Clinical Elective in Dermatology in India, Part 2

Cristina Thomas, MD

Resident in the Harvard Combined Internal Medicine-Dermatology Residency Program

PGY-5

02/25/2020

Dermatology Residents and Attendings at Amrita Institute of
Medical Sciences

I am wrapping up my time in Kerala, India and have been reflecting on the role of the dermatologist in India. With an interest in complex medical dermatology and tropical diseases, I am currently a PGY-5 in the combined internal medicine-dermatology residency program here at Harvard. While in India, I’ve noticed that almost all dermatologists practice at least some amount of internal medicine. Without a high prevalence of skin cancer, the majority of patients seen in the dermatology clinic are those with cutaneous manifestations of systemic disease. I can’t count the number of patients who have presented with extensive tinea corporis only to have the dermatologist check a HbA1c and diagnose the patient with diabetes which is a risk factor for tinea. The dermatologist often coordinates the multi-disciplinary care of leprosy patients who require neurology, podiatry, and PT/OT. The dermatologist manages cancer screening in a patient with paraneoplastic pemphigus. I could go on and on about the complexity of care that these physicians provide, and I’ve been so impressed with the compassion and expertise of these physicians.

Apart from the medicine, however, dermatologists also play a huge role in quality of life for these patients. Patients with dermatologic disease in India are often stigmatized against because of the visual nature of their condition. I saw a man with albinism who was fired from his job because of his skin condition, a young girl with vitiligo who was teased by her classmates, and a woman who was shunned by her family because she had lymphatic filariasis. The physicians I worked with not only treated these patients in order to improve their quality of life, but also sought to change the societal milieu which led to their discrimination. They took the time to educate the patients’ families and even organized educational activities in the community to reduce the stigma associated with dermatologic conditions like vitiligo, psoriasis, and leprosy. My interest in medicine as a field stemmed from a desire to improve quality of life in individuals and it has been refreshing to see this done each and every day at Amrita Hospital.