Priyanka P – Southern Dermatology – CA Work Experience Program

LAST DAY-Bullous pemphigoid, cysts vs. breast cancer, melanoma

Today was my last day and I’m so sad to say goodbye to Dr.Boyse and her team of medical assistants. Today was really special because we treated one of Dr.Boyse’s friend’s dad as he had a bullous pemphigoid that looked like a bright orange clear blister. It was really interesting because Dr. Boyse’s uncle actually discovered the medical diagnosis plan in his third year of medical school. Dr. Boyse showed me his diagnosis studies called direct immunofluorescence microscopy studies using antibodies stains in a couple textbooks and found that the patient’s blood pressure medication most likely attributed to the bullous pemphigoid. We also saw a patient who had a cyst in her breast which we biopsied to make sure it wasn’t breast cancer. Luckily the results from the lab came back and demonstrated that it was not in fact breast cancer! At the end of the day, we did an incision on a melanoma and basal cell which required lots of stitches. Finally to end my work experience with Dr. Boyse she let me practice a small Botox injection! I’m so sad that my work experience is over but I had such a great time learning about dermatology with Dr. Boyse and her wonderful team!

lidocaine, warts, keratosis pilaris

Today was a crazy day because there was a shortage of lidocaine. If you go to the dentist they use lidocaine as well which is a numbing injection that allows the patient to not feel as much pain during procedures. This was especially concerning in a dermatologist’s office to have a shortage because lidocaine is used frequently during incisions and even before cosmetic fillers and Botox treatments. Dr.Boyse taught me how to fill lidocaine in syringes from a bottle and even let me practice doing them a couple times. We also saw lots of warts between fingers, toes, hands and the solution was using liquid nitrogen to freeze the spots. This year I saw liquid nitrogen not only in adv chem class at school but I saw it being used a ton in the dermatologists office! Keratosis pilaris which is a common, harmless skin patch is often concerned by patients to be skin cancer is treated by freezing the spot until it falls off. Often it takes a couple times for it to fully freeze before it fully separates from the skin barrier.

Here is a picture of a liquid nitrogen bottle!

cysts, accutane

Today was only a half-day so I only worked from 8-12 because of Memorial Day weekend. That being said the day wasn’t as busy and many of the patients that came in today were teenagers pursuing Accutane. I learned that Accutane had several side effects such as dry flaky skin, mood changes, depression, and could lead to birth defects if pregnant on the medication. Many of the appointments that involved Accutane required pregnancy’s tests and discussions of birth control due to the severity of birth defects from Accutane. At the end of the day we removed a cyst in the arm and it was cool because the sac in the cyst was satisfyingly removed in one piece.

Keloids, lip fillers, and atopic dermatitis

Today was an interesting day full of a variety of different cases. Primarily today there were a couple patients diagnosed with keloids. A keloid is a thick raised scar that is caused by excess protein in the skin during healing. Most often, keloids hang from the ear and surgical incision is used to remove them. Todays patients had them in their ears and in the gluteal regions. I helped Dr. Boyse through applying pressure to the surgical area using a medical gauze and holding the areas firmly in place with sterile gloves. We also put in lip fillers and captured before/after pictures. Finally, Dr. Boyse explained atopic dermatitis which was seen in a lot of patients and is known as a more drastic form of eczema in conditions of itchy inflammation of the skin. Today was also my first day wearing scrubs!

Day 3- Surgeries and Fillers

Today I worked with Dr. Stephanie and Dr. Chalgren in the pm and am respectively. In the morning, Dr.Chalgren let me in on some of the Moh’s sugaries he performed on patients to get rid of skin cancers. After each surgery, we went to the lab to look at microscopic images of the cell he removed and detected whether the patient still had remaining positve results for further procedure. He showed me the different layers of the dermis, mitosis, and cancer in basal cells. In the afternoon, Dr. Stephanie performed fillers on a patient’s cheeks to give more volume as well as showed the process of laser hair removal. Dr. Stephanie is really great at patient communications and it was super fun to see her interact with them. It was really eye-opening to see the multi faceted procedures and surgeries that different dermatologists specialize in. Below is a picture of a basal cell carcinoma under microscopic imaging.

Day 2- UNC dental visit

Today was a unique day as a few students interested in dentistry went together on a dental visit to UNC. In the morning, Dr. Frazier taught us some basic skills on removing and inserting rubber bands on braces and the mechanics of orthodontists using YouTube videos. It was interesting to note that the a titanium wire is used accordingly to adjust to bodily temperatures which decreases flexibility as temperature rises. Later we went to a research facility and talked to students on a research study on the impact of early stress on teeth formation with the use of Zebrafish. We were able to look in a microscope of a zebrafish sample and see the growth dental growth of Zebrafish and how similar it was to humans. Finally, we took a tour of Adams school of dentistry with a couple of the dental students and they guided us through the different centers in the building. Although I wasn’t able to go into the dermatologist office today it was really informative to talk with dental students about their experiences! Below is a picture of Maris and I at Adams school of dentistry at UNC.

Day 1- Cases of Dr. Boyse’s patients

I started my work experience at around 8 am in the morning at Southern Dermatology and we right off the bat looked at some of the different cases of the day. It was really interesting to see the multitude of skin diseases that many people had and the solutions Dr. Boyse had to solve the diagnosis. For instance, many of the patients were on Accutane to fix their acne or required injections in the hair to help with Alopecia. Dr. Boyse showed me an image explaining how acutane works to shrink oil glands and reduce acne. Some of the patients were also interested in Botox procedures and it was really cool to see the immediate effects of the injections. The techs were really cool to talk to in between appointments and I am super excited to work with Dr. Boyse again later this week! Below is a picture of the effects on oil glands that Dr. Boyse described following accutane treatments.

Effects on Oil Glands after Accutane