One of the filipino band members visited the ship’s clinic with pus dripping from sores all over his face and body. I treated him for presumed staph, and it actually seemed to help quite a bit. Unfortunately, his roommate and fellow band member appeared with a rash about a week later, and I got a look at the earlier stages of the lesions. This time I got the diagnosis right – adult chicken pox. After a third band member contracted it, we clearly had a public health situation, and a lot less music.
Since the US started vaccinating kids for varicella I haven’t seen chicken pox in years, and certainly not in adults. (We still see shingles, but that’s varicella resurrected.) In the Philippines, the vaccine is much less prevalent and apparently many adults never have chicken pox as kids.
Eventually when we landed in Halifax, their public health department was kind enough to give us (imagine that) a box of varicella vaccine, which I used for the remaining band members, and others on the ship who’d never come in contact with chicken pox or the vaccine.
Since then my life in dermatology has been far less exciting. We see an enormous number of skin problems in emergency departments, and I get quite a few skin related calls through Pre-R as well. However, the large majority of patients improve, or they seek smarter dermatologists elsewhere. No rash in years has had me racing a bicycle across a foreign city with a backpack of vaccine.