Dr. Litt is Assistant Clinical Professor of Dermatology at the Case Western Reserve University School of Medicine in Cleveland. From 1974 to 1994 he was Editor of Cross Section — a Dermatologic Quarterly, and he’s published more than 40 skin disease-based articles in scientific journals. He has authored Your Skin & How to Live in It, Teen Skin: from Head to Toe, and Your Skin — from A to Z for the lay public. He is best known for his Drug Eruption Reference Manual, the bible of this genre of books.
Q. What part of your work gives you the most pleasure?
A. I get the greatest satisfaction when I alleviate and often cure those thousand natural shocks that [skin] is heir to — a painful longstanding wart, a disfiguring acne, a severely pruritic atopic dermatitis in a child, a generalized psoriasis.
Q. Do you recall a memorable patient encounter [and] what you learned from it?
A. I have learned and have always remembered that listening to the patient is a sine qua non of making an accurate diagnosis. It is unfortunate that many dermatologists either have too little time or not enough patience to devote to a meticulous and detailed history.
I have two examples of how listening to my patients has made a dramatic difference in their treatment:
1. 76-year-old male with a history of generalized psoriasis for 15 years. He had been treated with all types of topical corticosteroids and calcipotriene. He had never been without the scaling and plaques except, he averred after I had prodded him, when he was hospitalized some 10 years ago and before he had had dental surgery when he was given amoxicillin, at which times his psoriasis began to fade. When he stopped amoxicillin on both occasions, his psoriasis recurred.
I then prescribed amoxicillin 500 mg q.i.d., and he has been completely clear of psoriasis for the past 9 years. He and I are reluctant to discontinue it.
2. A 45-year-old Caucasian female patient with asymptomatic generalized granuloma annulare for 36 years. She had every type of oral and topical medication from me and from other dermatologists including all antibiotics, pentoxifylline, oral itraconazole, cephalexin, liquid nitrogen cryotherapy, topical corticosteroids, and vitamins, etc.
She is almost entirely cured after taking the following orally: One ounce, twice daily, of Eden Raw Vinegar Apple Cider (organic, made from whole apples).
She had read somewhere that this had helped a variety of skin problems.
Furthermore, another woman, having seen what I had posted on the Internet a few years ago, avers that she tried this apple cider vinegar and her “very severe generalized case [of granuloma annulare] is 70% better in 4 weeks.” (I have no financial interest in this product.)
Q. What is the best piece of advice you have received and from whom?
A. I have two “best” pieces of advice:
1. To paraphrase “Occam’s Razor” — “When diagnosing a given disease, doctors should strive to look for the fewest possible causes that will account for the symptoms.”
Other common, comparable, everyday sayings for this are:
“The KISS principle: Keep it simple, stupid.”
“The simplest explanation is usually the best.”
“When you hear hoof beats, think horses, not zebras.”
Q. How do you envision the future of dermatology?
A. I am not sanguine about the future of clinical office dermatology. It is not as it was more than 50 years ago when I began my clinical practice. There was little, if no, cosmetic surgery done by dermatologists at that time. The newest surgical procedure then was the original hair transplant performed for male pattern baldness by Norman Orentreich in 1952.
Surgical procedures done by dermatologists have now ballooned to include chemical peels, lipoplasty, Botox injections, collagen injections, cosmetic eyelid surgery, laser therapies, microdermabrasion, sclerotherapy, scar revisions, and the like.
I am troubled that the recent graduates of dermatologic residency programs seem to be more interested in performing surgical procedures (read making money) rather than alleviating the basic, common, banal dermatoses: acne, atopic dermatitis, psoriasis, eczemas and all the other surface problems that plague so many millions.
I am also troubled by the current concept — craze? — of evidenced-based medicine. While this may be heresy, I believe that this is nothing more than cookie-cutter medicine. Every disease, every ailment must be treated “by the book” according to standard and rigorous procedures and medicaments, regardless of the fact that everyone is different — that everyone is unique.
“I still feel the need for those dermatologic heroes — the experienced active clinicians whose authority is derived from experience and clarity of thought and exposition, and not from PowerPoint bar charts — to guide me with simple conclusions. And where a single clinical aphorism is usually worth a thousand abstracts.”
