Text and photos by Jonathan M. Bartnik.
When might a skin disorder also imply the presence of underlying systemic disease? Pediatric Dermatologist Lisa M. Arkin, MD, explored the intersection of dermatology and other fields including rheumatology, immunology and infectious disease at the Hubert and Mary Moss Lecture in Dermatology on September 16, 2016. The annual Lectureship, attended by faculty physicians, residents, medical students and related staff, opened this year with a buffet lunch and an introduction by Dr. Gary S. Wood, MD, chair of the Department of Dermatology.
Auto-immune and skin disorders
In the first of two presentations, “Lessons from Pediatric Collagen Vascular Disease: More Evidence that Children Aren’t Just Little Adults,” Dr. Arkin examined methods for evaluation, diagnosis, and treatment of two autoimmune disorders that manifest in the skin: morphea and cutaneous lupus.
Morphea, explained Dr. Arkin, manifests on the skin but is not limited to it: it can have musculoskeletal, ophthalmological, and even neurological manifestations. Hence the presence of morphea on the skin always calls for a meticulous physical exam and full review of symptoms, with work-up primarily driven by the search for other manifestations.
Lupus is also a systemic autoimmune disorder that can manifest in the skin. Sometimes patients present with disease that is limited to the skin, and other times the skin may be the first sign of systemic lupus, which can affect multiple internal organs.For both conditions, said Arkin, the key is early recognition, evaluation and treatment. In these cases, “the skin can be a window into a deeper issue.” Recognition of this can lead to earlier initiation of appropriate treatment with better outcomes for kids.
Finding the correct diagnosis
In her second presentation, “Pediatric Mimics You Don’t Want to Miss!”, Dr. Arkin offered “pearls for recognizing skin diseases that often look similar but require different management approaches in kids.” In light of these “mimics,” Dr. Arkin emphasized the importance of dermatologist consults on inpatients admitted for or co-presenting with a skin disorder.
This of course is where dermatologists are expected to shine—and they do. Dr. Arkin referred to recent studies finding that some 70% of inpatient skin-related diagnoses are changed by a dermatologist. “This is obviously a patient care issue,” said Arkin, “and it also has cost ramifications, as treating the incorrect disorder can lead to inappropriate use of antibiotics, lengthened duration of hospital stay for patients, and re-admission for the same condition.”
Dr. Wood, who introduced Dr. Arkin’s lecture, emphasized her distinguished training record. Dr. Arkin completed her pre-med education at Brown and Columbia, attended medical school at UPenn, and did her residency at Northwestern University. After a fellowship in pediatric dermatology at the Children’s Hospital of Philadelphia, Dr. Arkin served as Director of Pediatric Dermatology at Rush University before joining the UW-Madison faculty.
“Dr. Arkin’s interests focus on rheumatological diseases in children,” said Dr. Wood, “and she collaborates actively with other pediatric dermatologists and rheumatologists nationally doing research on these disorders. We are very pleased to have her seeing patients and doing research here with us.”
“It was super fun!” said Dr. Arkin of the lecture. As for joining the UW-Madison faculty, she said, “I’m very happy to be here, very engaged by this group of kind, academic, and caring dermatologists and pediatricians and look forward to lots of future collaborations.”
Dr. Arkin’s lecture was sponsored by the Moss Dermatology Lectureship Fund of the Meriter Foundation. Find more information on the Lectureship Fund here.