SDPA Summer Conference Preview

Renowned author and dermatology professor Jean Bolognia, MD, will be the keynote speaker at the Society of Dermatology Physician Assistants (SDPA) Annual Summer Dermatology Conference in Austin, TX, June 16–19, 2022. In addition to her keynote address titled “The Many Faces of Lupus,” Dr Bolognia will lecture on the differential diagnosis of Stevens-Johnson syndrome and toxic epidermal necrolysis in a second session held on Thursday, June 16. She recently participated in an on-camera interview to discuss her upcoming presentations and career with Dermcast live host Amber Blair, MMS, PA-C. An excerpt from the interview is below.

Amber Blair: Please tell us about the 2 lectures you will be presenting in Austin.

Jean Bolognia: In the first lecture, “The Many Faces of Lupus,” I will discuss the spectrum of how patients present clinically, as well as some of the diagnostic pitfalls and the most appropriate way to evaluate the patient, be it through histology or the ordering of lab tests. We cannot rely on rheumatologists to recognize all the forms of cutaneous lupus. This really belongs within the specialty of dermatology.

Amber Blair: I could not agree more. Lupus is definitely a disease state in which there are many intricacies to the diagnosis and clinical management, and I am very excited to gain more of your insight on everything that goes along with treating our lupus patients. Can you tell us a little bit about the other lecture you will be presenting?

Jean Bolognia: I will also be giving a lecture on the mimickers of toxic epidermal necrolysis. While you might say, “Well, that is a fairly unusual diagnosis,” the major point of the lecture is that sometimes we look a little too closely when we are making diagnoses. It is important to step back and observe distribution patterns. I use toxic epidermal necrolysis as a clinical example, but the main lesson is what I call the 4x examination of the skin. If you think about it, looking at the skin is analogous to looking at a pathology slide, be it 4x, 20x, or 100x. And often, when we go into the room, we automatically go to a 20x examination of the skin. With the advent of dermoscopy, we then move to 100x. The teaching lesson in my lecture will be to step back and look at the patient at 4x, especially when it comes to a rash. So, I hope at the end of the lecture, attendees will say, “Okay, when I go into the room, I will initially do a 20x examination and maybe I will use my dermatoscope. But if it is a rash, I will step back, even literally step back, and look at the distribution pattern.”

Amber Blair: That is exciting, and something that I learned very early on as well. Take a moment, take a physical step back, and look at the pattern of distribution, then sometimes you can begin to see the forest through the trees. For someone who has an incredibly long list of accolades, can you share your favorite opportunities or the achievements you are most proud of?

Jean Bolognia: I am most proud of the textbooks (Dermatology and Dermatology Essentials) because I believe they are great equalizers. No matter where you are in the country or the world, if you are willing to put the time in to read and synthesize the information, you will know as much as anybody, anywhere. There was a time decades ago when access to information was often limited to high-income countries such as those in western Europe, as well as the United States and the UK. Given the internet era, information is now universally available and, therefore, knowledge reflects the time and energy spent by the learner.

Amber Blair: That is so true. I am very blessed to be in medicine in a time where there is no lack of access to information, and I love it. Information is everywhere and access is great.

Jean Bolognia: Well, I also think books can give you a framework. I talk about the “cake theory,” which is that the book supplies the cake, but your experiences in seeing patients and what you learn on your own through reading is really the icing on the cake. You always need a framework upon which to add new information because you do not want just random thoughts and diagnoses. I always think of medicine like an upside-down tree, meaning that a book should give you the big branches, then you add small branches and leaves. Simply memorizing leaves on the ground does not work because then nothing is intuitive. I also think when you are a beginner, you can get overwhelmed, so start by knowing a few key features or etiologies. For example, a patient has a particular type of drug reaction. You have the 2 or 3 most common drugs in your head and then know where to look for a list of the less common and rare causes. Then you do not clutter your brain with numerous rare culprits. I think that is also the function of a textbook, to be your friend and colleague, especially when you are tired at the end of a long day.

Amber Blair: That is an excellent philosophy and great advice for newer practitioners who are trying to get their feet under them.

Jean Bolognia: Because there are so many diseases that people have never heard of or been taught about, be it in PA [physician assistant] school, nurse practitioner school, or medical school, they are really not prepared for those thousands of Latin-based diagnoses. It gets very overwhelming very quickly. I think you have to try to build some confidence, especially during that first year or two when you are trying to learn the correct vocabulary. For me, dermatology was really a foreign language, and foreign languages were never my strong suit.

Amber Blair: Tell us a little bit more about some of the international speaking that you have done.

Jean Bolognia: I would have to say that my favorite speaking engagements occur when I sense appreciation. The Regional Dermatology Training Centre in Moshi, Tanzania, is a special place. In addition to a resident training program, they have a program where people who have an interest in clinical care can train for 2 years in dermatology. After training, these individuals return to their country of origin, primarily English-speaking countries in sub-Saharan Africa, and assist in the care of patients with skin disease. In some of these countries there are fewer than 10 dermatologists, so they need the extra help. It is really heartwarming because you see the clinicians at the Regional Dermatology Training Centre doing so much with their visual diagnostic abilities.

Amber Blair: I would think that it would be incredibly fascinating to have the opportunity to participate in their lives in that capacity, and incredibly rewarding. If you could say one thing to all of the new providers and clinicians who are stepping into clinical practice, what would it be?

Jean Bolognia: Well, I really believe in block time to get things done. And what do I mean by that? I mean that you need a period of 2 and occasionally 3 hours to have a topic sink into your head. I always recommend getting up early on Saturday and Sunday mornings and reading about a group of diseases. Then you have the rest of the day to enjoy yourself, feeling really good about what you have accomplished.

Amber Blair: All great take-away points. Dr Bolognia, thank you so much for spending some of your time with us today at Dermcast.live, and we cannot wait to see you in Austin as our keynote speaker for the SDPA summer conference. 

Dermatology Essentials is the foundation of SDPA’s Diplomate Fellowship education program. Information on the SDPA Annual Summer Conference, including descriptions of Dr Bolognia’s presentations, are available on the SDPA’s website at www.dermpa.org.