Dr. Litt is Assistant Clinical Professor of Dermatology at the Case Western Reserve University School of Medicine in Cleveland. From 1974 to 1994 he was Editor of Cross Section — a Dermatologic Quarterly, and he’s published more than 40 skin disease-based articles in scientific journals. He has authored Your Skin & How to Live in It, Teen Skin: from Head to Toe, and Your Skin — from A to Z for the lay public. He is best known for his Drug Eruption Reference Manual, the bible of this genre of books.
Q. What part of your work gives you the most pleasure?
A. I get the greatest satisfaction when I alleviate and often cure those thousand natural shocks that [skin] is heir to — a painful longstanding wart, a disfiguring acne, a severely pruritic atopic dermatitis in a child, a generalized psoriasis.
Q. Do you recall a memorable patient encounter [and] what you learned from it?
A. I have learned and have always remembered that listening to the patient is a sine qua non of making an accurate diagnosis. It is unfortunate that many dermatologists either have too little time or not enough patience to devote to a meticulous and detailed history.
I have two examples of how listening to my patients has made a dramatic difference in their treatment:
1. 76-year-old male with a history of generalized psoriasis for 15 years. He had been treated with all types of topical corticosteroids and calcipotriene. He had never been without the scaling and plaques except, he averred after I had prodded him, when he was hospitalized some 10 years ago and before he had had dental surgery when he was given amoxicillin, at which times his psoriasis began to fade. When he stopped amoxicillin on both occasions, his psoriasis recurred.
I then prescribed amoxicillin 500 mg q.i.d., and he has been completely clear of psoriasis for the past 9 years. He and I are reluctant to discontinue it.
2. A 45-year-old Caucasian female patient with asymptomatic generalized granuloma annulare for 36 years. She had every type of oral and topical medication from me and from other dermatologists including all antibiotics, pentoxifylline, oral itraconazole, cephalexin, liquid nitrogen cryotherapy, topical corticosteroids, and vitamins, etc.
She is almost entirely cured after taking the following orally: One ounce, twice daily, of Eden Raw Vinegar Apple Cider (organic, made from whole apples).
She had read somewhere that this had helped a variety of skin problems.
Furthermore, another woman, having seen what I had posted on the Internet a few years ago, avers that she tried this apple cider vinegar and her “very severe generalized case [of granuloma annulare] is 70% better in 4 weeks.” (I have no financial interest in this product.)
Q. What is the best piece of advice you have received and from whom?
A. I have two “best” pieces of advice:
1. To paraphrase “Occam’s Razor” — “When diagnosing a given disease, doctors should strive to look for the fewest possible causes that will account for the symptoms.”
Other common, comparable, everyday sayings for this are:
“The KISS principle: Keep it simple, stupid.”
“The simplest explanation is usually the best.”
“When you hear hoof beats, think horses, not zebras.”
Q. How do you envision the future of dermatology?
A. I am not sanguine about the future of clinical office dermatology. It is not as it was more than 50 years ago when I began my clinical practice. There was little, if no, cosmetic surgery done by dermatologists at that time. The newest surgical procedure then was the original hair transplant performed for male pattern baldness by Norman Orentreich in 1952.
Surgical procedures done by dermatologists have now ballooned to include chemical peels, lipoplasty, Botox injections, collagen injections, cosmetic eyelid surgery, laser therapies, microdermabrasion, sclerotherapy, scar revisions, and the like.
I am troubled that the recent graduates of dermatologic residency programs seem to be more interested in performing surgical procedures (read making money) rather than alleviating the basic, common, banal dermatoses: acne, atopic dermatitis, psoriasis, eczemas and all the other surface problems that plague so many millions.
I am also troubled by the current concept — craze? — of evidenced-based medicine. While this may be heresy, I believe that this is nothing more than cookie-cutter medicine. Every disease, every ailment must be treated “by the book” according to standard and rigorous procedures and medicaments, regardless of the fact that everyone is different — that everyone is unique.
“I still feel the need for those dermatologic heroes — the experienced active clinicians whose authority is derived from experience and clarity of thought and exposition, and not from PowerPoint bar charts — to guide me with simple conclusions. And where a single clinical aphorism is usually worth a thousand abstracts.”
Dr. Litt is Assistant Clinical Professor of Dermatology at the Case Western Reserve University School of Medicine in Cleveland. From 1974 to 1994 he was Editor of Cross Section — a Dermatologic Quarterly, and he’s published more than 40 skin disease-based articles in scientific journals. He has authored Your Skin & How to Live in It, Teen Skin: from Head to Toe, and Your Skin — from A to Z for the lay public. He is best known for his Drug Eruption Reference Manual, the bible of this genre of books.
Q. What part of your work gives you the most pleasure?
A. I get the greatest satisfaction when I alleviate and often cure those thousand natural shocks that [skin] is heir to — a painful longstanding wart, a disfiguring acne, a severely pruritic atopic dermatitis in a child, a generalized psoriasis.
Q. Do you recall a memorable patient encounter [and] what you learned from it?
A. I have learned and have always remembered that listening to the patient is a sine qua non of making an accurate diagnosis. It is unfortunate that many dermatologists either have too little time or not enough patience to devote to a meticulous and detailed history.
I have two examples of how listening to my patients has made a dramatic difference in their treatment:
1. 76-year-old male with a history of generalized psoriasis for 15 years. He had been treated with all types of topical corticosteroids and calcipotriene. He had never been without the scaling and plaques except, he averred after I had prodded him, when he was hospitalized some 10 years ago and before he had had dental surgery when he was given amoxicillin, at which times his psoriasis began to fade. When he stopped amoxicillin on both occasions, his psoriasis recurred.
I then prescribed amoxicillin 500 mg q.i.d., and he has been completely clear of psoriasis for the past 9 years. He and I are reluctant to discontinue it.
2. A 45-year-old Caucasian female patient with asymptomatic generalized granuloma annulare for 36 years. She had every type of oral and topical medication from me and from other dermatologists including all antibiotics, pentoxifylline, oral itraconazole, cephalexin, liquid nitrogen cryotherapy, topical corticosteroids, and vitamins, etc.
She is almost entirely cured after taking the following orally: One ounce, twice daily, of Eden Raw Vinegar Apple Cider (organic, made from whole apples).
She had read somewhere that this had helped a variety of skin problems.
Furthermore, another woman, having seen what I had posted on the Internet a few years ago, avers that she tried this apple cider vinegar and her “very severe generalized case [of granuloma annulare] is 70% better in 4 weeks.” (I have no financial interest in this product.)
Q. What is the best piece of advice you have received and from whom?
A. I have two “best” pieces of advice:
1. To paraphrase “Occam’s Razor” — “When diagnosing a given disease, doctors should strive to look for the fewest possible causes that will account for the symptoms.”
Other common, comparable, everyday sayings for this are:
“The KISS principle: Keep it simple, stupid.”
“The simplest explanation is usually the best.”
“When you hear hoof beats, think horses, not zebras.”
Q. How do you envision the future of dermatology?
A. I am not sanguine about the future of clinical office dermatology. It is not as it was more than 50 years ago when I began my clinical practice. There was little, if no, cosmetic surgery done by dermatologists at that time. The newest surgical procedure then was the original hair transplant performed for male pattern baldness by Norman Orentreich in 1952.
Surgical procedures done by dermatologists have now ballooned to include chemical peels, lipoplasty, Botox injections, collagen injections, cosmetic eyelid surgery, laser therapies, microdermabrasion, sclerotherapy, scar revisions, and the like.
I am troubled that the recent graduates of dermatologic residency programs seem to be more interested in performing surgical procedures (read making money) rather than alleviating the basic, common, banal dermatoses: acne, atopic dermatitis, psoriasis, eczemas and all the other surface problems that plague so many millions.
I am also troubled by the current concept — craze? — of evidenced-based medicine. While this may be heresy, I believe that this is nothing more than cookie-cutter medicine. Every disease, every ailment must be treated “by the book” according to standard and rigorous procedures and medicaments, regardless of the fact that everyone is different — that everyone is unique.
“I still feel the need for those dermatologic heroes — the experienced active clinicians whose authority is derived from experience and clarity of thought and exposition, and not from PowerPoint bar charts — to guide me with simple conclusions. And where a single clinical aphorism is usually worth a thousand abstracts.”
